VTABLE OF CONTENTS SUPPLEMENT REPORT OF .SUBCOMMITTEE —rOTE'TPLCjF'ENT OF MILITARY ? EDI CAL RESOURCES Tab Code Place Tafcg 3 on Page Page A Table of Contents 3 3 ~ h B Introduction [l 5 ~ 6 C General Findings and Conclusions - 6 7-8 D Recommendations lU - 15 D-la Classification and Mobilization of Medical Manpower for the Armed Forces 19 19 - 20 * 1 Z1 1, Discussion 19 2.9- 20 Z2 2, Factors Involved 20 21 - 22 Z3 3* Classification 21 21-22 ZJU U. Mobilization 22 23 - 2I4 Z5> 5. Conclusions 2? 2? - 28 Z6 6, Recommendations 31 31-32 Z7 7. Letter Extracts and Testimony 33 33 « 3^ D-lb Professional and Military Emergency Training Programs within the Armed Forces 96 97-98 II 1* General 96 97 _ 93 Y2 2, Elements of the Problem 99 99 _ ]_oo Y3 3. Conclusions 105 - 106 YU I4* Recommendations 106 107 - 108 5* Letter Extracts and Testimony 108 109 - 110 D-lc General Policies Relative to Assignment QH Medical Personnel Including Use of Recognized Specialists and Consultants 17U 175 - 176 XI 1, Discussion X2 2. Conclusions X3 3, Recommendations XU hm Letter Extracts and Testimony 17U 175 - 176 176 177 - 178 177 177 - 178 178 179 - 180 D-ld Replacement Pools of Medical Department Personnel Wi 1, Discussion W2 2* Conclusions W3 3« Recommendations WI4. i|. Letter Extracts and Testimony 2h6 285 - 2U6 216 285 - 286 285 2\6 - 2h6 286 2h7 - 288 2kl 2h7 - 2U8 D-l© Redeployment and Demobilization of Personnel VI 1. Redepl/ Brig. Cos.* EC, USA — Eosbor JU* a# rwUi Colon*!* IB Eooordor 2 TABLE (F CONTENTS A. INTRODUCTION * B. GENERAL FINDINGS AND CONCLUSIONS C. RFCCMMKf® AT IONS D. SUPPORTING DATA !• Project Report* with Extract* of Cement* from Letter*, Interview* and other Source* 2» Report* of Subcommittee Coordinating Conference* 3 A. E/TF,ODPrtXCK 1* The members of this Subcommittee hare been in daily session since April 1, 1948, The approach to the broad objective indicated of "obtaining at the earliest possible date the maximum degree of coordina- tion, efficiency and economy in the operation of these services" as it is related to "careful considerations ***** given to the areas of def- iciency, the operational errors and the malemployment of our medical resources, etc," has been covered. The desire for provision of the best possible analysis of the controversial aspects, etc,, and the procure- ment of "as many statements or opinions from as many qualified witnesses as practicable in order that Impartial conclusions and recommendations nay be reached" have been fulfilled to the maximum possible extent dur- ing this period, 2, This Subcommittee under the guidance of the Executive Secretary and the Executive Committee has studied the problems indica- ted, by reference to available pertinent historical and statistical data from the offices of the Surgeon General of the Army, The Bureau of Medicine and Surgery and of the Air Surgeon, As approved at the regular meeting of the Committee on Medical and Hospital Services of the Armed Forces on Tuesday, April 6, 1948, the Letters, Subjects Deficiencies, Operational Errors and Malemployment of Military Medical Resources in World War II dated 7 April 1948 were sent to selected in- dividuals, 3, A total of 90 individual sources of information have bean utilised. The letter replies have been reviewed and opinions extracted. The letter response from various active and former members of the Medical Departments was enthusiastic in many instances. It is believed that very valuable basic material and suggestions have bean submitted, from which, if properly referred to, in future planning, much benefit can be derived, 4* The material obtained by interview has been, In certain instances, of the greatest interest and significance. The advantage of direct questioning In regard to certain concepts was obvious. In addition, several officers Indicated their desire to express their thoughts in such manner rather than by submitting written comments, A disadvantage of the interviews was the increased difficulty of compiling the data obtained with appropriate placement as supporting information on the particular subject. The time factor involved for all parties concerned and the overall magnitude of the Subcommittee'e task also contributed toward the limitation of the number of interviews held* It is believed interviews should in the future, if held, be restrict- ed to those with experts or moat experienced individuals* 5. The Subcommittee reviewed the subject terms of reference being considered by other Subcommittees along with available reports therefrom at hand and coordination meetings were held with available members thereof in all instances in which possible overlapping and problems of mutual interest were deemed existent* The reports of those meetings as held with the Subcommittee members are furnished as supporting inelosurea• 6. The source of other material as reviewed and considered appropriate for further study by reproduction, is clearly indicated in the inelosure of supporting data* 7* A total of thirteen main projects have been considered tinder separate headings and are presented in 0* There is considerable interrelationship between the projects In many instances and which al- lowed only for rather general classification of supporting data* Full consideration should be given that in the process of “breaking down* letter material furnished for consideration under separate subject headings, the sequence, full intent or effectiveness of a correspon- dent's written information as submitted may well have been lessened in some instances* In such ease recourse to the file copy of the correspondent's full letter or report of interview is suggested* Be- cause of the initial approach and wide coverage afforded by the list- ing of subjects originally suggested, it was not felt that any further breakdown or other change in form for presentation was feasible at this time* S* It is the Subcommittee's firm belief that a wide gen- eral cross section of many qualified opinions has been obtained from various experienced military medical men* In addition, in preparation of the report members of the Subcommittee have drawn upon their own war experiences so as to more fully complement the source material, As presented, it constitutes a variety of diversified opinions which are subject to thoughtful review, analysis and application to each situation* It should be emphasized that the material in no way ap- proaches a complete expression from all possible sources* Under no circumstances should the material be judged as representing a de- ciding majority vote expression on controversial matters between Force Staff Medical echelons because of the basic Medical Departmen- tal influence on opinion expressed in regard to certain controversial aspects. Likewise, the importance and worth of statements as made mast bo weighed aa to aouree and experience, wfaathar hearsay or biaaod. Thera la, however, a general trend to constancy in expression of thought on certain phaaea of the subjects conaidered and there la a varying do* gree of conflict of opiniona on other phaaea. It la believed fin and definite corrective action ahould be Initiated In the flrat inataneea and that further conaidered action toward solution of probleaa of sore uncertain statue ahould be resultant from the Subcommittee recommends** tiona aa are presented. 9* It haa been beyond the a cope or possibility of this Sub- committee to give due consideration, analysis and expression of judg- ment with recommended action for each of the many individual and some- tinea detailed recommendations aa have been received, extracted and subnittad in tha supporting data. Many of the points made may be similar or impractical, or well nigh' impossible, but, there la evi- dence of much individual thought and sincerity in most suggestions and meriting a continued reference to and utilisation of the material. Procurement of additional details and comment from selected military medical experts from idiom specific information may be deemed desirable and an active utilisation of the file by Medical Department planning eehalons is believed indicated. 10. This report has been prepared and submittad in quad- ruplicate aa directed. Tha extraction of confidential and frank testimonial opinion from basic material has bean tha method used as belnsr the most practical to provide the euooortinw data ten* as have base the subject for varied criticism Is based largely upon Multiple individual expressions of dissatisfaction to a degree in excess of that which would have prevailed had the opinion been nodi* fled by an overall knowledge of the various military medical require* ments and cirouBstances in the various situations which developed, 2. The occasional opinion expressed by various individuals that the performance of the military medical mission during World War II was in all respects very outstanding must be tempered with real!* setion that many tinea there was far frost ideal accomplishment• Chief causes for such were of course, the general inexperience of the Nation In conduct of war of such magnitude, administrative and Bodice! planning difficulties encountered eo frequently In command and staff relationships and finally a general lade of clearly de- fined consistent policies for Medical Department interrelationships, mutual and independent responsibilities and operational procedures. 3. The Subcocnitt.ee review of material pertaining to the various subjects suggested has been comprehensive and sincere. In many instances the Subcommittee finds that the corrective action indicated or needed Is most obvious but the means of obtaining such is, In turn, most involved and is a proper activity for existing Medical Department Staff sections in the Office of the Surgeon Gen* eral of the Army, in the Bureau of Medicine and Surgery for the Hevy, and In the Office of The Air Surgeon. A. In general, the Subcommittee, obeying the verbal in- structions received toward application of lessons from World fear II and their application in the event of a World War III, as It might occur either immediately or eventually, finds and concludes I a. That for adequate classification and mobiliza- tion of Medical Personnel Resources for the Armed Forces, the approach must be with the concept of total war involving this nation as never beforej that no single agency exists for determining uniform policy and method in classification of Medical Department personnel for military purposesj and in the procurement of Medical Officers inter service competi- tion and methods held over from World War XI and subject to extensive criticism continue in operation with certain dis- guising variations. % b. That the professional and emergency military training programs within the Armed Forces, as carried out in World War II ere subject to moderate criticism and should be revised in accordance with specific recommendations as are made in this report. 7 c. That the general polleiaa evolving through World War IZ relative to assignment of medical personnel, including use of recognised specialists and consultants, were initially deficient largely because of inadequate classification methods and procedures. There was progressive improvement in assign* manta as the War drew to a close, as improved classification procedures were adopted. The quota method of assignment with- out classification data will recur in the event of another war unless steps are taken to make available classification of all individuals includsd in the medical manpower resources of the nation. d. That replacement pools of Medical Department per* eozmel es operated during World War II were one of the great* est causes of wastage of critical doctor and other profeeeion* al manpower. The Medical Departments of the Army, Wavy and Air cannot auoeaasfully solve this problem until divorcement of critical Medical personnel administration from non-medical military personnel administration is provided. zed Medical Department authority for making appropriate duty am* sigments of replacements to the most suitably locally avail- able medical installations is mandatory in lieu of World War II replacement pool operation. a. Redeployment and demobilisation of Medical Do* pmrtment personnel necessarily paralleled for the most part that of the troop elements supported. There is no immediate panacea for the seeming injustices suffered by Medical Depart* ment personnel during redeployment and demobilisation which will be mere affective than uniformity in service overseas requirements and criteria for separation. f. Medical Department units and organisations from the standpoint of personnel, equipment, training and mission or tactical requirement, developed immeasurably during World War II in the concepts of Force needs therefor. Standardise* tion of certain units subject to common use by Ground, Wavy and Air Is feasible. Sufficient flexibility must be devel- oped, however, in all medical units to allow for maximum medical support required by the Force concerned. The Medioel organisations for the support of combat troops of the Army, levy end Air should follow a common pattern but with oppor- tunity for adequate provision of specific feature# desirable and as determined for their own needs by each of the major forces. The general policy for reduction of intrinsic Medical 8 personnel and equipment with combat organisations and develop- sent of suitable cellular units and independent medical or- ganizations to provide adequate medical support as circum- stances dictate, is strongly advocated* Planning agencies for the development of specific features of these unite as are needed by each Major Force should be activated* Parti- cular emphasis should be placed upon development and pro- curement of their equipment to bo airborne with utilisation of common type standard containers for packing and shipping of such equipment* g. The most urgent of all considerations are those associated with the early stages of the war in the field of medical logistics for allitary campaigns. Any re- currence of initial phase shortages of medical equipment end supplies as seen in many instances during World War II must be foreseen and avoided* Shipment of medical equipment with organisations being rendered support, will prevent many of the diversions and losses of equipment which handicapped rendition of medical service to troops during the first 12 to IS months of World War II* Decentralized stockpiling of critical items for immediate assembly and shipment In event of emergency is essential* The necessity for supply maintenance by automatic unit shipment should be limited to the early stages of any campaign so as to avoid wastage of certain unneeded and excess items as will not be used from such shipments* The early establishment In theaters of requisition procedures for exact needs is advocated* The tripartite procedures recommended by the Subcommittee for Medical Supply Depot procurement, storage and distri- bution methods, would allow for maximum coordination, adequate supply service for each Fores concerned and avoid- ance of duplication. h. The military medical doctrines and principles as prevailed for evacuation policies and medical care in the Theater of Operations were essentially sound as applied in World War II* With adequate planning knowledge and experienced medical planners superior results were accomplished. The responsibility for evacuation being placed cm the next rearward echelon is a sound procedure* Problems present themselves new in regard to correction of deficiencies as occurred, in thought concepts required in contem- plation of never methods of warfare and probable theaters of opera- tion in event of another war* Clarification of Geneva Convention and international agreements, better medical support for amphibious operations, nee organisations, tentage and other housing necessities for mobile and fixed field medical units, better evacuation direct to hospitals for definitive treatment avoiding repeated transfers through successive hospitals, forceful medical leadership to insure early return of patients to duty status, better troop selection and continued efforts to reduce large psychosomatic patient loads, better medical support for more isolated Air Force units, and need for more adequate communication facilities such a> radio between Army ground medical unite are examples* The evacuation of casualties from actual combat areas poses a different problem for each of the major Armed Forces* Units and means required by each will frequently be substantially different* There is ample evidence to indicate that full provision should be made to allow the Medical Department of each of the Armed Forces to develop and operate those facilities required for the complete care of Its respective combat and service troops and other supporting elements (civilian) from the time of onset of illness or injury to discharge, separation or retirement from the service. The principles of coordination and inter-depen- enee for avoidance of overlap, properly employed will eliminate any major objections to such functional necessities and the benefits to be derived from the proper medical support of the Armed Forces concerned, will far exceed some of the minor diffi- culties which may require solution by adoption of such a program* Thus coordinated evacuation policies and methods for ground com- bat areas, naval battles, amphibious operations and air parti- cipation in combat must be planned and accomplished by the Armed Force Medical echelons concerned* For long range evacuation, the utilisation of Air Transport has established itself as a method of choice and to be used whenever possible* 1* It is believed Zone of the Interior hospital plan- ning for a possible World War III should benefit immeasurably from the experience of World tar II* Design, location, construc- tion features, designation of numbered Armed Force Hospitals, unified and coordinated effort toward provision of joint hos- pitalisation, avoidance of unnecessary duplication of ouch facili- ties, civilian defense requirements, rotation of staff personnel so as to provide medical officers with more professional oppor- tunity, adequacy of debarkation medical centers, convalescent hospitals, control of hospitals and cars of dependents are among 10 the points which are considered. The planning for hospitals in the Zone of the Interior based on strategical concepts of war plane should be Bade now. Also the desirability of numbering military hospitals as Armed Force hospitals Is stressed. The discontinuance of certain descriptive designations of hospitals such as Regional and Station la advocated. j. The Medical Departments of the Armed Force* in their general relationships with other branches and staffs of the Armed Services relative to medical planning and requirements9 experienced great difficulties throughout '’•orId Far XI sot© of which-persist to date. The urgent necessity for joint Armed Forcq/Representation in the office of the Joint Staff of the Joint Chiefs of Staff 1* considered probably the moat important single conclusion arrived at by this Subcommittee and recommendation is made accordingly. In all echelons, information was all too frequently far leas than that necessary for adequate and proper medical planning. Operational con- trol of large medical installations with a medical department mission only, was frequently conducted with great interference from military agencies which had no responsibility in regard to the primary mis- sion, but authority to a degree entirely uncalled for. k, Factors which are alleged to have contributed to overlapping of medical functions of the Armed Forces are reviewed. The importance of determining the competency of the critic is deeded most necessary. The desirability of joint and coordinated efforts Is recognized and urged, but caution is believed indicated in the initiation of any changes which will eventually result in an in- adequate intrinsic medical support for any single Armed Force of the Nation, as may be required for it to satisfactorily accomplish its mission. 1. Procurement methods, dirty assignments, rank and pro- motion, unkept promises, undesirable family and housing conditions, class distinctions, lack of professional opportunity for advancement, dislike for regimentation, medical care necessary for civilian de- pendents, and the disparity of income between military and civilian doctors are among the causes of disaffection mentioned. It is con- cluded that much can be done by the military medical establishments to minimize causes for disaffection among civilian doctors serving with the Armed Forces in another war. Action is Indicated to adopt the necessary corrective policies and measures now which will re- move causes for disaffection. n* Other conditions which In the light of past experience are believed to merit consideration In order to obviate the repeti- tion of mistakes in the employment of military medical resources have been reviewed by the Subcommittee* They relate to Nursing Corps difficulties, training of doctors for the military service in Mili- tary Schools of Uedleino similar to West Point and Annapolis, civil- ian defense, medical intelligence information, reduction of paper work, medical aspects of military government activities in foreign countries, and application of the principles of Navy General Order No* 245 for control of larger medical Installation:;, They ere mentioned as constituting individual problems not previously dealt with under other subjects* Tho Subcommittee, with tho exception of the nodical Bom- ber roproaenting tho Air Surgeon wishes it understood that in using all terms in reference to the Medical service of tho Air Forces In this report, that it does ao without implication that It favors tba creation of a separate Medical Department for the Air force in the future* It has Interpreted the terms of reference for its investigation to exclude a study with recommendations in that area* c.. mmmtmBL. The Subcommittee on Employment of Medical Resources recommend s j 1. The establishment of joint medical sections on the following egencieet a. National Security Resources Board b. Central Intelligence Agency e. Joint Staff of the Joint Chief# of Staff 2. The adoption of the concept that in the future* medical per- sonnel resources will end must be controlled nationally and that no single using agency can expect to secure its requirements by individual divergent action. 3. The establishment of a national registry of all medical person- nel resources by the Rational Security Resources Board. Action to eliminate the following* a« Competition by each of the services for tho procurement of nodical personnel• b* Tho volunteer system used in the paat for aocuring nodical peraonnol daring nobilisatioa and war* 12 I, Adoption of a single uniform method for designating the classifica- tion of each category of medical personnel* 5* Action to effect the following* a. Full use of non-professional officers in administra- tive positions in all medical facilities In peace and in war. b. Greater use of the female components of the services in 21 medical facilities in peace and in war. 6* A thorough study of the present reserve systems of the services to determine their worth and proper method of operation under a policy of national control of medical resources* 7* The continuation of the affiliated unit program with reduction in the professional assignments to "key" personnel only* B. The immediate creation of a permanent Joint service medical institution as described In the body of this report and in Conclusion No* 16. (project - b). That the creation of a permanent Joint service institution for the collection, evaluation, publication and dissemination of current and future research and development in the fields of military and naval medicine and surgery, preventive medicine, medical aspects of atomic and biological warfare, is a prime necessity of the mom- ent for the peacetime and emergency training of all medical person- nel, civilian and service* That highly trained civilian and service personnel are Indicated to comprise the faculty of this institution* The active pursuance of every possible effort especially with civilian medicine to advance the training of civilian practitioners during peace to better equip them for service in the event of war. 9. The inclusion in the specific plans for training of medical personnel for future emergencies of the training facilities and methods used by the services during World War II, with the necessary Indicated minor improvements especially in the indoctrination field of newly joined officers. 10* Staff action to insure full control of all medical replacements by the Chief Surgeon in any area to eliminate the serious mie&ssign- ment of medically trained technicians that occurred in World War II in replacement depot practices and thus prevent the wastage of training effort and scarce category medical skills. IX* The constant and Intimate liaison between Medical Departments of the services with their general Staff agencies which are now plan- ning for emergency training in future mobilisations* 12* That adequate provisions be made immediately to train selected regular medical officers during peace for a career specialty in staff and high command assignment in war* 13* That action be taken to insure that all Medical Department per- sonnel in Replacement Pools arc without delay made subject to assign- ment fay the Medical echelon In the appropriate Command level, at all times in highest priority status for Medical and Dental Officers and utilising the practice of temporary overstrength in existing Medical installations* 14* That assignment of offloors to units should be made ae soon as possible on an alert basis in event of emergency and that critical professional personnel be allowed to remain in civilian status until the last possible moment and then be moved to duty assignments by high air priority* That in order to enable this concept in practice definite representation for air means is imperative* 15# That in future war planning be completed early for the rotation, redeployment and demobilisation of medical personnel) that the point credit system used in World War II for service be further developed and retained for the rotation of general medical service personnel from theaters of operation to Eone of Interior, but that it not be adopted without modification for specialist categories depending upon their replacement availabilities* That rotation between civilian and service status during war be not considered as practical except in the ease of scarce category specialists* 4 That the Surgeon Generals of the Armed Forces be given the authority to determine the criteria for discharge of medical person- nel based upon their post-war medical service requirements* That sufficient time be allotted in the demobilisation discharge process for a proper type final physical examination* That coordinated action by the Army, Navy and Air Forces to equalise wartime service of their medical personnel be provided* 16. That steps to gain the necessary authority to more forcefully utilise higher priority air and available nodical facili- ties in war for the movement of medical personnel be taken NOW. 14 17. That every effort be made through medical sources to educate the public and its representatives of the folly of demobilizing the armed forces and it« medical services in a similar fashion that occurred in World War II. IP. That each Armed Force planning agency for the medical support thereof extend coordinated and Joint effort to effect the followingt a. Designation of Medical units necessary for immediate support of their Combat and ser- vice troops in the £on® of Interior and '’’heaters of Operation. b* Determination of units and organisations with their structure, which may bo standardised and subjected to mutual interchangeable usage. 19. That necessary appropriations be procured to insure the develop- ment and earliest possible procurement in ©vent of war of standard equipment for Medical Department use most suitable for air lift. That the agencies now involved In such work be provided most able and experienced personnel. That coordinated Joint efforts in that direction be stimulated to the utmost by each of the Medical Depart- ments. That the Air Force facilities, their previous experience and cooperation In effort should be utilized to the maximum by Medical representatives« 20. That tentage, construction features of medical Installations, utilities and their maintenance, receive intensive study and effort to prevent deficiencies as occurred in connection therewith during World War II. 21. That suitable radio equipment and personnel be added to the tables of organization and equipment of all field medical units which normally operate in the Any Service area. 22. That plans be developed for the orderly procurement of the medical equipment and supplies needed by the Armed Forces in the event of a future war. 23. That th© present group of* experienced medical supply officers be maintained by th© intensive training of new officers in th© sys- tem developed in iorld War II. 24. That an Army-Navy-Air Force Medical Department board be organ- ized and assigned the responsibility of formulating plans for the supply of the whole blood fror the United. States to overseas theaters in the event of war. 25. That further immediate and detailed studies by competent joint armed service medical personnel are mandatory in the following fields* (ft) The Implication* of atomic attach* on large overseas bases as it involves the medical services* (b) The deter®!nation of our future status re- garding the provisions of the Geneva Conven- tion and allied international agreements for the protection of the helpless* This study to Include a means for the indoc- trination of all Armed Forces personnel as to that determined status* (c) the development of sound doctrine and methods of procedure to cope with all of the medical aspects of amphibious warfare* This study to include covering the entire field of floating medical evacuation transportation* 26. The development of a better system for the control and use of hospital ships during war* 27* That action be token by the Surgeon Generals to sufficiently increase the number of medical facilitiee in the Combat Zone to permit of the salvage of medical type cases In those areas* 28. That staff action be taken by the Surgeon Generals to Insure the Improvement of hospital construction procedures by the Corps of Engineer* in Theaters of Operation over World War II practices* 29* That necessary staff action be taken to set up a joint Army, Wavy and Air Force project for the development of better types of ambulances for land, sea and air medical use* 30* That more and better consideration for hospitalisation needs of Air Force troops in Isolated regions is Indicated and should be provided* 31* That joint Armed Forces planning be Instituted for standardi- sation of common fixed and mobile hospital unit requirements• That a study be mad© to investigate the feasibility of changing of designation of Aimed Force Hospital as practiced in World War II. That a numerical designation with standardised policy for type and location is indicated. 16 32. Initiating Radical military hospitalisation planning on National Military Defense laral required to coordinate nilitary and civilian dafansa in tha aront of total war involving the United States. 33* To provide for military medical Armed Forces (Army-Navy-Air) hospital planning in conjunction with Joint Chiefs of Staff War Plans and Strategical Concepts• 34* That action be taken by the Surgeon Generals of the Armed Forces by proper staff methods tot a. Assure their position in mars of the future on the proper staff level. b. Assure the position of Chief Surgeons in Theater of Operations on the proper staff level. o. Press the adoption by the Army and Air Forces of the Ravy system of supervision and control for thslr respective medical installations as prescribed in Ravy General Order 2A5# 35* That action be taken by the Surgeon General of the Navy by proper staff methods tot Assure the establishment of a medical section in the headquarters tJ, S. Marine Corps* 36* That considerations end recommendations of existing Subcommittee projects many of which are new oneratlng with concepts of peacetime needs only, be analysed fully as to their potential adaptation in the event of another National Ibtergency* That any peacetime unification and consolidation of activities of the Medical Departments for the Armed Forces as ore Implemented for existent economical reasons, he approved or accomplished only after full certainty and agreement Is established that an adequate Force identified Medical Department nay still evolve and be capable of rendering necessary end adequate eon* plots Medical service to the arm It serves. 37. That "unified and coordinated effort* be adopted as the guiding principle of the respective Medical Departments of the Armed Forces, but that any further stressing of unification and one Medical Service objective be tempered in order that continuance of the historically demonstrated efficiency and accomplishments of the Aray Medical, the Ravy Medical and potentially the Air Medical Departments may be In- sured, and their complete absorption of identity eventually in a civilian controlled agency, can be prevented. 38* Policy definition to allow for maximum administrative and opera- tional control of medical department activities and particularly medical personnel management by the Medical Department of the Armed Poreee concerned. 39# Continuing Armed forces Medical Departmental analyses and cor- rective action indicated against those conditions which caused dis- affection as are reported and available In detail by perusal of the supporting data. D-U. 01ASsmCA«Q» AM UtaiLlMlQM 0? MEDICAL MAlrtWM KM MB a» nHess U maousMoa Toll mlliiltoa of tin importance of aediesl service to the ration la future war has not bo*a sufficiently achieved la all- Italy or civilian spheres* nor will It be mill sound presentation of Its lapcrtaaoe has boon node oa a aatlonal basis* «ar aadleal resources «i» llaitsd* It Is lapirsUv* that they bo used asst economically if wo ars to avoid dsfsat la the faoo of a greatly «** pended aaad whloh future war is taro to denaod. The eosospt of “total* war wherein oar hoass aad faallios art prlas target* for destruction, tbs advoat of atoale weapons* tho developments la biological warfaro aad tha reduction of tho forcer military obstacles of dlstaaoo by guided missiles aad latost aircraft* all presage tho aood for aodloal sorrloos far la oaeots of sap overtones of this Batloa aad doaaad centralised control ovor all aodloal resources* Tho attach without warning of oao or acre of oor I arcs Industrial or othsr Important canters would pose a aodloal protelsa distinct fro* any purely Mil- itary plans for national dofsaso* This phase of providinc aodloal service to largo oocMoatc of our civilian population is currently ooacldorod as a local civilian responsibility. It is patent that provision for adequate civilian aodloal naans to oops with any local catastrophe oaa only be aesured by ooacidaratioa of thoco aosds in national planning for use of nodical roooureoc* Civilian nodical dafonco noods thorsforo loon for tho first tine in our history at aa important footer In the distribution and use of national nodical re- sources* However well inplonontod local nodical plans nor bst our present location end distribution of civilian and governmental nod- ical facilities to cope with a catastrophic attack ore far from ideal and mitigate against reliance on local independent notion* bit fact indicates the need for practical plans to enable tho shifting of nod- ical resources rapidly oa a nationwide bade* This connotos the price demand for n nationally controlled nodical corvioc* fc implement this concept* there nust bo fotMd at tho narliost date possible a nodical group on tho rational Defense level* further* because of the extme Inperleae# aid aanifeld facets which national nodical coverage presents* it is dearly indicated that nodical tactions oust bo established innod* lately In ell national agencies concerned with tho control of aodloal effort* Tho cdoctod officials to fern these nodical sections cast be eminently qualified to discharge their duties* The Ooanitloo believes that civilian practitioners should bo selected for these assignments as well as nodical officers free the armed services. To attest solv- ing this incense nodical problem on cay other basic Is useless aad can remit only in a return to our paet methods of divergent* wasteful aad aspensivs efforts by each agency concerned in national defense aad se- curity* Unless a dofiaitivo oodioal plan is developed 80b for an adequate oodioal oorrioo in all ophofoo and that plan Is iaploaoatod by pfootioal noma and aothoda froa a national lorol, tho possibility of a aajor oataatvopho to tha public’s eonfldoaeo ia aodiaal loadoiw ahip aad aorrioa oarly in nay international conflict it aoro than slapla ooajooturo* This factor aleno night woll roault ia a national psychology that would aaoopt oarly and ocaploto defeat. The roaooroh of tbit Ooanlttoo hat ostablirhod oridoaoo of tho aood for aoso tam of legally required aorrioa of nodical poraouaol rooouroos ia war, This fotaa tha fcoyatoao of a proooaa which, if sound- ly iovolopoi V 1 a** will porait equal and juat national oorrio* of tho iadlrlduala who oonpriao jyaorioan nodiolno. Medical aeapewer mmwt are not constrained to the physicians* dentists and veterinarian* ef the nation* full consideration in studying aedleal resources asset he fives to the acdiesl ancillary gMvpt to Inport- ant end essential to asder* acdloal prsaUce* Our resources in nurses* AUtlcUat, prostbodoatSets* phyel*-thsra$t s t« and eceupntionsl therapists* clinical psychologists* social vorksrs* laboratory technicians* cad asay othsr groups strutt be controlled on the state national beats as doctors* One national nedlccl agency should control the resources cf the entirs group* this CosmlUee he* not considered the present preenreaeat cf aadlenl personnel for pceceiiac needs as falling within the purview ef its directives* It cautions against the estnhUshaonl ef oar rigid syctea ef peacetime procurement which cannot he rapidly discarded if nseceeary or changed to saoethly fit late the system rseaancadsd for total aebilisatica of nodical personnel resource® for war* n* i, mmMmz a* tioapooito national nodical papccoaol roqulPSRoata caa only bo dotanoiooS aftor o&oh using aa&oal agency ooaoceacd la a total wu* effort hat oapoenod it« Individual a®©da. Individual faquieenoata »u*t bo W.&*d os *>e«e®at &ad projected anode and on wall aanaoirod plana Patterned with tha knowledge that our reeoueooa aeo Halted and that only tho atrlotoat ooomugr of thoa will poralt of adequate aodieal oar# in a global wap. fhoao plana, aa far no tho Oowslttoo h*a boon ahl# to loam, 4o m% oziat at tha proaent. Tho fleet atop iadleatod* thorofcro, to direction fron a national lord that tho so plana V» ptopaeod and adb* alttod. Tho second atop will bo tho careful scrutiny- of tho doaaada of oaah of tho ualag agencies by a ooopotont national aodloal group which smat bo enpowarod to aafce doolsloat loading to a proofioal alioomtioo of tho arallablo rooourooa. b. Pull eonaidomtion anat bo giwan to tho aoode of too aoay nodical toUvitiii whloh ara not at peasant organised to proaoat thoir in a unified manner, such at thi medical ItaoMii UilltaUoMi State. County, and Municipal Health Departaant*. Industrial MdloU# aje» panded for war production. etc* £aeh State should to repaired to nto&l it* eiainuai requiroaents for the adequate ear* of it* eitlseas during a. gsaoaaftsi There la no tingle agency now la existence which feat or Maintain# a complete registry of the nodical personnel resources of the nation. fJfetll such dot*'! It arcimland si&lntalned nationally on a warrant basis no worthwhile or efficient ovemll or specific allocation of resources ana fee node to any meins eganoy or ccawmaftr* A coasp rehanslvo and nil-inclusive curve* i« indicated few. Nation*! aachlnsry to effect thle first important •tan to a rational distrlbutlea end uoe of oar nodical Manpower resource# should be established *w, without adequate legislation which would aaapeI Individuals concerned to famish Initial and subsequent periodic report* ea their qualifications and status* the undertaking would prove worthless* The entire ->rohlea resolves itself principally late the immediate estabUshMsnt of e Oovemuentel agency which will eataVMth and aol«t!ii!i « notional ra#» ietry of ell freer** involved la the chores of ©adieu! resources. In the pursuance of strict econoa? of radical manpower in any fatara war. Individual« once registered should he protected by law free call end aeelfnaent to any eorrico other than the radical. flea, they should, h/ the erne legal restrictions, ho prevented free voluntary sorriee in other than radical assignments* One# tugged, they should only he relented by the national afancy In control of radio*! resources. it le logical that this promoted national agency should he estab- lished as a section of the national Security Heaoureee hoard. m. a^MOBSM It ie generally agreed that an accurate deteralaatloa of the efciU and potentialities of any individual cannot be and* solely on the heal* of hit or her Membership in or by certification of any nodical or organ* ination. neither can foil reliance he placed on the etateaente of over* teal on* indlvidnclt. the steins of each treeioliet dan only he establish* ed Oy the foil investigation of all sources of inf onset ion in each ease* the sac# law vninh receives regie trail on shoul d Include teeth to eoapel individuals to present only fwots concerning their cualifleatioae* Classification in past emergencies has feesn cade by each of the arnad eervlees often on a hurried and unsetsatiric bests. This has been a factor in wastage ef radio*! ekills* Further, there has not been a uni fora nethod ef designation for various gradations of particular Medical specialists or drille. The system currently used for this purpose fer the Amy has set favorable conourreaes by the other cerrloes and Might he offer* od for adoption nationally. Prior experience in one ef the armed eervlees can he coded as part of the classification. Apart from the classification of skill•• ii is neceedkiy to classify medical manpower aa a physical basis* fills is necessary to avoid wastage and alsasslgnments* la general* li is agreed that the military sorriest can utilise but a saalX percentage of the age group over forty*firs and of those otherwise physically handicapped* fas Amy classification of "limited* military terries for medleel personnel proved to be sound sad should be adopted oa aa Ideatiaal basis by all of tbs aimed forces* Just what the standard should be for "Halted* service Involving practitioners has brought forth saay varying consents* host are agreed that less stringent physical requirements should be established for any further emergency* Contrary to general belief* there are many civilian physicians who are qualified for and prefer medical administrative assignments rather than professional ones* these should be specifically classified as to their desires in the proposed national registry and called into service only when needed* It bat heea euggeeted to the Committee that pre-laduotlon class- ification of medical technician® would he a Mg etep forward la ftohllleiag that group of medtecd momi, while an admirable Idem, the magnitude of the problem oa a aatloavlde eemle mitigates egaiatt it* cou*ld«r.tloa me m immediate requirement* itoverer, it should ho retained me m very important matter for Sational Security Hesources Board mad Selective Ser- vice to eoaelder la improving upon world War 12 practice** It to hut part of toe promote watch should he operated for tha classification of mil still* prior to aetoal induction. She most individual in the medical services ef the aimed femes in war is the medical officer who serves with the combat troops* fie truly Is a specialist of the scarcest category and should be so classified and given additional recognition la the fora of p«gr for hie haeardeuv assign- ment* Sis knowledge and application la rendering the initial care to the sick and wounded ae well ae in preserving the health of hie unit plays a large part in determining the outcome of battles* fhese officers must have military training sad therefore must be celled late the armed services earlier than other doctors* They must be young and physically in their prime besides possessing moral strength far beyond that required for the stay- at-homes and those who work la rear areas* It has been suggested by tome that all of the armed services adopt a special classification for this cat- egory of medical officers* The coauslttae concurs In that ingestion ae meet praiseworthy end just* xt* nmimms a* araraRAt. The essence ef preparedness and the key to mobilisation for national effort is the exact knowledge ef and the ready availability under legal rein of medical personnel resources* The fire! step end the meet important in mobilisation will have been completed with the establishment of a national registry of medical personnel resource* as previously suggest- ed* The system established for the control of the actual celling into tha Armed services of individuals must be rigidly controlled* Ho system can be offoctlvo aaloos it l« ooXldlj mi dotoilod ploao •! mmk of Dm ?ro*aP ooalcaaoats of portoaaol will oMato l&o aftaao mroljr to rooeur ooloatlflo noproaoa io awl* to tfclo pitUw. JU*» point* antborlt/ anal to rooted It too mfimk l«NfHl« of Ho Smltt to dttsnia* tho Uao of ««U of it« allotted aodio&l poreoaaaU later* f«rono*o ocaeod V bleafcot regaletl*** or o*Uo aad* t «o*-o*dlOAi. per* oozmol otaffo or oootlono 0*000% bo petal tt*d. dood pi analog ofceold pro- vost lh«t* wvoh oonplaiot hat boon and* 1/ praotlUooor* woo bod war torrioo ovor tho lon< Initial period of promotional UuOtlvttgr wbloh oooorrod la tholr oxptrloooot of tor tholr ooll at Individual•* tad particularly by tho or 1» rotorro will of tor too oall of tholr unit* into active ttrtieo* Ctubtlote thoro la tmoh troth im tho to ooaplaUU. ft rtduot thio watUgo to tfer oboolato alalauo should ho tho goal of oil oorvioo oodloal planner** It tetonoo vo should strive to oall praotitloaort into torrioo only whoa aoodod oithor to prattle# tholr professions or to giro thoa tho ninitn of training they require to aooonplioh tholr uiiptMt* proficiently* Tfjtre vill alvayr bo Aobato at to tho anount of training tho alrllitt needs to tunw torrioo dot1st* )t oaoaot ho generalised at this poriod* sot only in nodieel fields bat la «U ethers* ho I tor elaatlfle-tlo a of civilise pmotitloaopo end bat tor plaao for tho phasing la of all nedloal rotocreon are tho twd keys to roaoh a reasonable goal la tho future* la coaoidorlng tho pxoblaa it la ooll to newer loot tight of tho fact that oor onony hat 4«f« la tho paot hod a groat deal to do with tho oontaot of oar* 0«r pleasing will bo onhioot to obtigo* often nodor in ooopo* ohloh will affoot tho nodical off art and oftlaoo pro halo oworegtt la «ooo aroao while shortages oodot la another* tho to aro tho fortooot of war oat art oharod hr tho fighting orao la tho otrito proportion at la tho nodlo&l eorwiooe* hodioal aoa will bo oaotod to tho extent that tho to fortuaat dictate* It oaoaot bo troidod Ig tho consideration of post-war eoaplalaSa* nor oaa aoaoaroo to oatlolpato aad provaat tone of that wantage he divined or tokoa without euperuatumi old* ft boo booa otrooood consistently W tootlaoay aad evidence giwea this Carolttoo that orltioloa of tho rooord of the aodloal oorrloot la atrld oar II t« aoot unjust aod baowloss la asyr of tho najor fltldi. Tartar* tho potty oooplaiatt invootig&tod eftiaas I afar that tho intffialtno/ of o»-oallod nodical "bract* wat tho tolo dsnoo of wattage and disaffection oad that tho ropltiototat of ihoto bluedsrsrt aad iaeaspe teats la war bp olwlllaa praotitloaort of outstanding professional qualifioMioas would tn» oaro a pleasant and prefettieeally iaetruntive parlod of nllitery torrioo for ouch tad ovevy doctor, tho falsity of thlo glbborltb io too obwloao to roooiwo further oo—oat* b* mmmM ftolag tho laplloaHoot of 1 war* thoro oaa bo no Xoogor tho dopoadoaoo for mm ahpat* national aodloal oerrloo oa a epotoa bated opoa tho ddat of tho individual prastltleaer* i'bero is m denial that our world war XI aobilltation vat too rigid, ospeoleli/ la the oalliag to duty of mmdieal offiotra. A large part of (ao tomb as sued « no nationally eontfollod ijrilM of tho doolrod tmivoroal nodical t®rrloo without remap log our prosant organised rooorto •ystsae In tk« v.»»rlcua urneft t.®rvl«sos, ttt enrsnot foeo ft notional anargonoy of the future cud eopo vita St on & voluntary oerrlft© basis waich font* tft® keystone to the pro son i organ!sod rsoerre system, A» »wick sms v* dis- like rsglsonWtiaa in t\»m it isaat ho aecoptod a« tho only sound Motnod of Insuring full asdioal coverage of ths nation in tha future, Conditions for difforoat fron previous oaporionoo eoupol its adoption* Ono* national r*%i*try bat bo*n oaooscpUtomd and plana profoalad* it it masoatiol tool oaoh UdMdtsl bo mamtirkod daring pane* lo Mo rolm ta var* tturgueetloa of rank oalort lalo Iho present r««*rv* *y*tan* and da* provided a groat d**l of dlft>ali«fnolios among «tdle«l p*r«ma&oX« II might bo said that too** individual* vbo voluntarily »eoopt«4 wwm amainUas in groat t»bri of Instances found toomaolvet *ty»i*d in pro* motion ml to* expense of toot* otoar ooaparable Individual* too prtftmd to mail until «ar develop*! and Ikon bargained wtlb to* oosrioat for higher rank* fbit must b« disasrdod at it* only rood! viU bo tom f*» fatal of personnel lo Join too reserve* Awing ponmm* for than, ono of too purpoaot of osgaoinad reserve nail* m* to afford pmamotiaa training in ftUltaqr duties* too imonltn v*ro very enable la matt minds and did mot Justify iha oqpo fled civilian and military medied leaders* That this agency should be vested with authority to diet the national means in all the arias ef medical service* That fer practical reasons it seeas best to place this mew medical agency as e section in the National Security Resources Boar#, Th**t legislation is necessary to secure data for the prepeeed national registry of ell medical personnel resources* That this legislation should compel individuals to fatal ah re* liable data on a similar basis to income tax requirements* 3* That the mobilisation process mast follow specific amd detailed plans which should be available now and well in advance ef cay mobilise* tlon* The so plans do not exist in sufficient detail at precoat to pro* ▼eat a rcnmrroAtfa of aany of to pitfalle which were apparent 1a world *ior n* 2h&t tom oaa We sta agratoa dooiguod vole* will totally oil** tot* mots$o» Jtovcvor, IS eaa Wo sainlnlaod dsrln# jfc&Hltoton by Tpmp&t v..d«h vlii proseat only to ovrro®LVdsg of pern oca&ol at sm? ti<», Wat also will pmvoat &&ling ioaivldanlt la He early* 3. That too few deata). reoonmst wore wrrdlabl e early to cope vilt the ooomouc aaosnt of wute nooooea*? to pl»oo ailii«*y personnol la acceptable denial health for ec&bet oorvloo* Thet thi* field deserve* latestive ittogr end eorreetive action fey the dental thisto ot ©»ch sanaed *ervl«s* 4* tot a si&glo oodlsg oyeUn for to daoigaatlon of to «lu«lf» Uitloa of practitioners s!w«Ji. We oetobllohod nationally. That until this it aooanpllthoA* eeafaeiea end aitaseigaaentft of resource vill oaatiane* fhat to acdiotd services of to ar»od lOreoe tould at toe tlao agroo to oot sp a slall&r syetcn a? a proposed oao for natlotml a*> dcptton* a* ffeat vithin reaeon* every of fort ehonld We node to advleo doe tore of their planted ear aeaSgaaents during poneo* toe vill afford ton to opportunity for some preparation ead &e«mrtoo that hie or her eorrieeo ▼ill not bo unduly vasto* C* ftet to rooerm opot«n of the various eraoa forces no eerrent* ly oprjrntlnc rro in neod of l»t«n«lr« etndy to change tore nooe«««iy to fit into t m oetoo of national control of nodical poreonaoi reiosroos* tot for to tto bel£|, there appoara to be no aoceestty for phandciiMnt of to mearv* eys»t«ao* 7, Thkt the ittoallM tor the tine feeing of affiliated aedieal «tito «f the ingr it iadie&ted* prlaoipally toeamw of the desirable feature vhloh enables their a*e la eae.rgtso lee* Severer, II is the eoneeaess cf all th&t they thetdd have only •fcagr* nodical personnel assigned vh«a called into active eorvftoe* 8« That rhavXA. fee gives to the for & alu^qpi to « fbftiror* tttelwr deei£fi*Uen of dcctare dull ad lata the tertiet durlag wr» >&% ifeftt eft til » loiter pies ie devised that the sUUeiy end saved rsult* Is we •nrrently to seed #.« Is the pset* , 3* That la future mobilisations of medical manpower more attention and oar* will oe aecessnry la culling personnel free civilian pursuits* That In principle no one should be nailed prior to ton earliest date his professional services are needed or for the minimum training period which is essential la his contemplated particular assignment* 10* that misalignments end Certain wastage of doctors did occur derm lag World war II* that in most instances glaring examples of these do- fonts were the result of situations behead the control of planners end modi* cal commander*. That in future wore wo want orpoct Identical situation* and the caM typo of ©osplainto* that all possible measures should be taken la medical planning and in execution to minimite personnel wastage* flint while improvement is undeniably indicated in cur personnel management and should be attained* no onus should he attached to our wartime medical lenders which is based upon the hindsight observations of unqualified observers* 11* That current surveys nod studies of tables of organisation and equipment for medical unite of the armed forces for the purpose of mete* lag fuller use of unprofessional personnel* including females, in the administration of those units should be continued* That noiv»regular medical officers* even though they prefer ad- ministrative assignments in the services during war should not be used on non-professional assignments except in the meeescasy medical comaand and staff positions* That active qualified practitioners should not be permitted to volunteer for wartime service in any of the other services or arms* IS# That to lasuro full coordinated effort in the use of national medical resources It is necessary to cafe-bli** medical sections in the following age not * of the Patio;* al Military Sstabllshmenti a* National Security Hesources Board b* Central Intelligence Agency c* Joint Staff of the Joint Chiefs of Staff 13* That further competition between armed forces medical services in the procurement of medical personnel Is unsound in light of the dictum frtm superior authority that every possible coordinated effort be made* 14* That rotation of aoiwopoeicdiftt Mdioal offieors b«tvoon field n«d hospital unit* in war oust ho accepted a« a *mm%* to ofrriato the Justifiable eriXieim of offloors Ih I they rogrosttod profession* ally hocanoo of tholr Xoagthly fiold aoalga&cat»» That all classes of medical officers* lacluding specialists* should be rotated to the gntttil practical extant between theaters of operation and Sons of Xatarlor medical facilities* That those me*#ur«® cannot be t*cao*$>llshe4 mlforml/ without specific plan* to Impleuent accessary §&&*&& directives that awed to be issued this problem* 15# Thai r«gardle«» of the concept that regolnr nodlc&l officer* will be retained os* aUicU/ prt>f*«i*i»u«l m&Usmm'** darlaf war* tiv t 11 will nol possible ic do so oxocpl In a olnor way# That the large demand for oooaaad nod staff medical of floor* la war eaaaot be ado$u&toly act trm civilian eourco* of these rare categorize ead farther* th»% qIvIUm MkUeln* viU not renal favorably la any «/•%«» propftftod vhorwld civilian praclIUcsorc viU la required la wort* aaa-pjvfaaeiarwfcl adol£&&e$l$ Ukm& In World War XX# tr. mmmtJ 1* foe Subcostal ttee recommends thas the following be accomplished in the order 11stem t* Adoption of the concept that In the future, medical per* soonel resources will end must b« ooatroiied nationally end that no single using agency e«n expect to secure lie requirements by individual divergent rntioum b* Sstnbliataaent of a Joint nodical section consisting of senior qualified medical officers of s«eh of the thr»© services with necessary eseistents on the Joint &taff of the Joint Chief a of Staff* (See Tab J}» o* SstabU sanest of Joint nodical section* on the following agenciest a* Bati»,»ual Security Resources Board b. Central Intelligence Agency c* Jwiat staff of toe Joint Chiefs of Staff d* of a actional registry of all medical personnel resources by the national Security He sources Board* e* Action to eliminate the following; I* Competition V each of the services for the procurement of nodical personnel* a* tm volunteer system used in tue past for securing nodical personnel during Mobilisation end war* f* Adoption of a single uniform method for designating the classification of each o tegesy of medical personnel* g* Action to effect the following! 1* full use of non*profes*lonal officers in administrative positions in ell medical facilities in peace and la war* 3* Greater use of the female components of the services In Z1 medical facilities in peace and In war* 3* A thorough study of the present reserve systems of the service* ta determine their worth and proper method of operation under a pel ley of national control of medical resources, 4* A study of the feasibility of controlling the rotating of medical personnel by definitive top level directive on field and hospital duties* It* toatlaaoUoii of thm ifmUwS mtt pNgnon with rwivoliw in tfc* profoimlottal tiiiiMMi* to *k*jr» portooxuil Mly. la So Ofeaotfot to w* os4* lu tbo policy of |&vU« iUitaij wo* oatfoX UU«» to pnoUUoMft vfclio oa Aulyr in tho oorriooo* i* #or pianola* purpoMo mador pro toot ooaiitioao toot OU *•**- lor offloor atliml ooroooaoi to ooaoi4oro4 «r*U«Olo for —maid ctod I toff ooolfoooato la to* cvoul of oar* TRUE CPF! EXTRACT (Letter, Captain F. C. Gmm (MC), OSS dated 17 April 19A«) ***** »(a) One critic!a* frequently heard was that all qualified sen were not need efficiently, or were used in ways that were not to their credit, or advantage to the sendee* It Is one that is probably very difficult in resolving to the satisfaction of everyone* The Medical Services were interested in assigning qualified Ben to impor- tant specialist billets* The difficulty was that there were Bore specialists, who were qualified in their own estiaation for the better billets, than thers wers billets* It might bo proposed, therefore, to establish a system of classification of specialists on the basis of their training and experience, and to similarly classify billets in Bodical activities* Such a classification should be Bade s routine, with the results published to the individuals and institutions con- cerned, and based upon a standard of nsasursnent drawn up by a recog- nised group of authorities* This, the best qualified Ben would bo assured of being assigned to the most important billets and the bil- lets would be certain of being filled with satisfactory Ben, at all tlBcs* It is realised that this policy was followed, bops or loss, in World War H but the way in which it was carried out appears to have created the depression in the Binds of many that favor!tin was being used and any suspicion of favor!tin is always detrimental to Borals* A classification system approved by leaders of the profession would tend to destroy such suspicion on the part of sen who are highly qualified in their specialties but who do not happen to be on the staffs of renowned civilian nodical institutions* •Efforts should be intensified to enroll civilian physicians in the Reserve Corps* It is questionable if this will produce enough results to insure a satisfactorily balanced Medical Service in the event of another eeergenoy. This statement is Bade mi the basis ef conversations with civilian physicians* They are not Interested in aligning thensalves voluntarily with a military organisation with the prospect of having to serve periods of active duty in a mobilisation for political and diplonatic effect* The alternative is Selective Service registration of all civilian physicians under a certain age and the organisation ef a Selective Service Medical Reserve* Such L. K. Pohl, Colon*!, MC TRUE COPT EXTRACT (Letter, Captain F. C. Greaves (IIC) USH dated 17 April 1948) - Continued a program would permit an orderly allocation of the available nodical manpower to cirilian and military needs and would avoid a haphasard program should the nation be confronted with a sudden major emergency* Selectees for military service could be assigned to duty in the ser- vice of their choice in the majority of instances* Sufficient effort could be exerted to commission then in their proper rank and data could be compiled upon their capabilities and most efficient usage in time of war so that calling then up and ordering them to duty would be largely routine* Such a program is a complete departure* of course* from the traditional past when physicians volunteered their services as a part of their civic duty* but in view of the competitive spirit of the majority of civilians* including physicians, this appears to be a practical attitude for the responsible authori- ties to take* Set the goals to be net* give them a reasonable chance to meet them but be prepared to meet them with Selective Service If necessary* A physician has the asms obligations toward national welfare as any other citizen*" ***** L. K. Pehl, Coldfeel, K TRUE COPI EXTRACT (letter, Captain 0. B. Horrloon, Jr., EC, OSD dated 23 April 1948) ***** "a. Classification and mobilization of medical manpower for the armed farces* A frequent complaint during the early mobilization period \ms that medical officers who had been in the inactive medical corps reserve had stagnated in the junior ranks for years and were called to active service as Lieutenant (jg) or Lieutenant, while doctors who had never bsefa members of the naval service were offered coc- ads cions on the basis of arc* irregardless of professional training or experience • It is believed that aedlcal groups should be organised into reserve units in accordance with tbs anticipated war-time needs of the Kavy in time of war* These reserve units must be convinced* that the active Navy supports then and is interested In their welfare and training* The majority of doctors are primarily interested in a 8peoialtyf and plans should be made to utilize aedioal officers In their chosen specialty when it is necessary to assign them to active duty*" seeeeees MS " L. I. Pohl, Colaail, * ISSg-CfiU ja&ICg (Utter, Colonel Arthur B, Welsh, MC, USA dated 19 April 1948) ***** "a, Tha Amy schema of classification of doctors was not generally applied and get under way toe late. There were too many * classifiers * and tee fee qualified personnel classification officers* The system wasn't well understood* The Amy Medical Departaent Class!- flcation Systea as established could haws been enployed profitably to qualitatively express the available resources and would haws assisted in quantitatively and qualitatiwely showing the requirements of the An&ed Forces and using ciwilian agencies* In ny opinion there was no long range Katloo-wide plan for the nobilination of nedioal nan- power, The strategic concept of the war and high lewel policies, when developed, didn't filter down to nodical planning agencies* There was no all out mobilisation plan* Selective Service didn't assist mater- ially in obtaining doctors* The plan formulated by the Preparedness Committee of the AMA, approved by the War Department in late 1941, and operated under the Federal Security Administration as the Procurement and Assignment Service turned out surprisingly well* There was dis- crimination so doctors say. It would haws worked to perfection had there been better classification earlier | had authority to ferae a physician to accept service existed) and had the armed services and civilian agencies conceived and effected an integrated plan of medical service supported by phased quantitative and qualitative requirements for an all out effort* A medical monitor at topside would have insured nedioal economy and operating efficiency. There was toe much decentralised control* That so necessary centralised control at highest command level was lacking.* **••* L. K. Pahl. Ceional. K TROB COPI EXTRACT (Letter , Colonel F. A, Bleese, WC, USA dated 19 April 1948) ttMtfiflag.tttm and reUlliaUcn gf itdlfii] mrffirfr f?r tta.Aritfl.lgcg«ft» •a, During World War II, about 60,000 of the 160,000 practicing physicians in the 0, S. saw service with the Arsed Forces* In any war of the future, it can be a caused that caaualtiea among civilians will probably increase the civilian requirement for medical service* Careful consideration must be given to civilian medical requirements and since the supply is limited, efficient utilisation is essential. •b. Separate procurement of doctors by Army, Wavy and Air Corps proved to bo wasteful and unsatisfactory. Competitive bargaining and hording resulted, me service had an abundance of a particular type of'specialist and others had a shortage• It is more important that this be corrected by a system of eon* tralised control government procurement, classification and. distribution. •c. In the recent war, many of the doctors who remained in their civilian nr—mnltlas took over the work of . one or more ether doctors who entered the Armed Forces, These civilian doctors worked under considerable stress, and needed mere physical stamina than many ef their colleagues who were in military service. In any future mobilisation, consideration most bo given to the physical quality, as well as to the numbers of doctors who are delegated to care for the civilian population. Early in the mobilisation, sons doctors who possess physical defects should be inducted into the Armed Forces, There is professional and staff wesfc that many of them can perform. Even the aged doc tore - those too old to carry on civilian practice or serve in active military units, can be used in physical examinations, laboratories, and similar places where physical endurance ie net required. This would save their able-bodied colleagues for the severe demands of civilian practise. *d* Doctors serving at induction stations should 1m given sore instruction concerning Military requirements, the man-power problem and classification of defects* Toe many men were lest to the service because of physical defects* Except for those unable to function in civil life, none should be flatly rejected (4F). As the demand for man-power for the military service becomes increasingly urgent, these defectives most be used and fitted into the service according to their capabilities * The morale and prestige of men mho have been rejected is seriously affected in a community and should be considered* On the other bead, there was considerable criticism of the system which rejected veil known athletes ete* who continued to Indulge in strenuous sports in civil life after being classified for military service as unfit* The im- pression that all man must bo fit for actual combat duty is harmful and mat be corrected****** L. Ke Pohl. Colonel. MC TRUK COPY EXTRACT (Letter, Dr. Howard A. Husk dated 22 April 194*0 ***** *1 also feel there is a great need for a civilian nodical board as a functioning agency of the National Securities Resources Board to establish national policies and programs for the distribu- tion of medical manpower and facilities to the civilian population, industry, agriculture and the armed forces in time of national emergency.* ***** TRIP. COPY EXTRACT (Letter, Dr. Howard A. Rusk to Secretary for Air dated 27 January 194**) ***** I appreciate your attitude that the broad over-all service planning must cone first and this should be carefully coor- dinated with the civilian needs and problems. I think it is gener- ally recognized that there must be a coordinated overall medical service, that many of the medical needs are common to all services and also many are specific to each. "With these facts as a basis it is ay personal conclusion that the problem could best be met by the establishment by directive of the Secretary of Defense under Public Law 253, a medical coor- dinating board composed of the Surgeon General of the Army, Surgeon General of the Navy, the Air Surgeon and such other medical, person- nel as might be selected by the Secretary of Defense. The purpose of this board would be to assure full utilization of all available medical personnel, medical specialist and hospital facilities, to develop plans for adequate and efficient medical support of task forces, to standardize administrative procedures common to each of the three services and to coordinate with federal, state and civilian medical and associated agencies. This would, in effect, be a contin- uation of the Hawley board as a permanent board." ***** K, Pohl, Colonel, BC TMZ con EXTRACT (Utter, Dr. Martin lair • dated J April 19(8) •X, lik* augr other aadieal officers, watched with sednesfl the «IX in which the Aray vested Manpower* I particularly watched the waste of wedies! ■on. I realize too well that there are no oeonosdcal ware, both from the point of view of dollars and Manpower* However, everybody sees a war froe his own perspective* It was disheartening to hear the eritieisn of ay friends at hone of the lack of nodical Manpower when I knew that so wany nodical officers sat idly all over the world* •I do not protoad to bo a spaoialist in any strategy* One little suggestion has beta in mj aiad for eoao tino and new I have takoa the eoarago to write it down* It would bo ay suggestion that tho Any and the levy and the Karine Corps draft all of the nan that they Bead* bet in the ease of nodical and other essential pro- fessional A ills, could it not bo poeslble that a snail percentage ef this gmp be drafted but be penitted to stay hone on a Military statue end be reedy to Move on 21 or 48 hours notice if the emergency became acute* X realise that non oust be indoctrinated and I realise too well that we oannet be civilians and Military at the earn tint, bet, if we sen consider this as an alerted group, who will net get theaeelvea involved in any financial transactions, houses, ate*, but ge an practicing in their various eoenunities on a day by day basin mill they are sailed or stay hone if they are not eel led* This will enable the nr—unity to still have adequate nodical Man- power and at th# anna tina, it will permit the Arny to have a reserve to sail on if the neergeney became grave** L* I. Pohl, Colonily liC THUS EXTRACT COPT (Letter, Hear Admiral C* 3# Caterer (MC), U*S*N., Retired dated 21 April 1948) ***** "In order to obviate infiltration of "misfits" throughout the Medical Services, the following is suggested! !• Careful screening re a« Age b# Health Cf Professional qualify cations and background d# Racial and social af- filiations« 2* Assignment of younger men in excellent health for active duty in combat areas re a* Afloat b* Air activities o» Advanced bases d« Marine expeditions, etc# 3# Men of acre mature years, etc#, for a* Training Centers b* Hospitals, dispensaries, clinics in home areas e* Blood banks, eto« A# Rehabtlated oasuala to be assigned only to such duty as their physical and mental condition warrants* 5* The prompt reversion or dismissal of all Reserve Medical Officers to an inactive status who have clearly demonstrated their unfitness for service with the Aimed Forces, regard- less of cease or excuee* (There are unfortunately many such individuals*)* * * * * x L*K* POHL# Colonel, MC TBIm COPY aXTHACT (Letter, Captain H. D. Templeton, MO, DSI dated 33 April 1948} »fi) CLASSIFICATION AND MOBILIZATION OF MBOIOAL MAXPOVXR FOR TSX mmnmm.' _ _ This very Important subject Mas received much eons Herat ion; ae early as 1936-37, tbs Bureau of Medicine end Surgery authorised the or- ganisation of several aedloal specialist units la various cities through- out the country, preferably those adjacent to a nodical center* The complement of those units was 12-14 nodical officers, and each member a veil recognized specialist In his particular field of medicine or surgery. Such units were Inactive volunteer reserve organisations, headed by a senior surgeon or a senior Internist, whose duty It was to organise the unit, convene monthly meetings, and keep the District Medical Officer advised of Its training. x Apparently the Bureau* s plan for the mobilisation of such volunteer organisations as complete units did not materialise. Zn 1940-41, when our entrance Into the last war became more and more Imminent, various nenbers of those volunteer units reported for duty at our hospitals. Several were quite disappointed and disillusioned In that they had been separated from their organisation, and In so doing, they felt they had lest their identity as specialists. I feel sure, however. In a great percentage of Instances, nleaesignnente were corrected, but only after each individual proved hit special professional talents and oepabllltles. The above noted procedure was no doubt the best plan dsvlssd at that time to effectively organise, classify, and tmin reserve medical manpower for the armed forces. And, had It been more vigorously pursued, It is reasonable to assume that a fair amount of classification and preliminary Indoctrination would have been accomplished prior to the beginning of hostilities. In September of 1947, the Bureau of Naval Personnel, through its Naval Reserve Letter No. 38-47, authorised the organisation of volunteer reserve components of ths medical corps of the Navy. This general plan for the organisation of some 240 volunteer medical divisions Is mot thorough and complete, and it teems to many of us that It Is the most practical method derided for the organisation, classification, training, and mobilization of medical manpower In the event of a national emergency. At the present time, there has been much discussion and debate relative to the feasibility of re-establishing selective service and universal military training. Many of our most reliable political and military leaders, as well as a goodly number of educators have questioned tho benefits derived from short tor* basic alii tar/ training and indoctrina- tion, and have reinforced thalr arguments vith aaa/ convincing raaaona for not reestablishing this type of training. As far as tha training aad effec- tive indoctrination of aadioal is concerned, I feel that we could accomplish far more by assisting materially in tha organisation of the 940 aadioal divisions as outlined in the above-referenced plan. Training perforated in such organisations could vail supplant that of tha training stations, aad core affect Its indoctrination of nodical personnel in specialised duties night ha accomplished. I feel that it is necessary that tha proposed 240 divisions ha given financial support and administrative assistance, plus individual rsnunaration conparahla to tha training pa/ received h/ active reserve unite. St la site foita aaaeeaary that arnory facilities ha provided where such divisions eould nsat at rsgular intervals and conduct a veil organised training schedule that would accomplish the purpose far which each divisions are designed. I feel reasonably certain that this assistance ie necessary, heeauee very few doctors and nurses and specially trained personnel will give their tine aad services without n aoninal r scran oration. The eonstaadiag officers sf such nodical divisions require a cinlaal acouat of clerical assistance in order to effectively organise and maintain their Complement up to strength at all tines. X feel that anything short of this will not assure the results desired hy the Bureau; the volunteer nodical division without such aid will amount to little more than a roster of the names of certain doctors, nurses, aad enlisted ratings who agree verbally to serve ae a unit in the event of another national emergency. Oertainly such is not ths latent sad purpose of the plan, because conscription would accomplish this sad squally as well. This plan, in my opinion, serves two major purposes of equal value cad importance; it assures organised, classified, aad partially trained medical manpower that may he quickly mobilised, and it provides a more desirable substitute for universal military training aad selective service, which will continue to be vigorously opposed by political factions and various ether influential organisations.********* K. Pohl, Colonel, MO THUS COPY EXTRACT (Letter, Colonel 0, F. Mcllnay, MC, Air Force dated 20 April 194#) ***** "a. Preparation for mobilisation of medical manpower for the Armed Forces should be accomplished- during peacetime and should be kept current just as in the case of industrial mobilisation* Participation in national defense should not be left to the whim of an individual and should not be dependent upon voluntary membership in any reserve or Hational Guard organisations* Knowing the total number of medical per- sonnel required by the services in various military situations and also knowing the total number of such personnel within the United States, & decision should be made as to the numbers that should be taken from various localities, thus attempting to leave those localities with an equitable medical coverage* Those scheduled to join the Armed Forces in ease of an emergency should be so informed, and so long as they remain on the mobilization list, they should be required to undergo a brief annual physical examination, and they should submit an annual report, indicating their training, retraining, experience, and interest In the various fields of medical practice* During any emergency, the portion of this medical personnel actually taken from any locality should be dependent upon the military aituatlon and priority of call should be previously established* This system would establish the basis for classification, aa well as a plan for mobilisation* A great portion of the functioning of this plan should be made a matter of civilian responsibility•" ***** L. K* Pohl, Cblonel, UC TRUE CQFI EXTRACT (Utto, Obtain Robjrt I. 011X.«, (K) OBI diM 15 April mR) * The prutfy or the present Mdittl reserve organisation, does not appeal to mm as the proper method for speedy or adequate mobilisation of the medical department. The establishment, by District Medical or the Corps Area Offieera, of an active fils on every Doctor in the district — cross indexed as to age groups, professional qualifications, solitary training, availa- bility, etc*, would serve the purpose such better} as undoubted- ly any future ear will necessitate the use of the draft system to s greet extent." ***** L. X. Pohl9v€oloMl9 K TSBS WTX HnffiAg (letter. Dr. A. 1. Shands, Jr. dated 20 April 1%B) ***** *The olaaslfication end mobilisation of medical man- poeer appeared satisfactory. A greet meay of the apedalista wore net aasigmed to wnt in their capacity in the beginning because of faulty clanaificatioa. However, this was the ex- ception rather than the rule." ***** L. K. Pahl, c#loD«l, MC TRIPs CO FT EXTRACT (Letter, Captain Lewis T* Dorgan (MC) USK) “Classification and mobilisation of medical manpower for the Anaed £ttCCfig« “Entirely too many physicians were declared essential by a local board regardless of their physical condition and fitness for active military duty. On the other hand, many men motivated by patriotism were accepted for active duty regardless of various physical handicaps, Many of the latter broke down under sea and field conditions «hen their services were most urgently needed and at a time when replacements were difficult to find, “The doctors who did not enter service held lucrative practices and bettered their financial condition unreasonably while their collea- gues in the Armed Forces sacrificed equipment, practice, and savings to serve. "Suggested Remedies: *(l) That all physicians be conscripted into the Armed Services; those who are in the younger age groups, and physically fit, to be as- signed to sea and field duty while the physically handicapped and aged, man the continental activities and care for the civilian, “(2) That all physicians under the age of 45 years be inducted tftto a reserve Medical organisation and that they be indoctrinated in a basic course of military medicine. "(3) That all physicians over the age of 45 years be assigned to a *home guard* subject to the same military control as the younger age group. These men should have extensive training in atomic radiation protection and general first aid and emergency surgery procedures, "(4) That all reserve medical officers be trained to serve as independent medical officers and that no stress be laid on specialist units. These units were clannish and in many instances offered serious passive resistance to the senior administrators of the regular corps•“ H M M M M wwwww L, K, Pohl, Bqlonel, 'HUTS) COPY EXTRACT (Letter, Colonel C. J* Baker, HO, Air Foret dated 22 April 1948) **** *a* Classification and Mobilisation of Medical Manpower for the Armed forces* It is my belief that all medical and dental practitioner* throughout the U, S. should be classified as to their specialty, if any* Classification should be based upons (1) Their demonstrated ability before the various professional boards, (2) Their reputation as known In their County and State Societies, and (3) Their age and years of experience* Classification could best be accomplished by the American Medical Association federally sponsored through a committee appointed by the Secretary of Defense* The mobilisation of medical manpower should be based upon the mini- auai needs of each community, considered with the minimum require- ments of the Armed Forces, i*e* City, County, end State, and no volunteers accepted from any community after the minimum number or community requirements is reached* Mobilisation should start with volunteers, but selection should be carried out to fill the needs of the service after volunteers are accepted.1* *♦** THUS COPY EXTRACT (Letter, Colonel Hervey B. Porter, HC, DSAF dated 23 April 1948) ***** "a* Classification of medical man-power I The human attributes were untouched upon* The lower age group, lower classified officers performed better in the field and presented far less of a morale problem than did the specialists*n ***** L. K, Pohfv Colonel, «T TRUK COPT (Extracts from Ltr Col* Harry Q# Armstrong, itC, 16 April 1948) ***** "a* Glassification and Mobilisation of medical Manpower for the Aimed Forces*1 (1) Defects! (a) Reserve officers colled in at their rank, while civilian components often given initial higher rank. (b) Trained Medical Department specialists (enlisted) assigned to combat units because of being physi- cally fit* (c) Classification system not established early enough* (d) Specialists celled to duty before actual assign- ment available for them* (e) HI-trained medical officers accepted for military service early in emergency, giving wrong impression of caliber of medical care. (f) Uncoordinated staff planning between Medical Depart- ment, line and other service branches* (g) Dental conditions existing in draftees on induction made adequate dental care impossible during service. (2) Haeoediess (a) Early classification and periodic review of all potential nodical officers—preferably through county medical society under tfar Department guidance* (b) Utl JLtatlon of specialists in general hospitals or centers only, (except where specialty needed on front line)* (e) Retention at all tinea of personnel trained for medical service. (d) Full use of limited service personnel under the provisions of ME 1-9. (a) Exploitation of female manpower for Medical Department service* TBDB OOPT BXTIftOT (Loiter fro* Boar Admiral A. H. Bearing (MC). 0. 8. Mary dated 36 April 1948} ••••• »(*) Classification and mobilisation of medical manpower for the Armed forces. Prior to Pearl Harbor day a great many Reserve medical officer* had bcem forced into "Specialists Units" cons iking of highly trained specialists, ostensibly for the purpose of manning a hospital or composed of medical officers with partionlar skills and with a specialty such as; surgical teams, neuro-surgical groups, etc. these officers were recruited for the Bfcval Reserve with the idea that they would be utilised in their specialty and as teams. However, very few of these teams were utilised and in many oases the teems were broken up, the units were dispersed ftnd medical officers were assigned to duties which had mo relation whatsoever to their training as specialists in civilian life, this has been a subject of considerable bitter eoamomt on the part of Reserve officers and has been quoted as a reason for their lack of confidence in any aedieal plan in the part of the Medical Corps of the Bevy. With regard to class iflent ion of specialists, the writer observed a ✓ nomber of medical officers who were classified as specialists. When they were placed in duties which a specialist should be Ale to perform, these officers were totally unable to perform these duties. In short, it would appear that the premises on which they were classified as specialists were ftntirely inadequate. To the knowledge of the writer there is as standard set up at the present time to determine which officers of the BsvmX Reserve shall be qualified as specialists in a particular branch of the aedieal pro- fession. The Supers Manual in paragraph E-1206, page five, states that MOS, USHB will consist of aedieal officers in the following categories)- "Those whose training is so highly specialised that they do not qualify for general duty) (who trill determine this and by what standards) those whose ege is 60 years or overs and those not physically qualified for unlimited duties"• Xt would appear incongruous that the designation of (8) which all Reserve officers have been glvsa to beliefs applies to specialists should also apply to officers over fifty and to officers unable to do sea duty. Kith regard to mobilisation of nedieal officer* it vt« noted that innsdlately after Pearl Berber hundreds of eedleel reserrs officers were ordered te Karel Hospitals nersly for the purpose of getting then on attire detp for indoctrination end then within a week or ten days were ordered te sene other duty. this nee of a Karel Hospital as a Beeeiring Ship for nodical officers at a tine when the. hospitals are at their busiest because ef the increased lead of adnissions, appears to be a nistake.v there is me tine for the permanent staff of the hospital te indoctrinate nodical officers when they are busy with their clinical duties. It is beliered that it would be ef benefit te hare tone eeatral point within oach Kami district for the mobilization of medical officers rather than harassing the workings of a Naval Hospital with these supernumeraries at the time of mobilization." **** JL. K. MC Tfm COPY EXTRACT (Letter, Captain F, R, Urban (MC) DEN dated 28 April 1948) ***** *(a) Classification and mobilization of medical manpower for the Armed Forces* *(1) In the mobilization of medical manpower, consideration should be given to those who prefer administrative duties and those that prefer purely professional duties. There were ashy in the last war whose talents were entirely lost to the service** ***** TRUE COPT EXTRACT (Letter, Dr. Russel V. Lee dated 18 April 1948) L, PC, Pohl, Colonel. MC •There was unquestionably widespread dissatisfaction and criticise of the military nodical services during the past war on the part of medical officers. There is an apparent disinclination on tie part of well qualified young doctors toward entering military service. There will be even greeter unfavorable re- action in a future emergency if no remedial steps are taken. The opportunity to comment on these natters is welcomed. "Reference is made to Paragraph 3 of letter dated April 8* Coament ie aade on the subjects as Hated* *(a) Classification and mobilization of medical manpower for the Armed Forces. ’ "In tines of peace, now, as soon as possible, every single active doctor in the country should be classified and catalogued for possible nilitary or civilian service in tines of war* It should be recognised that civilian defense is equally important with nilitary nedieine, and service therein no less praise* worthy. Every doctor without exception should have a role assigned to bin and a ntmber indicating his liability to call* This should bo dene through the Anerioan Medical Association and County Medical Societies under legislation by Congress* The physical standards for nodical officers In the Amy, and parti- cularly in the Mavy, were absurdly high and these should bo nodified in accord- ance with a eoKnon sense appraisal of what a nodical officer's duties are likely to bo rather than on the apparent assumption he was to march 30 miles a day with a pack on his bade." »*«** L* K. Pohl/Xplonel, MC TRUE COPY (Extract Ltr Nellie Jane DeWitt* Captain (ilC) USH, 29 April 194B) ** Colonel, vc THUS COPT XXTIAQf (Latter from Captain K. J. A»ton (KC), OSH Portsmouth, Virginia, dated 23 April 1946} ••••• «(a) Classification and mobilisation of msdleal manpower for ths Armed Forces. Bespits many difficulties and duplications of effort, some degree of criticism and perhaps a degree of confusion, X believe that those charged with the mobilisation and classification of our medical manpower performed their tasks efficiently and well. The services were, however, engaged in competitive recruiting. This had its undesirable and untoward effects. The competitive bidding defeated the standardisation and resulted X think in certain basic inequalities of rank, assignment, and opportunity. In any future Xational emergency in which the several services engage as a more definitely merged armed force, a central personnel agency could func- tion td the best possible advantage in the assignment and deployment of medical personnel. However, if the union of the services is to allow each service freedom of action in it* procurement and mobilisation functions, then I toe much merit in the plane and measures that art now in force. Z refer particularly to the creation of medical divisions which are set up in cur naval districts. These to my mind represent a marked improve- ment over the medical specialists units which served so well during the paet war. The medical specialists units by reason of their small s&se And the limited number of poreonnol which comprised thsm could bs used to beet advantage in duty assignments wherein they mors or less eossplotoly staffed the activity, so for example they were utilised in hospital ship duty to the best possible advantage. Squally important and practicable perhaps was their use in certain shore activities where again they more or lest completely staffed the facility. In some instances where two or more of these unite served together matters did not always proceed smoothly, Personal relationships at times became stalled, professional inequalities were unduly emphasised, and jealousies wdre sometimes developed to an unwarranted degree. This was particularly true when the medical personnel were not fully occupied by professional work. When they became eo ocoupled the clashes and differences rapidly disappeared. Indeed, as can b# well understood, I never came in contact with a busy actively engaged medical unit which failed to exhibit a high degree of morale. It might bo oxpeotod that a future war will see visited upon our civilian population more of the death and destruction which has hlterto boom reserved for our uniformed personnel in conflict. Perhaps our own land will not bo spared in a war of the future. Casualties among civil- ians may bs heavy. If this is a possibility then due regard must bs paid to the medical needs of our civilian population. They must not bo reck- lessly stripped of their doctors nor should they be sxpoeted to furnish an undue proportion of the able-bodied and more active members of the medical profession. The army and nary need for the most part, young able-bodied medical officers particularly in those duty assignments which require prolonged and exhaustive efforts: however, we shall continue to need also A fair leavening of the older and more nature groups| so it would seem that what we should strive for is the procurement and operation of a well-balanced group. Whenever and wherever possible, rank and duty assignments should conform to the qualifications of the individual. If a single agency for the procurement of medical officers is to bs set up In the future, I believe it should be operated and controlled by officers of the servte rather than by civilians. The services of civilian doctors as aids and consultants can be employed according to need.11 ••••• X. K, Pohl, Colen«l, MO TOg OQPT mxmat (Col. Robert X. Sl*p*oa, USA (Bet.; dated 1 Key 1948) ***** «(a) Classification and mobilisation of medical manpower for the Armed Forces. It is ay opinion that military medicine should be compulsory in all recognised medical, dental and nursing schools, and graduates of such schools automatioally commissioned in the Res errs, even the physical qualifications nay restrict activity to limited service. If some form of military training be adopted, high school and undergraduate students may be selected, depending on aptitude and inclination," ••••• XBBE.CPi3.EXmi (Uttar, Brig. 0 Robert C. McDonald, MC, USA (Ret.) dated 15 April 1948) ••••• *(a) Classifications and mobilisation of medical manpower for the Armed For c«s • •(1) Comment« tack of timely classification of medical manpower prior to admission to the Service was a disadvantage to the Medical Service in that insufficient personnel with special qualifications were not made available, or were given improper assignments* Mobilisation of medical manpower did not therefore meet medical requirements in the early stages of the war* **{2) Suggestlonsi Classification of Personnel should be accomplished as far ahead of admission to the Service as practicable} certainly not later than a pre-induction examination at least a month before induction* Classi- fication of officer personnel, particularly physicians, should be accomplished prior to the beginning of hostilities.* *f%2p L, K, Pohlv ColonelKC TRUK COPY EXTRACTS(froa Report of an Exploratory Survey Conducted In 3L Hospitals, entitled "The Interne Looks at the Any*, and as made by the National Opinion Research Center*) "This report is based upon the results of personal interviews with 194 internes in 34 hospitals all over the Suited States, during the first two weeks of August 1947* "The survey had three sain purposes* •1. To determine the Interne1* plans and expectations for the future *2* To study the internet attitudes tovard civilian nodical practice "3. To study the Interne's knowledge and attitudes con- cerning the B* 3/Army Medical Corps ****** ***** "Two-thirds of the internes plan to continue training when their interseshlp ie over* Host of the others will enter private practice*" ***** ******Hei»e of the internes studied mentions the Army a* an Ideal career, and none is planning to enter the armed forces on completion of interneshlp". ***** ♦♦♦♦"•The feeling of social usefulness is mentioned by the majority as the chief gratification from the practice of medicine — but there is evi- dence that the nature of their work, their expectation of high financial returns and ths prestige of the profession are equally compelling factors** ttu ■ a u ***** "Three-fourths of the internes have seen service in the armed forces, and two out of five have had firsthand experience with the Army Kedieal Corps* "Tet only about one interne in five has ever considered applying for a regular Army commission, and only one-tenth of this small group finally decided to do so." ***** ***** "But, by and large, the great majority of interne# hare a definite aversion to Army life, and to a lesser degree, they have an unfavorable ia» preesioa of Any aadleal practice* TRUE COPY EXTRACTS • Continued - (from Report of an Exploratory Surrey Con- ducted in 34 Hospitals, entitled "The Interne looks at the Army*, and as Bade by the Rational Opinion Research Center.) •The reason for this antipathy lies largely in the personal and pro- fessional regimentation which they feel most inevitably accompany any life in the Amy. •In contrast, they feel that civilian practice offers than personal freedom and a chance to practice as they wish.* ***** ***** •Internes fed keenly their need for farther training, and the Amy Is not regarded as a good place to get it. Whatever educational and training facilities there are In the Amy should be well advertised. •Few internes seen aware that the Array treats dependents of soldiers, as well as the non themselves* and many internes complain that there is no variety of patients In the Array. Most, too, have a particular Interest in some specialized field, and any opportunities for specialisation should not be overlooked In Army information,” ***** ***** *The shorter hours worked by Army doctors and the opportunities for travel are natters which do not seen worthy of much attention. Long hoars do not seriously concern the Interns, and the overwhelming majority are such more interested in settling down than In traveling,* ***** L. K. MC 67 TRUE COPY EXTRACT (Latter, Captain Emmett i)* Hightower (M3), U. 3, Havy dated 21 April 1$*8) ***** "(a) Registration of all medical am and women in the United States at a central agency for the Armed Forces, those who are not members of the Organised Reserve to be drafted and allocated to dif- ferent services by the central agency as need far their services arises* This should aid in avoiding duplication and competition* The first doctors to bo called, should be obtained from thickly populated areas with an excessive number of physicians* Confidential files diould be kept, not only of all specialists, bat also of the more qualified men in each specialty for key appointments • 8 leal Corps, aad/or forming mew medical units, is the failure on the part ef the Bureau ef Medicine and Surgery, to give some assurance that erganised TUBS BXfSAGY COPT (Btr Cndr Martin T, Maorila (KC)CSB. did 12 May 40, GOSTIKlflEpt units would rocs In intact, in the event of an emergency. The general reply from individuals who are prospective candidates is, •why Join or organise aa ef fid eat, nail trained edit * then in the event of an emergency the Bureau would split us up and assign us to some other outfit (tincans, LSf*s, etc) as was dene the last tins* Whereas, if the unit remained intact as organised, trained and a ‘happy ship*, a good Jab could be acconpllahed as a Bevel Hospital Staff, Base Hospital, on a hospital ship, as an evacuation unit, dth the fleet Karine force. Auxiliary or Mobile Hospital etc*** Meddles* to say, there are arguments la fearor and against the goo- oral attitude as expressed above* However, I do think the Bar oast should give son# assurance to Bosorvo Unit Ceacaaders sad prospective oandldates, that their efforts and alas la peacetime, would bo utilised to the scm eas- iest as aa organised unit la the event of an oaeigeaey* Bush an assurance would be aa incentive to Mahore cf county* district aad local Medical Soc- ieties, hospital staff nsnbcrs aad physieleno associated with teaching tap stitutioai* Bosorvo enlisted personnel complement any bo procured free pharmacy, business or high schools, Youth Clubs, Athletic aad Soei&l Clubs affiliated with Church or other responsible organisations. With the coop* oration of established Saved Activities the individuals would undergo a course of training and Indoctrination from the Medical Officers of the Beit, la the fundsjucBtals and essential® required ef hospital ccrpsnea* A success* ful policy would assure a basic professional aad Military training pragma, which could be readily ircppl sweated by advanced training la accordance with the proposed disposition of the unit la the event of an emergency. On acti- vation the officer eoapleaeat would be suppleumtad V Medical Special Corps personnel fer Administrative, Ooaalssary, fiscal, Maintenance Duties, etc* The classification aad mobilisation of medical manpower for the Armed forces# should be under the supervision aad direction of qualified Medical Officers of the Army and Wavy leeerve Medical tope, with the sanction and support of the recognised city or county Medical Society; with* eut reference to ser Jurisdiction of neighborhood, district er county draft hoards, 7 Medical Officer# of the Beserve Gerpe should be cognisant of the qualifications of anchors of their profession who practice within or in neaxe- by ceottuaitiee* they would dee hare a working knowledge cf the medical ro- rnirenonta fer the ccnsesillyi and of the Iced hesi ital staff requirements and quota for maintaining and teaching and clinical staffs of local nodical schools* fhia would obviate the possibility of individuals being unnecessarily declared osscatisl to a ccnsusialty, likewise grating hoopltals the peregaiive of declaring on Individual as oscoatial to its staff and finally, prevent Sofemecat ef individuals due to their friendship or association "with a aeater or sailers of local draft hoards or bccisuse of a lucrative neighborhood prne» ties. ffes dty or csnaty Medical Society Classification Board (M3CB) should be cecprlsed of senior ncabers of the local Angr aad Bavy Baser? e Units, the beard necbers would classify all eligible nodical manpower according to their specialty, and the oeaplled list Una submitted to the area Procurement Office, fhe Individuals would to notified by the frccurenent Office for latoxglov, physical exeat nation, node etatno la accordance with ago, and fSm 2XTBA0T COPT (Ltr Csdr Martin 9. fcacklln (MC) US* did May 43 C01TISQSD professional qualifications and disposition to the service of preference* la the event of aa emergency, the members of the Hogular Medical Corps supplemented by the immediate mobilisation of physicians who received their education under the f-12 Training Program, should ho assigned to emergency billots until such tine Isserve Units are prepared and ready for activation* Those officers should also bo available as replacement (pools) for independent duly sea billots or other assignments, the emergency demands,eeeeee c losal , hc Sxtract of Statement! made by Brig Qen Robert C« McDonald, 1C, USA (Attired), 21 April 1948, before the Subooeaittee on the Employment of Military Medical Resources* ee««*Aegarding the "Classification* and mobilisation of medic dl manpower for the Aimed Faroes*” Lack of timely classification of medical manpower prior to admission to the Service was a disadvantage to the Medical Service in that insufficient personnel with special qualifications were not made available, or were given improper assignments* Mobilisation of medlcalmaapower did not therefore meet medical requirements in the early stages of the war* What I have reference to there is the drafting of occupational specialists and assigning them before they were properly classified, or assigning them as a matter of necessity to combat units who did not need their special quail flea- tlons* ■ However, these units bad to have their quota of men, and naturally the technical specialists were put into these as infantry men or cavaliy men, or according to the necessities of tbs service, and de had a difficult time getting those occupational specialists out of there, the combat organisation into the proper medical organisations* I presume that other technical services had the seme difficulty* My suggestion for the correction of this Is assign them* X think that could be doss on the pre-induction examination* I think that Me did have lata in the war, or maybe when they got wall started on the draft, pre-induction examinations which were mostly physical* I don’t know to what extent they dealt with the qualifications—that is, tha occupational qualifications—of men* However, X Should think that would be the latest tins ws could get these sen classified! and than when wa did call than at a later date, one, or two, or three months Istsr, no reexamination physically was required*. 1 think ws had It up to within 90 days, if I recall# therefore, these men could be called in accordance with their qualifications rather than Just to fill up numbers* that might requirt calling a la 19 number ef ncnischnioally-quaXlfled man ahead of the others, but X think It would be worthwhile from the service standpoint* « * « « X think that a national registry of all physicians as licensed by State or Territory for the practice of medicine and aurgey Is essential for use as a basis for timely classification of medical men, particularly the specialists* Without this, I do not see how a balanced supply of physicians can be obtained far the medical service of tha armed forces* a • * « ■Do yon agree that the armed services should rely on tbs AMA for evidencs of classification of madloal officers? AHA? AVAt* X thirik that tha information furnished by the various professional associations, such as tbs AHA, is invaluable* Bawver, wa can’t rely on that solely* ■What would yon propose doing to avoid tbs over-calling wa medical officers/* ;s I propose timely end careful planning of the medical phases of the armed forces in the campaigns planned, together with a careful estimation of the time element in the development of these plans* ■'•‘Do you favor an organised reserve for all of ‘the services?* X do favor an organised reserve for the services, but X do not think that this organised reserve should include all technical personnel that they may require* I think that the organised reserve is a valuable source of training for certain members of the profession, but all do not require it* "Do you favor affiliated units for all the services/* Yes, I think that affiliated units for the services is a valuable may of getting important units ready for mobilisation* "Do you think our present system of classification is sound? Art there any improvements that you would recommend?* I thin* the present system of classification is valuable* I haven't thougnt of the matter enough to recommend any improvement* "Is it advisable to assign all reserve medical officers to reserve medical units during peace? After experience of World War II, in your mind did break- ing up of this assignment develop uncertainty in the medical officer's mind as to the value of our planning?* We have got tb use the personnel to the best interests of the services, and X think that they will have to be reassigned as the conditions of tbs service demand** "What is your honest opinion about relying on organised medicine, say the AHA, to furnish medical officers for the services?* **»* What authority did — I think it was called the Committee on Procurement and Assignment of Medical Officers that was appo nted by AMA during the war — what authority did they have in connection with the calling of the various physicians to the various branches? They appointed very good men to do this work* For example, in Baltimore Dr* Maxsom v;as in charge of that, and when the Service Command was given, a quota of medical officers, he inquired into the situation of the various medical officers who were needed to find out if they could be spared* When he found a man that would fill the requisition, he would put pressure on that man to join up with the service* If the man was essential to the civil community, yet he had special qualifications that the Army particularly needed, he would arrange for a relief in the way of another civilian physician to take his place, and he hadnled it very tactfully and very well* So X think that while he didn’t have any great authority, he was able to put pressure on the younger medical officers by ad- vising them they were liable to be drafted if they didn't, and some of them were drafted when they didn't follow through hie edrlce. So they have no particular legal authority, tut I think they have a great ds£L of actual authority# . —, Another question# If a national registry of physicians is established sod the procurement of physicians is affected through the Selective Service organisa- tions. would the local boards be able to perform the function that you have Just described as having been done by the AMA representative in the different communities? Not without a special provisions being made for that* Some medical representation on the local board? That9* correct# "*«*** U K*. POBtix M3 ( Extract of statements mads by CoIooqI Thomas J. Hartford, 1C, USA on 23 April 48 at interview with Subcommittee on the Employment of Military Medical Resources) ***** «a# Relative to classification and mobilisation of medical manpower, I think that is the responsibility of the Rational Security Resources Board, and within that Board I believe there should be a group of civilian and military medical people to advise the Beard on the classification and mobilisation of modi cal manpower* I believe that any mobilisation of modi cal manpower should be preceded by a classification of doctors within certain groups* In so far as the allotment between the services, I think that should be on a Rational Defense level with representatives of each of the services sitting on a committee on that level* X don’t want to moke this dismcsalon too long, but 1 believe that seme form of bringing to medical units by echelon is feasible* It’s not as simple as some people would like to believe, and 2 am not naive enough to think that you can fly them to battle and bade to the El as a matter of convenience to them whenever you are going to fight because — I mean I think anybody that has had any administrative experience realises the complications and administrative impossibility of some of the things that have been advanced! but I do believe that some system of echelon is possible* In other words, a unit like a general hospital, that perhaps the chiefs of services, their call might be delayed, say, a week or so prior to PCM* If you are talking about unit corananders, nedlcal* they certainly have to be there with the unit, and you can’t bring" a commander in the lest minute or bring him in at the port* That’s Just ridiculous, I an talking about purely professional people who are led in the tent and directed to the operating room and operate and cone back out of the tent end to the quarters again* . If you are talking about a group headquarters commander or a battalion commander, or even an evacuation hospital commander, If he is going to run that unit at all, he has got to be with it* I believe within the services that certainly the respective surgeons general should set up a board and determine or recognise certain specialists that may not belong to this specialty group* ***** m i.pohi Colonel* U* S* Aray, IT TROK COPT EXTRACT 0? XVTSBTXSV '.’ITH COL MART 0* PHILLIP-, ABC, 27 Apr 1948 a* •Oar next Mg problem, I think, was in recruiting. W© feel, and hara always fait, that recruiting of nurses cam he done most effectively by nurses; hut, of course, we hare to have assistance through publicity, have funds to provide publicity, and get personnel who can Interpret our need to the nursing geoups. Our greatest responsibility during World War II was obtained during the period that we had nurses assigned to procurement. At the beginning of the oasrgency, the Sod Cross was charged with the responsibility of providing reserves for the Army. It was not organised for service on as large a scale as was found to bo necessary; and, just as they were reaching the point when they could satisfac- torily accomplish their mi salon, the procurement and assignment branch of the War Manpower Administration was eat w>. Sow, one of our problems ms far as that organisation was concerned was the fact that they declared aaay young graduates essential. We had hoped they would allow us to go out and recruit unrestrictedly from the 1945 class, X think It was, but they declared aany of those people essential. So it limit- ed our procurement. We had agreed that people who had special preparation and were needed la schools of nursing In teaching programs and supervisory positions wore essential, but we couldn't understand how these young graduates would be as essential. So firm program as to our military needs could bo announced. Our in- ability to ksep the nursing profession informed as to our needs resulted la an Inadequate response. If we could have said to the nursing grow that we needed six nurses per thousand troops and held to that goal to work toward, we felt that our procurement program wouldn't hare met the obstacles and opposition that It did. X think we were first authorised to procure 4,000 nurses. That was In the early part of the emergency. Then, I believe, it was 6,000 and later 3,000. X know that, at one time during ay tour in the office, requirements were set at 60,000 eat to 40,000, and later changed to 50,000, and & draft proposed. This change in requirements caused confused thinking regarding the Aray1 needs among the civilian nursing groups who opposed the draft. We all felt that our needs could have been more easily met If we could have been fair and open with the Civilian nursing gxups who were trying to plan for the noeas of the Army and civilians. * BklSADISE GSM/.3I& MARTI*; lorn expressed your satisfaction with the drafting of nurses. In the event that the drafting of doctors* Is made a matter of law, would you agree that the drafting of nurses would be equitable? CQLOKSL PHILLIPS? | don’t think X mentioned drafting of nurses any- where, General Martin. tlSIGASm GXM1SAL MARTI*s X remember that you did. OOX»oa3L PHILLIP5; The reason It created that isapression was that the profession felt there was aot Just a shortage of nurses; there was a short* age of ether personnel in hospitals, and the nurses were taking up the slack. In ether positions that voaaapower should he drafted for* If the/ draft woiaea:- * mmkBim ammxL MARTI*: X aa ask lag you a particular qua tioa. If they draft all doctors, would you agree that it would be equitable to draft nurses? COLOUR!* PHILLIPS; X think 1 mould say that we had to have that pro- mm sxtbact copy of intbrvisw with col mahi c. Phillips, ahc, 27 Apr 48. coNTiausa vision in case we couldn*t get them any other way, instead of going hack; later oa for legislation, I had suggested that It he included in the draft machinery there in ease we needed it. BHIOaDI&H QM BAL MABfIH* What is the present status for vartiae pro- curement of nurses as far as the Surgeon General's Office ie organised at the present timet COLOSSI, PHILLIPS* At the present tine, we are working oa our roserro to huild up our roserro of 29,000 nurses which will he of a larger nucleus than before. We think that, if we hare that group and can he fair with the nursing profession as to our needs, we won't hare the difficulty that we experienced ho- . fore. You see, we had to depend on the Bed Cross, The Bed CrCvx Just kept a list of qualified nurses for us. When we asked those people to cone, their Joining the Bed Cross didn't as an they were going to he available* Many were overage and many decided they didn*t want active duty. If we huild up a reserve like the aale officers* reserve, if they Join the reserve, they hare indicated their desire te cone oa active duty, during an emergency and have a good group te come up with. COLOKEL POBLt flow promising dees it look at present! COLOHXL PHILLXPSt We are Just getting a geed start on it. There 1* n procurement division eat up in the personnel division, and we hare, at the present tine, four nurses assigned, Ve have two civilian consultants who are helping us with our publicity programs. One of them ie also taking ever the medical depart- ment program now. he hare about, I think, 5000 signed up in the reserve, X read eons reports this morning. We have ene ef the consultants on a trip bow following up our program, and it Is interesting to see that, in seme areas, ate feals there isn’t too much enthusiasm for the program except within that area to get personnel for themselves. There ie misunderstanding among the civilians and opposition from the hospitals teoauso of the fear that we are going to take the people free then. When we can get out and explain what the purposes of the program are, it changes their attitude. BRIGADIER »sh BAL MARTIN* Are you experiencing any competition from the levy or ether federal nursing services! COLOISL PHILLIPS* X don’t think so. Z haven’t talked with Cap!* SeWUt, I think thsy are having the same difficulty ve are. BRIOADIEH CHIT BAL MARTIN * To what extent can the partially phy sically handicapped nurse render service, especially la hospitals of the sene of interior during the war! COLOKSL PRILLXPSs With the limited mothers that vt hare for staff lac* X would ha reluctant to taka people os who vara not ahle-he1ied personnel. Sow* those with poorer aye sight sight ha kept om Halted service hade hare* hat ear* tainly a nurse has to hare fall ate of her eras sad legs; she has to hear veil; and* If the is not physically fit, she heooaes aa added hordes to as because she is hospitalised. lir X# jrvHiif \UOlOMlX§ 86 BAT8ACT OF SiaS&UBWS MADE 1Y CAF7. S.E. ' %mm, JJL. (MC> U3N OB 22 APRIL 194« at xroatvin with sxmQQktarsm on the mployjomt of military msdxsal h:;.sou8C3ss, »»««»«****»«• ig %%ioaai R«gl»trj of all Phy*lclfta» as 1located by Staia or Territory for the Practice of Medicine and Surgery. Alone that Xiao, as It affoots me in ay eaployment la tho service right now ofc the job I have, this Beg- ietjy would certainly servo a grant purpose. For la tsnce, if wo were mobilised Immediately. X want to have book vdth ms In this particular employment of amphlb- ious warfare some of tho officers who X know have had experience along that line aad who would be qualified to act in some of those billets. And therefore* a Rational Registry with their qualifications and background would certainly seem to ae to be essential. X feel we should net lose track* especially ef these off- icers who served in tho last war and who were outstanding aad who eaa accomplish or hold certain positione.*********** ; mo TOfl?., REDACT (better, Brig. Gob. Goorge R. Ketmebock, DC, Air Force, dated 7 May 1948) •*♦** "Dental manpower la a futare eaergeaey should be classified by the dental profession of each State according te ailitary end drill an needs* Military Cossdttses of State Dental Societies should be appointed end they should advise local Selective Service Boards as to the dentol neede of each ccaaranity. Dentists selected for serflee, or exespted fnm service, by local beards should be cleared through the State Society Military Conuittee* It is ny opinion that physically qualified dentists who hare not passsd the fortieth anniversary of their birthday should be considered as eligible for active duty in the Dental Corps in an emergency ♦ This State Society Coaaittee should also be concerned with the specialist qualifications of dentists in their State and determine those available for ailitary duty and those who should remain in civilian life.****** /57J£&£<,0 L. K* P&rJ>C^lcmel# MC 77 EXTRACT OF STATEMENTS HADE BY COLONEL OSCAR S. REEDER, MC, USA, on 15 April 1948 AT INTERVIEW WITH SUBCOMMITTEE OH THE EMPLOYMENT OF MILITARY MEDICAL RESOURCES. "I think doctors should bo imbued with the idea that they have professional responsibilities to fulfill whether in uniform or not* I think maximum use should be made by the armed forces of professional services in various localities. This may lessen the number of doctors required in the armed forces and result in a more equitable distribution between armed forces and the civilian popula- tion. It applies particularly to specialists. They Might utilise the services ef specialists In a particular area,**** Certification by American Specialty Boards should not be the only criteria by which specialists are selected* Specialty Boards are relatively young and therefore they exclude a large group of doctors of over ten years experience who never have a chance of becoming certified by a Specialty Board* I think that screening boards should be set up in peacetime to categorise all doctors in the U, S. according to age, phy- sical condition and professional qualifications* ***** ”3. Tea, but I think sons military paraoonal should bo members of the Board* "A, 1 believe that the Selection Board that wo have spoken about would bo the agency to asks the decision baaed on overall strength of the services and each service should be allocated an appropriate number and that would In- clude the Public Health Service, along with Arny, Havy and Air Force.*****” ***** *6. Yes* I am particularly in favor of affiliated units but formed and utilized early in theatres so that when the pressure gets greater they can be spread out to other units and other units can utilize their war experience. ”7* I mould only fora up the basic unit of the hospital and allow other people to remain on-the-job training until they are needed*”***** ***** ”12* I think they should be promoted en the basis of professional ad- vancement during peace ****** ***** ”(C) X would categorise professional personnel as to age, physical condition and professional qualifications by a combined civilian and military medical board* That Board could determine the overall requirements for the military service including Army, Navy, Air Force, Public Health, Veterans Administration, and civilian medical service•”**** ****** (M) 18* I do not favor any reduction in physical standards for accept- ance of commissions mainly because of the present Ihbta in force regarding retirements* If the IBs* could be changed suitably I believe the physical standards could be lowered as far aa doctors are concerned*”***** v: K, PohlV Colonel, MC 78 MB mmt co!* (letter **<» Capt, Warwick I. Brown, (BB), USB dated 20 April 1948) ***** "a. Classifica tion and mobilisation of medical manpower for the Armed Faroes, For wartime mobilization and olasslflcatlcn — no caaosnt* For the long haul procurement of medical officers for the armed services, it is suggested that medical school scholarships he offered in connection with the ROIC programs in the various colleges* The period of obligated service to be at least equal to the time spent in medical school* ****** t. K. Colonel, U S Anay THUS ZXfUACT COPT (Ltr from Dr. %a.O. Meaninger, Topeka, Kansas, 22 Apr 48) «*«•««« s, »jf we ease to an emergency at the present tiaso we again would be short of certain extremely important specialists. I apeak with special &tten~ tlon to nenropsychiatrlets. The military mast hare prepared ways and means for training many of the yonager sen who would come into the any at the A8TP level in this field. Therefore* ve vast have schools ef a minimum ef three months deration to provide thin training.»•••*♦ Colon*! . TRD3S COPY EXTRACT (Ur tear Ada ?.L. Conklin (MC) DSS, 27 Apr 48) "All Medical Officers should he classified as to professional and administrative ability, and he mobilised from a pool.••••*♦• Colon**. KG Bxmcr of sTkTBmm Mm b$ as. U.8.A« UP 22 April me at intarvlyr wife op of Uiliiaury Uealctall rUocureee 1 #**■»* MI feel definitely that all medical personnel should be classified and that the classification oust cotae fTua a reputable source such as the African Medical Association, ’.-©cause ay experience has neon that yea cannot rely on individual questionnaires* The average doctor tends te overestimate his experience in certain fields, or he will raster Me sup- posed ability in certain fields because of the fact he feels that this questionnaire my toapor the type of i* is going to get* ■The doctor should be classified by an over-all at reason- ably iapartiol agency* *Tiie Surgeon General's Office very definitely should do that for people who Iiavo military records* Tliere are thousands of doctora that the Surgeon General's office has no knowledge of and he couldn't pos- sibly classify. X was l inking of nodical imnpotmr as a wlsole, country- wide. 1 "If tic Surgeon General's office could get an accurate appraisal of the professional experience of the saedioal mapewer, than Z think the Surgeon General should sake this classification! but he is not going to get it froa the individual doctor* He will have to get it froa an agency like the AMA, and then superiaposc or add to that for the necessary classification that he seas fit* "As far as * national registry of all practicing physicians, dentists, vetorinariane, and what not* I consider it necessary and an ijaiaodiate need* I can’t conceive of intelligent use of.professlonal talent until there Is s registry of these individuals* HsgardLsss of bear that talent aay be called or the oexposition of the various beards, seasons oust know who thaas people are, where they are, and all about thea professionally and ailitarily* And since it hasm* t already bean started, I think it should be started at the earliest possible laoaorit* "Ail I can say axut Selective Service, about which X knar very little, Is that whatever system is used to handle it. Selective Service should have a medical staff agency Incorporated into it, and it should certainly have fiuaple civilian representation* Z don't katm whether it Should have a civilian head, or not, but it should have civilian repre» arotation, because it ties la with civilian doctors*"#*#*# mc -rtxri (a) cont’d X, 5XT8ACT OF gTAT!«3iTS m.M lit Colonel t, MC, O.S,A*©n 22 April 19U8 at interriew with m of Mlitary UeiSoal' 'ifescurcaa ***** "No* S* Tes, if* I do favor an organised reserve for all tha services, providing the reserve people, particularly from ti» medical angle, can be assured that it will be worth while to b© a member of the reserve corps* If they can be assured that their interest in joining the reserve will result in at least equal consideration at the tias of mobilisation rather than the advantage apparently at least going to the hold-out, to the man who plays then I an in favor of a reserve, and our reserve is not going to bo successful medically speak- ing until something can bo put in writing and there can be a reasonable guarantee of its being fulfilled* that your being a roservo officer shews that you 'nsm done this in good faith, and w© will protect year interest, and w© won’t take this man who is not Interested in the reserve and promote him over you or bring 'da in at a higher grade than that which you have Just because he is playing hard-to-got and we need his at the moment* "Ho* 6(A)* I feel that affiliated units for all services are a fine tiling for immediate stages of mobilisation# I don't believe these units can, under the present circumstances, be given much training, but they are someth ng* They are a stopgap. They are a beginning for any emergency tiat happens in the interior, sad they certainly are a readily* available unit for dispatch to an overs as theater* •The big arguments presented a winst them that you can’t maintain the integrity of the unit in particular—that is the chief argument— isn’t as serious as it sounds because on the face of it individual maabers of the units don’t present any serious objection to being transferred out providing they can $st a position of greater responsibility or get a pro- motion from it* •In answer to question 7* this baa been partly answered by avoid- ing an improper call-up of medical off icers. We should avoid calling medi- cal officers until w© need them* This can be done partly by a knowledge of when we are going to need thorn ami par tly by a proposed plan of echelon medical-type units into the training phases, so tlmt we don’t put the pro- fessional people into those units until Just before the units are going to be utilised* can so through part of the activation phase of a nodical unit with a minimaa number of doctors and then add the doctors, particularly the highlywqualifiod professional aoabero of the teas, only at the tiaw that they are going to be needed*”***** TVT 82 (a) coni'd 2* ■UTMACT OF 3Yt dclonel I'roderic1 IC» U«S»A.« on 22 April lSj;3 at wiib §ij»r(aiiii~it^nS'T*'je liod'lcAl teocmrceg ***•*«»* "(M) f>. I think soma of the ate,‘-a that should be taken now to .re- vent's oae of those mistakes would be first of all this classification of doctors nationwide* secondly, a devolopiaant of an ed .el on-type of build- in: up, an echelon method of building up a unit so tiet ti» professional oluasnts of the unit wouldn’t be called in until they were polng to be needed* and even with tills provision that the professional people be kept busy Jj :®lng put w iero they can bo used and not be allowed to hang around inactive units " (11) 13. That is difficult to answer in view of the present feel- ing of the Surgeon General, cur Surgeon General, fast people should bs given rank asod upon their length of tuedical experience, They are talk- ing and aro actually pros antly in top’s ting people direct from civilian life and giving then an advanced rank merely lecauao they have '**m out of medical school for a certain time, and they are doing that to the detri- ment of people who arc actually i i the service. I don’t approve of it personally, but that la entirely ray personal opinion. It does not represent the opinion of the hr cut office, H(M) li>. I see no objection to cube editing medical students any more taun there is objection to subsidising students at best hoint and Annapolis. There doesn’t seem to be any stigma attached to a graduate of weat Point cr Annapolis, and he has been subsidised for ids collega- typ© training and therefore I don’t see why there should be any stigma attached to subsidising a ram for hia professional education, It’a a new thought* It’s very controversial, and I den11 know what it’s loading to, but I personally see no Ejection to it. **(!i) 16, In view of the shortage of doctors and medical officers, if vre are going to prevent uom of these potential doctors fresa becoming doc tore by drafting than before they graduate, I think w© then should justify taking oboe raonstirea that will, eaarapt them from being drafted while they are continuing their medical education* If that involves co/aaioaioning thorn as second lieutenants in the ICC, I am In favor of It. I am in favor of something to keep potential doctors fTca being interrupted in thoir studies, I don’t think it should be carried too fnr, I don’t think it should be carried to .remodical students or to a fierce that would encourage people to o into the study of medicine purely from avoiding being drafted, bit I think once a mn shows that ho, intends to go into the study of medicine, than he should be iierraitted to continue that s tudy. "(H) 13. I cto favor a reduction in the physical standards bocane® w© have to use :xre aen than we have in the past# Our ’manpower can’t be stretched any further, am we have to adapt the joba to the people or adapt our standards to the physical limitation of the people we .save in tills country 'Kmr 'goiawT,1 is111 fm* mstHAGT cujpi of iitmtiew nm colokxl vimgil cukksll, kc. gsa, so April 1948 •••••♦♦•A* "Under item (a), "Classification and mobilisation of medical manpower for the Arsed forces’1; first, classification should act he overdone; the need for basic medical officers is too great. Second, the preliminary psychological build- up for ell medical men is needed to induce them to accept that fact. It will re- duce the difficulties discussed under (X), Register ell medical personnel. Includ- ing affiliated units, in order to avoid weak and strong units. That is, we have found, and | m sure everyone realizes, some units with a lot of good men in, other units with very meek spots. text, require the high grades, particularly in affiliated units, to ac- quire some elements of basic military training as preparation. Too many times the sealer professional officers did not have enough acquaintance with military proced- ure and staff wort. It is presumed that rosters of all medical specialists and allied sciences are available. If not, they should be carded. Parenthetically, Just before the last war, we worked on the roeter of the artists and photographers of the country through their national societies, and it was only by that that we had available these people of the medical arts units, knowing their family situ tlon, their age, their capabilities, and so on; and I believe much Information can be gained by the people they are working with now wile there is time and know what those people are capable of if we need them. That, of course, has been worked on from the angle of physicists; I think it should be Carried into ail of our subdivisions such, as we were speaking of, bacteriologists, and so on. Choose representatives for medical school details with a view * their personality and salesmanship* Too often a man Is sent to a school because it was his school and he is a little tired, perhaps, of professional work and would like to teach somewhere. I think that it one of our most Important sources of officer material. SSAH ADM I HAL ABB81S0H - OFF THI I1SC0SB COLOHL COHSSLLt I think It’s one of our sources of our best material and our incoming material. In other words, the impression made on the young men in medical school by the pKS&T*s is most important to our acquisition of good men. Along that same line, send some of our keen young sen to such schools for post- graduate work as examples to the undergraduate body. Encourage religious objectors to prepare as medical assistants; for in- stance, the Seventh *fey Aventists. Recently one of ay former sergeants, who Is now dean of men at one of their schools, wrote and asked if they could arrange with the Surgeon General to substitute first aid and medical work for firing and rifle drill. I ft Ink that sort of thing should be encouraged because they make good soldiers and some of them good officers. Register all medics! and premedical students and graduates in separate files as a source of material so that we can know that is coming along in the way of officer material. I think that should be carried farther than the Adjutant General's office. It should be carried on so that the Surgeon General’s office knows what these men are. THUS jSXfflACi CO*»I Of ISTI&rZJW WITH COWBSL V* CQHHKLL. MO, USA, 30 April 1948 A ffgjfgMSiai Preliminary mobilization in separate camps for basic training, probably sectional c&aps, and then assiga to training centers according to units for special training, tut not too mas/ units in one place for the training facilities. I would like to expand that Just a little* X had a large laboratory unit* All the laboratory units were at Port Sea Houston for training. There weren’t enough facilities there to train all laboratory personnel in their specialty* tie could do our basic training, but it vasa* t until Just two weeks before wo were alerted that we managed to get a snail laboratory building that we might send our men in to do laboratory work. Screen Medical men xx well as to their basis of training and previous experience before assignment to units. X might ousts there. X have talked with one of ay assistants who was a division surgeon In the South Pacific and ho stated that when they received their officers from Carlisle they came in all the way from B to 2, or something like that, anf P to 8 were sent to general hospitals, or something. Consequently they got dpecialists and they got aeh who weren’t suited to frontline duty, and that lost them after awhile because when that was realised they were pulled out and sent back to other units; so time was wasted and training time was wasted********** * * f'J { v k, pomrT coumiL, m TH02 COPY KXTBACT Of IHfSmRW WITH &:r the Amed force**, do you have aay suggestions to offer about classifying aad mobilising doctors, courses and other numbers of the aedical services? I sight say. to give you some insight into what the committee has been discussing, that we feel that the classification of medical officers should be uniform in the three Services • Amy Mary and Airforce - in order to facilitate the procurement, which properly, we think, should be a Joint procedure* for instance. If in the draft all doctors are registered and if then they could bo classified, obtaining the neceseazy information on special- ly* ago* dependents, constancy in the specialty - if that classification could be uniform for the three Services it would facilitate the procurement of per- sonnel. ¥« feel that an accurate classification is neceseazy for Intelligent assignment. MAS ADMIRAL tXU,OlfS¥SS$ But hy classification you don’t stem ' n« essarlly job analysis, I think the Kav.y will require nodical personnel, just as the Airforce will and just as the Amy will. By classification do I understand you to mean to classify these doctors as general practitioners, as surgeons, and so ont SUM ADMIRAL AJmtiSOM: That*s right. RRA& ADMIRAL WILLCUfTSj Tor hospital work of course t think that could be done, but In the field X don’t know, Job analysis - filling the Hary billet* - I think definitely will be distinctive from the sister Services to a degree. I scan, after all, submarines and special weapons that we all hear about trill involve specialised medicine distinctive to the Amy, *avy and Air force. SUM ADMIRAL ARDHSBQR: As a basis of aedical personnel supply, would you consider it logical to hare a basic classification upon which each of the Services could then act in supplying farther training, or, in in- dividual cases, take the officers vho are considered qualified sufficiently for assignment without training? MAK ATMIRMj vilt.CUTTS: It 1ft difficult to make a general statement unless we know what the pattern of the next war that we fear and anticipate will he, Ve know it will he total war and will involve civil defense. Share* again* you bare special 1 fed weapons, I think, definitely* classification vast include not only the needs of the Services hut keeping in nlnd always civil defense. TSUS COPT KXTEUCt Of mssnstf WITH &■ AH ADMIRAL KOHTOS D, VXJ.LCUTTS (MC) USE O' 4 Hay 1948. A.CQmMPSPi There comet in any Service a matter of esprit de corps, of choice. Our doctors are medical officers, and I don’t believe they can be regimental or classified Into a commodity, may I say, like perhaps our fighting forces, our enlisted personnel* Ve have in our levy 14,000 reserve medical officers, which, should they all come back - and most are available to come back; a fev are getting into the 50s - would serve our needs for a tremendous Savy, for a 4,000,000 man Mavy. But can you think of a 4,000,000 «an Mary Is the next few years} Mol We have sow a Mavy that is the biggest is the world, with a half mill- ion people* Vh&t are you going to do with our naval reserve officer vho likes the lavyt They like the levy better than the Army or Air force, or they wouldn't have bees in tie Mavy, Just as you people have adherence to the Armed forces - to the ether groups, the Army and Air force. If Z may explain that more, the Army, as 1 understand it, if 1 may speak on the Aray ae I get it, had the bulk of the Aray based upon a group classed as AOS, Any of the OS, And upon demobilisation that group went heme. The doctors demobilised separately and did not constitute an Any nerve. Am I right on t& tf CQLOMKL POHL: I believe that Is correct, sir. BB1&ASI1SH 0SH3KAL MABTIK* I would the hulk did not Join the ftesenre. REAR 4DMIJUL WIZJXITTTSI You demobilised and they were separated. Our people dlds t do that. They went right on Into the Reserves. We have established a very close contact with that group, that 14,000 and we have them In great divisions throughout the country, We have 240 divisions for M-Day; and 240 divisions will have 76 doctors per division. We hope to have 18,000; at the present time we have 14,000, Mow to classify these doctors all In one* big pool would demoralise our Reserve, I think, because the Reserves are peculiarly I aval la choice, I would hate to see therm all thrown Into one, great American backlog of medical power and say that we had 14,000 doctors. In t o last war we had those 14,000 doctors in the Bevy, and you had 60,000 in the Army. I would hate to see them messed up In one, big pool. Wo are active la oar Kara! fie serve. Fortunately ve did not de* noMIize as you did. Tou didn't have the ssjbs set-up. You bad the MIS. la the same aarnier we have aore regular doctors than the Arsay. I tdnk the Arsy has something like 1,200 doctors; ve have close to 1*500 and 100 la the process of coming in. We will have 1,600 la a fev weeks. We knew ve will have 1,600. fh&t Is odd when you think the Aray is ordinarily three times the sice of the levy. But it is not odd if you stop to analyse fms COPY iiX. RACT or lUTzmiS* WITH a£AK ABKI&L M0ST03 3. V1LLCUTTS (MC) US* OM d Kay 1948, The Army during the war emit ASS rather than legalar or Reerve. The Mary maintained an active roeurement and enrollment Into the legal are all through the war, to that ve obtained 1,000 legalar doctors during the war. I don’t believe the Army had ever 100, I aa told, roughly that, not ea any eo«petltive basis, nor any reason like that, for that was act the scheme of the Army. We had, I would say, an Input of 1,000 Regular doctors during the warj In other words, we went to 2,000 Regular doctors. SMSL ADMIRAL AHBSSSOHs As the Subcommittee has been considering this subject of classification, it has not been our idea that classification would aeon a redistribution of nodical officers. As X understand the teat, it re- fers to a record In the Office of the Chief of the Bureau of Medicine and Surgery for each Member of the reserve and each regular officer. BOSAft ADMIRAL WILTjGBTTSi That’s what we havoaow. 1SAB ADMIRAL AHDEESOH: That will indicate what his gpalifications are, so that when he is Mobilised he can he intelligently assigned. RSAR ADMIRAL VILLOBTTS; Surely, if you class!ty the® per force. Our 14,000 are classified not only by name and address but also by profess- ions! cards that are kept up. REAR ADMIRAL ASSEScOHi To go to the Matter of Mobilisation, as I understand it Idle Savy at the present time is in a position where in ease of Mobilisation the requirements for Medical officers could be filled from our Be serves. SiAE ADMIRAL VlLLCDTTSi That’s right - oar Reserves plus recently re-signed Reserves who have never served actively in the corps. ERAS ADMIRAL AKDSESOHt Bo you £have any CDimaOat about procure- Mont ef medical officers through the selective service draft? Jt’AB ASMIBM* WILhCUTTSj Oaring the hearing it was brought out that never has a doctor been drafted in the recent history of America. They weren't sure About the Bevolutlonary phase. The statement was made and accepted that doctors are never drafted, and that I believe Is the feeling •f the American Medical Association and organised civil medicine. I think the doctors will be the iery first to co?ne forward, should we get into a true national emergency; and to draft them will really not be necessary. I think the mere registration will bring forth all that we need In the levy. 2M1 MM1ML AMDBESONj There is another feature that should be considered la connection with the drafting of medical officers - I would like to hare your Idea - sad that is that bith aev methods of warfare, atomic bomb* or other methods of warfare, the demands of the civilian population for doctors will be greater time it was during the last war* As one can visualise in ease of attack by air, theneed for doctors in civilian life sight be very such greater than It was during the last war when no such attack occurred. Tsm COPY EXTRACT OF I5TBRTIS* VffH EJUH ASHIML HORTOH 0, WILLCUTTS (KG) USH, 4 May 48 4i gfigXXJflg/!;, My conception of the draft la that it would provide a mean* of calling doctors into the service in an orderly manner, The draft would he administered by the local hoard* which would he in contact with the local situation; and doctors selected could he selected for the service on the basis of the ability of the community to spore then. iL\AK ADMIRAL WILLCUTTSj I don’t t«ito follow you. first you don’t draft on officer, and then you would have these doctors drafted. These doctors would ho Officers. The mechanics of drafting a medical doctor would he to make him an enlist- ed man* because that le what a draft does. HU, X can't conceive of any of our doc- tors being drafted* USAS ADMIRAL AIBMSOSi That would he true of the draft hill under consider* ation now* would It notV tiXASk ADalEAL WLLCUTfS: Be* The draft MU will provide for the procure- mint of doctors to moot the services* meeds from age 46 down. Xf they are drafted* they will he drafted ae apprentice seamen in the Busy. Jut they will he registered end will come in end he activated into their officer commission according to rank* and so on. EFAR ADMIRAL mmsast That is the idea I was trying to make clear - that it is necessary through some agency to have a Rational Registry which will indicate whet medical manpower we have* se that that portion of it that is needed by the mil* itexy services can he selected without upsetting the doctors remaining for work in the civilian comal^y* EMM. ASMIBAL V2LLCUTT3t I hove boon in close contact and in eesmlttoe with eiv lien medicine* with the Coma ttee on Rational Emergency Medics! services* and they moke a very definite statement in that Civil defense that la the civilian econ my today the doctors run aboftt 1 to ?S0* They said in this commit toe that they feel that they need that nasy deeters* They had a horror of going back to 1 to 1*6000* as they claim It was during World Mur XX* A very happy average* they thought* woe around 1 to 1**00. The Secretary stated 1 to 1*260, hat the members of the committee didn’t like it* The Secretary was very earnest* Or. Ml el lag gave it a let of thotght, and ho thought 1 to 1**30 would do* So we will have to have one grand classified Job to that we in the military do not again take ton nary doctors and so that Civil Bifcnso doesn’t hold too many of them* REAR ADMIRAL ABSlE&OIj Could you give ns an idea as to whether sufficient medical officers could be obtained for the Services if in civilian life they would retain doctors at the rate of 1 te 12801 R3AE ADMIRAL VILLCDTTS* X think so. I think it could be dene, and today without great dlstrubance of the medical situation because so many young doctors are still engaged In pest graduate work and have yet to establish themselves as Tmm COrl EATEACT Of IStasnJSV WITH aSAJt MOHTOH 0, WIi,LOUTfS (HC) USB 4 May 1948. . iu QOHTIiaatas practicing physicians. Oar greatest pool would be these youngster who hare not yet become fixed in the community, And* 1 don’t believe the communities are suffering too much at the moment. Certainly there are enough doctors, if they were distribu- ted properly. Some doctors are denied hospitals because they wont clinical medicine on the level of their teaching. They don’t want to go out and he the £*nend prac- titioner, saddle- hsg doctor of the old days. 1 believe if the rural districts had medical facilities we would have plenty of doctors in America, BSAE ABKIKAL AMDSKSOMs % you feel that the medical services had too many doctors during the Inst war? BMI J.XMlMXt WILLC0TT3: X do not think so - definitely I do not think so, the Bevy at the peak load had 14,000 roughly. And at th t time we had in the Hsvy and in our Marine Corps over 4,000,000 perso tael, which gives a ratio of eometniag ever 9 per 1,000, The law provided us with & formula of S-l/S per 1,000, True, in the Feci fie, as I am sure Admiral Anderson will bear out in the fleet, 1 would go visit a little ship, tin LST with, say, 3 or 4 doctors aboard and nobody sick. These doctors were chafing at the bitt, wanting to do something, and yet they failed to appreciate the Bevel need for these doctors on that 1ST had the enemy been more powerful. ¥e did net know th t Japan was folding up so rapidly; we didn’t know that Germany was going to fold. What if the Bulge had succeeded? What if he had to invade Japan? We would have been yelling for those doctors. You have definitely got to have more personnel than you actually need if you are going to win a quick war. % having these doctors, by having this strength, act only doctors but all classes of Americ a manpower, we overwhelmed the enemy rapidly and saved many, many man hours of medicine, 1 think. BEAK ASHXHA1 AB3XS&30K: Are there any other queetione that occur to cither of you people In connection with this subject - classification and mobilisetionf•eeeee cmo AlSTRaCTSi) FKOK PRKSOJUL LS’Cf'slH TO COL, L.&. poHL, MC. FROM COL. 3. BRKHtffl ST, KC, mf&O 19 Hay 1948. *»*«****« i. "In handling the Reserve program, It Is larpor&tlv© that the former •istake of penalising Reserve officer* 'by early calls to active duty, and then pronoting non-Reserve civilian doctors at a faster rate, or commissioning then in higher grades, he abandoned, la order to stlaul&te interest of the Reserves, the active duty tours should consist of very pleasant indoctrination, including cocktail parties, airplane rides, and cordial reception by all concerned, in- cluding Line officers. So attenpt should be nade to occupy their tine with dry lectures about field sanitation, paper work, etc. They should not be cade to doaoaolenous physical examinations for two-week-period*, or other eenial Jobs, fhey should look forward to the two-week period as a vacation with pay, and should be allowed to hove their wives and girl-friends in close attendance, if desired. the Medical officers in charge of the Reserve program should he select- ed for their enthusiasm, integrity, and professional attainments. The old system of putting & man on Reserve duty to get rid of hist, should he abolished. Reserve officers should he included the year round at the regular Officers Club, and should he encouraged to socially participate in Club affairs. The 20TC system In Mali cal schools should be abolished, and medical students should be put In the Medical Services Reserve Corps, and treated like other college graduates, as Reserves on active duty, for which they can now he paid. The Havy has long since recognised this fact. Another unfavorable policy which discouraged our Military doctors Is one which would not allow qualified na, at station hospital level, to reader nod- ical care of a type of which they were capable, and which, la civilian life, would have bees considered coaossoaplace. Fatting a Mediocre ©an in a general hospital does not sake hia store qualified than a superior ©an in a station hospital, the Medical Service should not bo by inflexible policy direction, but by close super- vision of coapetent hospital eoaoanders.eeeeeeeeee OLGEBL, MO 91 THPR COPT IKTRAOT (Arm address of Major General Albert *. Keaner, MC, USA, 13 May 1948} ••••• MAJOR GXSBRAL BOWSR* In Answer to this first question — classifies,, tioa and mobilisation of medical manpower for the Armed Zeroes — it should be done by coordination with the civilian agencies, either through the ANA or local medical societies, the Surgeon General to list doctors with their respective NOS and establish rank accordingly. Obviously the only way to secure information on Dr. Jones in Altoona, Pennsylvania would-be through some civilian agency, preferably a medical society, lacking any information in the Sturgeon General's Office that might have accrued through the war years It would seem to me that the Surgeon General could earmark these people for certain Jobs and establish their rank in conformity with their MOS. for Instance, an outstanding general surgeon would be given a 3150-A category and would therefore be eligible for assignment Immediately In the grade of lieutenant colonel in a major installation as chief of the surgical service. 1 believe there uhould be an integrated medical staff at the national Sefenee level to place requisitions for medical personnel for the several components with the procuring .geney, the civilian agency, all doctors to be earmarked for assignment either military or eivil. The determination as to whether certain doctors are going to be eligible for military service would rest with the looal agency, the looal medical soeiety or maybe the AKA. X don't know what part they would play la this, but ocrtainly enough doctors would have to be left behind to meet civil requirements. Another thing, toe, it it apparent that a doctor called to service in the Armed Forces would be sacrificing much more than the doctor who stayed at home. Therefore, the local medical society uhould take measures to pro- tect this doctor's practice. Mow whether there would be a rotation after one year's ssrvioe la the Armed Forces, whersby this fsllow could be re- lieved by somebody who had not been called, is something that might be eon- eldered. There should be development of a proper oorpe of medical reserve officers with an adequate promotion system and in active duty pay. The Reserve Officers' Association Is working towards that end now, and the 381 law also contemplates a one-half percent per year credit for retire- ment age 60, as you all know. I see no reason Why the aedioal reserve offloer may not be given the same advantages and why he nay not, in order to get full credit, be called to active duty for limited periods — 30 days, 60 days, or 90 days — and for duty within his own residential area. If there are no farther questions on what I have said, and if what I have said is clear, I will go on to the next question. BRIGADIER GKNfiHAL MARTI!j Would you favor a national Registry of all msdieal personnel resources? MAJOR 0330SRAL KSSRlRt X thjnjg^thafc is th*tgftly solution to the 92 problsn, Obviouely In the kind of war that wo contemplate there it bo longer a combat iobo; and civilians art Just at susceptible to atomic bombing and everything alto that may ooao along la another emergency. X think all nodical torrleot, your hospitalt and everything tilt, mat ho taken ever at thit Rational D of onto level, Utilisation of all of eur resources to tho hoot advantage lo to obvious that I don’t think It rtquirot any argument." BRIGADIER OSHXSAL KAHTII* X think that1! tho picture. ••••• MAJOR OSMRHAL KSIBBHi "I would like to preface my renarkt by stating that X believe that there hat been too much emphatit placed on specialisation, having in Bind that the primary mittien and the essential mittion of the medical service, whether it bo Army, Havy, or Air, it the medical support of troops in the field. Che reason for having the medical corps, and incidentally of having an army, it to prepare for war. I therefore believe that we should establish a specialist NOS for the military surgeon with g 60 percent increase in base pay to compensate for hazardous duty to which the medical specialist is not subjected la 21 hospitals, for instance, and to compensate for the denial of opportunity for professional advancement for those officers who are attached or assigned to field units. X believe, furthermore, that the t/OdSs should be modified as follows! battalion surgeon, Uajor, with an NOS of ”d*. That is the category of specialist NOS. The regimental surgeon should be a lieutenant colonel with an NOS of *e”{ the division surgeon, a colonel, with an NOS of *b*} and the army surgeon, a brigadier general, with am NOS of ■a*. Tour theatre surgeons and surgeons of major commands, depending upon their site, may be major generals. Z believe we should establish a system that more or loss imitates the British System of automatic rank within the assignment. Vo all know that many an officer has been assigned to a job that calls for a higher rank than that held by him at the time. Due to admlaiotrativo delay* it may bo months before he is promoted to tho appreprimto rank. Z believe, therefore, that with proper selection an officer who is assigned to a job that calls for a certain rank should automatically got that rank whoa ho reports for duty. V# have teem some instance*, particularly with reserve officers, where there wae assignment to a position that oallod for higher rank and yet they were not promoted, which ie one reason why tho reserve it so critical of tho Regular medical officer. They have teem the younger Regular step up a couple of grades while they, in a position call- ing for a higher grade, marked time in a lower one. Z may say that we have precedent for this 60 percent increase in pay. A submarine officer in the Navy gets it; tho Air Oorpo officer gets it. And wo have already recognised tho foot that assignment of modieml personnel with troops is extra-hatardous because of the 10 percent combat p*y- The argument that nay he advanced again*t this nay apply to our surgeons la the higher echelon*, hut there again we hare precedent heoauee we know that general officer* of the Air Corps on purely staff assignment a, required to fly four hours a nonth, continue to draw fly- lag pay whan everybody else on the staff it flying at nueh or more than they are and getting no increase in pay. BB10AUZ2R OBSZHAL MABTZBt Do you favor a uniform system of national scope wherein all specialties are classified similarly, and the adoption of that system hy the Armed forces? MAJOR GfiSRfiAL mHUHi X don’t think it would he worthwhile unless there was formalisation end standardisation of ths parts that dstormine tho specialty. Rear Admiral Andereont In your concept of the control of the national medical resources, is It not imperative that we discard the prior voluntary system for getting doctors for federal service? MAJOR GianSRAL KMNXHi I am of the opinion that the only way to nest the national commitments for medical service, civil and military, is to do away with any volunteer system and to draft every doctor for some function either within the military or within the civil society.• i. K. Po'hl, CoIoft«lr*C THUS COPT SXTBACT OP ISTSamW WITH Bfil&AOISH GSJOSliAL J033SPH I. BASTXOX, HC, USA (XStlHSB) OK 3 Hap 1948. A. *&a&A»lSa OSHIHAli BASTIOW; With reference to (a), I bellsve that the medical manpower Sad woaenpower of the country should Be classified in such a Manor that on M-Day they eon be called in like Any other classified group. la order to do that, eooe central agency should be eot op, a National legittry* or tone otaer name, bat these people, the professional group, should be a&de to understand right fron new on in that they will bo called as necessary for the work that the board or the agency think they can do; and there must be a setup there so that the civilian population can be taken care of. And I believe that the whole professional group should bo taken up to the age Halt agreed on, and that they could be seat to any civilian community to help out Just like they would be sent to a post or station. You can't work it any other way. In other words, ar Qen ral Martins soys, there oust be a central agency to classify these people according to toe my the Arsed Services with the classification. One thing that I have thought about, the high cosaaaad, or medical eos- aand of all the services, goes through every year, year, year, year worrying about where they are going to get their >ersonnol - I laean, professi on! per- sonnel. And I think the tine is coming to think about it spyway, that we should subsidise professional services something like the laval Academy, or the Academy at West Point, and take these people fro® pre-medical — I know Just how It would work, get them in and pay their tuition and maybe give then a coma lesion in the reserve during those four years* but the idea is that you would build up your pools then for years and years to cose. And they should be kept a certain time — I don’t know, five years would be the minimum afterwards before they are permitted to go out* but I think it would do away with this business of the higher echelons worrying about where they ware going to get their professional personnel. I to ink right now - I don't know - Just from talking to younger doctors and dentists, a few X see around, somebody is promising them an awful lot. How, I don't knew whether it has really been promised. They will coma in the service for two years and don't hare to do anything but that little professional Job right there, and at the end of that time they can take their beard. Who at those posts or on your ships is going to take care of the big ness of our people, the enlisted personnel T• 95 D-1*. fiamasiQHAi. AHO 3ua»Hiot miKiaa «ns mikih ms A»jg3 WHOas. 2. sarm Because of the mission ef the eased force* curing oeace, the discussion of this subject cannot he restricted only to training of medical personnel during mobilization and In war as implied In the verbiage tne directive. The training of those who must direct, control, and operate the medical facilities of the services during war is con- sidered the crime responsibility of the peacetime armed forces. The premise that prewar training of all medical personnel for their war assignment?, is the ideal method of insuring host results In all medical fields is sound and should he accepted as the basis for the pur- suance of ail prewar efforts in the training field. The Intangibles associated with the rapport between unit med- ical officers and their troops, including commanders, is no less than the patient-doctor relationship in civil life and a most important factor in service medicine. Combat troops admire and depend upon their medical mom to a remarkable degree if they are known to be qualified. This de- pendence cannot bo developed in a few hours and indicates that adherence to the previous policy of assigning doctors to combat unite during the latter phases of their unit training is sound. To change this general policy would be dangerous in any future mobilisation. It has been suggest- ed by some that doctors should not be assigned to any unit thtll that unit is reedy for departure for combat. This is false In the ease of non- medical combat units in that it denies the necessary training to combat medical officers who will surely be incompetent in their important duties without that specialised training. There Is preponderant evidence to substantiate the need for military training of all doctors for the military part of their duties in war early after Joining. Highly specialized individuals may possibly be excused from some ef this training but only on an expediency basis and not on the assumption that more complete military training would not materially improve their overall efficiency as members of the armed ser- vices. vuch of the criticism of military training on entering the services stems from a lack of understanding in the case of medical officers that they are military officers a® well as physicians end that tne morale and discipline of the ranks In their units is depen- dent upon their attitudes end knowledge of military affairs at officers. Justifiable criticism has been made of the misaseignment of officers trained In specialties during the war after the completion of their special courses. This resulted from poor planning of requirements and should *>© ureventsd In the future. Thor* Is universal accord in the necessity for utlllsin., the tine available for pbat-induction training to beet advantage. Military exigencies will always play a dominant role in controlling thut important phase in mobilisation. Training programs must be so designed to permit of giving essentials primary importance early in training periods. Past ex- perience indicates that certainties of the available time cannot be deter- mined with finality because they are dependent on the uncertainties of war in which the actions of an enemy ploy a large part. The atomic bomb threat poses a problem which may well prevent any time for training. Too much reliance should not o« placed on the stockpile of exper- ienced of fleers and men who served during World War 12 in the medical ser- vices. Admittedly its value it great hut each day reduces Its effective* ness in numbers, physical status, and military knowledge. Progress in the military has only bees achieved by change and there Is much as* today that World War II veterans are totally ignorant of in each of their former mil- itary fields. We cannot assume that the stockpile is fully qualified to jump into any future war to perform without additional training. World War II produced for the first time in our history an ex- cellent scheme for the training of most components of the medical service. It has been universally recognised as producing superior results and there should be no deviation except for minor improvements in the major methods used for accomplishing the results. The question of training of the medical reserve components during peace it a knotty one. Undeniably It should receive intensive study and action. It appears that individual incentive will continue to form the keystone to progress in medical-military education, Recognition of this voluntary effort to improve individual knowledge in this field must continue in any system devised to prepare reserve medical manpower for war, Reward for this effort in preferred assignments and with advanced rank must be tempered by the obvious fact that theoretical knowledge cannot alone be the index to any individual's capabilities to perform adequately in military position. Actual experience will always remain the most important element la the overall or specific value of an Individual to the service. Means to give medical-military experience during peace to reserve components must be expanded and utilised more fully and scientifically than in the past. Medical training facilities of ell elements of the armed forces should be utilised Jointly wherever possible. Caution, howafer, must be exercised in any general implication that the duties of medical officers especially are similar in the three services. Only In those particular fields of preventive medicine and in the actual care of the sick and in- jured can their duties be held similar. Thus, training must be provided separately by each of the three services for their personnel in ell special- ised fields demanded by the mission of ths particular aimed force. There can be considerable economy in war practiced especially in the enlisted specialist categories by Joint usage of training facilities. The enigma of administrative system differences between the various services which are 97 beyond the control of the Medical Department* must be always con- sidered in plans for the major joint us* of facilities in any field* The terrific wastage of trained enlisted medical socialists overseas by the Army during war should never be countenanced again* Many hundrodo of these Atoy trained specialists technicians were di- verted to other services and arms on and before their arrival over- seas, by personnel authorities who controlled the flow of all replace- ments* Most of these saalassignaents ware charged to exigencies of the service tjjr those responsible for such action, The high caliber of those technicians made them especially desirable for any type of clerical cr other duty where intelligence and general educational qualifications were most desirable* The necessity for establishing specialist schools overseas in all theaters by agencies ill-equipped and fully engaged in duties in prosecution of combat medical service for these technicians resulted from this nefarious practice. Surety by regulation that the Medical Department of the Army and Air forces will retain all men when they have trained under their control must be sought* if we are not to waste time and effort la this field in the future* The deliberations of this Subcommittee have brought the startl- ing realisation that one of the most glaring deficiencies in discharging our peacetl:as responsibilities is the lack of an agency to keep our pro- fession up-to-date in our specialized field of military medicine, there is a primary and most important need for some form of institution of joint civilian and service composition which will assemble* decide* publish* and in all other ways be qualified to inform all medical men of the best and latest developments in the fields of military medicine and surgery* pre- ventive medicine* atomic medicine* biological warfare possibilities* «fce* Our service efforts in recording the results of our research in all fields are woefully uncoordinated and are not available in usable fens for the continuing instruction of the medical fraternity. All the medical ser- vices are proceeding in divergent paths In the publication of recent ad- vance* even in the strictly professional fields* This suggestion when posed before a considerable number of qualified witnesses had broad and full support in the soundness of its concept* Zt is believed that the high type personnel and facilities for such an institution are current- ly available and that farther study of details of composition, adminis- tration and operation and scope of mission of this proposed egeney should receive high priority consideration by the main committee of Medical and Hospital Services. A commonly overlooked but most important factor in planning for training of all categories of medical personnel during mobilisation is the supply of competent instructors* In the last two mobilisations insufficient early effort was made to provide the means for meeting this essential re- quirement* without competent instructors being available prior to the in- duction of large increments of manpower, serious wastage of time will ensue* It is the first step in any wartime training program* This connotes the 98 abeolute necessity for piaiming HOW for formal Intensified training courses at selected service schools for this corps of specialists. Concept regarding the medical requirements of future wars lead to the realisation that the medical requirements of the pas|pill he greatly in* creased. With a shortage of doctors surely facing us in the event of a nation* al emergency of total w.r, ve rnuat see that the nurses and all other medical categories? including enlisted specialists, are trained to do things medic* ally vhich wo now consider wholly within the realm of the doctor, Thle training must he part and parcel of their basic training rather than special- ised for selected Individuals. II. , Q,if„ .Taugflaw 1. Categories of Personnel a. .Kalis tod (l) Basic training the systems usad for accoaplishing t.ls training during the period 1941-1946 by all the services proved eminently successful and plans for future national mobilizations should he patterned after those system, the length of this training will always have to he adjusted to the demands for the outpUi. which in turn depends noon situations beyond the control of the medical departments. Different systems for this training obtained in the Army and Havy during World War XI. The Wavy enlisted men first received •thoottt training at non-medioally controlled training centers. Later they wore sent to medical training facilities. Army enlisted men received both their basic military and basic medical training simultaneously at large re- placement training centers at times under the direct control of the Surgeon General. Both systems proved efficient for meeting the different needs of the services. In general, the basic medical training given by the Wavy con- sumed twice aa much time at for taht type of training conducted by the Army. The demands of the Army for medical service in its rapid mobilisation deter- mined the length of the training periods rather than the desires of the Sur- geon General for better and fully trained medical men. (2) Specialised Training Realisation of the paucity of qualified technicians in comparable civilian skills forced the establishment early in World War II of schools for enlisted, specialist technician*?. Their vlue hat. been universally asserted. There is no indication at present that the same system of train- ing must not again be used in the future, pre-induction classification of the medical skills under Selective Service machinery will. If established, alleviate to some degree the wastage of skilled technicians by Improper assignment. Specialist schools for the essential categories of technic1sue are currently being operated for peacetime needs by the Army, Wavy and Air Force. There is a diversity of the length of courses for similar skills in the Arny and Henry. The present unsatisfactory enlistment rat* in the Army precludes the adoption of the Savy type of specialist training. This factor tends to prevent joint use of present training facilities for these categories. The expansion of thee# facilities plus the necess- ary additional ones best located in eonjunction with medical centers should bo the basis for the wartime needs la these categories. b. Officers. 1. Medical-Dental-Veterinary and KSC Specialist Corps. (a) Military training. Ho subject has elicited more universal agreement for its necessity for all officers iswsdiately upon their entry Into uniform, or more diver* eity ef opinion as to the proper context as to the proper context and lengths of the course that should be given. However, the majority of opinion favors n short intensive course of approximately two weeks duration In which the broad essentials cf the military fields, each befitting the particular service, are stressed. Under present limitations essential Instruction in medical military aviation fields must be included In these courses. The majority are in favor of giving this training at medical training centers of the Army, Havy and ef the Airforce as may ba developed later, principally because thee# facilities are equipped to start courses each week. These Centers nre equipped to process newly appointed officers with dispatch. Their connection with of fleer replacement pools proved advantageous to the Surgeon General when trained at these centers. Because of the wide variance in the military feature requirements ef the Army. Bevy and Air force, it is not considered possible to utilise joint facilities for this type of train* log* Those individuals with prior service should be exempt from this train- ing. aer# proved sound for both Army and Wavy, fhsre lias been much discussion regarding the merit and necessity for sub- sidization of medic*.! students during war to insure the current needs and a reserve for the Armed Forces. There is no Indication in the forseeable future that the supoly of doctors will be sufficient to eliminate the need for the resumption of some similar provisions in ths event of another war, There was little, if any, coordination between the Amy and Navy la their identical programs, This deficiency should be corrected In planning for ths future to avoid in producing the identical product, The «3&- perienoes now current in meeting the postwar medical needs emphasises the need for a change in the process which will demand of each subsidised student a specific term of se vice upon his graduation. This provision, thoroughly understood by the student at the beginning of his subsidised training, would eliminate to a great extent the disaffection so apparent among such recent graduates called to duty. The fairness of this form of contract cannot bo questioned. It should bo planned for the future. 4. Jursei (a) The establishment of ths nursing Corps in the Services is a change from World War II conditions* lack of the services is currently enrolling large number? of reserves In an attempt to reach Its wartime requirements. The establishment of a national registry for nurses wi.il clarify the resource problem os In the case of all other an- cillary groups and permit of an equitable allocation of nursec the using agencies. The Army is being forced to re-establish its school of nursing in order to obtain its peacetime requirement?? but this action will be of but minor help in ?a©eting war demand*. Continuing dependence must obtain on civilian teaching institutions for our wartime requirements. (b) There la no change indicated la the wartime system used for training of selected nurses in thoir specialties, at 'Serrlce hos- pital*, or at Air Force Training Centura for aviation auraes, It produced good results. (o) All nurses •vonld be a short course of military indootrin tion training of not over one month*« duration immediately on their entzy into the service, This was done ia some measure in conjunction with' medical replacement training centers during the war and it should he in* eluded In the plans for the same facilities ia any future emergency. (d) It Is universally sgreod thct Surses Aides are an important factor ia the process of saving stale manpower in war# This pro- grata, which entails the tralniu£ of women In nursing technique**, ©an beet he conducted in the service hospital®. There is no need for change from World WaiXI ojNtbtleee la this field. (e) Because of the unicue problem of the martial status i * in the female, the supply of nurse reserve is bound to be a fluctuating one. There can be no legal measures taken to Insure stability in this field even with a national registry operative. Hence, wartime training of nurses will be a necessity. The Cadet Horsing Program used In World War 11 proved effective and should be re-established early in a future war threat to the nation. (f) The training and procurement of nurses has never been coordinated before in peace or war between the services. Its im- portance demands it in the future. 5. Medical Women's Service Corps. (a) The modern developments In medical practice have brought the need for these specialists Into major focus. The current peacetime training output from civilian institutions is far below that required for peacetime needs of civilian agencies. The Army had been forced into the establishment of service courses for full training of dieticians and physiotherapists to fill its peacetime needs. As these courses are of long duration, reliance should not be placed on this meager source of wartime needs. The only solution rests In the development of civilian sources of education to furnish an adequate reserve in these cat- egories. The method of stimulating sufficient interest in civil life for these svoc tlons should receive proper study and action to achieve that result. (b) The military training for members of this Corps should parallel that for nurses and can be given jointly with them. 2. Medical unit Training. Undeniably medical unite must receive training as a group to accomplish the smoothly operating facility necessary to perform its par- ticular mission. Much time and service was wasted early during world War 11 in this training because of several factors. Units were activated too early with entire complements of personnel. There was little for the doctors or nurses to loam during this phase of training because of their profess- ional training which could not have been accomplished in a period of not over two weeks. The principal need was for the thorough training of the non- professional individuals of the unit in a group action in the packing, load- ing, movement, establishment, maintenance and operation of these unite from an administrative and equipment standpoint. This can be accomplished with the full complement of nose-professional and command personnel with only •key" professional personnel present. This system was developed In the later stages of the war and proved efficient. It should form the basis for "leaning procedures la future mobilisations. 3. Medical Staff Planners, etc. Previous experience Indicates the training of this category after war has become a fact, is too late to be of real value. Mintages are made mostly early In mobilisation and during early phases of war, principally because of the Incompetence of our medical officers to plan effectively. It is true that time corrected many of these early mistakes because of the training received by hard experience, To accept this insecure method of discharging our peacetime responsibilities is to admit our In* ability to learn from experience. That there is Insufficient effort being made by the services to train selected officers in the advanced phases of this work is conceded by all. World War II demonstrated the unfairness and inefficiency restating from the lack of a definite pool ef this category of medical specialists. These selected officers must be trained with the line and other components in the service and staff schools. The importance ef association as classmates of the line In these schools cannot bo ever* emphasised. It proved to be Invaluable to the medical staffs in World War I and II In their positions of high responsibility. The provision for this training must receive the attention It deserves SOW if we are not to fail in our efforts to conserve the national medical resources In future war. In the face of past experience which will surely be repeated it can be categorically stated that every regular medical officer must re- ceive during the first ten to fifteen years of hie career a comprehensive course in the military aspects of his duties on an advanced basis. This can bo accomplished at our medical service schools. The Army Serov plan of training provide* this and every effort must be made to carry out its concept and spirit la all of the services if we are to establish the quality of medical leadership essential to a national war effort. 4. Demobilisation Training of Medical Officers. Considerable criticism of the poet-war professional training program offered medical officers by the Army has been elicited. The program me conceived was am excellent one and is considered worthy of consideration for study In the future, The general chaos that eanixed with the national demand that everyone in uniform bo released immediately after Day re- volted in the elimination of all ordor and aenae in the demobilisation pro- cess, This doomed the refresher training program which was offered medical offleers. It cannot bo divined at this time that the same hysteria will net recto* under similar conditions. Plans fer the future should include not only the programs for such training/ but specific details as to how this training oen be given in the face of a recurrence of the conditions which followed ?-J Day la World War XI, Dales* general demobilisation plans arc adhered to meticulously in the future, little improvement can be expected and previous errors will be repeated, Basically, it must be made mandatory that no promises be made in this fisld unless it ean fee definitely assured that proper and adequate facilities are going to be available. Because the process must remain voluntary and the applying for it can only be very in- determinate, extreme caution is essential in premising anything that cannot be adequately planned far. III. CQMLPSlQgS The Committee concludes* 1, That the ernergeaqy training of medioal personnel Is essential to the eooeeee of medical effort in war. 2. That the emergency training given medical personnel in World War XI was successful in general said plans for similar training agencies should he adopted for future mobilisation training. 3. That indoctrination medical-military training of all officers of tho medical services, including nurses, Women's Medical Service Oorps and selected members of the medical service corps is necessary immediately follow- ing their entry into the services. That the training period should he as short as possible and not exceeding four weeks. That officers with previous military training and those for aoeolallst assignment in specific fields should he excluded from this training. 4, That training an adequate supply of Instructors must precede efforts to train the masse*. That this is best accomplished by training of regulars for these duties during peace. 5. That there it need for bettor training of all medical officers in the fields of psychosomatic and physical medicine and in the medical aspects of atomic and biological warfare. That this training should be stimulated during these peace years in civilian teaching institutions. 6. That the officer candidate school system was an ideal method for the selection and training of members of the Medical Service Oorps and should be readopted in plane for the future, 7. That every method for improving the peacetime training of medical reserve components should be colored and developed. That peacetime train- ing of reserves will reduce the post-induction training periods, especially in the purely military sphere. 8. That Joint use, wherever practicable, of all medical-military training facilities in peace and war is indicated in the interests of economy and should be developed fully In planning for emergencies. 9. That the T-12 and ASTP programs for training undergraduates prov- ed sound. That they should be combined as a Joint national Defense Estab- lishment activity in future war. That provisions for a definite period of post-war service, if it is required, say five years, should be written Into the law to prevent disaffection. 10. That medical smite require training as such prior to their use. 11. That short courses of training for officers after entry into the •erviee in the specialty fields will be necessary in the future in the scarce categories. That similar methods utilised in' World War IX should be planned for the future. That more c r must be exercised In the assignment of graduates of these courses in the future. That tnls feature can be accomplished by better planting. 12, That medically trained enlisted technicians were wasted in overseas theaters by staff and command interference, principally in replacement depots. That to avoid this, the Chief Surgeon must be authorized to control all medical personnel arriving as replace «nte In overseas theaters. 13. That much of the success of the service medical effort in war is dependent upon the quality and training of medical officers assigned staff and command positions. That this field constitutes a specialty. That it is essential sufficient importance is given the training of these specialists during peace. That it cannot be accomplished in war as an emergency, measure. 14. That service schools for phyaiothcrapl ts and dieticians will be necessary to provide the requirements for service needs in wax. That provisions for the joint use of these facilities which must be greatly expanded in emergency is indicated. 15, That the Mur see Aide program and the Cadet system for training nurses were necessary and successful in World War II. That they should be re-established in future ea rgencies. 16, That the creation of a permanent joint service institution for the collection, evaluation, publication and diesemination of past, current and future research and development in the fields of military and naval medicine and surgery* preventive medicine, medical aspects of atomic and biological warfare, is a prime necessity of the moment for the peacetime and emergency training of all medical personnel, civilian and service. Th-.t highly trained civilian and service personnel are Indicated to comprise the faculty of this institution. * That accommodations are considered available within present facilities of the services for this insitutlon. That resident, extension and special courses are feasible under this concept. 17. That because of the extreme specialised nature of all medical training full control of all medical training facilities in war be vested in the Gurgen Gsnrals of the respective services. 17. The Subcommittee recommends the following: 1. The immediate creation of a permanent joint service aedl al In- stitution as described in the body of this report and in Conclusion Ho. 16. Active pursuance of every possible effort especially with civilian medicine to advance the training of civilian practitioners during peace to better equip then for services in the event of war. 2, The inclusion in the specific plans for training of medical personnel for future emergencies of the training facilities and methods used by the services during World War II, with the necessary indicated minor improvements especially in the indoctrination field of newly Joined officers. 3. Staff action to insure full control of all medical replacements by the Chief Surgeon in any area to eliminate the serious mltassignment of medically trained technicians th??.t occurred in World War II in replace sent depot practices and thus prevent the wastage of training effort and scarce category medical skills. 4. Constant, and intimate liaison between Medical Departments of the services with their general staff agencies which are now planning for emergency training in future mobilisations. 6. Adequate provisions be m: do immediately to train selected regu- lar medical officers during peace for a career specialty in staff and high command assignment in war. 107 OT1 OOP! EXTRACT (Litter from Brig. General Roy C. Heflebower, USA (Hot.) doted (undated) - received 30 April 1946) ooooo «g# | mi alto of ths opinion that all Medical Department enlisted personnel should receive their basic training in Medical Replacement Training Centers. During the recent war the ©round forces desired to train their own personnel, and in the .case of the Divisions which were trained at Gamp Barkley, Texas, the training of Medical Department personnel in these Divisions was certainly net to be compared with that received in the Training Center. In fact, the Training Center cooperated with seme of the Division surgeons and trained both officers and men for them. In ay opinion basic training should be conducted by the Medical Department and then unit training should be conducted by the unit to which the men are ultimately assigned. 10. The experience with the Medical Administrative Corps Officer Candidate School shows a faulty method ef selection of candidates, and it is believed that this was eoarnon to other officer candidate schools. Blghteen thousand nine hundred ninety-eight (16,996) candidates were en- rolled in the school but twelve thousand four hundred eight (12,408), or 65.6 per cent graduated and were commissioned. Seven hundred seventy-five (775), or 4.1 per cent, were found deficient academically; one thousand five hundred ninety-three (1,693), or 6,4 per cent, were relieved because of lade of leadership; one hundred fifty-nine (169), or 0.8 per cent were physically disqualified; and three thousand three hundred fifty-nine (3,889), or 17.7 per cent were relieved at their own request. Row this situation can be corrected is a problem. Xn my opinion the quota system is to some extent at least responsible. Commanders are told that they must send a certain number of men to an officer candidate school, and those quotas are filled regardless of the fact that the men seat arc net officer materiel. Xt was very noticeable that a much higher percentage of eueooeeful candidates came from Medical Departmeat Replacement Train- ing Centers vhers special courses of instruction for potential candidates wore conducted. This leads to the conclusion that preliminary courses ef instruetiem for officer candidates for the schools ef all branches might be conducted In the various Service Commends and thus serve te eliminate many of the applicants which would otherwise be sent te the Officer Candidate Schools only te be relieved Inter because ef undesirability. Such n method would mot only save time end money, but would undoubtedly result in obtaining bettor officer material. ***** 16, § •aurally, I fasl that the tralaiag progw* far offloars, off tear eaadldatas and aallntad Baa was veil soaslderad, efficiently laelusiTs, aad produced excellent results. fhls apiaion is hasad o» ay ova observation aad also aa statements aada ta aa ty thasa officers have invariably baa* to tha sffaat that tha officers aad aalistad parsoaaal trained at Oaap vara generally of ▼•’7 high caliber. 108 17. It &• alto tuff os tod, whoa training profraat for offleort art to l»o eoaduotod la Boplaeoaoat Poolo la tho Zoao of tho Interior, that the to poolo ho local od la roplaeoaeat tralaiaf contort. Za tho lattor, tralaiaf it hoiaf eoaduotod in all of ito phatot at aay particular tiao duo to tho foot that tho hofiaaiaf of tralaiaf period* it t toff trod. By utilixiaf elattot of iaotruotioa foiaf oa la tho Ooator, it it potoihlo to otart tho iaotruotioa of aa Individual offioor iaaodiatoly upon hit roportlaf to tho Btplaooaoat Pool, fhio tarot aaeh tiao, at tho aow arrival loot aot haro to loto tiao vhilo waitiaf for tho otart of a mm elaot at would ho tho eaao oatoido of tho Tralaiaf Coaler. *00000 L. I, Pahl, Ooloaal, MO tuns mmci COPI (Utter froo Cept. Warwick T. Bran, (MB), OSH dated 20 April 1943) ***** "b. Professional and military emergency training programs within the Armed Faroes* From the standpoint of amphibious and field medicine, military training for medical officers is essential to the advantageous utilisa- tion of their services during war* of the deficiencies of the last war In the functioning of the medical forces were due to the, lack of medical officers with military training. The training objectives should be (l) to train a selected small group of medical officers In military tactics, techniques, and staff procedures and (2) to famil- iarize a larger group with the field or amphibious medical organisation, equipment and functions* Training facilities should be available at an early date as mobilization is always hurried and much valuable time la lost in setting up the training facilities. In World War II the number of medical officers trained in line staff schools were sufficient to supply the need for lieutenant Commanders and Commanders of the Medical Corps capable of functioning in medical staff sections, as Medical Battalion Commanders and as Division Surgeons. It is recommended that a certain number of medical officers in the lieutenant Commander end Commander grades be assigned to the senior course in Amphibious Warfare at The Marine Corps Schools. It is also recommended that schools for training in field medicine be organized at Camp Lejeune, North Carolina, and Camp Pendleton, California. These schools to be utilized for training medical officers and medical department petty officers in the functions, equipment and organization of field and amphibious medicine. In this connection It Is recommended that the . opportunity for both types of training be also offered to certain selected reserves during peace time. »»**»•* cy^^^S) L. X. Pohl " Colonel, U* 3, Amy TRUE COPT (Extract -Hr Quinton M* Sanger, BUMED, USK, 7 April 1948) ****»The liaison between the Bureau of Medicine and Surgery and the &ar Plans Section of the Navy Department was inadequate* "During World War II the lack of early and adequate information regarding strategic requirements led to erroneous estimates of material, requirements and resulted in numerous em- barrassing and emergency situations•" Admiral King did not accept a full time assigned medical officer as a member of his war plans staff* To Effectively support the operating forces, the Medical Department needs to know better the type of war and combat operations the operating forces expect to conduct in a possible future war* The location, size and type of medical installations can then be systematically planned, but not withoutthis knowledge* CNO felt liaison was adequate, but was hampered by the need to maintain secrecy for information that really required widespread dissemination* During the war the Medical Department had to depend on the reserve medical officers. This individual was often an excellent clinician but had no experience or training in handling groups of men or problems nhicn arose when hundreds of men attended sick call. The interest of these reserve medical officers should be stimulated during peace time so that they will be willing to take necessary indoctri- nation work in leadership and in medical problems peculiar to a wartime Navy* It was claimed that medical officers were not sufficiently trained in what material is req ired to accomplish a specific mission* It. was proposed that the Naval War College should instruct medical officers on the medical problems which arise in connection with the general war problem that the War College is carrying on* Reserve medical officers compla ned to Congress that they were in many cases not ordered to post graduate training courses which had been promised them** ***** L. K. POfEL Colonel, UC TRUE COPI (Extract Ltr James E. Hix, Lt Col., MB, (Resigned) 11 April 19^8) *****1 believe that the Regular should be so constituted that periodic professional training is available for those desiring* To eventually success- fully achieve this, there will have to be an increase in personnel—'which I know is a problem* Lost doctors can be trained very quickly for military service* It is by no means necessary to send all to Carlisle for 1 month*°**** L. K. POflX. Colonel, MC TRUE COPY EXTRACT (Letter, Brig. Gen. Robert C. McDonald, MC, USA (Ret.) dated 15 April 1948) ***** "(b) Professional and Military Emergency Training Program within the Armed Forces. "(1) Commenti Professional training of medical specialists in W.W, II lagged behind requirements. Courses were too short, while on the other hand, military emergency training was more than adequate for many medical special- ists* X *(2) Suggestionsi: Medical specialists should be called into Service far enough ahead to allow time for adequate special training in civilian and military installations prior to assignment. Military training of medical manpower, both basic and technical, should be conducted at Armed Forces Medical Training Centers*• ***** L, K. Pohl, 'Colonel, MC 112 fMi POETTORAQf (Letter from Colonel Robert I. Simpson, USA (Set.) dated 1 Nay 1948) •eeee (b) Professional and Military emergency training programs vithla the Armed forces. Special emphasis on field trainiag, sanitation, hygiene, evacuation, field heepital eperatioa for those net specially interested in any of the specialties; refresher postgraduate courses at Military, or civilian, institutions for those with specialised training, or these apt and interested is one of the specialties.••eeoe TRUE COPY EXTRACT (Letter, Col Robert P. Williams, MC, Surgeon, 16 Apr 48) ***** (b) "Professional and military emergency training programs within the Armed Forces. Purely military training* drill, customs, courtesies, uniform regulations, etc., to be given in a short intensive course of two to six weeks.* ***** L. X. Pohi,CoIoa«l, MO mm OQPT EXTRACT (Ltr Oapt B.fi. Bering (MC)USH. dtd 17 Deo 47) ***«**•«•£' "Lack of understanding of tho basic need for sanitation and pro- vent Its medicine In tho field. Early in tho war it became apparent that the doctrine of securing labor for major sanitary projects from the fighting troops themselves was unsound. Various expedients were tried, including the order assigning additional men to Constructions Battalions to work direct- ly under the medical department. On the one operation (Okinawa) when I observ- ed this system, these personnel were never available either for training or field operations as they were, urgently needed for their primary function of building roads and airports. The formation and assignment of the Malaria and Epidemic Control units was a master step in tye proper direction but with- out personnel to actually carry out thoir directives, tho provenlive aodieino program fell short of its goal in the field. A training course for Medical Officers in Amphibious and field Medicine should be established in much the n same manner as courses in other medical specialties. By so doing we could assure ourselves of a nucleus of trained officers and actually decrease the n number of medical officers assigned to Marine Corps forces on n year around basis. By assigning medical officers for a two month course as recommended la enclosure A, we could give adequate medical service vhem it is needed and confine our activities to purely medical matters for the rest of the y**r. After preliminary training, such officers showing an apptitud® for this spec- ialty could be assigned to various *taff and command schools for advanced training,»•*••*••• L.K. POHLVOolonel, MO 113 THUE COPT (Extract Ltr Quinton M. Sanger, BUM, USN, 15 April 1948) ■*HH**"It was suggested that BuMed’s Professional Services Division be responsible for medical training programs, for the initital assignment and periodic evalua- tion of medical officers\ and that assignment, transfer and promotion should be made only in consultation with or on recommendation from this division* A generous policy permitting attendance of medical officers at meetings of recognized civilian clinical organizations should be instituted* This was proposed in part as a way of keeping the good will of civilian medicine. The complaint was made that Navy , nurses spend too much time instructing corpsmen, and in administrative or clerical work, and not enough in bedside nursing* Waves were recommended for the administrative work, and special instructors were suggested to train corpsmen* It was pro osed selected members of the Nurse Corps should be permitted to obtain post-graduate training in special nursing fields at selected civilian or other hospitals. Nurse training after entrance into the Navy was criticized as weak during the war****** ;<• * s /7M 1/ K. POMk Colonel, MC fMH COPY TSXTSaCT (Ltr Brig ften &uy B. Denit. MC, Surgeon, dated 13 Apr 48) *e*ee» professional and military emergency training programs within the Armed force* - The military training program as conducted at the Medical field Sergio* School at Carlisle Barracks was in my opinio* of inestimable value to all who received training there*. Likewise the professional training urogram in the various schools throughout the country were of great value. It Is possible that this program can and should be improved uoon but as an aaergencxmeaaure It was very effective. V.K, POST Oolontl, HcK rails COPY EXTRACT (Ltr Bear Mi f.L. Conklin (MC) USN, 27 Apr 48) •••♦♦ "All Heserve Medical Officers should receive peacetime training, either on an active duty status, or hy a eorreapondenoe course. By calling Be serve Medical Officers to ahtive duty, their services can he utilised, even though in a training status, By so doing, their nrofesslonal qualifi- cations can ha better judged. lHc. PCm7V\Colonel, MO THUS COPT HTHACT (Letter from Captain M. J. Aston (MO), USH Portsmouth, Virginia, dated 23 April 1948) •*••• «(b) Professional and Military emergency training programs within the Armed Forces. Tinder the category it is ay sincere belief that the training pro- grams in force at the out-break of World War IX were excellent in type and reflected great credit upon those who had created them. This, of course, represents a most favorable reflection upon the quality and standards of our medical profession. Insofar as the efforts of the mili- tary establishments are concerned in this respect, here also do 2 consider that thdee several programs were of a high quality. X believe that the medical services of our army and navy in this late war met their respon- sibilities in an outstanding manner and fully and completely answered every call of duty. X do not know of any single instance where there was a failure of the medical services to function in the highest degree and in keeping with the highest possible standards. Our medical services were ready, we were prepared. Certainly this was true at Pearl Harbor and thereafter during ny experience in the Pacific. X am not competent to compare the training programs employed In the army with those of the navy. The success of our T-12 program has been well demonstrated and It would teem to me that a program of this sort could well be utilised in the future. A consideration of our present professional training programs might be in order here. I refer specifically to such programs that are now provided and which will Veeult in fctgher standards of medical education and training. Many of our yodng doctors are receiving lesidency Training and special courses which in doe time would lead to certification by various specialty boards. Certainly the individual benefits greatly by such train- ing and the standards of our medical corps are thus enhanced. It Is to be hoped that our services will be benefited permanently by such professional training programs. Ve should expect to retain in the services, most if not all of such trainees inasmuch as such programs should be expected to confer lasting benefit upon the medical corps as well as the Individuals concerned. Our medical corps exists primarily to serve the needs df our naval estab- lishment. Over-emphasis in any training program should be avoided. In other words, "The tail should not wag the dog." ***** / x L. X. Pohl, Colon**.. MC fBOg 001*1 JSBEMX (Letter froa Or. Wa. C. Mennlnger, fepeka, laa tee, dated 29 March 1948) ***** "(11) X think ve ought to aake a strenuous effort to endoctrinate all of our nodical officers with the concept at least of psychosomatic asdicine and sons orientation as to vhat to do about the functional physical eoaplaints that coapose twenty to forty percent ef our gastro- intestinal, cardiac and orthopedic sards. ****** L. X. PohItColon«l, MO IHDE COPT EXTRACT (Ltr fr N. C. -ashb-om, Colonel, 1,'C, AT, 19 April 1948) ****"During the critical time of expansion in fforld War II, medical administra- tors ware the big problem. Specialists were available from civilian sources. Recommend the training of medical administrators not be overlooked."**** L. K. POHL\ Colonel, MC 116 EXTRACT COPY OF PERTINENT MATERIAL CONTAINED IN AIR FORCE MEDICAL DEPARTMENT HISTORICAL RECORDS OF WORLD WAR II. (1st Bombardment Division 44) ***** ”In connection with the problem of medical personnel are the factors of professional staleness, waning Interest and morale, and the tendency to become self-satisfied in a smoothly working organization. Various means were utilized and initiated to combat these, particularly in the doctors who have served overseas the longest. Higher echelon instituted various research problems in aviation medicine. These will be discussed in their proper medical category, (Higher echelon also made possible detached service at various station and general hospitals in professional capacities. These brush up periods were extremely valuable to Medical Officers who were anxious to bring themselves up to date on the newer aspects of more defini- tive csie of the side can be accomplished in a small side-quarters) • For rest, relaxation and change of scene, the Surgeon, Eighth Air Force, has allotted this Division several of the Air Force Rest Homes to cover medi- cally. Each weds;, one of our Squadron or Group Surgeons has been sent for a tour of duty at the allotted rest homes. Other medical officers and enlisted men were sent in teams, to various RAF airdromes near the south and east coast of England. 1st Division Bombers, when returning from a mission, would occasionally come into these dromes in an emergency, and the personnel on detached service supplied medical emergency care of the casualties. (Appendix A) Another method of supplying the medical officer*s need for professional change and stimulation was a system initiated by the Division Surgeon for exchange detached service with several RAF combat and training fields. Our medical officer would put in a weeks* service at the RAF station actually working and filling a job there. Thus he would be able to observe and appreciate the RAF methods for handling sick and in- jured flyers. The comparisons afforded the Flight Surgeons while on this service helped to establish a better perspective in the care of their own flyers when they returned. Most of our Flight Surgeons who participated in this exchange, favored the RAF combat stations. These exchanges were stopped shortly before *D* Day, Still further professional stimulation was afforded our various Flight Surgeons by attendance at and participa- tion in frequent medical meetings of the station hospitals serving the area.* ***** (Medical History, 1st Bombardment Division - 1942-43) *The inherent nature of the Flight Surgeon* a work is such as to renews hi* fro* the sphere of hospital Bedicine and methods. The need for keeping Flight Surgeons informed and trained in advances in this type of care was recognised early by higher echelons In the Eighth Air Force, and to supply it they arranged for the squadron and group surgeons to attend various short courses in both military and general medicine and surgery.1* L, K, Pohly Colonel, MC 117 ggs, Cv. i SCTBASX (Letter, Colonel Janes H. Forsee, K, QSA, *0 April 194«) eeeee "(i) fhe Professions! and milter? auergcnegr Training Program V&|Ua the inti forees. ' 1* A largo active Medical Meeerre Oorpe training pftim would appreciably aid la the eelatiea of thle prohlea. Preparatory aoaearoe are the ealy aeem of adequate training la the adrent of the preewaahly atoalo typo of warfare. 3. Time sesas to ho sash a trsaendous faster In the antl~ sipated warfare that emergency training paegraas for doctors, nurses, etc, as? he alaost Impossibis ef accomplishment. Teaching In nedleal, dental and nursing schools, at the undergraduate lore! pins training la Ssxridc Schools sad Hospitals appears to ho the nest feasible plan. In view of thooo statements the following is rseoaasadsd. The sstahlishaent in ear teaching hospitals of the Are? and lavy proscribed courses of instruction fer reserve ef fleers and sirilian doctors in professional natters pertaining te War Surgery, Medicine, Prevent Its Kedieine, etc. These sources should he ef at leaet ef one (1) scathe duration. Ho institution should ho hotter able te teach these subjects then military hospitals. Heoegiitien from professional channels will he readily forthcoming If the Instruction ie good." eeeee x>. x. jpon, ko 118 TRUE CQFY EXTRACT (Letter, Captain 0. B. Morrison, Jr., MC, BSH dated 23 April 1948) ******* "b. Professional and military emergency training programs within the armed forces• Short courses of instruetic© and practical training should be offered to volunteer reserve groups to keep them up-to-date In the art and science of warfare* The armed forces must have at least a well-trained nucleus, so that in time of national emergency, additional medical officers can be instructed In such subjects as aviation medicine, submarine medicine, atomic bacteriological and gas warfare.®*** ■rang COPY amcl (UtUr, *«r Ad*r«l C. t. Andra. (IB) OS* d*ud 27 April 1948) «mm »(b) It la considered that intensive military amergency training programs should bs afforded all medical personnel as soon as possible after aobillsatlon In order that through indoctrination and special instruction they will be prepared to carry out their duties in the field. numerical assignnents without consideration as to qualifications nay be wasteful of manpower and effectiveness of service performed. Many of the special training courses that were organised tod carried out during world Mar II paid real dividends and contributed greatly to the effective conduct of subsequent opera* tlone.* •••** L. S. Pohl, Colne 1. UC 119 TRUK COPT EXTRACT (Letter, Rear Acfcdral C#B# Casaerer (MC), U.S.K., Tic tired dated 21 April 194B) **** “Along the general linos approved and followed during the progress of World War II, amplifying essential Military Medical training In Service Schools and Hospitals PRIOR to assignment to active “front lino" duties of whatever nature# It appears that the establishment and maintenance of full time Service Medical Schools becomes imperative in order to obtain uniform teach- ing and indoctrination of medical students who are prospective candidates for future commissions as Service Medical Officers*«** TRUK CQJT EXTRACT (Letter, T. F. Cooper, OSH, dated 19 April 19X8) ***** “In the interest of a medical military and naval arm, special courses in military and naval medicine should he established in all medi- cal schools* Taking the course should be obligatory. Officers teaching the courses should be specially picked regular officers of the Medical Corps whose business would be not only to teach but to recruit. The course would lead to a regular or reserve commission for those physically qualified. The Job could be combined with regular recruiting in the large centers and would at the same time offer opportunity for postgraduate training of the Instructors# "I believe the present training program to be excellent and hope that It can be maintained and expended. It will soon be seen that opportunity for self-improvement is far greater In the service than is possible in the practice of medicine as a civilian, Medical men will be attracted to the service by the high level of medical competence that will obtain. •Internships should te lengthened and all medical officers, regardless of specialty, should receive sufficient surgical training to perform traumatic and emergency surgery with a degree of self-assurance that is comforting to the patient, when confronted with such problems at sea or la Isolated areas.” ***** t { s L.K. ?OHL,vColonel#' IsC TBU1 COPT (XxtFMt tm Ltr AX ted «• kyer, Certain (ISC), USM, 17 April IW) •(b) Profess ionel tad e—rgetwy military training progrant* within the Axn&A Forces* •I oarcwQt on this question with « greet deal of heeitation dee chiefly to a tether Halted and narrow experience with Naval nodical eervlce personnel in the field cud little contact with thinking on nervine policy asking levels* ■However, It appears to wo that entirely too wneh ewph—1i is being Koed upon professional specialisation in the asdics! service of the Vm S* Navy* loally, in the poet, the Naval Surgeon baa bean an individual with diversified training which adapted hie peculiarly to the needs end reqaireeeote of the naval Servian in pesos sad *er« Further, it tended to devel p confidence and ability to ■eat nomal and aaaiganay eltoaiiona in Individuals* and, ahat la none to the point, a etnaa of xeeponeibllity and the wUISngnaao to aaeapt inch responsibility in eoaooatlon with their duties* . , •I do not find such attributes aapheelaod in the piaaent day* It appears rather that the mum of nedicel pereonnol art being encouraged* at an early stage of their earner, to seek specialisation in a Thin policy, even though predioated on a basis of urgency, is considered falleeleua and datrisental to the beet intereata of tha service* •The voting non who aar be favored by the aireanstanee of aaleotloa Magi op a amber of problem* •If pasidtlad to nalntaln profeeelonel profielenay and asnellence la hia ahoeen dpaeialty by salaetive aaaiynewnta* hie relative value far general aeelgneeat requiring broad ngesima is gpaatly diadLutehadU •If the individual in not given aalaetiva eaeignaenu which tend ta vnlafme bin specialty qualification, discontent in invariable* mis incomes i vable that all nadir al sencenal can be trained end beesse apenielietd la the accepted sense* This giwerlne to seoient mug thane net fortunate enough to be selected* •There is ne qaeatias regarding the value of the specialist la bin paHisalarf laid* Howovar, It in Iblt that sarvloa naade in wartsm should be filled tes civilian aslegorlei* In paeoetlwa* vaphaale toward epaoialisatlan ha diraotad toward Service fractional mllaiilaa in the brans he# which VSfiilw particular technical appreciative of tha prcbleaa Involved* •Ail aedJaal waa ardor ta or uaan indue ted into tha Service eMqld have a abort Indoctrination period* This period Should vmvpwe weaves vp w wp^p Infoiwatiee an aadleal cervine erganlaation, functianing, procedures sad a bread pletafs of service wasdi» ICaah discontent anong nodical personnel was sssewwtaewd daring the last war bsecaee of lack of usdevwtanding asoqg theae whs had wade m sapid change fra their peaeetine pppnit to as imfaslliar wtikUg sanriraasastp (Extract from Ltr Alfred W, Eyer, Captain (iC), OSN, 17 April 1948, cont*d) “Wherever practicable, short refresher courses in service hospitals should be given to personnel returning fro© sea or foreigh shore billets* This would tend to maintain professional standards and capability among those personnel whose duties required narrow limits of professional service Colonel, UC \ TRUE COPY (Extract Ltr Nellie Jane DeWitt, Captain (MC) USN, 29 April 1948) «****! *IL, CTRIMATI QlI AND DISTRIBUTION Indoctrination centers should be established at large hospitals in certain areas, such as - Rethesda, Great Lakes, Mare Island, Oakland, San Diego, and Portsmouth, Virginia# (a) These centers should be permanently staffed with personnel especially adapted to and trained for this assignment# (b) These centers should act as pools both within and beyond the continental limits• (c) Ship*s Service stores at these centers should be prepared to supply all necessary uniform equipment# The training period for indoctdnees should ochre-* four to eight weeks and should be followed by duty in the center giving the training, and should provide a total of not less than six months before assign* nt In another activity is per- mitted# During the training of these indoctrinees the importance of military nursing should be stressed, and they should be Instructed thoroughly in the handling of service personnel, and in methods of planning and organising their details, so as to require the least possible expenditure of time and energy# , Zndoctrinees should fas required to f aailiarlse themselves with military customs, courtesies, drill, and should learn to swim****** Colonel, MB 123 nn ocfi tobaw (mm, o«pt«t> h. s. mo, m da%«d S3 April 1948} ••♦♦••(B) PBOfXSSIOXiL JOB) MXLITAHT BQO&XBGT 1841 TOO OB^mZATZOBS yxpjgjsp.-Aiffip, — Che training of medical personnel to cepe with all type* of military emergencies received much attention daring the pact mar, and it would he highly unfair te criticise a method of training that proved so effective <« reducing the mortality rate of ear wounded. eeeeee TRUE COPY EXTRACT (Utter, Captain J. H. Robbins, (MC) DSN dated 26 April 1%8) ***• •Recomaendationet It would appear that the majority of these complaints could have been avoided if our Bureau could have in some manner prior to the opening of hostilities, informed all physicians of what the exigencies of the service expect from them and had some policy laid, down for their rotation of duty#* L. E. Pohl, Coloail) KO 124 TRUE COPY EXTRACT (Letter, Colonel 0. F* icllnay, «, Air Force dated 20 April 1948) ***** «b* Professional personnel should be required to participate in only a minimal amount of military training* Professional training should be as extensive as possible to the point of diminishing returns and dependent upon available time and personnel.* ***** imjmjm&l (Letter, Dr. Russel T. Lee, dated 18 April 1948) ***** "(b) Professional and military emergency training programs within the Armed Forces. •The so-called ’officers* training courses* insofar as they applied to medical officers were almost 100% wasted effort. AH the strictly military matter which a medical officer should be called upon to know could be gotten from an intelligently written manual in a few hours. Professional training courses were eagerly sought by medical officers bored to madness by inactivity, but with the exception of the tropical disease courses and the aviation medi- cal examiners * courses they were largely useless. The stupid malassignments of medical officers who had attended special schools were so numerous as to appear deliberate. Radical schools should bo asked to give a certain amount of military medicine of an ’indoctrination* kind ns part of the course and largely eliminate such training for doctors already mobilised*• ***** L, K. Pohl,M5el ■tbf irart Imti* •a* As a policy, peacetime training of reserve officers should be limited to medico-military training. The short time available for training of reserve officers must be used to adjust his professional knowledge to the requirements of the military service* His professional training is a personal, civilian responsibility and goes on constantly during his career as a practicing physician. •b* Specialists should be divided into age brackets, in addition to their classification according to proficiency. Those assigned to the active theater of operations, and especially those assigned to Evacuation Hospitals, Surgical Hospitals and cellular teams (6-500 series), should be in the younger age bracket* *c» Medical officers of the regular army who hare fully qualified in one of the specialties should be kept on such assignments during war as well as during peacetime. To relieve such officers f£om their assignments - as professional specialist in time of war, seriously retards their progress and reduces the efficiency of the Medical Corps in the post-war period. Their assignment as unit commanders ete, places them in positions for which they are totally untrained and reduces efficiency* "d. The individual training of certified specialists, whose duties in the army will be identical with those performed in civilian practice, should be omitted, except for training within the unit to which assigned* Such specialists should be ordered directly to their units for duty and training should be in addition to their normal duties* In making such con- cessions , however, consideration should he given to the fact that most of the criticism concerning mi suae of medical officers is due to a lack of understanding by the individual of military organization, functions, mis- sions, tactics and problems. Such criticism is most frequent among untrained officers* "e* The Arey Specialized Training Program and the Navy V 12 Training Program for the undergraduate training of candidates leading to the M, D. degree, should have been coordinated. One program should have been adopted and the output proportioned according to the require* ments of the Armed Services• t. K. Pohl, Coifinei, MC 127 TUBE copy EXTRACT - Continued - Colonel F. A. Bless*, MC, USA "f. Professional training of inedical officers during a period of emergency, should be conducted at installations best equipped for such training and standardised to meet the requirements of all the Armed Ser- vices* Consideration should be given to location to avoid unnecessary loss of time and travel funds. The length of courses should be coor- dinates with the training time available for long periods of preparation will not be possible in an accelerated mobilization training. •g. The technical training of enlisted men should also be standar- dized by the Army and Kavy, Since there is no difference between sick or men whether Army, lavy or Air Force, this would appear feasible* Thdrcnagh basic training should, however, always proceed technical training# “h. Military training of officers of the Medical Deportment can also be best accomplished at a center, or centers, such as the Field Service School. All officers, except qualified specialists and those with recent, prior service, should be given a thorough course of basic training prior to assignment. This training should be coordinated with the Office, Chief Army Field Forces. *1, The broad mission of the Medical Department is to maintain the fighting strength of our troops and this involves numerous responsibilities. There is a growing tendency to concentrate on professional training and to negleet the others which are equally important in the final accomplishment of our objective as expressed in the broad mission. Officers are assigned to command of hospitals and other similar units or higher staffs, without any training for such responsibility. The qualities of leadership, and ability to properly commend and deal with the many administrative problems of a unit, must be developed by training. If command of medical units is to remain as a function of the Medical Department, then we must provide for their systematic training so as to meet all the responsibilities implied in our mission. The selection of medical officers for other than purely pro- fessional assignments must be given the same thought as the selection of other specialists, and they must be assigned to such duties for practical training. A medical professional background is essential for such assign- ments. It must be understood that this does not constitute a misuse of doctors, unless we are willing to release all command, staff and adminis- trative responsibility and restrict ourselves to professional care of patients only. This would no doubt result in *a question as to the need for the ledieal Corps as a part of the Army and place medical service on a contract basis. Many medical officers who have demonstrated special ability and interest in this field of work, have requested and been trans- ferred for training in a professional specialty because of a feeling of less ef prestige resulting from suck other assignments. This most be overcome or the accomplishment of the broad mission of the Kedical Depart- ment will fail. Carter planning of Medical officers must be primarily based m the needs of the Medical Corps and not on the individual desires ef each individual* L. K* Pohl, Colonel, 1C TRUE COFT EXTRACT - Continued - Colonel P, A. Blasse, VC, HSA •j. It is believed that the training of apeeialiate is beyond the needs of the Corps. This should be given careful study to insure coordination with actual requirements. The lie!tod authorization of medical officers for Station Hospitals does not permit the assignment of officers oho can function only within the limits of a specialty# ■ere attention should be given to the need for general practitioners and station hospital requirements• •k* The training of Hedieal Service Corps officers must be care* fully studied and improved. There will probably be a demand to reduce the number of medical officers required by the military forces and this can only be accomplished by substitution of specially selected and trained Service Corps officers# They are not available at present and steps should be taken to select the best Medical Service Corps officers possible and broaden their training. Veil planned training courses in preventive medi- cine, emergency treatment of casualties, and other duties not purely pro- fessional, may qualify many- of these officers as replacements, lore must he sent to our higher level schools and the general morale and prestige of this Corps must bo improved in order to attract better candidates I. It, Pohl, Colonel, «C 129 TRUE COPT EXTRACT (Utter, Captain F. R. Urban (MC) US* dated 28 April 1948) ***** "(b) Professional and military emergency training programs within the Armed Forces. "(1) There was an excessive amount of military training for officers, especially in the Army. It has been stated that in some eases the ragged training program was carried to the detriment of health. (Amy) *(2) 1 believe a pamphlet about the administration, organisation, and routine reports of the Havy Medical Department in the field, ship and shore establishment be issued to all incoming medical officers mould be of help* “(3) Sine* cirilian physicians are avers* to regimentation, Military training should not be over-emphasized• "(4) It has been noted that there was a non-availability of medical reference texts and professional publications for tactical medical officers of the Army in the last war.* ***** L. K. Pohl, Colonel, HC rang COPI EXTRACT (Utter, Captain T. C. Grearee (IK), OS* dated 17 April 1948) ***** "Consideration should be given to the future of the Regular Medical Corps. Perhaps a modified 7-12 program should be considered. Carefully selected first year medical school students in terms of physical and mental qualifications night be enrolled in a Medical Training Corps on a basis similar to that of midshipmen and cadets, with regular medical school instruction given at government expense at the various civilian medical schools. Trainees could be required to spend a portion of the regular summer vacation periods receiving instruction in the military aspects of the Medical Services. Upon completion of the 4th year in medical school trainees could be given competitive examinations to determine their precedence within their class, after which they could be commissioned and ordered to duty as interns in Maval and Military hospitals. Such men would necessarily be required to serve a specified period of time in the Medical Ser- vices before their voluntary separation would be considered. "Routine professional instruction of the great majority of civilian candidates for the Medical Services is probably unnecessary* They are as well qualified professionally as their instructors, prob- ably more so, since they have been practicing in a highly competitive field. More attention should be given to teaching then the military aspects of the Medical Services* They should be fully indoctrinated in the fact that an Armed Forces Medical Officer is not only a phy- sician but a military officer as well and, as such, has definite re- sponsibilities and obligations which are distinct from those required in treating the sick and wounded. They should be instructed in these responsibilities. One of the unfortunate situations in the last war was the attitude of the Reserves toward their responsibilities in pro- moting morale by upholding discipline with justice and firmness and exerting the qualities of leadership toward their subordinates. High morale is a priceless Ingredient of a military organization and it stems from discipline and leadership at the top." ***** L. K# Pohl, Colonel, MC TRUE COPT EXTRACT (Letter, Colonel Robert E. Peyton, IK, TOA dated 19 April 1948) ■MM3. ianaggffiQnt afli fegM.grgMa* Management is just as essen- tial to medical success as are the purely technical (professional) procedures. The success of the medical service depends equally on both. I am sure that the Medical Department, unified or separate, cannot win a war, but I am confident that it can lose one. V* had in the Medical Corps of the Regular Army in World War II about 1,000 Medical Corps officers who had the versatility to provide a management nucleus for 45,000 other Medical Corps officers throughout the world. If vc cannot look forward to proper and timely management and leader- ship we will fail as soon as we are tested. I firmly believe that every regular medical officer should be given every bit of medical training in peace time that he can take, but on top of that he most be capable of leadership and staff understanding when the time comes that the A ray must mobilize for war. This is of particular import when time is of so much more importance than formerly. In peace time we cannot rely on the emergency officer to do our professional work, and in war time we cannot rely on the emergency officer to pro- vide the management nucleus essential to success. Therein lies the key to our training. In peace time we are forced to a duel mission — i.e., to take care of the sick and to train a management nucleus for war time. In order to do both these things, adequate provision of medical personnel is necessary, *♦**" /<>. (jf&U L, I, Pohl, 'Colonsi, He 132 TRUE Cop* (Extracts from Ltr Col* Hany O* Armstrong, MC, 16 April 1943) **•* a**d Military Emergency Training Program Within Ths Armed forces. (X) Defectsi (a) Insufficient medical personnel to permit wide spread specialised training* (b) Insufficient training in specialties required in military operations, such as plastic surgery and psychiatry* (c) araergency training at military professional schools often on a "quota” basis*. (d) Insufficient ackninlstrative officers trained to taka load from professional personnel* (2) Remedies i (a) Selection of key personnel for specialty training* (b) School assignments based on Interest rather than the use of the "quota" system* (c) General indoctrination of civilian components through extension courses or lectures* ***** L.K. POHL x Colonel, MC 133 TRUE COPT EXTRACT (Letter, Colonel Arthur B, Welsh, MC, USA dated 19 April 19A8) ***** *b. The Medical Department Mobilization Training Program in the Army Service Forces was well planned ami well carried out. Inspection of technical medical training was denied The Surgeon General. For example, within the Army structure The Surgeon General couldn't inspect air force or ground force medical training. It was much easier to Inspect the medical service of an oversea theater? The Army Ground Force Medical Section and Service Command Surgeons' Office were too small for the jobs to be done. Army •one of interior hospitals might well have 'sponsored* oversea fixed hospitals. "The Medical Department failed to provide schools for training higher staff medical officers, hospital commanders, and logistician* — particularly those required for army, communication tone, tone of interior, and joint staff positions. •The military Surgeon, a long established and esteemed position in military history, was almost overshadowed by bellows1 and 'Board members1. The pendulum swung too far toward specifUzation. Pro- fessional courses in field medicine and surgery and in preventive medicine should have been given to more medical officers.* ***** L. K, Pohl, Colonel, BC TRUK COPY (Extract from Mar W, H, Michael, Bear Admiral (Mb), USH Retired) "Efcergency training, I believe, was one of the weakest links in our utilisation of medical personnel* As far as I know it was left entirely and without direction to the Senior Medical Officer and almost always neglected. At Long beach Naval Hospital, I carried out this program for each newly commissioned officer reporting! 1# Immediately reading in my office a 15 page article! "You*re in the Navy Now," an article I wrote in 19A0 for the purpose of instructing reserves entering the service. 2, Accompany inspection parties until he had seen dll the hospital in every detail. 3* Spend a day in each administrative office. Beading of organization of the hospital. 5, Careful demonstration of field and non-hospital procedures at weekly staff meetings. 6* Explication of differences between Naval medicine in war and civil medicine." **** l. k. imV Colonel, IK? TRUE COPT EXTRACT (Utter, Captain R. F. Sledgs (UC) OSH dated 26 April 1948) ***** "2, (a) Professional and Military Emergency Training Program within the Armed Forces. "Consideration of Training Programs for regular and medical reserve personnel in Chemical and Bacterial Warfare and in Radio* logical Defense for each Naval District should be considered* Such programs could be conducted by the Army, Navy and Air as a joint program* Credit for time spent by the reserve forces in attendance could be handled in the same manner as any other reserve training time. However, while the basic training for the throe sorvieos is similar, there are principles of applies* tlon peculiar to oach requiring special training to meet the needs of that aorvieo therefore it is believed each service should be responsible for reserve training. "Reserve Hospital Corps Officers or Medical Service Corps Officers should be assigned to the nearest Naval Medical Supply Depot for a two or more weeks training. The Naval Medical Sup- ply Depot, Brooklyn, 1. T. can accomodate from four to six each Officers at all times. A Reserve Pharmacist has just completed two weeks of training and stated that his stay had boon vary profitable and instructive•" ***** L. K. Pohl, Colonel, MC 136 sm WUBSma «. b. s«ai.(HO). s. i«r. dated E Iter 1*48} ***«« «3c Professional and Military «morgeney training program la the levy dor lag World War XI fall far abort of what oould bara baaa daaa for adequate preparation of aadloal personnel froahly r acral ted from civil Ufa. This was doa la part to tba fact that, at least early la tba war, few of as la tba regular Xavy really knew what ws ware up against, aad tbara was too nob aisdirected aad aaorgaalsad effort at indoctrination. There should be (a). A continuous, well-integrated, progressiva, aad. If advisable, repeated prograa of Ins trust loa for aadloal officer* af tba regular Service* to Include (1) Professional subjects. (2) Military applioatioa. (3) Personnel Management. Tha current courses at Zdgnood Arsenal are a long stop in tba right direction. ;uu *. o. (tee), on bM U April 1948) ***** ' Za view of tho possible oar requlrenente of acral nodical •ervloo, it i* hollered Mit desirable that a« massy nodical personnel at porooaaoX ceilings vlll pomit attoad aa ladootriaation course ia tho nodical oopocto of anphlhlens warfare. Such a course night wall ho established no a joint anted force* projoet. fhio recomnenAction it nado la view of tho difficulty encountered by the Bureau ia aeetiac it* obligations daring the Inst war and ia view of the Tory Halted masher of nodical officers and enlisted non now familiar with Medical field Service. • ••••• It. E. PoU, OoloMl, KO TRUE COPT (Extract Ltr Albert T, talker. Captain, *C, USR, 26 April 1948) **** "With respect to professional and military emergency training program within the A mod Forces, I believe a great deal of this should be accomplished in the medical schools and after gradaatlonwhile medical officers are in a Reserve status as 8tat d above and should not be left for the emergency period when the services of all medical officers are going to be required on a full- time basis# During the last war, we bad too many medical officers tied up in training programs and other unnecessary duties which left those of us in the field with insufficient help to handle the casualty and epidemiological problem* properly* Should continue throughout the medical student's full course as a part of his obligation as a doctor to his country."**#* Colonel, MC 154 TBUE COT (Extract Ltr M« C* Stayer, Major General, U* S* Amy, fie tired 19 Apr 48) «HW»(b) Professional and military emergency training programs mi thin tbs Armed Forces* It is ay belief that It is highly necessary to give men training as was done in the military emergency training programs during the last mar* Many of the men taken in do not understand the profession of arms and should have an education that mould integrate them with the Armed Forces* Professional training has been given these in- dividuals, and I think it is a duplication of effort during an emergency to give any further training of this type, except in so-called tropical medicine* Such a school was established in the Canal Zone «****» itfk£ Colonel, 1C CBM COPY H«AQf {Letter from 2ear Admiral A. H. Bearing (MO), 98V dated 26 April 1948) ***** *(%) Professional and military emergenay training programs vithia the Armod forces. fhs vrltsr ohserred several inst&nces la which premia lag young surgeons vers placed andor the training of older and experienced individuals la Saral Xespltals, qpea the request and reeommoadatloa of the Medical Officer la Command of the hospital, only to hare them ordered away vithia a short period after starting their training, fhls created am Impression among the experl eas- ed specialists of the leserre who vaa sailed vpoa for training these men, that the detailing authorities la Washington did met hare any firm policy vith regard to training.# ***** /) > ' 'rX. t. Pofci, CoIomi (no) 156 TREE COPY EXTRACT (Letter, Colonel R. t. Stone, MC (Res.) Air Fore# dated 22 April 1948) ***** "When mb in the eerviee are needed for advanced training, feel that aore careful consideration should be given to the selection of that personnel. Only have knowledge of personnel sent to the School of Aviation Medicine for training in Flight Surgery. It is ay conviction that too often a Base Surgeon used this aeans to cull his staff of the less desirable personnel and those persons with the personality, tact and ability to sake good Flight Surgeons were thus deprived of the training. In the end, it was the Medical Service of the Air Faroe that suffered froa such a practice.****** t. K. Pohl, Colowl, MC 157 TREK COPY EXTRACT (Stter, Colonel Burl Maxwell, KC, Air Force dated 19 April 1948) ***** *3, in general, it sensed that the Cossanding Officers of the hospitals cosing overseas had had Insufficient training, hut the resainder of the personnel were well trained* Therefore, it would sees indicated to give Cossanding Officers additional training."***** L. K, Pohlj'Colonal, MC TRUE COPY EXTRACT (Letter, Colonel C. J. Baker, MC, Air Force feted 22 April 1948) **♦# Bb. An indoctrination period of training, both professional and military, should be attended by all who are coralssioned directly from civil life with no previous medical reserve corps training. Courses should be on a different plane Bar veil qualified specialists who will serve only in hospitals or as consultants; their course should be de- signed to familiarise them with military procedures and methods only. It is also ay belief that a comprehensive course in military medicine should be included in all medical and dental colleges.” **** L. K« Pohl, tolonal, HC tpgg COFI EXTRACT (Letter, Dr. Martin Karr • dated 3 April 1948) #li far as indoctrination is concerned, I think this could wall bo taken care of by making it mandatory for this group to attend classes, either one a week, or in the evening, or twice a week, or any other stated time, so that they would be up to date on the Army*a latest practices and problems so that if they were mowed from San Francisco to Berlin, they would still be able to carry on and not be as civilians who would suddenly have to find themselves all over as far as an Army routine is concerned•* > L. K* Pohl, Colonel, MC fairs SXTR&.GT COPT 0? MEDICAL SUPPORT Of THE USAAT Hi THE KSDITSBSMSM THEATER HISTORICAL SKJTIOU - APi'AS ********* jk * One surgeon suggested rather caustically that It should he coia- pulaory for the commanding officers to attend these schools, for it was his nexperience ... that lack of appreciation of the problem and Interest la appli- cation of control measures by commanding officers has been and continues to he the aost cause of the breakdown of malaria discipline. *♦•***♦*♦<' T»Dw»V^Co,lonel, NO 161 mas copy (wee nuK asu u*s* mmmAM ma is mat ms) *,«>,* «xt appears to ne in the final analysis failures in this were due to tbe leak of intelligent indue irint Ion and orientation of toe war ti*& inducted fleeerre hediuel Officers* Shie opinion would appear to be verified la the few eaaaplea of peeper indoctrination noted* la these instances die* satifaction* were inf request* The oft heard ejcouse was, of course, that ve were observing too stony flue, capable heguler Off icon with unusually hsav> deeands on their Uae and energy who still found thenselves able to advise and help eoae of the confused he serve Officer* under their cosuuaad* The chief difficulty arises free the feet that no where la the peace tie# training of the regular sorvic&s ere officers taught that la the event of war non? thousands of civilians will he inducted into th« fo cos and since it is not feasible to endoetrineto a large fr>roup of civilian doctors in peacotiae this responsibility nitet always devolve upon t|« Seculars* It le essential, therefore, that in ponce tine heg- nlar Officers amt be trained to understand the eleaente of the problen and he adequately prepared to effect a rapid yet thorough and intelligent ladoctrinn* lion of these civilians after induction* In the past, although the pattern has been repented with every war we have fought, this item of training has been neglected and the regular forces are caught short each tine without the •know how* when war begins* Implicit la this breakdown is not only that the Jbbgulh* falls to do his best lob la war Une, but he creates a large and influential peacetime group that is antagonistic and even hostile to the Anted forces during peacetime. In closing I night say for the record, that while instaacee of in* adequacies on the part of ha serve Officers was practically unheard of, never* thelesa it is conceivable that senewhere in this large there nay have been a stupid ass who did aet contribute substantially to good relationships between the two groups • or anything else for that natter********* SJCTHAC7 OF STATJMIBI UAJM M» dolonel ?tr»feic **« »egt4Mny»it# MC« on 22AprH 1$>U8 at intanriwr with on "i&T Sipiogaant of Miiliary iSejicail aenJurcg* ***** »(B) x« 1 certainly do think it1* neoeseary to give all medical officer* a basic military course on erasing into the service* I have had little experience in training ma&oal officers in wartime* I don’t think they need very ouch* I think that It can be brief and informal and possibly even could be given at their original station* X don’t think it needs to involve hording together large groups of these people for a month or tvs and having them pack their equipment around and pitch pup tents* ■That sounds like a quibbling answer* I don’t mean it that way at all* It’s necessary, but it can be practical* brief, and to the point, and I believe in most instances at least can be given at whatever station the medical officer is being seat to for bis original assignment, and it shouldn’t be restricted to junior officers* Everybody should get It* ■1 can’t answer Mo* 2 at all* ■Me* 3, X ought te be able to rawer. X had the extension courses for a little while at Grant* Z doubt if extension courses on purely pro-* fosaional-type construction can be mads sufficiently instructive to justify the effort that is entailed* By that I mean Z don’t think that we can keep at oar schools, or at places where we prepare these courses, doctors and reviewing officer* who are suffieieutly up te the minute professionally and who can afford te take the time, the great amount of time involved in pre- paring professional-type courses* ■As far as professional training on their entry into the service, that, X think, iu entirely an Individual question. X don’t believe that X can make a general statement as to how much professional training these doctors need when the/ come in because it depends upon their background and on the type of job they are going to be given when they come in to the service* ■U(B), As far as the demonstrated value of extension courses few reserve officers, X believe it’s shewn te be as important as most mj type of training given te reserve officers. X think they get out of It what they put into It* I thixfc that a person who Is expoeed te training Is bound te get some good out of It, even thou# he may not recognise it at the tine* n think that extension courses for reserve officers should be given In fields in which they can’t radlly get the material locally, end X think that extension courses should be given only as pert of a recognised program for the reserve corps# •I think It 1b (till rabbet to decision at higher lard whether the extension course® now being given ere going to credit e son toward promotion or something dso»* 1. *b) cont*d 1, £TWiCf OF STATEMITS &EB 33f| doionel t«eaierwii# BdO. on 22 April X9U8 at intcnrieg with on the 'of Military Medioal rnmm ■I donft believe they knew that yet. I think a man who takas ease* thin-: like that, that eonsumss a considerable lot of time, should know it'e port of an over-ell training program which lead* him toward consideration for promotion. I think courses that are properly written end intelligently graded are of considerable value. "6(B). Tee, I definitely think so, X think the only way you can . make a medical soldier is to train him, and I think that that is different from the officers because the officers have professional background when they coos in. These people come £Toa all walks of life and from all sorts of avocations in trades, and many of them have had no medical connection whatsoever, and all of a sudden they find themselves in the medical do* partment, I think they should have a very definite concentrated and thorough course, starting at a training cantor and continuing aslong as they are in the service on the Job.**tHMNi ■8(B) 'See. It*a one of the projects we have right now, is how can we keep cur Army medical men from being dissipated from being pushed into all sorts of other fields, and we have Just finished a staff study on that in which we have recormaended very strongly that regulations be re* written to protect the medical department enlisted man.****** "(a) 31* X think in answer to Ho# IX that training facilities la armed service hospitals for selected civilians would definitely engender better mutual understanding of our problems* 0ndarstending of problens always tends to iron out difficulties which are usually caused by lack of understanding of other people’s probl^aaq t. r. pm, t mm COPT WBACT OP INTERVIEW WITH COLONEL TIHGIL CORNELL, NO, UaA. SO April 1948 ********* B. "Professional and military emergency training programs with the Armed forces” - She over-all need is a continuity of the program to a definite end. I have seen many training programs started hut none finished. Policy changes so fast that we never were able to maintain continuity of any single training program. I speak of that particularly with respect to our own branch in pathology. We have tided many ways to train them, hut the men would he pulled out and pit on something else. I think that's one of the reasons for dissatisfaction. A. permanent hoard of service and non service personnel who would he qual- ified directors. Probably not more than one replacement a year might produce con- tinuity of program. Screening of personnel early to avoid waste of time on inept personnel. 1 feel strongly that the time we need to weed our officers is when they come up for their first promotion, and I always have fait strongly on that. The time to get rid of a man is after Ms first three years of service when he comes up fhr captaincy. The time to get rid of a resident is in the first three months. I recently had one for two years. I tried to get rid of him for a year, and I couldn’t. I think that everyone supervising personnel should txy to weed out the ones that aren’t going to make good early. We waste time on them which we could srAch better apply to someone better qualified. Of course the old one of avoiding Imitation in stagnated or Inactive post#. Avoid purely administrative medical men by returning them hade to professional duties periodically. That is diametrically opposed to General Hawley’s idea of an admin- istrative corps, I feel very strongly against that, X don 11 believe we will ever do any good to the services by having a purely administrative corps of medical men, X mean; men who become only what the services commonly used to call •brass hats1, Xf that is to be done, we are so definitely going to divide the corps into a pro- fessional and an administrative group that they would become two distinct corps. Xf we need a corps of only professional men Just to tsko care of sick and wounded; train the men in those hospitals to take ever the professional duties of the sesvioes. However, I feel that you cannot separate a professional knowledge of narration of medicine from the administrative phase of the work. The minute a man loses his professional attitude and becomes entirely administrative, he cannot understand the requirements of the professional side of the game. 2 think General Martin agrees somewhat as I do on that, although X don t speak for him; only for nynolf. 2 will say this, however* the reason X make that reman* is because Gen- eral Martin always backed us up on professional things without in the field looking after the professional side of it. We didn’t have to argue professional ideas with him. We have always had to struggle with under-staffing so that rotating to educational schools was meager, Ve need at least five to ten percent over-strength to permit proper modernizing of medical manpower. Several times in my career X have asked for details where I felt X could better myself with the service, and have always been met with the Idea that X was needed in the field somewhere. That has been the ease with maay members of the service, X know. With leave time, sick- ness, school details, we need more men than are actually called for, and we can’t TRUE COPT EXTRACT OP IKTMVISV WITH COLONEL 7IB&IL CORNELL, mC USA 30 April 1948 H flftOTT'iil'IBQ* train men in these other details unless we have more than the actual number re- quired for staffing. I also feel that some of that training could he well acquired outside of the US. I had that driven home perhaps a hit in ay trip through Central Amer- ica just before the war when for the first time I realised there were many things going on in those countries that we had never heard about. We knew nothing about their diseases* and there is no place you can learn about them as well as in their countries. 1 feel that such centers as Brasil* Columbia* right in our own hemis- phere* could teach ue a lot. I believe the young officers need earlier training in staff liaison. It has been a bit of the policy to beach, you might say* the level of company medical administration to the younger group, and only to the majors and lieut- colonels staff liaison became more well inculcated in them, but the junior officers jump a couple of grades and immediately need that staff liaison about which they know nothings so 1 think the training of junitr groups should be on a higher level for future use. They are the ones that are going to have to do it from the regular service. I think we should coordinate the general military training of all med- ical personnel through our state and county medical societies with perhaps officer details to regional groups. Stress to the medical profession by good represent- atives the new ideas that are being developed. They are all eager to hear about new supplies, new development, new equipment, blood procurement programs, atomic and bacteriological warfare. X think they would welcome such information and would like to ask questions about the service that could be answered in person, and that the service in general could be better represented to them In that way by personal contact. I think you have the general idea of what X mean there. BBIQAB1S& GSH1BAL MARTIN; Shis Committee is particularly interested in elements affecting the medical services in the combined forces that must be accom- plished now. Bo you favor, in furtherance of your already expressed opinions, the establishment of some form of medical Institute at some medical center composed of outstanding scientists, both service and civilian* which would principally gather the information of the past and that currently under Investigation regarding military surgery, medicine, preventive medicine, atomic matters, and biological warfare matters; and further, could this institute give resident courses of various types to service personnel, civilian practitioners, and so forth, and further pub- lish to the medical profession the results of their findings, Including material for undergraduates* PH847*6, et cetera? C0L0S8L COHHZLL: Would this bo on investigative group or would it be a teaching group? BRI&ADIXR 0BN3RAL MARTIN; BOTH. COLONEL CORNELLt Who then would be taught? X would like to get that clear in mind. BH1SABISK CBSEML MARTIN; The entire medical profession. COLONEL COBNXLL; Both within and without the service? TB*2 COPf ..XTHACT Of IHfSBTIXW WITH COLONS! VIBOIL COHNBLL, MC, uSA 30 APRIL 1948. a sfinawgp.;. BRIGADIER GBHSHAL MARTIN; Tie. that would be used in any future mobil- ization of medical manpower. OOLOUSL CORNELL; I believe that the Inculcation of a new Idea and the introduction of & new plan of doing things like everything else is best begun with the youngster. You can*t teach the old man to like doing things new ways. I be- lieve that if we could get a group of younger men who knew they were coming into a combined medical service — let’s say the US Medical Service, and that they would be allowed some choice, would never be stymied in — let’s aay on sea duty for tern years, £0d never get back to a general hospital, or they wouldn’t be sent out to some small poets and left there to do email post duties ell their life, and were going to be able to carry on progressive medicine with perhaps details in tropical areas and details somewhere else, always coming bade end being refreshed in their medicine, I believe we could interest the youngster group la each a service. We hare seen recently a lot of young men cone in with the idea that they did not want to stay Ih the service* hut out around Walter Seed where there is lets of medicine* many of them have found out that they can get reel medicine in the eervlce and they will stay in after they have their residency depends a lot on soma of the things I have mentioned like continuity of training* keeping them in prof- essional work, having them understand why they most do certain nonprofessional duties - it's just like wiping dishes at hone. There are some things like that have to he done. BRIGADIER GENERAL MARTIN: THAT• a all I have. COLONEL CORNELL; X thin;: in general that the scheme would he a good one and tht it might he veil to approach It on the 'TrffrcPbHL . MO TEliE COPT BITE/ OF INTERVIEW WITH REAR ADMIRAL MORTON D. WILLCDTT5 1C) DSI 4 May 1948 ~ last *•*•*»• R, B U© you have any comment to make on emergency training early In the/war, or during the last war? REAR ADMIRAL WILrCUTTS; 1 hare the highest trihate to pay to igar reserve doctors In the Navy in the last war, who came to oar hospitals. They were highly skilled clinical men who were able to train oar youngsters not only in clinical med- icine bat also in traaaatie surgery and in things pertaining to emergjipnoy service. They were able to carry on in San Diego, if you will pardon me, interne ship that is superior or equal to anything in the land today. At San Diego an interne cospleted his 12 months rotation with a score of several appendectomies personally performed, with the required number of deliveries on babies, tonsillectomies, eye examinations, fractures, and everything pertaining to not* only civil medicine but to our needs as we saw it coming rxp in the Pacific. The training was under war conditions, but the clinical material was so rich and so great that I know the youngster in the Navy on the West Coast had good training. Bow the ppor devil who got out on the ships and stayed out months and months surely didn’t get obstetrics and very much general medicine. Bat by rotation of services, I do not believe that the levy training was too badly off. HEAR ADMIRAL ANDESSOI: I gather then that you ..feel that the place to give what training is necessary for a medical officer as at our hospitals. REAR ADMIRAL WILLGOTTS: At our hospitals and hospital ships. KBAJt ADMIRAL ANDERSON: Do you feel, la the Navy at least, our officers should have special training for their administrative duties aboard ship? REAR ADMIRAL WILLCGTTS; I don't think so much for administrative duties as for the special duties. BEAR ADMIRAL ANDERSON: Tes, Z mean for the special duties that come to a doctor on a ship. SEAR ADMIRAL WILLCUTTS: Oar Reserve program, is such that oar doctors are la daily practice and training because they are carrying on professional activities. They are not well trained, except the veterans, in preventive medicine, say, in am- phibious warfare, for duty with the Marines in the field, with medical aspects of atomic bombs or bacteriological warfare or any of the special weapons. That is where we hope to emphasise training with oar Naval Reserve medical officers —- in subjects other then clinical nedibine that is so commonly thought of when you speak of a doctor. We feel that our laval Reserve doctors who are graduates of Class A medical schools are sufficiently trained professionally. They do nedd to be alerted as we pick up special weapons, and especially in preventive medicine, sanitation, field medicine and amphibious warfare. HEAR ADMIRAL ANDERSON: Bow can training be given medical officers in our Service for staff duty? What I have in nind is that Naval medial officers on staff duty in the Pacific, particularly on the planning staffs, encountered many diffi- culties because of their lack of training in that kind of work. REAR ADMIRAL WILLCDTTS: I used to marvel at Admiral Adnerson’s office in the fleet carrying on logistics for the most enormous flotille of ships that was ever known. We had at one time 91 percent of the Navy in the Pacific. But there I think we must depend spun our Regular carter seen for staffwork, for logistics, for TKEE COPT EXSRAux* OF IRISRTI2W WITH REAR ADMIRAL MORTON D. WILLCUTTS (MC) USN 4 May 1948 1 OQHTISB1D: that specialized form of Hav&I warfare* As a Reserve they don't get interested; they don't keep abreact, and they can’t. They are too busy, from the knowledge of the last war we hare doctors attached as students at the War College, at these logistic schools, and especially trained to take up this part of the strategy of the next war that our Reserve Naval nodical officers could not possibly got without special incli- nation ar special training for it. MAE ADMIRAL AHDSRSON; What training should we plan for onlisted non of the Medical Service in the levy? I refer to enlisted non that are drafted or inducted dur- ing emergency. MAR ADMIRAL WILLCUTTS: I think our Class A schools for enlisted non cover- ed that vezy wall. We have good schools on the last Coast, West Coast, Croat Lakes. There subjects and basic sciences were stressed - first aid, laboratory, x-ray, and all those points. So X hlnk within 6 or 8 moths these youngsters can all bo trained. BEAR ADMIRAL ANDERSON: Those are the Hospital Corps Training Schools. HEAR ADMIRAL WILLCUTTS; That's right. MAR ADMIRAL ANDERSON: Tour idea is that the hospital corpsmen can receive hie preliminary training, military as well as technical, in those schools. BEAR ADMIRAL WILLCDTTSL; That's right. BRAE ADMIRAL ASDSB30N: It is not necessary to have special camps where they can be sent. REAR ADMIRAL WILLCUTTS: I do not think so. Of course they all go through the training camps. They must be taught the fundamental of the tailor, and that, dur- ing the war, was cut down to a very few weeks; and then, depending upon the and the deswnds, our Class A Schools turned these boys out in good fashion in a period often as low as four moths. But wo preferred the 6 to 8 month's course. At the moment it is cut down to 6 months, and then a SO day period in our hospitals. REAR ADMIRAL AHDSRSOH: Is there an. thing further on training! {no answer) MAR ADMIRAL ANDERSON; This Committee is particularly interested in elements affecting the medical service in the combined force that met be accomplished now. Bo you favor, in furtherance of your already expressed opinions, the establishment of some form of medical institute at some medical canter composed of outstanding scient- ists, both service and civilian, which would principally gather the information of the poet and that currently under investigation regarding military eurgezy, medicine, preventive medicine, atomic matters, and biological warfare matters; and further, could this institute give resident courses of various type to servieo personnel, civilian practitioners, and so forth, and further publish to the medical profession the results of their findings, including material for undergraduates, FMS&Ts, et cetera' BEAR ADMIRAL WITLCOTTS: Z do definitely. That could be carried to the AKA conventions as an exhibit. Mm Admiral M»ms eaid*jftu had thiegareeletu bulletin which we all uni »o ««eh* May we hare IMs Savydfeve hetteav tht It is act reviewing the thihfs that should >e reviewed. THUS COPT ?RACT OF INTERVIEW WITH REAR ADMIRAL MORTON D. WILX ?TS («C) USE 4 may 1948, jossmssajL HEAR ADMIRAL ANDERSONj This same question has come up with the Bureau, and I hare the file. Their answer was that the Naval Medical Bulletin and the Med- ical lews Letter form the means by which the Bureau publishes these technical de- tails. But my idea is that it Is scattered through the bulletins and they are isolated articles and concern details. They don11 pick up the things that are needl- ed practically by the men in the medical service waxy often. That is needed is sene- thing just like the Amy Technical Bulletin, where the treatment of wounds, of em- trealties, and hearts, and so on is hut a couple of pages so that you can sit down and read it add bare the essentials. The sane thing would he true for a thousand other conditions that the doctor meets. It would he a concise statement that in- cludes the latest in concrete form — Injuries from atomic homhs and new things, and the eld things, hut put together not necessarily as a t est hook hut as n bulletin, loose leaf, so it can he revised easily. REAR ADMIRAL VILLCUTTS: Sot as a hook. I like the idea - old things. There are many old things we need to review. HEAR ADMIRAL ANDERSON: The bulk of it would he the things that are facte that have been long since established. So one nan has got than all in Me head* And when he get# to a particular section, he will have a reference that he can go to and get the dope. REAR ADMIRAL WILLCOTTS; X think It could host put out nodical subjects. Every war hat brought out the fact that we have failed in malaria, in dysentery. RSAS ADMIRAL AKDSRSOHj It’s a ▼•xy wide field. The scientists and experts who are assigned to the Institute or school, or whatever you call it, weald he the people who weald have to decide that, i**eeeeeee £1L POB<* COLOSS., KQ THUS COPT EXTRACT (from address of Major general Albert *. Kenner, MO, USA, 18 Me/ 1948) ••••• MAJOR OBHXEAL XBHHXSt MAe to the next question — professional and military ssergmojr training progress within the Armed forces — 1 don't see why ve should hare any training for specialised lectors whose oon> template* asaiganent presupposes the continued performance of their pro- fessional voile, for instance, if you pull a noted surgeon into the Services and assign him as chief of a major surgical service, what training in the military sense should he need? There should be comprehensive training for doctors to be assigned to tactical units basic with the medical department and tactical training units basic with the medical department and tactical training with troops in the field. Z am Just speaking Of doctors. ****** ***** BRIGADIER aXNBBAL MARTIN* I would like to ask you a question. In your experience, is there a need for an armed forces medical intelligence agency to establish and maintain on a current basis worldwide medical in- formation that is so essential to planners for global wart If so, what organisation seems most practical? MAJOR 0B5NKBAL KBNHBRi Z believe it is essential in long range plan- ning to have a proper and current idea of tho nodieel information, or morbidity situation, throughout the world. That may bo aooompllshod by coordinating with two agencies — one is the State Department where the Consular Service famishes that information. However the consular fellow is usually net capable of evaluating a medical situation. The next would be probably as a branch of the M.Z.A., cr Military Intelligence — to have n medical branch in that, or else under this thing Z mentioned before cot up as a section under medical rascarch. BRIGADIER GENERAL MARTIN; This Committee it particularly Interested in elsmente affecting the medical service in the combined forces that must bs accomplished now. Do you favor. In furtherance of your already express- ed opinions, the establishment of some form of medical institute at some medioal center composed of outstanding scientists, both service and civilian, which would principally gather the information of the past and that currently under investigation regarding military surgery, medicine, preventive medioine, atomic matters, and biological warfare matters? and further, could this institute give resident courses of various types to servlet personnel, civilian practitioners, and to forth, and farther publish to the medioal profession the results of their finds, including material for undergraduates, PMS&Ts, st ostsra? MAJOR GM1HAL KKNHBRi I think there should be eet up an agency such ae you propose at the highest level? and I think, furthermore, that our Secretary of National Defence would be very remise if, in the event of am saorgonor* |h# pvUli wsro not tftriicd m to that Munma thgjr should know tho offost of (tana a»d othor ngrs. Thoor should kaow snouts* shout tho •Taptons of ssrtaia hiologlaals to ho ahlo to pfstsst thsaoslTss, Xs thsro anything olssT" L, X, Pohl9 C&loa«I, MO TKOb COPT EXTRACT OF INTERVIEW WITH BRIGADIER GENERAL JOSEPH 1. BASTION, MC, USA (RETIRED) ON 3 May 1948. *»*•««*»« m gjfcig Committee la particularly interested in elements affecting the medical service in the combined forces that must be accomplished now. Bo you faror the establishment of some form of medical institute at some medical center composed of outstanding scientists, both service and civilian, which would principally gather the information of the past and that currently under investigation regarding military surgery, medicine, preventive medicine, atomic matters, and biological warfare matters; and further could this insitute give resident courses of various types to service personnel, civilian practitioners, and so forth, and further publish to the medical profession the results of their findings, including material for undergraduates, PMSftT't, et cetera? BRIGADIER GENERAL BASTION: I certainly do* I don't know about (b) "Professional and military emergency training programs within the Armed Forces", Do you mean as applies right now, or when M-Day comes, or when? BRIGADIER GENERAL MARTIN: We believe right now, before any actual calling to reduce the wastage from professional duties that is bound to occur if we wait until K-Day to bring doetors in and then begin to train them. BRIGADIER GENERAL BASTION: Tou have to set that up, but that's going to take a while, and I should think the professional groups, AKA, and Dental Assoeiationi and so forth, ths high "brass" In it should bs made to understand this thing and start programs right away. There are certain things that they can teach in their every-day work. As for the ni«m, and so forth, I suppose that summer training will go on just the same. What I am trying to bring out, after hearing you, the only thing you can do right now is to make high people in the AJ(A, as Z said, the dental associations, and all the other professional associations see the light and start programs right now, Z believe it can be done. XVs going to mean an awful lot of work, but Z don11think that the average person realises what's gding da at all. I do think ltf» a professional thing, hat I think it's neglected la that wo don1! emphasise It enough, and that le the preventive medicine or health teaching; for after all, if we can prevent these sporadic things that occur, even accidents, we don't need all these hosnitalethat Is. we don't need all the beds during the peacetime.eeeeeeeeee 'L.JL POHL/ MmsL* MO D_lc. GENERAL POLICIES RELATIVE TO ASSIGNMENT OF MEDICAL PERSONNEL INCLUDING USE OF RECOGNIZED SPECIALISTS AND CON- SULTANTS 1. aiaoussioa l* There It considerable variation of opinion in regard to assignees t methods and nuch critic!sm of the overall nodical personnel aanageatsnt as existed during and following World War IX. tioas are node freely for assignment to duties hoot qualified to per* form; for proper utilisation of specialists; for centralited Medical Department personnel control and against such control} for fin rota- tion of hospital and field assignments; for permanent assignments so ao to limit wattage resulting from frequent transfer he tween unite; for age Unit restrictions and mere careful scrutiny of physical limit- ations which should restrict officer concerned to certain assignments; for utilisation of interviewing hoards to insure proper placement; for assignment in accordance with the individual*e desire; for phasing of the assignment of skilled professional personnel to field unite in accord* aaee with their anticipated need therein; for and against the presence ef many surgical specialists in forward areas) for avoidance cf ever* staffing; for the desirability ef overstaffing to allow removal ef Med* teal Department personnel from replacement pools; for assignments to re- serve units of varying category for mobilisation purposes; for and again- st assignment cf non-aedleal officers (Medical Service Corps) to relieve the majority of professional personnel from other than purely professional duties; for desired policies relative to assignment and utilisation of lagular professional personnel components; in regard to policies relative to rank end its relation to assignments; end for the Command level in vhieh consultant services are deemed meet desirable* 2* Bather uniform agreement exists that the everall consultant or specialist advisor utilisation as Medical Staff memhate was sueeessful during world War IZ and should bo eentinued* Zt has boon pointed out that there were Instances of nal assignment resulting therefrom when employed in other than major command Medical Staff echelons; that such staff ad* visor requirements could bo had frequently by utilising individuals from nearby hospital organisations. 3* The joint uee of civilian consultant and specialist advisers and teaehars in dray* Wary and Air three institutions was discussed and the following factors deemed pertinent for considerations a* In peacetime, the time that civilian eeneultante can be available to the mllltaiy Is ea an average of two half-day* par week* Where possible use is contemplated by two installations within reasonable distance of each other, the wasted travel time is a major factor* Zn view of ouch time limltatlone, generally speaking, the joint utilisation ef the cane specialist consultant is not practical. b« Zn wartime cad in the ease ef recognised Military Fro* feesiosel Specialists, full eo-utlllsatlon of such recognised specialists and consultants it more practical* Chic applies to Headquarters Staff, Hospital amt field consultant utilisation* It can be Implemented in most instances by local arrangement and should bo stimulated and planned for by highest echelon Medical personnel offices concerned* 4* The duty assignment of professionally trained officers nerits the most careful consideration and should be predicated upon up-to-date classification as to training, previous experience and war- time capabilities and adaptabilities. The •■umbor*" or •bodies* net hod of assignments without proper previous classification is conducive to aalaseigrunent with resultant great wastage of effort and of uadi dal man- power, Assignments as made and as they probably will continue to be made in event of another emergency say bo classified into two main groupst those mad# on the basis of available classification date (often totally inadequate> and to fulfill a "number requirement*« 5* The breakdown of assignment of Nodical Department pereonnel as evolved from the last war was largely for a Staff consultant Nodical Department Advisor to make recommendations for that purpose to the per- sonnel branch concernedi Specialist Doctors by the Staff Specialists concerned) Dentists by the Dental Surgeon| Nurses and ether female com- ponents by the Chief lures; Staff assignments as desired by the Chief Surgeon of the Command concerned* 6* The desirability of Regular Officers continuing in professional work in tint of war with i nor eased utilisation of Aoservo of fleers to bo Commanding Officers is considered a sound policy by some. The main benefit to be derived therefrom, would bo e more adequate supply of professional capable medieal officers of the Regular exponents, upon demobilisation. 7, The recent American Medical Association questionnaire (1947) revealed that from 20,001 Amy replies, 4,751 (23,8$) felt they should have had and needed better assignments; of 5,727 lavy replies, 1, 448 (28$) felt personnel could have been used mere effectively by better assign- ments* Small percentages adked for lets rigid methods of assignments nod transfer, rotation of duties, assignment according to previous training, bolter assignment of doctors and replacement of non-efficient doctors* All comments (100$) made, referred to the same Idea that the numbers of doctors in the service eouli bo reduced. Alto 100$ favored the assignment of medical officers to purely professional duties* The questionnaire dealt with non-profdeslonal duty assignments and such ue$age of professional pejv sonnol. Boaprofoseional duties, as described. Included; Administrative, non-medical military, food and sanitation inspection, training of per- sonnel and first aid* fhe alula!strative group included administrative respoael- bill ties, paper vork, reports, Commanding Officer, Beards, Executive datles, aedleal and miscellaneous supplies, ourt* martial, I area to rise and property responsibility, records, welfare aad recreatioa, censoring, mess officer or treasurer, hospital admlni strati on, auditing aad financial duties, legal duties, duty watches aad postal duties* The non-medical military duties included; inspections, non- medical training, drills, tactics and maneuvers, hikes, lectures, marehing, use and maintenance of weapons and equipment, gas and chemical warfare. 175 military conitmetion, ceding board and intelligenee duties. The food and sanitation group included} general sanitary Inspection, kitchen and latrino Inspection, Inspection ef buildings* wards* food Inspection* medical inspection of personnol and insect contrcl* The training of personnel groups of duties included: Training of aoa in military duties, training of non in hospital and medtal duties* first aid instruction, and physical training* Finally* the first aid dutias consisted of teaching first aid to various groups and minor laboratory duties* 8* To avoid nalassignaont and insure fullest use of aost critical dental officer personnel and their assistants as veil* their operational con- trol la cellular units free Division or comparative Command high Bsadquart- ors appear* nest logical and was recommended* U. CflBM8I&88 1* That importance of proper duty assignment ef professional Nodical Department personnel eanaet bo ovsrsaphatised. Dissatisfaction with assignaants aay ba eoasidorod on# ef the primary causes for disa* of the Medical Department professional personnel during the past war* There is no solution which will eliminate complaint end satis* tj all* obviously* but policies end methods based oa accurate classification data and the continuance of rclldnco upon the advice of the key professional advise? in the particular specialty involved la mandatory* Such Individ* uals* In turn* should bo top level from the beginning with foil grasp ef military requirements, psychologies! knowledge and ability in dealing with individual** understanding and analytical judgment in estimating Individual capability and above ell honesty, both in premises as node and earnestness Of effort to Place individuals where they will bo of most value to the military effort and yet in*sofar as it is possible whore they wish to servo* end with adequate explanation whoa such Is aot possible* 3* That it it oonsldered that eoae fora of fira and just alter* aatloa of duty aseignaont for Medical Department personnol botwoon ooabat* tactical* dispensary, physical examination center* end these acre routine or lees desirable professional positions with the pmforablo hospital and ether duties presenting better professional advantages and opportunities, must be insured and carried out la the future to the maximum degree* 3. Shat la considering assignments la the all Italy nodical ilmtan, the objective being primarily conservation of professional manpower* there is a consideration or ooaoept of melass&gament seemingly aot touched apoa la various eoaaeats received. Zt it deemed a fundamental ooaaideratioa from the viewpoint of the primary alesloa sad should be realised la the fullest spirit ef service rendered to the eountsy* Zt should be realised that no soldier or doctor or civilian* whom his antion Is at war* should object to the job assigned him if reasonable* reliable and honest asking of such assignment has obtained* She viewpoint of expecting assignment solely in accordance with eertala previous training and personal wish cannot be justified under the girwssfMliy tf wri „ 176 4* That oonsonsus of opinion is for assignments based upon physical and nontax capability, degree and typo of previous training, la ksspiag with the Job to bo dona. Whore multiple capabilities for Job assignment present, that which le to aoot benefit the war effort or any situation after the war it over, and not the individual, should prevail. 5. Shat majority of opinions received favor the criterion of professional capability for assignments, with rank eonsisteat therewith* American Specialty Board membership It mot considered to be the tele in* dex to the recognition of specialists in the Services. Shat the si der- ation of a Military Surgeon Specialist classification as being contem- plated by seme, to provide an attraction for service on Staffs and with troops, is considered a swot desirable step forward. III. BBCQMMMBaglOMS 1* Shat a searching study be made by a Joint aimed fereee medical body to establish the specific duties of questionable professional character which should be eliminated or rotainod as essential for perform- ance by medical officers so as to enable the publication of n practical policy and guide on the proper commend level that can be used in the employ- ment of medical officers in peace and war* 2, That policy be established with periodic reemphasle to la* sure that all KSC officers will be assigned to nonmedical department duties by Commanders concerned only under meet exceptional oireumstances and in ouch instances only with approval of the local Senior Surgeon, 3. That notion be taken to secure regulations in the Army and Air Force consonant with those in ends tone In the tl.S. Havy which prohibit the assignment of all categories of enlisted medical personnel to duties other than those of the Medical Department, 4. That there be continued emphasis of preeent policies which utilise MSC offleers to relieve professlonally trained Medical Department effleere of non-prof e• slonal duties. TRUE COPY (Extract Ltr Bascom L Wilson, Colonel, MC, Air Force, 21 April 1948) Reference par 3 (c)1 General policies relative to assigxment Of Medical Personnel, including use of recognised specialists and consultants,* due to the apparent lack of far reaching plans in peace time, for the training of Medical and Dental officers for their war time assignments (with the exception of certain General and Station Hospitals sponsored by Medical Schools and Hospitals through- out the United States), these officers were not trained for the assignments received by then# As an example, many Medical and Dental officers sere assigned at the last moment to various Air Groups and Squadrons and sent overseas immediately* Many of them had no previous experience with such units and were totally unpre- pared, and in faany eases, physically unfit to oope with t he situation* The emergency was so great that tins was not available for proper selection of these officers* A large number of the i&dioal Officers assigned to these Tactical Units, bad not been trained in Aviation Medicine* However, in most eases, they were willing, and accompanied these Unite overseas, and did good jobs, only later to be replaced by officers who had been trained in this specialty (school training)* By this time these officers, who altho they had not had the school training, but who had received their training in actual combat service and were well liked by their Commanders and other associates, were released to be replaced by these officers* Oils caused disappointment to the officers concerned and, in many cases, actual resentment by the Commanders of the Units* This situation was later alleviated to some extejrrfc by authorisation to return the displaced officers to the United States for assignment to tho School of Aviation Medicine for training in Aviation Medicine* While this was quite a help, it caused some disappointment and resent- ment among those who were not returned to the US as early as others* This could not be helped, however, for it depended on how soon replacements arrived* This whole thing could have been obviated had there been an adequate and well trained reserve of Medical Officers to call upon as soon as our mobilisation started* Our Regular A ray trained personnel is so small in comparison with our war needs, they can be counted on only to fill key positions in our organisation, and we have to rely on the trained Reserves for the bulk of our needs ******* ***** During tine of peace, a very carefully planned system of assignment of medical officer personnel, to the various types of Medical establishments Should be formulated in order that when mobilization begins, personnel may be assigned according to their capabilities, specialties and physical fitness* Numerous instances sere noted where officers, especially well qualified in some specialty, were assigned to Administrative positions| such instances as Obstetricians being sent overseas with Tactical Units* Many such officers continued on the mal-assignoents without complaint, considering it patriotic duty, while many others secured proper assignments due to their continued efforts for same* Instances were noted in which older, almost elderly Dental Officers accompanied Tactical Units overseas. They were not physically able to a tand up under field conditions and most of them were ultimately returned to the States thru the hospital route* The same may be said of many medical officers* I recall one instance in which a Medical Officer ae-» oompanied a detachment of casuals oversees* He was obviously physically unflf for overseas duty* He spent over six months in the Theatre, a large part of the time unassigned, and finally returned thru the hospital route* He was patriotic and wanted to go overseas, but a careful screening would have caught him before he de- parted the states and tbe government money and the officer much hardship and embarraaaent* «**«* Colonel, UC THUS COPY (Extract Ltr Baecom L. Alison, Colonel, m* Air Force, *1 April 194#) *«*«” In reference to the lack of a veil formed plan for assignment of Medical Department Officers overseas, it is obvious that the younger officers should be assigned to Tactical Units where the going will be rough arJl requires, in most instances, physical stamina beyond that of the average older man* In too many instances this was not done* Especially noted was the sending of officers overseas in a group of casuals, some specialists and some not* On arrival overseas, often there were no vacancies for the specialists, and they, as the non-specialists, were assigned to Units in a rather haphazard routine manner wherever an officer happened to be needed* This was most disappointing to the good officer who looked forward to an assignment where he could be of the most service to the government* Many of these finally found their way to assignments suitable to their experience and training, but many were shifted from pillar to post, res.a ting in many cases, in discontent, lack of Interest, inefficiency and often in hospitalisation and return to the States* In these times of Air travel, the need for specialists in overseas theatres should be accurately anticipated in order to send them over in increments as needed* The accumulation of large numbers of Medical Officers in overseas theatres prior to the time they are required causes a great loss of morale in those concerned* It all boils down to careful planning in peace for the requirements of war*■♦***•* TU K. Poh3> Colonel* MC 179 fBBE iflETKACT COPYi (latter from Colonel Richard T# Amest, Ret. dated 19 April AS) **** Bc. Key personnel onlyAbe assigned Medical Field Units such,as evacuation and Surgical Hospitalst the sene should apply to non-separating General and Station Hospitals. Helical Officers in theater reserve would be attached to such units as required when set up and operating. Nurses should be handled in a similar manner. Under this plan only a skeleton medical officer and nurse personnel would be assigned. Additional personnel required would be attached from the medical pool. (Actually few officers and nurses would bo in this pod since the majority would already be attached to units that were closing.) " ****** L. K. Pohl Colonel* u* s, Amy nm» COPT KHMCI (Mr Oapt *.a.H.rtB,(*C)US3. dtd IT Ms 47) ****** 0. "Lack of Senior Nodical Officers trained in K&vy and Narine Corps Staff Administrative work. This, la Captain V.I. Brown’s opinion was our greatest need In the later stages of the war. I hare seen time and again where a senior medical officer was assigned either to the Amphibious Forces or the Marines in a responsible position with the only qualification being hlsrank. The result was invariably that he had to take a bade seat until he learned the Job and by that time he was so disregarded by the Line and it was extremely difficult for him to get proper recognition for tho medical and of tho operation* The proper planning and coordinating of evacuation from an amphibious assault calls for an intimate knowledge of tho facilities at your disposal and the capabilities ef those faellitie*. Sven with an adequate doctrine, it takes a forceful, well informed individual to push his demands through to conclusion in tho faeo of a sometimes unsympathetic attit- ude to the part of Task Forces Commanders. Assignment of medical officers to tho asphibious and landing force without due regard for the need of a high per-eentage of doctors with surgical cxpericace. The surgery dens la the forward area, cither oa tho beach-head or afloat, is tho surgery that saves lives and limbs and It ie there that tho best surgeens available to ths Maty should be utilised. The assignment ef a proper percentage of surgically trained personnel with the AmphiClous Forces in actual engagements would be the responsibility of the Amphibious Nodical Department in the Bureau as pointed out. above.»*••••• S. L KG TIPB OOPT JBOBUQt (Letter froa Dr. Wa. O. Manainger, Topefcn, Kuata, dated 33 April 1948) ••••• •(«) Z vould feel 1% vat eaeeatial that ve hare to improve over tho last var for the aeeigaaoat of needed specialist* la their specialty. Many, aaay tlaoa ao Attention vat paid to a asn's abilities and ho vao assigned wheroror vi aoodod a aodieal officer. Vo alvayt justified it oa tho hails that a doctor ought to ho a doctor first and a specialist soooad hat actually this did act aeet our needs aad it certainly caused hares la tho aoralo of those aaay alsaselgned Individuals. Nodical officer* should never he assigned to dutioo vhleh tan ho porfonod hy aa adaiaistrativo officer. Chiefs of Sorrieos aad Coaaandlng Officers of aodiool units and hospitals should ho selected vith aueh greater regard fon a. ProfMiloaal kaowXad^pa b. AdwlnlftratlTf ability e. Leadarthip ftialifioalioM, Many tlaes a nan vas solootod in tho last var purely on tho basis of length of service aad rank. As the result, aaay 00*s vers grossly incompetent, providing ao effective leadership aad vers disastrous to aorulo as veil as to aodieal practice. They tried to establish standards for surgery, aedicine and neuropsychiatry and enforce them on clinicians vho vero far thsir superior as olid* lams. *•*••• 1. X. Pohl, Colon*l# MO 181 THUS COPT (Extract Ltr Uteri T« Walter, Captain, MS, OSN, 26 April 1948) regards the assignment of medical personnel including specialists and consultants, I believe that, except for key positions, this should be decentralised as such as possible* Medical officer assignment should be ■ads by the medical officer on the Staff of the Unit Pomander, such as a Fleet Surgeon, teo is familiar with the problems in his particular area* This question, of course, is intimately associated with proper casualty ears and hospitalisation, and dll be elaborated upon a littftj* later.*1**** "L# I. PQKK Colonel, US mn con matey (letter, Brig. Oea. Robert C. RcDonald, RC, ttU (Ret.) dated 15 April 1948) ***** **(e) General Policies Relative to Assignment of Radical Personnel, including use of recognised specialists and consultants• "(1) £m>B&t In the early stages of R.V.II, technical medical personnel, both easedsaloned and enlisted, were often assigned to positions where their special qualifications could not be utilised to the beet advantage. Rasy months passed before an effective plea for assigning specialists and consult* ants was implemented. Properly assigned medical specialists and consultants rendered invaluable service in establishing end maintaining a high standard of nodical ears and treatment. Timely classification of personnel is essen- tial to giving specialists their proper assignments. "(2) Suggestionsi The assignment of medical personnel should be made in accordance with their primary qualifications. Specialist! and consultants should be assigned no as beat to supervise professional work in general hos- pitals end on nodical staffs of. territorial eomnands. Specialists at general hospitals may be used to supplement the work of consultants at various head- quarter*. The meat used consultants at a headquarters are the Radical, Surgical, X.P., and Orthopedic•* ***** O^/^S) I. K. Pohl, Coloml, ac 182 1B0X COPT (Extract Ltr X* C« Stayer* Major (tenoral* U« S. Army, Retired* 19 Apr 48) *«HHfo(c} General poll dee relative to asslgnawnt of radical personnel* including use of recognised specialists and consultants* As a Theatre Surgeon in the Caribbean and in tbs Mediterranean, It has been ay privilege to see the assignment and use of specialists and consultants* Many of the so-called specialists coaplal nsd to as ahen they had been assigned to places and kept in positions which they believed could have been filled by others* although they were sen of sobs years of experience in a specialty and were not being used properly* In handling a Theatre* it le ay belief that consultants and specialists could be handled te a ainiaua* providing you can have units free nod- ical schools* shore you have many people who are well trained in the various specialties* I had the privilege of having two wain consultants* and if I needed any other consultants, I produced thea from the various units which were with as* I be- lieve* In this way* there is much acre Incentive to do good work, problems are more easily solved* and decisions reached sore quickly* Medical personnel arriving In a Theatre should be assigned as needed for particular positions after considering the advice of his consultants and executive** **#* L t PQBEu^— Colonel, IKS TBDK COPY mmcr (Letter, Captain F. C. Greaves (MC) CSV dated 17 April 1948 ***** *(e) Medical personnel should be detailed on the basis of obtaining the maximum benefit of their services. Overstaffing should be avoided as each as understaffing, perhaps nore so, because toe many persona on a particular job results in skylarking, lowered morale and neglect of details. A slight understaffing keeps people on their toes« They do not have tine to skylark and their atten- tions are on the work all the tine during working hours*11 ***** I* K« Pohl, Colonel* MC MS CffiPI PTRMft (letter. Boar Adniral C* I* Andrus, (1C) MSB dated 27 April 1948) eeeee *(c) General policies relative to the assignment of nodical personnel have been toadied upon above* In addition it is believed that full advantage should be taken of recognised specialists and consultants and that these can best be employed at established centers for the care of certain types of war casualties* Amputation centers, neurosurgical centers, centers for the blind aid for those who have lost their hearing, centers for tuberculous patients, centers for cord bladder eases, centers for the mentally disturbed, etc*, fully equipped and manned by recognised specialists provide the means whereby the best possible medical care can be given* Equal facilities can net be provided in ‘every general military hospital and it is considered that She best is none toe good for the man serving his country in times of national emergency* "Consultants such as thosa serving with the Kational Research Council and thosa who actad as special advisors to the Surgeon Generals (Amy and Mary) daring World War II. follyntlli &ad** «a»aa L. K. Pohl Colonel, MC TUBS COPT (Extract Ltr Quiton M* Sanger, BOMSD, USB 15 April 1946) ****•11 was claimsd there were not enough specialists in the Medical Depart- ment* The use of civilian hospitals for training in specialties for certifi- cation by Specialty Boardsf was recommended to supplement naval hospital train-* lng« It was proposed that civilian consultants be made available to each hos- pital approved for training programs and that a system of adequate remunera- tion be established* This was suggested as way whereby the Navy could us# In peacetime the war experience of medical reserve officers separated from the service* Hospitals should use Hospital Corps (Medical Service Corps) officers as afeinistrative 0»D.'s« This proposal fits in with criticisms mentioned in the previous memorandum regarding the undesirability of diverting medical officers from clinical to administrative work* There was too rapid a turnover of B* C. personnel assigned to records offices* This contributed to the inaccuracy and incompleteness of medical records* Hospital Corpsmen did many job? that could have been done by civilians* Coastal hospitals were all taxed to capacity and there was an inadequate member of corpsmen on duty during the earlier emergencyjprlod* The corpsmen were inadequately trained, and were put to work too quickly without hospital experience in seme oases* Sometimes training was too general and not equated with the specific job to be done, especla ly in oases of corpsmen detailed to sh'p duty Colonel, 1C THUE COPT (Extract Ltr Quinton M* Sanger, HOMED, OSN, ? April 1948) *«*«*It ns proposed that when a nodical officer la in the commander grads, certain ones should bo selected for administrative duties and others should reraaln In the clinical grovp| #and that there should be equal opportunities for promotion and pay for both groups* CKO felt that radical officers should not be divided into adsinistra* ties and professional officers* It clairad that officers of command rank engaged in exclusively administrative work sera too divorced free the realities of field experience j and that this resulted in retarded or errone- ous translation of field raquifeeants into appropriate and affective ad- ministrative action* CEO favored rotation of duty* It ess proposed the medical commanding officers be furnished with ad- ministrative assistants trained in administrative procedures* Tbs prospect of training Medical Service Corps officers for s variety of administrative duties (supply, finance, records, budget, etc*) may bs considered, as a may of enabling high rank medical officers to continue to pursue professional responsibilities at a high level* It was recommended that a staff Indoctrination school for selected staff corps officers to hold administrative positions should be established* Opponents of this proposal clairad it was an invitation to the Line to take over Medical Corps administrative responsibilities* This counterargument mould not apply, however, to a proposal to establish such a school for Medi- cal Service Corps officers In the Medical Department*”**** Colonel, 1C 186 TRUE COPY EXTRACT (Letter, Colonel James H. Forsee, MC, USA, dated 20 April 1948) ***** "(0) General Policy Relative to the Assignment of Msdieal Personnel Including Uee of 8peeialinte and Consultant a. It la eaay to atata that doctors, dentlate, noraea. ate, should he assigned to duties which they or* hoot qualified to perfora. Unfortunately, the diversity of duties required of auoh peraonael hy the Anted Toross doea not permit of perfection la this problem. Za ay opinion thlo mo aeeeqplieh- ad to a very aatlafaetory degree la World War II. Improvement ahould he strived for and oan ho aeeoapllohed. How to attain thlo objective la a difficult tank and a few suggestions sight ho of aoae praotloal value. These arei The doe Ignat lea and training of aortal a dootofo for particular military positions whoso specialty Is not re- quired la large numbers in the Anted forces might ho con- sidered. for example, gynecologists, obstetricians, pediatricians, dermatologists, and many general practitioners eould probably ho mere usefully employed as executive officers in large hospitals, as cotwtandiug officers sf field and evacua- tion hospitals, and la aortain staff peaitleas. Such positleas would offer these individuals aa eppertuaity for adraaeoncat la rank which nqr act he readily available if they ore re- tained la their professional specialty while la military service. The whole prohlra cf promotions based upon posit Ion vacancy discriminated appreciably against this group cf personnel. Obstetricians unable to find proper professional assignment would still be permitted pronetlone to a higher % rank. Many ouch officers are capable of owryiag responsi- bility ooameacurate with increased rank, and ouch a plan peralte of utilising their services to a bettor advantage. The present policy of utilising recognised civilian specialists and consultants le a moat valuable leeeea learned from World War 11 and should and moot be continued at the present time. One point io interposed at this time because I believe it merits consideration. It le as follows! At the present time am attending staff member (consultant) Is permitted to make 90 visits per year to our hospitals, at the rate of pay of $60.00 per visit. As turning that each visit averages 3 hours of tine, which Z believe le a probable reasonable estimate, the total tine spent on these 90 visits is 370 hours for which he is paid $4600.00. It le act easy to convince the young, able doctor that he should neks a earner in the military or naval service, and spend approxi- mately 10 or 13 years to become a Major and receive on approxi- mate eannal income of $4800.00. Assuming that a doctor in the Anted forose spends 10 hours a day, and I boilers this la a eons erra tire latiaats, la the performance of hie duties the attending staff asaibar earns am this basis $4600.00 for 2T days of duty. It la likewise net pleasing be those aha bars attained professional ability and recognition equal ta aaay af tha attending staff ta note that their yearly inesaa re- presents about li Months af the pay level af the attending staff nsmbsrs.'xlt is recognised that sush a pay Isral is adequate and necessary ta attain proper attending staff nan- bars than it would be apparent that pay increases for our awn Medical Carps personnel is awardee. It la ay honest epinian that tha Medical Officers of tha Arnad forces are now receiv- ing Just about 90% af what tha good doctors in tha Servian rightly earns. She pear dsatar is ararpaid regardless af his salary. To gat and to keep goad doctors under present aaononls conditions no nethad which doss not provide adequate pay will be successful. Lets asst the issue squarely and obtain in- creased pay far all Medical and Dental Of floors. During World War XX net n single regular Any officer was actually tha consultant in nadleina or surgery nt an Any* Theatre, Corps Aran or War Department lard. It met bo assumed that there vara either no qualified officers ar that ether petitions of administrative nature ware more important. X da net believe that either of these assumptions are aeeurate. We had a few men qualified but tea few. the reason far this deficiency was n lack of vision, planning end training of our surgeons, end internists far high professional tasks, The present residency program in our teaching hospitals will go far to altar this situation. V# anst not, however, step hate end the fellswing proposal is submitted far considerations that 30% of the residents having the highest rating at the termination of their residency training be desig- nated to attend various service school* of the lime far n period of 6 months to a years. Duriz* this period they will become better acquainted end obtain n broader aspect tf military problems than can be accomplished in an equal parted of tine by any ether pease-time method, they will asms in eon tact with the officers who will be In Command in times of war. Both groups will have a better mutual understanding of one another's problems and toleranee based upon knowledge will ge fsr to dissolve sums of the apparent difficulties encountered in tines of war as well as peaes which the Medical Department mast face in presenting their problems to the tenoral staff. At the end of this ported of instruc- tion these officers should return to professional work. It is bo I Intended, and osrtalal y not dot trod to suggest that olTlllam consul taats should aot ho utilised la tlass of poaoo and war, fftito tho contrary io dotlred. Prohahly aot aoro than 10 to of all tho oonaultaata at thooo lords could or should ho from tho regular military ostahlistossnts, however, officers of tho regular establishasats should aad would greatly aid tho eiTlliaa consultants la asking tho latter's task aoro easily accomplished during Mu Military Berrios.” ••••• lu X* JPohl, Colonel, NO 189 nBlOQFTBmM (MW, Cantata I. 0. laapl.tM, MO, DM dated 38 April 1948) ••••••(o) tnui rausxai nuaxn to dutunoc or obioal ranonm, amm im or °»rmt4»«. fho ooolfoaoit of oodlool porooaaol 1b |M«nl ohoold eoinolAo ao BMrlf ao post mo with tho prefooOl ml fulifintUBi of tho ladirldaol, with too ooaoldorotloa of hlo phgrolool otoalao aid Mtanosa. taUf thooo foolltloo om >o oroloot «d during tho poriod of tho ladlrldnal'o iadootrlaatUa uA Mo reporting ooaior ihnU prorldo tho Boroou vith o nwyrohooiiTo afpnlitl of tho offloor'o fiollfiootlooo prior to troaofor. Toon* and laoaporloaood ooilul offtooro ohoold ho oaolgaod to orcaaloatleao vhoro oocporioaood ooaloro ooold ovporrioo tholr ootlrltloo ood ooadoot tholr tytisiii. iooognlood opoetoUoto oad eoooultoato ohoold ho ototiomod at oodlool ooatoro, proforahlr la tho aooo of tho interior, whoro a tvtlaiai pragma ooo ho ooodootod aid tholr opoo&al tolooto otillofd to tho hoot odraatogo* 9o or knoolodgo, thoro worn rorr for iaotooooo of oiooofligaoaoat of oodlool porooaaoif noagr ohjootod to holof Miifud ooo datjr, hot la tho root aojorltjr of iaotooooo ( tho ohjootloao orooo fhoa tholr oooploto look of tawdodn of tholr dot loo aboard ohlp.***** A ** hul. ooi*a*u m TKBt COPY EXTRACT (Letter, Colonel 0. F. «cllj»y, K, Air Foret dated 20 April 1948) ***** "It will be noted that tha undersigned la one of those who belieree that, insofar as possible, professional personnel should bo utilised for the aeeoapliabsent of the professional, duties for which they’ are qualified and that such personnel should, in general, be freed fros administrative and 'military* functions. In other words, it should be node possible for physicians and surgeons to be princi- pally physicians and surgeons while in the silitary service •"*•*** ***** ■«. The assignment of nodical personnel (professional) can be aarkedly iapreved. Much talent was weeted during Vorld War IX because of nal-assigment• So recognised specialists should bo called into the senriee until there is an actual need for his in line with hia specialty* Ha should be permitted to remain, providing service to his hoew on—unity, until such s need exists* The umber of such recognised specialists required by the services could be nsrfcedly reduced by peraitting then to act as consultants to nultiple nodical facilities and through tha rapid evacuation of patients to tho Zeno of Interior where largo specialising aedical facilities should be established*” ***** L. K. Pohl, Colonel, KC TRUE COFI EXTRACT (lettw, Colon.1 Sari ltaxw.il, HC, Mr Fore* datad 19 April 19i8) ***** There was a definite tendency to send enlisted sen overseas who had gotten into trouble or were found worthless in medical installations in the United States. This was apparently less true of officer personnel* However, with the exception of affiliated units, the professional talent sent overseas with hos- pital units was inadequate. In my opinion sore of the renowned specialists should have been sent overseas rather than remaining in the general hospital in the continental United States*” ***** TRUE COFI EXTRACT (Letter, Captain J* H. Robbins, (MC) US* dated 26 April 194*0 •Considerable confusion, at tines causing actual embarr- assment, existed throughout the entire area due to Bureau of Medicine and Surgery interfering with Force Medical Offleers,in assigning and detaching medical officers of the area without the knowledge of the Force Medical Officer, To overcome this, it is recommended that all medical officers be assigned to the Area Medical Officer for such disposition as he deems advisable, keeping the Bureau informed by copies of orders in ease of any change and that the Bureau in tarn process their changes through the Area Medical Officer♦* ***** L, K. Pohl, Colonel, MC ram COPI EXTRACT (letter, Colon*l C. J. Baker, HC, Ur Pare* data) 22 April 1948) **** *»c. It should be the general policy to assign specie Hied medical personnel to positions in which their specialty will be taken advantage of, and only for cause should the classification of a special* 1st be changed* It is ay belief that in general a Class A or nationally known specialist should be oonnissioned aa a Colonel* A Class B or a specialist who is a Diplomats of the Aaeriean Beard and a Fellow of the American College comaisalon as a Lt« Colonel* A Fellow or e Diplomat# as a Major) also others who are well qualified because of experience and ability in a specialty* Those hawing no established specialty, but who have oonpleted a recognised residency, should be ooaodsslonad as a Captain* A 1st Lt* in the Medical Corps should be eligible for promotion at any tine after one year of active duty* Age linlts for grades under that of Colonel should be adhered to in original appoint* Rents, not to restrict younger sen, but to prevent the bown!aliening of an older nan as a 1st Lt* or Captain, i*e* a Doctor or a Dentlat 35 years of age should either be qualified for cosodssion as a Major or above, or he should not be accepted*1* **** TREE COPI EXTRACT (Letter, Dr* Russel 7* Lao, dated 18 April 1948) ***** * (c) General policies relative to assignment of medical personnel, including use of roeogniaed specialists and ponsultents* "If a proper catalogue of available medical men by specialty, age, physical fitness, ete*, is made in accordance with Paragraph (a) and if a proper T/0 of all military establishments is drawn up, the one checked against the other would result in batter assignments* In the sons of the interior, the hospitals should bo largely staffed by older, part-time specialists who devote pert of their time each day to service in military hospitals and part tq civilian work and teaching* Military hospital* should be located near centers of population to make such personnel available* Those older men are possessed of high tic ills and would welcome the chance fear such service*" ***** \ L. R* Pohl, Colonel, 1C TRUE COT (Extract i-tr Nellie Jane DeWitt, Captain (1C), USN, 29 April 1948) ■»hhhi*a system for the assignment of nurses similar to that used by Army Nursing Personnel should be established* For examplei The bureau of Medicine and Surgery would have a pattern for a 25 to 100 bed dispensary, or a 500 to 1000 bed hospital* Sufficient nurses would be ordered to each District where they will be assigned as needed by the Commandant, upon recommendation of the District Medical Officer and Senior Nurse in the District* Such a procedure wo Id provide better nursing care and preclude the possibility of an unequal- nurse-patient ratio* Examplei a 500 bed hospital needs a minimum of 50 nurses. % Chief Nurse 1 Assistant Chief Nurse 1 Anesthetist (nurse) 2 Operating room nurses 2 Dietitians 1 Instructor 2 Physiotherapists 2 Psychiatric nurses 1 Obstetrical nurse (if a dependents hospital} 37 sard nurses id iWrAL mknEk ■¥ nurses • Colonel* MC TRUE COPT (Extract from Ltr Alfred V*. Zyer, Captain (!iC), VS®, 17 April 1948) **** »{c) General policies relative to assignment of medical personnel, including use of recognized specialists and consultants* "It is net believed to be good policy to utilize specialist personnel in the front lines. sphere combat conditions exist, working situation are apt to be highly'- fluid with little opportunity for the specialist to fully exercise his talents. Additionally, assignment of such personnel to individual units tends to violate the principles of conservation of medical personnel and effort due to tin restricted numbers of service personnel cooing under their cognisance*, Assignment In base hospitals, hospital ships and continental hospitals is considered practicable. "The utilization of civilian specialists and consultants in both peace time and war is considered highly desirable* It provides excellent training for service and, offers, on the part of both service and civilian doctors, an opportunity for appreciation of the outlook and problems of each group." *«♦* Colonel, HC TRUK COPY EXTRACT (Letter, Colonel John A. Rogers, *C, USA (Ret.) dated 19 April 1948) ***** "(c). faagrfllJP.gtlcigg. laliUTg .\<2..&sslrvmiiX qT Brcdlwl pprggiiBtli including ttat-gf .jassmiagd., aagciaJllgtfl., aad ggnsulAaflU* No consent on the consultant program which was excellent. It is believed that the utilisation of special!etc, as such, was in many instances carried too far. The services of many of these men were restricted to their specialty when they could have been utilized for duties outside of their specialty. It was my experience as Surgeon of the Fifty Any Area in Chicago, after the far, that this did not make for an effective utilization of manpower and somewhat hindered more rapid deeobiliaatlon." »«««» L. K, P6hl, Colonel| MC TBBB COPI EXTRACT (Uttar, Colonel Robert R. Peyton, MC, USA dated 19 April 1948) ,#m5. Economy and Safety in Medical Plans and Operations. Let us Aiee the hard fact that in the pact war ve possessed not only some skill but an inordinate amount of good luck. Uncontrollable epidemics of disease and blockage in the chain of evacuation from the theater to the acne of Interior were ever-present potentialities which cannot now bo forgotten merely because they did not materialise. All our reverse# were temporary. Ve must face the fact that our combat troops had things pretty much their own way once they got rolling. Enemy capabilities to inflict higher casualty rates with new weapons and new techniques must be considered at all times. After the shooting is ever and our hindsight becomes more acute, ve are apt to engage, in a type of "Sunday morning quarterbacking". Therein Ilea danger — just because ve had good luck before it does not follow that good luck is a national birthright and that we will have it again. "Rational Interest must be sirred by the utmost economy in the use of every medical officer. On the other band, national interest and the common dictates of an enlightened humanity demand the highest standards of medical care for the men who fight our battles on ths land, on the sea, and in the air. The mass of casualties will never adjust themselves exactly in number or in location to the medical means provided. In ether words, just because we provide certain means it dees not follow that the casualty load will stop when those means are exhausted. Ve must provide the means ve feel to be safely sufficient to maintain the highest medioal standards for peak loads of casualties in the constantly changing situation. To assume that either the civilian or military medical pro- fession or the statisticians can ever predict with certainty the outcome of military operations and the exact requirements for medical means at the proper time and place is to endow them with a divine power which no one possesses. Reserves sad flexibility for the medical service are just as essential as they ere for combat trofps. If wo provide too little toe late ve assure a medical debacle and a national disaster. It is far verse te swing the pendulum from toe much to toe little. That every medioal officer at all times be kept comfortably busy is in all respects an ideal situation not logically capable of fulfillment. Ve do not believe that every infantryman or anti-aircraft artilleryman can be kept busy *t oil times shooting bis weapon at the enemy, ill manpower will be in short supply, further, if, due to slackening enemy resistance, wo get by with less casualties than we had reason to expect, then there is cause te re* joiee and thank Divine Providence for hie mercy. "The medical service is Just pert of a toon engaged In a moat supreme undertaking and we cannot gamble on ita success any more than we can on the auceeaa of the armed forces as a whole. Safety is assured only by the physical presence of estployable and adequate means within the theater of operations. In our eagerness to conserve critical medical manpower, let us take care that we do not fail to accomplish one of the major missions of the Medical Department • namely, the conservation of all military manpower. L. K( Pohl, Colonel, HC TREE COPI EXTRACT (Uttar, Colonel P. A. Blase*, VC, USA dated 19 April 191?) firBBarai.Fftllcloa te agglgBitBt yf wwllfal p*rp prowl» including mc gf. Mfiggniiwd and cpmbI,tenia* "a, The assignment of medical officers must be controlled at a higher level to avoid improper distribution. During the last war the combat divi- sions were usually below 50% of their authorised allowance of nodical of- ficers. Last ninute additions were usually made at the Port and untrained officers sere thrown in fron the Service Command, Investigation showed that Service Commands and Air Corps had 100% of their authorised allotment during this period and they were at one time directed by G-l, W, D, (Gen* Henry) to immediately release' a minimum of 400 to the Ground Forces for assignment to units preparing for overseas shipment. The Field Forces should at least have equal priority in assignments and consideration oust be given to the fact that these officers cannot be qualified for field service without proper basic and unit training. They are needed early to also assist in the training of their own personnel. Complaints heard fron battalion surgeons, for example, were that their professional training was wasted and that a sergeant could do their job as well. In every instance investigated, it was found that this opinion was based on a complete lack of understanding of the job due to a lack of proper training* "b. As a policy officers over 40 years of age should net be assigned to combat divisions. Officers over 48 years of age should not be assigned in the army area behind the combat divisions. Officers who can serve In the 21 can serve in installations in the theater of operations, outside the army area, regardless of age or physical limitations. There were many In- stances during the last war where medical offlcars were classified as "limited service, ZI only*, The physical impairment given as a reason for such clas- sification was frequently some minor defect such as, chronic colitis, chronic sinusitis, chronic bronchitis, etc. These were so numerous as to cause frequent criticism and were a bad morale factor within the Corps, Service in a fixed installation-in a Theater of Operations does not differ greatly from service in the ZI and as a policy, such limitation in assignment should not be tolerated. "c. The records of reserve officers are usually not fully known to those making assignments* A system of records should be compiled Showing b*ti£ly, the pertinent facts concerning prior service, training, quali- fications and capabilities. These should be indexed in age brackets, specialties and likely assignments, and should be available for all those responsible for future assignments. L. K. Pohl, Colonel, ISC TBUS COFI EXTRACT - Continued • Colon*! F. A* Blast*, MC, USA *d. Recognised specialists should bs assigned direct to units where they are to function. There is little need for their military training and training in the few subjects considered essential can be given in addition to their normal duties as a specialist. lowly activated units could delay the assignment of suds specialists until the latter pert of their training period* •e. The consultant program should be designed to furnish the Sur- geon General with advice in specific fields of medical practice and admin- istration , Consultants need not be limited to their own fields of interest in giving advice, bat they should not be given authority that might prove embarrassing to the Surgeon General, the General Staff or the Secretary of Defense* It should be a fixed principle that each Surgeon General is responsible for the medical service of hie own department, and that the consultants ere merely to assist, within the general scope of their specialty, In the discharge of that responsibility* It is believed that this relationship between the services and the consultants can be es- tablished with tact and firmness, and it is essential to the prestige of military medicine that this be done. "f• The duplication in assignment of consultants of various levels la a theater of operation is wasteful of this scarce category* Assignments as consultants in a theater should be at top level, at other levels they should normally not exceed on* surgical and on# medical consultant* If ethers are needed for special surveys, this can be accomplished by detail for temporary duty from a unit having such talent* ♦***• ti« I« MK# THUS copy (Extrecto from Ltr Col* Harry Armstrong, X, 16 April 194#) ♦*** •©• general Pollciee Helative to Aaeiqraaent of Medical Personnel, Including Uee of Recognleed "specfallgta and Conaultante* " (1) Defectst (a) Specialists not used as specialists* (b) Regular Amy personnel, no natter how sell trained medically, given administrative work commensurate with their grades* (c) Failure of Command to properly evaluate medical service* (d) Ineffective use of highly trained personnel in awinii units* (2) Remedies i (a) *esp specialists at their Jobs or uss only as consultants* (b) Indoctrinate Command with better concept of good medical care* (c) Indoctrinate civilian components to accept 3100 1405*8 rather than that of a specialist*11 L* K. rGHL Colonel, TRUE COPY EXTRACT (Letter, Captain Lewis T. Dorgan (MC) OSH) ***** "General Policies relative to assignment of medical personnel toladtag ms.o£. rgcsgplggfl wregialUto apd ssnaaltflata* "During the last war it often occurred that after a careful distri- bution of medical officers within Seventh Fleet area so that each unit had its necessary specialists, orders would be received direct from the Bureau which would nullify all previous plans* An attempt was made to rotate doctors back to the States at the expiration of IS months of foreign shore or sea duty but often Bureau orders would be received re- turning one man to the States after from 9 to 12 months outside duty which necessitated holding another doctor of the same unit for as long as 24 months* "In global warfare only the personnel of a particular area can be cognizant of the peculiar personnel needs of that area* They should be free to move all doctors, and corpsaen within the operational area at local discretion* In the last war many medical officers spent Idle months in pools ashore or uselessly rode LST’a as surgical teams long after their ships had ceased to engage in amphibious landings* Seventh Fleet was cognizant of these excess medical officers but could not utilize them as they were under the administrative control of Central Pacific* *§Bgggg,tgdi PffiBfttiiifg; "(1) Medical Department representative* of areas should submit personnel requirements monthly and needed personnel should be specifically ordered to within that area* They should all report to the area or Fleet Medical Officer for reassignment* All personnel declared excess within that area should be ordered out only by the local command* "(2) Surgical team and other specialised medical personnel should be used only temporarily aboard landing craft* As soon as thair mission Is accomplished they should be returned to a working pool, preferably one maintained at a large hospital such as the one established and main- tained at Fleet Hospital 1X4 on Samar by Seventh Fleet*" «**♦* L. K* Pohl, Colonel, MC 200 TWSmamtCT Captain O. B. Jr., MO, US* dated 23 April 19(8) eee»ees **«. General policies relative to assignment of asdioal personnel, including use of recognised specialists and consultants* Probably the greatest criticism of the Havy Medical Depart- ment was due to the assignment of well trained specialists to Jobs having no relation to their specialty* Two examples which came under ay observation will serve to illustrate t A well trained obstetrician and gynecologist who had 14 years of successful practice in this specialty in a large city was called to active service; given a 6 weeks1 course In psychiatry; and then ordered to duty as a psychiatrist In a large training center* The second case was an excellent young surgeon with 12 years in surgery; including post-graduate work at tbs Mayo Clinic, who was assigned duty with malarial control units and forced to do this type of work during the entire war* * Obviously, tbs needs of the service are of paramount importance, but such assignments are sure to create resentment and discontent and are viewed by the individuals concerned as examples of pure arbitrary action which is foolish and inefficient* A method used by the Tenth Arwy in Okinawa seems to be s good way to solve this problem of efficient assignment of medical personnel* A board of specialists consisting of a general surgeon, orthopedic surgeon, internist and psychiatrist were assigned to the army surgeon* This board was authorised to visit all medical activities in the area, to live end work in each of the hospitals until they mads a thorough study of the needs of that activity* They individually interviewed and observed each medical officer and were given full authority to assign medical personnel in accordance with their experience and ability/ ****** u* L.K. POKL> Oolon«l, HG 206 titus copy jsjkbact from aih boahs 3*,ta aspuaT so* 36* m j-^oical SUPPORT 0/ Aid WAdfAdl IK TILS SOUTH ASP S>Th FHOK USX! 7, 1541 TO AUGUST 1945 ********* c* “The efficiency of a unit vas frequently closely related to tha ability of toe PIigut Sturgeon to obtain the confidence of the personnel In ids caa.u*aad. Approximately XO percent of the Flight Surgeons assigned to these theaters ware unable to establish the mutual understanding noces aiy because of £raijUs of personality and character which aaad# thee lllfltted for this type of duty. It was difficult to assign such man as it was import- ant t.ui.t they not be assigned to positions where they might coa*e in contact with flying personnel. Approximately 10 pear cent of the Flight Surgeons assigned to tuese theaters lacked the personal attributes required for this type of duty. ?h«re wore insufficient Dental Officers assigned to tae Mr -i'orcoe in these tue ter a to maintain the dental hod th of Air Force troops*1** L« K. POHL, COLOSBI.. MC EXTRACT COPY OF FrRTINENT MATERIAL CONTAINED IN AIR FORCE MEDICAL DEPARTMENT HISTORICAL RECORDS OF T/ORID WAR II. (Lts. 13 Aug. 190 f*. Brig. Genl Grant TAS to Col. Malcolm C, Grow, Surgeon, 8th AF) ***** "More or less in connection with the above, I have caused a survey to be made of all officers in the theaters from a strictly professional point of view. It Is quite evident that the number of professionally qualified officers in service with out most active Air Forces overseas is considera- bly below the desired number. In the rush of expansion, the tendency has been numbers rather than quality. I think, for the future, that we have made a mistake in concentrating everything on the idea of the flight sur- geon being a ’hail fellow well met’, instead of a professionally qualified Individual. To this end we are working toward seeing that every group has erne man qualified in each of the followings Internal medicine, general surgery, ophthalmology, otolaryngology, and neuropsychiatry. Also, I think the tendency has been to use a very young age group, whereas it would be more desirable to have men of more mature judgment. The group of men now being sent to the School of Aviation Medicine fall into the category men- tioned above. L. K.JPohl, Colonel, MC ■mm mci Copt of medical support of tkic usaa? r a*:it: of qplviatioss. historical srCTiox - *ms. *«•«««* o, "Professional staleness, waning interest and morale, end the ten- dency to become self-satisfied in a smoothly working organ!? tlon were en- couraged by routine tasks which allowed the officer*?, surgical and other acquired skills to gradually fade through disuse. The duties and rrsnonei- Lilitier del gated to many of them vern so short of their abilities that the successful execution of them failed to generate any pride la the work. •***••• Colonel, £CX THUS EXTRACT COPT 0? LTH CKQE H. T. MACXLIH (MO) DSN DTD 12 Ray 48 ******* C.*fhe recent establishment of the Medical Service Corps, should be the long awaited cure to the Medical Officers plague. The experienced capable men of the Hospital Corps, can now in their entitled position assume the admin- istrative duties. Counts, Boards, Enlisted discipline etc., and this permit the Medical Officers to perform their professional duties in a more efficient and conscientious manner.•••••*♦•♦ jQz/Z2.e U.K. TUHirr^oIoG«l, MC ThJUK XXThUiu.. COPT OF KKDICAl 'PJfPO : OF fnJ UdaA? in TK* MMDXT&kuAXSAB THI&f'iR HlSfOdlCAL SkCflOS - AFi'AS c* jurisdiction over assignment of all classes of aedteal personnel was essentially a function of the Ari Fore© Sturgeon, a large degree of latitude with regard to reessigmtent within the respective coamande, after euch action had been coordinated with the Office of the Air Surgeon* was found to be desirable,******** LKtt^vTtD^Colonel, Jiff TKUiv S3KHAffP COPT (Ltr Brig. Gen. G.E. Keanoback, Dental Corps, dtd 7 hay *o; *•***• £# *fhe staffing of dental installations dculd on the basis of not less than two (2) dental officers per 1,000 strength of individuals entitled to treatment. All jobs not requiring a dental degree should be filled by Bsaber* of ether Corps or by qualified enlisted men or civilians; thus assuring that aental officers will be employed full time on dental professional duties. . MO TBU3 SSTfACT COPY (Ltr Lt.Col £.J. Heuter. Dental Corps, dtd II May 43) ******** c, #AsaigUia©at of Staff Dental Officers - &, Deficiency - fable of Organisation did not authorise staff dental officers in the e&rlypart of the war and many Air Forces suffered because they were not assigned. In come Air Forces their need was immediately recognised and they were assigned as overages until authorisation for them was obtained on Harming Tables. In other Air Forces they were not assigned until 1*44. The 14th Air Force apparently did not have a staff dental officer at any time, jfc. Unfavorable Xffects - In the absence of staff dental officers, dental problems too frequently did not receive their due attention at Air Force headquarters in order to obtain effective and timely solutions. This was true particularly in the Pacific and C dna Theaters s where the personnel shortage was critical almost throughout the war. Problems of station level were slow in reaching Air Force headquarters and dental officers at station level were denied the benefits of staff visits. £• hecommendations: That Tables of Organisation of Air Force Commands* Air Force headquarters and higher AirForce Headquarters utilise in foreign theaters be authorised a staff dental officer for staff duty, ifher# staff duties do not require the services of a full tlmo officer, this officer can provide the professional care of the headquarters personae! as well as an additional duty.********** C.&T , MC 209 TRUE COPY EXTRACT (Letter, Colon«l Arthur B. Welsh, MC, USA dated 19 April 1948) ***** «c. Difficulties in control of air and ground medical Barrie# war# created by the Army command structure. For example, a medical monitor was absent at topside to equitably distribute and assign personnel among major commands. It was chiefly a job of 'horse trading' in World War II •• and a difficult one at that. The Surgeon General mas 'boxed' in Arsy Service Forces, had the responsibility, but couldn't exercise authority in many instances. There should hare been more joint use of specMists and consultants." ***** HIDE COPT EXTRACT (Letter, Colonel Herroy B. Porter, MC, OSAP dated 23 April 1948) ***** "Lade of trained nodical department personnel; indi- riduals and unit, attached medical, arrived overseas who vers evidently the culls of their home bases. Drunkards, perverts, and psychiatric eases were among such, which caused a heavy load on an already overtaxed medical who had anticipated the help of these same individuals in remedying the situation,♦♦*** ***** "c. The T/0 assignment of medical personnel was too rigid. Too many units had no assigned medical, and would be dependent on a parent organization, such as a Service Center or Bomb Group for medical services. I have seen one dental officer responsible in this manner for the care of over 2300 men, and have seen one medical officer responsible for the health and sani- tation of three fighter strips, fifty to three hundred miles apart In jungle area and only air communication between." ***** L. K. Pohl, Colonel, 1C ••••• *8mtral poiieitt m«UT« so auifuMt ox mucm pwwbbm «n of recognised sptelaUiti and eoanlU&ii - It it absolutely iapmtlrt that tha Armed Forces he lap re seed frith the fact that the medical serrlce cannot ho properly conducted without a wide use if specialists of all typos aad that those specialists must he given recognition la accordance with their ego* and profess- ional abilities. Therefore, it is essential that wham hulk allotments are aado far the entire forces in the grades from general officers down to the lover rooks that a spselal allotment of grades he aado to the Nodical Department* One of the greatest defects in the past war was that no prowl si on had hson mads for the pro- motion of the deserting consultants and specialists. Those officers had to oom- poto with all other special and gem rml staff officers for position vacancies in the higher grades. There was no f/O allotment for them aad la consequence in many instances they were denied the promotion that they so richly deserved* It is essential In time of ponce to prepare well-thought-out Tables of Organisation for General Headquarters Medical Sections* Communications done Nodical Section, Base Section Nodical Sections, Army Headquarters Nodical Sections end the like and that special tables of Organisation ho prepared for consultant groups with ranks corresponding to their abilities aad that t*>ccc consultants he not placed in a position of competing with off leers who are carrying out the vital tactical* administrative, cad staff duties in the higher headquarters* The proper use of consultant! is vital to the success of the Medical Department undertaking, this should he recognised and prcv&sisns should he made in advance fer their util ism* si on *ad scenes Ooloael, NO 211 Extract of Statements made by Brig Gen Robert C# McDonald, MC, USA (Retired), 21 April 1948, before the Subcommittee on the Employment of Military Medical Resources# regarding “(Tenoral Policies Relative to Assignment of Medical Personnel, including use of recognised specialists and consultants#" "In the early stages of WW.II, technical medical personnel, both commissioned and snl isted, were often assigned to positions where their special qualifications could not be utilized to the best advantage# Many months passed before an effective plan for assigning specialists and con- sultants was implemented# Properly assigned medical specialists and consultant* rendered invaluable service in establishing and maintaining a high standard of medical care and treatment# finely classification of personnel is essential to giving specialists their proper assignments*" Regarding the use of recognised specie lets and consultants, I am enthusiastically for it# The medical consultants in my office when 1 was surgeon of the Fourth Service Ccsaaand were i nvaluable in maintaining a high standard of care and treatment for the patients in our station regional and genera hospitals* They did a splendid Job* They were well qualified# They were cooperative, and I feel that they did particularly good work* The most valuable of them, from my standpoint, were the internists, the general surgeon, the neuropsychiatrist, and the orthopedic surgeon* We did utilise brain surgeons, for example, and other specialists, but those were not so much used, and when they were needed they could be taken from a general hospital which was a center for their specialty, and the patients couid be taken to those particular hospitals* So we did very well on that, and had the consultation service, plus the actual operating service at the various specialist centers*" «**-«■» "What would you advice doing to prevent wastage of medical officers during the training period of medical units?" I would reduce the assignment of medical officers to units during the training period in so far as practicable using administrative men in their place for normedicai duties* " "How do you feel regarding the acceptance of lower mental grades of an- ils ted men into the medical department? Should wa take our proportionate share of these types? If so, what assigrsaents would you recommend for them?" I think m can take our proportionate share of lower mental grades* They can do Janitor work and perhaps litter bearing and other tasks that do not require a great deal of intelligence# * would like to make a comment regarding the use of limited service personnel by the medical department* I think we would have much less difficulty in holding our BbcELcal department if we could find men that were limited service because of minor defects, who have special training In medical work, assigned to the medical department and noone else would want them* I have heard that during the last war many of our units with medical sections with combat units were just taken out bodily and put into the combat units, be- cause they needed able-bodied men* And, they traded us limited service men who didn’t have the medical qualifications* So X believe that we should plan to utilise limited service men, insofar as practicable In the medical department, from the beginning, particularly in those positions wliere technical training is required* "De you consider it mandatory that once a soldier is accepted by the medical deportment that he not be transferred by staff action to other branches of service? How would you implement this authority? Did transfer of enlisted men affect the morale and efficiency in World War IX?” Z would say that a physically qualified medical department soldier who has no special technical qualifications for the medical department might have to be transferred to the line under certain conditions* I don't believe that we can have an ityron-bound rule on the general service man* Now, on the other hand, limited service men. I think, should be put in the medical department and retained there* Some medical department men desire transfer to one or other of the branches, perhaps in the interest of promotion or to a unit where his special qualifications may be best used* "Do po need doctors in many of the positions ws have used them In habitually, vis*, executive officers, adjutants, registrars, supply, etc*?* All medical units whose function is to care for or treat patient* should be under command of a medical officer* But in large units, where the executive officer has sufficient work in administrative matters to do, without having to do any professional work, we can use other officers when there is a shortage of medical officers* Where there is a good supply of medical officers, I would pre- fer that the executive officer be a medical officer, because he has more control over the staff and better cooperation with than* The adjutant, I think, can be an administrative officer and need not be a medical officer, except in a special Situation* Registrars are better if they are medical officers* But we can get by when there is a shortage of medical officers, by the use of administrative men* The same way with supply* "In your opinion, should regular officers be given command of medical units and installations without regard to their administrative qualifications? Would Reserve officers acquit themselves as well? What is your solution to conditions where all regulars were removed from orofesslonal duties during World Wars I and XI and as a result became deficient in medicine after those wars?" I think that every medical unit should have an officer at the head of the hospital adminlstratively qualified to carry on* That hasn't always been the ease, not, of course, through the fault of the men they put in charge of units, but because we simply didn't have the trained men to put in command of the units* Would Ho serve officers acquit themselves as sell? In manor instances, yes* Generally speaking, almost as sell* As to the solution, I think It is unfortunate that highly trained professional Regulars should have to be taken off their professional duties* But I believe it sas a matter of expediency* We just simply didn’t have the officers to do the workj that sas ail* I soild like to see a highly trained medical specialist kept on his sork in sar, no matter shat branch he belongs to* •Should American Specialty Board membership be the sole index to the recognition of specialists? If not, sould you suggest a basis for decision in this field by the Surgeon General’s Office?" I certainly don’t think that Board membership should be the sole index of the recognition of specialists* X think that there must be some plan, or system, set up whereby se could verify the man’s qualifications* A medical officer might be carried as a specialist by the American Specialty Board and not have practiced his specialty for some time* Generally speaking, X think that certification by a board is a legitimate evidence of qualifications, but not always* •Did the consultant system work efficiently during the war? Bid sectionalism * have any part in their selection or assignments? How much did personalities play in the assignments by consultants? Sid lack of general military knowledge of staff relationships play an important part in the disagreeable instances of command interference in assignment of specia ists?" Uy answer to the first part of that question—did the consultant system work effectively during the war— is that it did so far as I knew* It worked satisfactorily in my service command* Sectionalism had nothing to do with the selection or assignment of consultants, so far as ay experience goes* I know of no instance where pe reonalitles played any Important part in the assignment of consultants* & would be natural that it would happen, but I didn’t know of it* Z have no comment on the last part of it* "Axe consultants necessary in each medical section headquarters from the field army on up? Can or cannot a generaly' surgical consultant handle all of the field of surgery?" I think that medicalconsultants are required at section headquarters from the field army on up* They certainly worked to great advantage In the Zone of the Interior in World War II* I do not think a general surgical consultant can handle all the field of surgery in a large territorial command* X certainly think an orthopedic surgeon would be required, if you get in very many wounded* The general surgeon doesn’t know enough about orthopedics to assure that the wounded get a high standard of oars* nrnfninrrn ”2h the civilian 'consultant program now flourishing in our federal medical services, do you see why a single list repognlsed sod available to all services should not be established as an economy measure?* "Do 70a believe the accepted notion that troop* respect and have confidence in their doctors as the result of their long association in training, through hardships, etc*7 If not, do you consider withholding the assignment of medical officers in war to non-medical units until just prior to overseas movement?" I don't believe that you should waste medical talent with units who are not in combat, when they don't need the medical care* I believe that a medical officer should bs used in accordance with his qualifications and be kept busy# 1 do realise that It is Important for members ctf combat units to know their deetor and to have confidence in him« I don't think It takes a long time to bu id this up through long association* I think a good personality on the part of the doctor san bui id this up in a matter of weeks** Colonel, UC 215 nms STIRACI CQTXi (Extract of atatsnwrto i»de by Colonel Thooaa J. Hartford, MC, USA on 23 April AO at interview with Subcommittee on the Employs©at of Military Medical Resource*} ***** "o* Mali, number 1, I think tbs present plan In all the services along career raaagaiasnt io excellent if carried out, and of coura© they will he Just as good as the people administer- ing it and no better, bat it’s certainly a step in the right direction. Daring peacetime la the assignment of reserve personnel X believe that baa to be centralised to the services* As It nos stands in the /my—I am speaking for the Amy only—a certain number of reserve medical units am given to each Amy as their msponaibility and they have the reserve officers in their geo* graphical limits, end frequentlyd]even if they give the man the best possible assignment available within the Amy area, the men still is not properly assigned* N X feel that we most get the information on our reserve officers, which we in the Amy do not here, and the Adjutant General does not have, and once we get the Information that we should assign them from, in our case, the burgeon General’s office, or fro® the Bureau of Medicine in the ttavy* X don’t believe we should use doctors and physicians, that they are not needed if we hove trained personnel to replace them) but X believe them are situations and positions in which you do used doctors, although they am not doing purely professional work* X think an emeutive officer of a general hospital way be a point in kind* X think that you will have a better hospital, especially If you am using a lot of civilian personnel, if the executive officer, for example, is a physician* X also believe that we cea get mast of the highlywddlted professional personnel from the dvilian pod during emergency, sad that while certain regular off loam probably should stay on professional week, md those obviously who can’t do anything else shouldn’t be put in administrative positions, but X think that a good many of then will have to do lust the sacs as they did in this war regardless cf any high and nighty plans ws make to the contrary* X think this question of consultants Is important* X think it walked quite well in the last war* X think consultants am necessary in sod nodical section in headquarters in the field on wp, bat X think they have to be limited, sad X would say in the swgeon’e office cf the Any, for example, that a surgeon and medical CCBT»D ***** "c* man and neuropsychlatrlst la probably suffioent, unless you speak of the dental and veterinary officers as con- sultants In preventive medicine* Relative to affiliated units, 1 think they are a desirable pert of the organised reserve system* 2 believe the echelon-type of assighsmnt to these units is feasible and ought to be looked Into, and perhaps it should be a skeleton organisation with only certain chiefs of service actually assigned, andthfetdt be so called to duty* I think that it would, might well do Just that. In other words, if we replace medical officers by laymen in these key administrative positions and they all call for high rank, that eventually it will dawn on soon body that we are depriving pro- motion opportunities| that we already have reached that phase* In other words, we all know that there can be Just so many cardiologists, for example, or neuropeychlatrists, or anything else* We can use Just so many in Jobs that really call for the skill that we are educating them to have* There is going to be a group of people that we are trying to save them by calling it a new name, master physicians, or something, that are Just general practitioners. How, that group probably would look favorably towards some of these Jobs that they could better fill, but now me are apologizing for the fact that occasionally a doctor has to do some administrative work, e&mall amount, apologising for them and trying to tell them that they Just wcn*t have to do any of it the rest of their lives* ****** L, K, Pohl ColoOftl, m 217 mm oorT nxauat (captain w. », s»ii. (mo), v. s. ««t. dated 5 May 1948) ••••• "3. There will probably be, as In the past ear, aore special- late than the Services can wploy in their specialty. Recognised specialists and c pa nil tarts are of inestimable value la training Junior officers end a certain number San be utilised here, Recognised specialists smet be the profeeeional backbone of all major hospitals and in this poet-war period consultants hare amply demonstrated their value. The Army's system of specialised surgical, shook, aad similar teams which were highly mobile and could be uccd to amplify professional services wherever needed was effective and the scheme in suitable modi- fleatlon could be employed thruout the Armed Forces. The Kavy's epidemiological units were extremely valuable. Inevitably all doctors cannot be utilized where they would like to go and certain specialists must be employ ad outside their specialty. Adequate aad early indoe- trln&tion in this respect any avoid many of the made about the past war, w*seee £ L. K. Pohl, Colonel, MO THUS SXTKACT COPT OF ZBTiaTISW WITH COL MAST ft. PHILLIPS, AHC, 2? Apr 48. «•*••*»« "we Had to assign large numbers of aarr.es to the transportation corps which was a bow thing as far as assignment of nurses had been concerned, and it farther depleted the number we had available for hospital dot/. We know that, daring the war and up to the present time, permanent assignment of nurse personnel to transport duty has bean available* We would like to soo It got back to our peaeetlae status or acre nearly to our peacetime status where we depeud upon our people transferring back and forth to tako care of moods on transports, or probably It would bo bettor to have one or two nurses assigned* and then depend on the additional needs for the nurses that are traveling back and forth — have then travel to foreign stations and return, regulate that so that there will be available nuree personnel on all transports in officer travel duty status* Of course, transportation has been a different attitude regarding that* and they feel that they would like to have a full complement of nurses assigned to their ships* In the transportation of surees back and forth wo have problems that, X think, could have been taken ear# of had the troop oomaaander been in charge cf all porso r.el on the ship* Z don't know the vat in charge, whether it mis the captain or who it was. But Colonel Aanchfield had requested that the senior nurse be put in charge of the nurses* 2 know that the chief nurse who was assigned to the ship In soae eases had suggested that she take charge of the nurses who were traveling, but she was told by her eemmaadiag officer that they had nothing to do with personae! traveling* We felt that somebody should hare been definitely res- ponsible for the personnel who were traveling for transfer to foreign theaters and return. I night at this point, since X an talking about transportation, mention the quarters* situation on transports* Wo have felt that duty personnel assigned to transports should have suitable accommodationss that is, bettor than it was* But, again, 1 think they are beginning to have to double up. Their duty on n ship la moat confining, and I think that they ought to hnvo, as far ns possible, tits boot accoamodations that earn bo provided for duty personnel. I don't Man that nurses should hnvo the best there is, but I think duty personnel onn ship should be given good quarters* Wo had many complaints from nurses in transit that proper accom- modations were not supplied them as civilian personnel, war brides, and other groups were given pmfareneo to them who were in officer status and who insisted wore la officer status. Vo were tolling thsm of the typo of person wo wanted in the service because ef their responsibilities, and they would come back aad tell us, "Why area H we treated ns suchTt Z will say n little bit more nbeut quarters later on* So much for transportation anyway* In the program of returning the war brides, wo used aany nurses to assist with that program* We felt that this problem would recur again should we have another war on foreign soil, and that, when such personnel ia returned, it would be bettor If they wore first oriented; if they were oriented before they boarded n ship ns to what to expect, because many of women, Z think, oxpeet- ed — Z don't knew what they expected from the Americans — but Z think that, if they could be oriented ns to what would be offered then in the way ef medieal service, care ef their children, etc*, it would have helped things* tees uatrnAf copy or misris* mu col maht o. Phillips, asc, 37 Apr 4a, con. Heoessnry decentralisation la attUrt of assignment of moraine personnel frequently resul tod la the ovsrtsfflijg of hospitals ndtr ths jurisdiction of ana authority with resulting undersluffing of ana hospital la 41m near vicinity. I as thinking of hospital* thrt ware general hospitals, the Glass it installations whish night be soar a station hospital which was wader ths coaaend of ths Mssaadliii; £M* oral of an Aray * or a station hospital under tho command of aa Amy with an Air Tares installation nearby* When w« assies personnel to ths Aisjr areas, to the Air Taras, and to transportation, vs don't touch that psraoansl seals without concurr- ence from that service. Than X vas Cvlcf narsa in n station hospital, doss hr was a pnnl hospital vhsrs oar personnel poll alee could not always ha kept ths sane. Sometimes 1*4 have »eh acre personnel than ths general hospital had, and %e couldn't transfer it hack aad forth because ws wars under different Jurisdiction. I think that, if tha Office sf ths Surgeon general canid aako ths traae- fsr on a temporary basis for tha Any installntlons sad Glass II installations as the hsaplt&l aasds require, each conditions aieht not txU. The surgeons sf the waansnds have always been asst cooper at Its, hat X think tha blockage would aaas probably through ths personnel officers in ths Avalos sad ths Air Tares because vs redly had no authority to transfer their personnel. People whoso approval amt be obtained In natters sf personnel authorisation sonatinas, I think, have diffisalty in andsrstandiae that tha osrrlaa east operate a seven-day week, twenty*fear-hour merries aad that, in natters of personnel assignment, patient lead isi bed autherlsatisa are net the only criteria apea which authorisation for ■arsing personnel should be sons!dared. Sufficient personnel should be aatherWed to nllsw the proper coverage of aarsiac service la natters of care ef tha patient la tha bed aad, in addition, the neap asdgaaeate that ws have Is asks te positions, sash an anesthetists, administrative, supervisory, cl inis, ate., which ere aet represented bp beds. ttOOABXSH mi. KAHTIBi that do you consider the aest important step that should be taken now te prevent any of tha serious mistakes that were made during the war in connection with wastage of nurse personnel! COXtOSSL PHILLIPSi On* of thm things Uut, I think* the planning I»1m i« probahly working n is ft plan la balling ptmuil, to call than to active duty according to certain echelon* to that «• wa't get all the group* on at oae tint and have than wait for a long period of time for ahipaeat oversea*. If ve could bring car key personnel oa duty and give thee the necessary training and. when It coaes eleeer to the tine Ter ahipaeat* bring the other graqpa oa* X be* I leva It would be helpfnl. be are eertalnly going to hare to set up oar basic training centers daring war and gat ear newly appelated personnel * have the* flea late those eenters first before sending thee to oar goa ral aad station hospitals and trying to give then >>lt-tqr-blt orientation* SKXK JUHIXAL AIDSRSOSi At X ititnlaaA, yo» fittl that tht IVh Oerpt tf tht asvqt if so larct that tht attlftatai, dietritmtloa, tftliisiisi of tht \ Bather la tht staffs of Ttiiou hospitals taanot toll ht haadltd la tht 8W|Mft Atatral’t Off let, that It ft atettstrr to Aottairtliat tht ptrtwad tdtlai straw loa la that rscard* Coaid jroa casfftet htv tht dlfflcalty la npit to di strife*- tioa ttold Ve aorrtoted If tht Mitisanti tad timnsftars tart htadltd hjr ladtpsad 220 TJBIS KCTBACT COPT or IW;iam« WITH COL MAH! a. FHIULIJPS, ABC, 27 Apr 1948. gQH7IK«pS 00L0H3L P ILL IPS} Tho Surgeon Ottenl's Office Mold out to one of tho Armies and sop "Would you lot uo transfer unroot frou thio station hospital oror to thio general hospital oa a temporary basis because wo ai« short oror horo right now?* aad lot tho surgeon do that without haring to go through poraoanol channels* Lot than handle assignments in tho Medical Department. Z think that would taka aaro of seme of it* Wo hare a nurse out in oaah Any Headquarters; hut, of course, they work with the surgeon who lass charge of tho medical sorrica* The hospitals assign to tho Amy. not to the general hospitals. BHISADI1B OXKLRAL MARTIHi What da you think the ratio of nurses to patioate should bo to insure proper core rage of nursing eorrico and a reasonable work wookl COLOKBL PHILLIPS* I think that, in order to aoapoto with other hoe- pi tale and federal sorrieos, wo must keep our personnel policies and standards on tho Iorol of tho highest or tho beet clrilian hospitals. Tho trend is toward n forty-hour week. Certainly, wa should not hare eur nurse pareoanal working beyond a forty-eight-hour week* Wo should walk toward reach! a forty-hour week, 3 eight-hour shifts. Whore wo are oaring far largo department sorriest, wa need additional personnel. My recommendation is at least ana nurse to eight hospital bads* 1 think that, with that, wo can sorer tho eorriees that aren’t represented by tho patient in tho bod, and put our people on on eight-hour day***** Coloa«l, 16} THDE COPT (Extract from Ltr V. H. Michael, Bear Adtelral Retired, USS (MC), 19 Aprll 19*8) «**# ■ The assignment of regular senior medical personnel was reasonably satisfactory as was the assignment of senior reserves as chiefs of service within the United States* Mazy mistakes mere made in the assignment of juniors, especially junior reserves because no qualification description was received with the officers* In the States sometimes it was possible to learn a man's background and make an intelligent assignment, but overseas a man's assignment bad to be made immediately after - at the most - a few minutes talk with the man* % experience was that many, if not most, overestimated their ability in some speciality* * brief official resame' of every medical office 1% background received with him would be most valuable in making assignments* "Lastly, the rapid and —* to those in the field — totally ant- explicable continuous change of duty of many officers contributed to inefficiency in the Medical Department*• ««*# —^ L. K. PCHL Colonel, SC TRUK COPT EXTRACT (letter. Brig. Gen* George R. Keimebeck, DC, Air Force dated 7 May 19**) ***** * Qualifications of dental officers called to active duty daring a war should be carefully reviewed to insure that, so far as possible, they cam function in their specialty or is the branch of dentistry in which they are most proficient. In general, this means that Individuals with the most civilian experience should be assigned to hospitals while the younger officers should be on duty with tactical organisations* "in the next emergency greater nee of dental specialists and con- sultants should be msde* They should visit dental installations fre- quently, at least three times a year, and remain at the stations long enough to acquaint themselves with the problems existing and be able te cone te definite conclusions. In the past, these consultants have net spent enough time at the stations they visited******* L. K, Pohl, Colonel, SC 222 EXTRACT OF STATEMENTS HIDE BI COLONEL OSCAR S. REEDER, KC, DBA, OS 15 APRIL 1948 AT IKT*R?XE1 WITH SUBCOWOTTEE OH THE EMPLOYMENT CF MILITARY MEDICAL RESOURCES. ***** *Aa to um - up to the ago of 36 X would rocownd assigsnent to the ground forces, havy afloat and oonbat groups of the Air force. 36-45 years of ago - service in nodical bases overseas and in the interior. 45-55 civilian nodical centers la ZI and civilian population. "Ad.tePfcalCfll WBdlttffft* Personnel with Incapltating defects should not com into the service. They should reaain in civilian life subject to duty where needed. "frtftHllflMli flWMflfiiUflMi Those with no specialty* up to 36 - conbat forces, Any, Mavy sand Air Fores. 36-45 - Miliary installations in ZI net requiring specialists. Any, Savy and Air Fores. 45-55 - civilian institutions or localities in the 0. S. not needing specialists. "SltettUgg, rmulriag to 36 - Any, »avy, Air Fore# units in oonbat son# and connunl cation seme. 36-45 - Any, **vy. Air Force installations in ZI. 45 on - civilian institutions in the 9. S. X think that with personal in scarce categories then should bo exceptions node. "(C) 1. I don't believe we do, with the possible exception of the Executive Officer in General Hospitals. The reason I say that is that doctors resent a non-profeeaion&l nan. "2. I do not believe regular nodical officers should be given commend of these units without regard to their qualifiestione. I believe that reserve officers would acquit thaasalvas just as wall if properly selected. This in effect is that if reserve officers an given command of units in accordance with their abilities both professional and administrative, they will release a great number of regular officers for upper echelons of staff duty for which they have sore training.«#*♦♦♦ ***** *5. I think it wold, an an overall rule. Thera nr© exceptions, ®f eonrM. I believe sectionalism had an inflame©* Personalities played far tee mwh part* I don’t think that tha specialists had sufficient Military knowledge in administration for‘ the Idlings they did in matters of assignments, transfers, ate."***** whoCh X7k. Colon«l, HC SXPRACT 0? STATSMJHITS HADS BT CAPT. S.H. HBSIH&, JiU , («C) USK CM 2r. APRIL 1948 AT ISTSRYIStf WITH SUBCOMMITTEE OH THS SKPLO BOTP OF MILITARY MEDICAL RASOUHCSS. oeeee C. ■The third point, which you probably received from other sources also, is the lack of skilled medical talent lathe forward areas available at the time of the greatest initial casualty load. This was true mot only in the forces ashore, but mi very marked la the forces afloat. The first pi>iat X made was the lack of medical officers trained la staff work. I observed numerous times where a senior medical officer on a staff was assigned with the only qualification being his rank. Division surgeons who had as previeae experience with the Marines were similarly put right in as a division surgeon; and the same way with the amphibious feroes afloat. X remember the APA that I was aboard didn't hit the beach until D-Plue- lt mad we got 90 casualties aboard. Ve had one surgeon. Abet to bring It home to you, there were elm bellies la one operating room with oma surgeon. There was just toe much of a pile-up, and you couldn't gat to them. The general lack ef skilled surgeons wore so widespread that it is difficult to pick out any particular operation. However, I have one example which X think will prove this point. I received this information from Oolonel Openhelm at the 148th General Hospital, I stopped off there oh a mounting out force for Okinawa. It's he re say, but X have every reason to believe it's true. 8e states that ef the first 21 casualties that died at the 148th, following their evacuation from I wo Jtaa, 16 ef the cases were belly cases which had been operated on prior to reaching that Hospital. At autopsy, 18 ef those eases had unclosed performances, which is indicative ef the type of sur- gery that was being done. X consulted with Captain Celloway before coming UP to ask him it ha had anything that he weald like to bring up; and he said that without any in- crease In personnel whatsoever, the 148th bed capacity was doubled and that the entire medical facilities ef the Second Mariam Division, which was biv* euaccd. there in preparation for Okinawa, wore turned over to them. At one time there were 172 oases awaiting surgery at that Hospital, a backlog of 172 casts. for instance, in ay organisation new X am the surgeon in charge of anil the fleet Marines for the Atlantic. I am getting no Regular Officers to train. X am getting all h»12s. If we were forced to go in an operation today, X don't have on# man who can do surgery. X have every hope that we would have these men ordered in. These men need training to operate in the field. A Uniform Duty Classification for Of floors of the Medical Depart* meats of the Armed forces. Such a system, in my opinion, it new an absolute necessity. Xt has one, great drawback which may be overseas in its execution, end that is a man gate stuck in a particular classification or employment and has very little chance ef bettering himself. EXTRACT 0? STafSMlHfS MADE BY CAPT. £. H. H32iISO, JR. . (MC) USB OS fed APRIL Lf48 AT ISmviX WITH SUBCOMMITTEE OJJ THE EMPLOYMENT Of MILITARY MEDICAL RESOURCES, COST, 1 don't know how that worked out at higher level•» hut I refer e•pee- led 1/ to our non la the war where the morale among our battalion surgeons was pretty sad. lo natter how good a nan he was* because of this S/0 vacancy bus- iness* he was stuck there. Be eoulda't get promoted. Be couldn't utilise hie foil facilities. If he was a good nan, his commanding officer wouldn't let him go. There is a danger in a system like that. I think something must be put In so there is an elasticity or flexibility* where a nan will not get stuck in a certain classification unless he rated it. B I0AD1ER OSHSRAL MARTIH: Wouldn't & policy of rotation* in your opinion* help to prevent that? CAPTAIN HERIHG: Tes* I believe to. I don't know whether the Admiral (Admiral Adnereon) would agree that our Kaval Medical Policy that a medical officer can do anything it certainly outmoded. I know X found myeelf in many situations where 1 just kept my fingers crossed and hoped nothing would happen* because I wasn't prepared* uyself* to take care of it. (General policies relative to assignment of medical personnel, includ- ing use of recognised specialists and consultants. There le one ether point I would like to bring out in regard to this. I was tremendously Impressed by the Amy's system of consultants* and the cali- ber of those consultants* in the operations that I observed. I know that they raised the whole level of hospitalisation treatment In the particular theatre which I observed them in. They had such men as Walter Martin, John Honey* Ben Baker* and other who were tops in their field. They would get right down to these pedple and say:"Look* you are not doing It right boys. You have got to handle them in this way* The shock has to be taken care of,- And* they did it. me doctors In those hospitals appreciated that type of personnel coming to them and giving them that information. It was not only for the benefit of the casu- alty but for the benefit of the doctor himself. And* as far as X know* we had aothing like that. REAR ADMIRAL AHOSKSOI: Would it be your idea to plan for consult- ants in other units than hospital units* under the SavyT CAPTAIN KBKlBGi Yes sir. E3AE ADMIRAL ASDSHSOB: Tou would have eon suit ants la th« at^pjil'bloue foreat. CAPT HSRISOi That is a must. Sight now nobody knows what kind of an outfit I have get. X inspect nyself as being the IMF* Atlantic force Surgeon; end I know what X have got as the best. Well, it isn't the best; it isn't the worst. But no ody knows hew prepared I am — what my capabilities are* what ay imitations are* with the personnel mat X have* whether I am doing a good job* or not. I would welcome inspection. Xt would raise the whole tenor. A man in the field* if he is any good at all* likes to be inspected. So it raises the morale of the whole thing* if somebody it paying attention to it. lTx. POHL, Coloaal, HO THUS COPY SXTKACT (Letter from Captain K. J. Aston (MO), USH Portsmouth, Virginia, dated S3 April 1948) ••••• *•(«) General policies relative to assignment of medical personnel, including dee of recognised specialist* and consultants. In the main, according to ay observations and beliefs, such policies employed during the late war were realistic and practical. According to ay observation It was usually found that the right man was sent to the right Job. There were exceptions to this, but instances of this sort which came to ay attention were very few. The policy of assigning young and active medical officers to duty with troops in the field was mainly adhered to and was & good one. Combat personnel of necessity must be young and vigorous. Sustained mental and physical hardships ere not well endured by middle-aged or elderly officers and men. Instances of this are recalled. One such deals with a forty-five year old medical officer serving with Karines In the early days of the Guadalcanal campaign, This officer was received as a patient suffering from more or less complete physical and mental collapse. Only a short time previously he had been observed in quiet and peaceful surroundings and was considered to be m healthy stable and wall ordered individual. The strain of a few days combat had effected very definite and serious changes. After his re- covery had been established he attempted to explain his break-down in this manner. "The continuous noise of battle kept me keyed up at all times. I was unable to rest and during a lull In the firing I could not sleep yet the young fellows around me were able to put their heads against the soft side of a rock and go sound asleep.* during my services in the Pacific I observed the functioning of practically all of our hospitals in that area. I also knew most of the medical personnel of our forces afloat. I believe that the personnel of these units were properly assigned in the grgat majority of instances. Medical officer units at our hospitals represented well-balanced groups possessing the necessary and desirable professional qualities for such assignments. The same can be said for the hospital ships and hospital transports that came under my observation. In my own ship. The USS Solace, I began my service With a staff consisting of regular naval medical officers and three or four doctors of the naval reserve. All required speelallete were represented in this group. In may of 1942 this group was replaced by a medical special 1st unit from the University of Pennsylvania. They too represented a well-coordinated and well-trained group of doctor*. It was the desire of these medical specialists units to regain together during their period of service. The hopes of all of then in this respect were net fully realized and as a result some feelings of disappointment and deep regret were expressed; however, I believe that it was necessary at times to utilise the services of one or more members of the units in situations that developed and where these service* were urgently required. The needs 226 of the naval service in this respect should supersede the desires of the individual. Most of the griping and criticism I heard resulted from inactivity, and no doubt was engendered by an overwhelming and understandable desire on the part of the individual to get into the thick of things. I know of few instances where "race-horses were hitched to plows,” Perhaps on occasion a highly specialised medical officer might bemoan the fact that he was serving in some other professional capacity sud not doing the work of his speciality. Such few instances in my opinion were largely unavoid- able and should not be given undue importance when the paramount needs of the services and of the conduct of the war are considered. It Is to be expected that we can benefit by experience and commit fewer errors In the future. In most of the Pacific areas with which I was familiar, recognised specialists were available if not readily available to all pesslble needs. The hospital and hospital ship staffs were vell-balaneod and included out- standing doctors. Such excellence was represented also in our forces afloat. Insofar as the assignment and deployment of recognized specialists to the hospltale and other medical facilities of the continental United States is concerned, It would seem that here too realistic and practical measures were employed. During the mid-year of 1943 the navy began the employment of travel- ing consultants In the Pacific areas, this policy van not an expanded one and involved the use of a very United number of medical officers, fie army on the other hand employed these traveling consultants mush more extensively. I think their use by the navy was of doubtful value except when sent to areas where experienced and veil-trained medical personnel were not immediately available. The present policy of the bureau of Medicine and Surgery vhich provide* for the services of recognised spe- cialists and consultants in all of our teaching hospitals and many of the others is considered to be highly desirable and one vhich vill be of great benefit to our medical officer personnel as veil as to our patients. Civilian influence on the future development of our Navy Medical Corps vill perhaps become more apparent but this should be beneficial in all respects, provided that the fact we are maintaining Service hospitals with a singularity of purpose is not forgotten. Naval administrative control must not be relinquished.*••••• L. K. Pohl, Colonel, MC fBSTS OUPY 'EXTRACT (Letter from Colonel Hohert X. Simpson, USA (let.) dated 1 May 1948) General policies relative to assignment of medical personnel, Including use of recognised specialists and consultants. In every instance qualified specialists should he assigned duties wherein their services could he utilised to the advantage of all concerned, regardless sd "Jta&Jto a£ imalsftjklaa*» "-position rj&§»SX.W\ etc. Mal-assignments of this nature were the source of lowered morale and discontent. For example, 1 found an exceptionally qualified plastic surgeon operating a small dispensary with a general hospital nearby badly in need of a plastic surgeon, a well trained maxillo-facial surgeon on duty vith a squadron and the nearest general hospital without such a qualified officer, a diplomat® of the itmerioan Board of ophthalmology on duty as assistant to base surgeon,etc. L. K.rohl, Colonel, HC 228 TRUE COPY EXTRACT (Uttar, Captain Robert U. Gillett (MC) OSH dated 15 April 19A8) ***** "The assignment of medical personnel by too high echelon was one of the major errors of World War XI. Better utilization could have been accomplished by permitting final assignment by Task Force, Area, or Group Commanders** ***** L. K. Pohl. CVlorwl, MC TRW COPY EXTRACT (Utter, Dr. A. R. Shands, Jr. dated 20 April 19A8) ***** *The assignment of medical personnel at the end of the mar was quite good. One of my duties for the last 16 months in the Air Sugveon's Office was to be responsible for the assignment of all surgical personnel. In my opinion this was 9$% the way it should be done.” ***** jZ L. K* Pohl, CWonel, HC TRUE COPT EXTRACT (Letter, Captain F. R. Urban (UC) USI dated 28 April 19A8 ***** *»(c) General policies relative to assignment of medical per- sonnel , including use of recognized specialists and consultants* "(1) Many medical officers, both Army and lavy, were used in sani- tation and public health capacities that could veil have been performed by sanitary technicians or sanitary engineers* •(2) Too many professional personnel employed in purely administra- tive duties* •(3) Professional staffs of medical units were too tightly tied to rest of unit. e*g* When & hospital is being held awaiting shipment or in reserve, professional staff were unemployed for long periods* (Both Army and lavy). *C0 There was a lade of medical officers with joint operations experience and training* Recommend more use of available military schools for selected medical officers* (Maval War College, Armed Forces Staff College)*■ ***** L. K« Pohl, Cdionel, IK TRUK COPY EXTRACT (Letter, Captain C. D. Middlestsdt, (MC) USN dated 17 April 1948) ***** "In reference to paragraph 3(e) of the cowaittee cm Medical and Hoepltal Serricee of the Aimed Force letter, in the tine of war I bellere that all recognised specialists and consultants should be as- signed to their specialties* There is no tine to try to train these officers to be what we consider an all round naval nodical officer* I personally know of one officer vrho had been doing tuberculosis work for several years* However, he was doing the work of a general prao- tloner for a year under ae and his services were needed at the Naval Hospital, Corona, California* The Bureau of Medicine and Surgery ignored his request to continue in hie specialty* I also know that there was a need for roentenolgist and I know of sons who were assign- ed to genito-urinary services or other services in which they had no interest* While these are only isolated eases, it is ay opinion that it is bad for the aorale* These officers will never help our prograa in obtaining reserve unite* We premise then they will be able to practice their specialty and after they have signed up, they are then inforaed that they will be used where they are needed with no farther consideration to our premises to thea*" ***** La K< Pohl« Colonel. MC 231 TRUE COPY EXTRACT (Letter, Hear Admiral C. B. Camerer (MC), U.S.H., Retired dated 21 April 194-3) *HHHe-«(c) Again in general as followed heretofore. HoTsever, while the assignment of highly specialised civilian consultants is most desirable, it is held thay should HOT be assigned inspection duties, etc., ALOIS, but with and under the direction of a Senior Regular Medical Officer, thereby avoiding inevitable friction, misunderstandings and unpleasantness, a frequent result of this practice of sending such consultants ALOIS with Department orders to inspect and report on Service Medical Activities, with his impressions, etc., directly to the Bureau* While doubtless motivated by the highest ideals and objectives, this should be interdicted along the lines suggested. "The assignment of highly specialized Reserve SIO»s to active Service Medical Centers in forward or advanced areas, hospital ships, and other vital Medical Activities, is considered most desirable and the necessity therefor is stressed# But they should ALWAYS be subordinate in rank to the S*M»0« of the activity concerned# Their services, roperly distributed and assigned has heretofore and will in the future prove invaluable to the Medical Services •* /O _ rx wci'ToKiaL'; nr TftUE COPY SjCTdACT (Letter, Captain Emmett D. Hightower (ilC), U, 5, Navy- dated 21 April 19U8) ” (c) In the general policy of assigning of medical personnel, an effort should be made to assign each perscn to the job for which he is best fitted* An example of improper assignment, is the case of an bSN&T specialist who was order®! on board ship as the only medical officer and he was not equipped to handle a simple appendix or other emergencies outside of his own specialty." «-**** L. Pohlj^Colonelj Uc THU1 COPY EXTRACT (Better from Captain W. 0. Baty, Jr., (MO). USB dated 19 April 1948) ***** »flie establishment, at theater level, of the required number of special surgical teams, to be assigned to appropriate APA’s for a specific operation on the bases of operational requirements. The practice of loading ships, other than hospital ships, to capacity vith wounded, risults in a backlog of urgent operative oases aboard these ships. Xt must be emphasised that wounded cannot be loaded aboard ship on a basis of space availability alone as stqpplies are leaded. Bach ship's capacity to care for wounded most be of measured In terms of available facilities and the skill of embarked medical personnel.f t. I. Pohl, Oolo»«l, MO 234 rmi>: flgritu (Ltr Dr. H.S. *toffx.an* ltd X3 May 48) ******* Q, *Vithin the Continental Units: In general, the Ife.Tal Medical Corps accomplished a reasonably goo* assignment of personnel to jreoet establishments. In addition* sore* often than not» nodical officer# in ©o.n»T>uad seemed pleased and even anxious to avail then* ©Ires of the special ‘training and experience of recognized specialists 4ctailed to their commands. It is felt that thought should he given to certain present day trends in medical education qnd training which should have an important bearing on the problem of assignment of medlcsl personnel In the future. World War II iie serve modi cal officers qualified In a specialty frequently questioned their ns ignroent to duties for which they felt themoelvss unqual- ified. More often than not, the answer was "Son, in the Wavy a doctor is a doctor - - even a pediatrician’'. On December 7, 1341, few if any officers of the Bsgulsr medical corps had not at some time in tholr careers dene prac- tically everything in the field of medicine and surgery. At the same time, among civilian doctors there van a growing number of men restricting their practice to narrow specialties who had had no experience In general practice previously. However, the great majority had a background of general practice. So, In spite ef instances of errors in the assignment of personnel, the situation was not too critic©!. Practically the entire Regular corps and the great bulk of Reserves could adapt themselves to the exigencies of war by whatever the sit- uation required. At the present time the picture It; changing very rapidly # To practice in a specialty today it is essential to he certified by a Specialty Board. These boards almost universally require five years practice in the specialty before admission to examla tlon by the Board, This practically in- sures that from now on doctors who become specialists will not get any exper- ience in general practice. It Is well known that at the present rate, special- ists will soon outnumber general practitioners. In a few years we will have a large pool of civilian doctors qualified in medical specialties who will be as incapable of doing major surgery us any Line officer. With the very nature ef combat creating the necessity for surgical procedures, this situation should, in a relatively short time, set up a nice problem for assignment officers. As a matter of fact, the Havy itself is contributing to this problem. As an in- ducement to young graduates to enter the Wavy, they are being promised training that will qualify the® to pass Specialty Boards. This program, if adhered to, can only result in an appreciable percentage of the doctors even in the Regular Ooros not being qualified for assignment to general duty«‘W,**,,"',**,> Z.frpmft COLOm, fcC 235 stoact y m maps CoTaiel 4» rrWjorveTt* SIS, P*S*A, on 22 April at interim with *tm tVj» "o‘i Miliary ''l^&cSrllfwairc«8 ***** »Ilo* 10* les, Tii* but way I knew to discourage a reserve officer, cr the second boot — the best one, of course, is to let him think it dooun’t do any good to be « reserve officer — the soecnd best way I know to discourage a reserve officer is not to assign him to anything* If oar general reserve isn’t large enough to accowsaodato—in other words. If tfj* unite that belong to whet w» call our general reserve aren’t adequate to accaaaodate ell the doctors, and they are net today- there aren't enough whet wo call T/0 positions available In ell our general reserve units to accommodate ell the reserve doctors, then we should set up something else* lie should set up composite groups, or what the ffavy calls divisions, X believe, or something* This man most feel that m belongs to s^usthing, even though It means vary little in the long run* He should fed that ho belongs to a unit or an organisation of some kind* "As far as breaking vp this assignment, that’s not desirable, but it’s necessary, of course, in a great many cases* The old idea of a mobilisation assignment gave the man the idea that he was belonging to sosaetdng and was going to be needed* the fact he didn’t go there didn’t hurt his morals too much, I don’t think* •I don’t understand No* 11, relying on organised medicine to furnish medical officers for the services* X don't believe organised medicine furnishes doctors when they are drafted* X m not Vying to quibble* Is that an implication that the AM hit cut people? X don’t know* If it is, X am not prepared to answer the question* "Ho, 12* That baa to be answered both ways* If you have unite, and if your unit Is going to mean anything—>1 refer, for example, to an unaffiliated unit—the am have to be assigned in grades roughly ritimm curate with tbs table of organisation grades* ••-ta the other hand, we are going to liave other people, as I hare just intimated—I hqpe wo are—who belong to flexible unite* *!h«ee people should not bo kept from promotion cusrely by virtue of the fleet they don»t belong to a particular unit, nor should people assigned to a unit be held in a position year after year after year, getting older and better quail* fled all the tiae and kept frora proaoticn merely because they are In this vacancy* Thera should be florae mam Sot keeping this classification thing up to data, and than if a nan Is qualified for sons tiling also, either trans- fer iiia on paper into the other position, promoting hla, or keeping cor other units sufficiently flexible be promoted on hie professional ability* a rnu,vM;t6m£L9m'm ■ 'o) continued X* E.XTIUCT CF S?ATflfiiafFB Mm JXt tfctonel ■Frederic VCm U.S.A. on 22 April 1>%8 at interviswr wrtbrku&o' melt tee on of' ftdli'tary ISSEL'cSaiT om people do any kind of a job without mush of any preparation. Those arc exceptional people. They are not avora-e individuals at all. ■ brigadier General ifcrtlm What is year answer to the preparing of regular officers for administrative positions during peacotiias? ’’Colonel Wsstervolt* I m glad you asked me that question. I will answer it by mking a preliminary statement* *1 think first the decision should be smd@ as to w.bat we are going to do with our regular officers. If the balk of the regular officers are going to, as in World B« II, be required to take over the so-called operational activities of the medical deparfcaont, then I think an evavincreas ing and immediately increasing number of them should bo given this type of training. If, as I board expressed as an opinion of the front office the other day, we are not going to Increase our proportions, but are going to expect a proper proportion of our reserve officer® to o&m in and command hospitals and do ear staff work, then arrangements should be tiade accordingly to train those people. That latter is practically impossible* Icu cannot at this day and age, with conditions as they are on the outside, expect a reserve officer to take adrainis'irative-type training, to leave his ractico md take that type training* Therefore, of any personal opinions, I think I would recOBKBend that we immediately start repl«iis!dng our rapidly-deindllng corps of adalnistrativclyKjualified Army medical officers. L* iv* Fold., Colonel, j continued 2* EJ3HACTP OF STATS2.1STTB Colonai rrotloric "^Q3;Karw5.1£M MC. U«3«A, on 22 April at interview ir£th on tho' oi? MiTtary ~‘^ Colonel, MO TiiUC COPT SITaACT (Letter, Captain Srmastt D* Hightower (112), U, S. Navy dated 21 April 1943) ***** w (d) Replacement pods of Medical Department personnel are vital and necessary* However, they should be formed at major hospitals ■whore the talents of the personnel can be utilised, and not formed at a Fleet cr Force Headquarters or Receiving Station* An effort should be made to have all the various medical specialties represented in these pools,* TRUE COPT EXTRACT (Letter, Colonel Bascoa I, Hilsoh> MC, Air Force dated 21 April 19A8) -xrr. cbionax, m ***** “Reference the system for release of officers and others after cessation of hostilities, apparently there was no definite system in existence at this time. It Is probably true that the enormous demobilisation of the Forces which began so shortly after the shoot* ing was over, was not anticipated, however, whether or not it was, some definite plan should have been made prior to that time, flexible enough to apply to complete or partial demobilisation. Hot only plans for the actual release of personnel, but plans for the criteria for release and for those to remain in service during demobilisation should have been in existence. The forever changing of criteria for release appeared to have a demoralizing effect on all concerned, even to this date in the case of Medical Department Officers, Ho one can fail to see that the release of those Medical and Dental Officers trained thru the ASTP Program, who had no active service, with no strings attached to them, was a great mistake. This Is so evident now then the Armed Force* are so sorely in need of Medical and Dental Officers. Careful planning In anticipation of future needs of the services would have prevented this,* ***** L. K. Pohlj Colonel, MC 248 THU1 COPY EXTRACT (Letter from Colonel Hebert I. Simpson. USA (let.) dated 1 Her 1948) ***** "(4) Replacement pools of Medical Department pereonnel. "Poole* as such should be abolished — if at all practicable. General and station hospitals may absorb excess personnel and be used as a source of personnel for replacement purposes. Keep all Indirlduals as active professionally as possible. The monotony and laaetlrity of boinc assigned to a "pool” or staffing area adversely affects morals." ••••• dS-tZeS) L. X. Pokl,Colon«X, MC TRUE COPY EXTRACT (Letter, Col Robert P. Williams, MC, Surgeon, 16 Apr 1948) ***** u(d) Replacement pools of Medical Department personnel. Replace* went pools are necessary. However with better staff planning and elim- ination of competition between the services it should be possible to alert doctors st their homes, then call them when they are actually needed. Planning will eliminate the Justified criticism which has existed." ***** L./l.POHL, Colon#!, MC 249 Bna COFT PTRACT (LetUr, I.Illa Jan* Captain (BC) OS! 29 April 1948) ***** taoBiuanoi •Demobilization to follow the mm pattern used after World War II, except that its progress should accommodate itself to the needs of the patient-load* •The Bureau should keep each District or Area Senior Worse advised of projected plans so that she will be better able to estimate her person- nel needs and deploy the personnel. This also would apply to mobilisation, casualty loads, and to demobilisation activities. Inch valuable personnel was lost unnecessarily in demobilisation because nurses available for re- assignment were not returned to the States until maturity of demobilisation points enabled forward area commanders to order them back under demobilisa- tion authorities«• ***** mm con STRUCT (Latter, T. r. Cooper, DSB, dated 19 April 19a8) ***** "Replacement pools in time of war are essential to Met the require- ments of military and naval strategy. To the officer standing by in a replace- ment pool, it seems a tremendous waste of time end talent, and, therefore, much criticism arises. This criticism tends to snowball until one hears on •very good authority1 that ’there are several hundred officers languishing In the pool1 when, in fact, there My be no more than ten or fifteen present. It is possible, too, to keep most of the pool officers busy on temporary as- signments while awaiting permanent orders. With an alert assignment officer, replacement pools can bo administered with ominAnt satisfaction, ComServFae administered a medical officer pool at Pearl Harbor during the late war without which nodical service in the Pacific woul'" have boon greatly hampered ,* ***** 1* K. PoW* Coloa«l, «C TROTS COPY EXTRACT (Letter, Colonel Arthur B, Welsh, MC, MSA dated 19 April 19(8) ***** "Zone of Interior Medical Department Replacement Penis were unduly criticised* Bren though stagnation sometimes occurred therein, such peels were necessary to meet promptly the oversea demands and last minute requests for unit fillers* Bad such pools net existed and had excess doctors been assigned to commands (air, ground, ASP) it would hare been toe difficult to 'extract* them to fill requests* This condition night bare boon corrected by providing The Surgeon General mere control over all Medical Department personnel along with authority to cut aeroes command channels* It tech tee meh effort to shake doctors loose from the. Air Forces, for example, bat it was dons frequently* Since eoemands were not permitted ewer* strengths it is difficult to visualize how they could function ef- ficiently without the existence of pods* Theater surgeons didn’t have but should have bed pools far strategic placement within their commands and should have been permitted to dictate assignment of critical category personnel* Close harmony with the Theater Re- placement Command in screening requisitions on the zone of interior end in interviewing end recommending assignment of replacements to positions within the theater was almost universally lacking overseas* It seems moat necessary that theater surgeons should have this priv- ilege since classification and proficiency rating is but an index to assignment and won't work without medical control of assignment** ***** TROTS COPT OTRACT (Letter, Captain H. D. Templeton, MC, USI dated 23 April 194*) ***** *G» BCTLACfOTKT POOLS Of MEDICAL DgAgmnrf PffiSOWIB.. •The desirability of a replacement pool was well recognized during the last war, and it would seem entirely feasible to maintain such a group of medical department personnel well forward in the zone of communication."***** * L* I. Pohl, Colonel, MC THUS COPT (Extracts from Ltr Col* Harry 0* Armstrong, 1C, 16 April 1948) *&• Replacement Poole of Medical Department Personnel# (1) Defects t (a) Replacement pools wasted too such tins* (b) Pools in general considered unsatisfactory* (2) Remedies t (a) Better staff eorkf in that personnel called to duty chon needed and not when convenient* (b) Pools in general considered unnecessary* (c) The use of pools and airplane travel to provide emergency service in special areas is justifiable* l7k. poHir Colonel, MC 252 true: COPY EXTRACT (Letter, Captain Robert K. Gillett (fcC) USM dated 15 April 19AS) ***** “The use of ‘medical pools* are too Inaccessible and fosters discontent due to lack of employment* All types of personnel should hare a definite assignment controlled by proper echelon. All types of personnel under this plan could have been gainfully employed In teach- ing, consultation, inspection, and educated in military problems, op at least kept busy, between actual combat assignments ***** V i,, kV Pohl , Volonel, 14C TRUK COPI EXTRACT (Letter, Captain Lewis T. Dorgan, (MC) TON) ***** **(<*) Replacement Tools of Vedical Department Personnel *A definite policy- of rotation should be established and strictly adhered to in regards to forward and rear duty. As an area becomes inactive the medical department personnel should be withdrawn and re- assigned elsewhere without delay. The most marked cases of poor morale seen in the last war were among doctors In rear areas where there was not enough work to occupy their minds. Few men complained about their assignments for any reasonable specified period of time but at that time deadline was passed without definite word of relief, discourage- ment, listlessness, and dissatisfaction rapidly appeared and spread. "SBggMtflA fopcdlm "(1) Keep replacement pools and rear activity personnel at a minimum so that Idle personnel would be few* *(2) Rotate Medical Officers frequently fro® hazardous duty assignments.*1 ***** U K • Pohl, CxA&nel, VC 253 TSOI! COPT EXTRACT (Uttar, Colonel 0. T. Hellney, VC, Air force dated 20 April 1948) ***** *d, Replacement pools of Medical Department personnel, insofar as they apply to physicians* surgeons* and nurses, should be kept to an absolute minima# and should be sufficient to Beet emergency requirements only* Such personnel should in effect be taken into active service only as they are actually required* During a national emergency, all such personnel scheduled for mobilisation should respond to a *master’ which should be as local as possible, should have a physical examination, equipped with uniforms, and then, unless required by the services at that particular time, they should be returned to civilian life and per- mitted to serve their home communities unless their professional services are actually required, at which time they will then be ordered direct to the medical facility requiring their services* During the period of awaiting such such orders, they should be supplied with study material, aimed at preparing than to meet any new and unusual professional pro- blems, such as those which might be encountered in atomic warfare or bacterial warfare, etc* Other Medical Department personnel should be kept out of replacement pools so far aa possible and should be given intensive training in the manning and administration of various types of medical facilities so as to qualify them to handle all hospital ad- ministration, and thereby free professional personnel for professional duties•" ***** V t. K, Pohl* Colonel, MC TRire COPY EXTRACT (Letter, Captain F. C. Greaves (MC) USN dated 17 April 1948) *♦**♦ »(d) The maintenance of pools for medical, dental and nurse corps officers and corpsmen should be avoided as much as is practicable. We hear too many complaints from former members of the armed services that they were assigned to such pools for weeks and sometimes months, with no responsibilities except to report to some equally bored individual at stated intervals. To then military life means 1 stand by to stand by* • It would seen that pools of this nature are justified only during the build up and early phases of a military operation. As soon as it becomes ap- parent that the operation is proceeding successfully the pool should be dispersed without delay. Planning Sections of the Medi- cal Services should be kept informed of the implications calling for medical activities in all projected operations. This calls for closer integration of military and medical planning than ex- isted during some phases of the recent war.* ***** L. K. Colonel, MC 255 TRUT: COPY TXTR. CT (Letter, Captain C. D. Kiddlestadt, (*C) USK dated 17 April 19/8} ***** "Relative to paragraph 3(d), my experience with replacement pools is limited to Samar - Leyte Area, The receiving ship pool was controlled by Service Force of'Seventh Fleet, A junior medical captain assigned these men and looking from the opposite end, it appeared that he had no conception of the overall needs of the area. The Service Force Flag was often so far away that requests required weeks to pass through the chain of commands. At the same time I could not draw upon any of these men even in a temporary measure. Hospital Corpamen whose services were needed in Fleet Hospital # 11/ were digging ditches or were on working parties in no way connected with the care of the side and wounded. There was a G-A hospital unit waiting on Samar for assignment. They had been waiting for over three months when I ar- rived, I made several attempts to have these officers assigned tempor- ary orders in order to use their services, So action was taken until the fall of Japan, Then they were ordered there to process the pri- soner? of war. These officers were outstanding men at home, one being on the faculty of a medical college. They told me they had done nothing of a medical nature for almost a year. They were disgusted with the treatment they were given. Such conditions as these do not help our program in obtaining reserves,"***** L. K. Pohl,Colonel, WC 256 HBBi COT MMST (Istter.Captain 0*B, Uorrisoi», Jr*f MB, W dated 5j April 1940} ■*«*»«« «d* Replacement poola of Medical Department pericanel* Replacement pools are on absolute necessity* but It Is the opinion of meny Observers that they mere improperly used In the pent ear* To ay knowledge 9 a large pool of aedloal offleere and oorpeaen spent nine months of an eighteen months1 tour of overseas duty doing nothing but malting for assignment. At ths seas time, eoefeat units desperately needed replacements but could not utilise the personnel In this pool because authority for assignment rested with higher authority In the rear areas* It Is ay belief that aedloal off loan mho are sufficiently well qualified to be assigned as Task faros surgeons or Corps surgeons, end mho ere actively engaged In safest, should be capable of deciding ha* and when to utilise medical personas! in tbs replacement pools* * *—•»» L* K« Fohlf ttolrol, MC 257 Tjjdffi CQFI* (Latter from Colonel Richard T. amest# Rat# dated 19 April 48) ***** °d. A strictly medical pool should be set up for each theater of a large base* Feu of these officers would be idle since they would be attached to functioning unite# As a front advanced all attached personnel would be releaved end reattached to a newlysat up hospital unit# The theater or base surgeon would have complete control of this personnel 1a pod# Consultants are essential though it Is fait by ns that one good surgeon and a good nodical consultant for a theater, if not a large theater, would be sufficient. Specialists during World War U were occasionally wasted# however# the utilisation of good specialists me Inadequate# A good psychiatrist might cover several hospitals#* ****** K« Pohlv Colonel* U» S* Amy THUB COPT flyFfffT K*ar Ada F.L, Conklin (KC) US*, ltd 27 Apr 48) *•««*«* ■Reserve Medical Officers wonld be better than the Medical Division8 now being activated. «* sp sy L.K. POiUiVCaloael. MO 258 TRUE COPT (Extract Ltr James K. Hix, Lt. Col., MB, (Resigned) U April 19*g) ♦HHMUKJould be utilised on breeder Seale. As we had talked about in Italy, organise your hospital minus all professional components. When com itteed, professional components to be drawn from a pool in accordance with the mission.***** Colonel* m TRUK COPY EXTRACT (Utter, Brig, Gen. Robert C. McDonald, MC, USA (Ret.) dated 15 April 1948} ***** *(d) Replacement Fools for Medical Department Personnel. *(1) Cement» The establishment of replacement pools for Medical De- partment Personnel at certain general hospitals and at Medical Departmant technical training schools worked Tory satisfactorily during l.W. II. *(2) Suggestions i The operation of Armed Forces Replacement Pools for Medical personnel should work well in next war.* ***** L. K, Ponly Colonsl, MC TRUE COPT (Extract btr Albert T. Walter, Captain, &£, USS, 26 April 194B) *«■**•Beplaceme nt pools of Medical Department personnel as used during the > last war resulted in a great deal of inactivity on tii© part of medical officers and was orobably one of the most potent factors in generating dis- satisfaction* Here again, decentralisation should be practiced* It is most important for proper casually care and epidemiological control to have recognised specialists in the forward areas. Banning surgical teams and epidemiological control teams# It is in the forward areas where early definitive surgical care can best be given, that lives are saved* It is also true that epidemiological control measures must be Instituted early In any ■' campaign if the desired result is to be obtained* In this respect, it was found highly satisfactory in the Seventh Fleet, with which I am most familiar, to combine our malaria control and epidemiological control teams so that they sould function together and continuously* Future plans should provide for mobile epidemiological control laboratories which can be dispatched on short notice from place to place as requirements demand# Properly constructed landing craft such as the X£I type of ship, with supplies and equipment,would make ideal mobile epidemiological and malaria control team and laboratory, including facilities necessary for shoreside transportation# They could then be spotted in as early as the day of a landing and commence the control measures Miich are so necessary for the success of sty amphibious operation*"**** **• £• Colonel, VC TRUE EXTRACT COPY (Letter, Colonel H. Foraee, MC, TKA, 20 April 19A8) ***** *(9) Heplaomaent Poole of Medical Department Personnel, The functioning of Medical Department Heplaooaent Poole la the £one of the Interior may veil he required to gear to a level of air travel. It may he feasible to think of oversea* x In terse of functional unite. In World War XX transportation facilities and other requirements made it necessary to gradually concentrate large numbers of actually unemployed Medical Department personnel, especially doctors and nurses, etc. in overseas areas. This resulted in stringent criticism of the War Department by doctors. An Infantryman seldom complains of not being employed but doctors, nurses, etc. feel that long waiting periods, especially overseas, are unjustifiable, transportation by air of even satire hospital staffs, that is doctors and nurses should warrant con- sideration. In one field. In particular, this seems most feasible and that is relative to surgical teems or units which function in forward areas. These surgical teams perform a highly specialised function in concentrating on the care of the meet severely wounded, they afe not needed during quiet periods but their demand is great and urgent during periods of heavy fighting, they work under very hasardous conditions and it was clearly demonstrated by both the British and our own esperleaee that unduly long periods of such duty was highly undesirable, the organi- sation and placing of such teem units, on an emergency call basis from the Zone of the Interior with the employment of air traaeportation would make them available to overseas theatre Surgeons when most needed and permit a system of rotation home which would improve morale and efficiency, «*•••• L'. X. ?ohl>Colonel. KO TEPK COPY EXTRACT (Matter, Colonel R. E, Stone, MC (Rea.) Air Force dated 22 April 1948) ***** "Replacement pools are necaaaary but feel that the tine spent by physicians and dentists at these stations should be re- duced to a minima. Vas often told by men coming over seas how long they had laid around Replacement pools in the U, S, while there was a crying need for their serricea in the E.T.O," ***** TRUE COPY EXTRACT (Letter, Dr. Russel V. Lee dated 18 April 1948) ***** "(d) Replacement pools of Medical Department personnel* "These *pools' were all too frequently 'sink holes' where medi- cal officers passed many useless weeks in stagnation. A proper bookkeeping system which showed where medical officers wsre and where they were needed would eliminate these foolish wasteful replace- ment pools* Medical men should be kept in their communities until they were really needed* (Remember the Mart) men at Corona in the Rawy in the past war?)*" ****** L. K, Fobl/Colonel, Me" TRUE SXTHaGT COPY (Ltr from Capt. Warwick T, Brown (*C) USE dtd 20 Apr 1948) ******* D. "Replacement Pools of Medical Department Personnel. Medical officers who Mare Been trained for field and amphibious assignments should be earmarked for the forces for which they are trained. These office s should be ordered direct!/ to the theater replacement pool.•*•••*•**• TEUS 5JCTHACT COPY Of MEDICAL SUPPORT Of THE USAAf IH THE BUEOPSAE TBSAT2K OF 0PS8- ATXOK3. HISTORICAL SSCTlOK - AJ*TAS, 9. “The need for casuals had been urgent for a long time. It became Im- perative during the last mouths of 1942 when a considerable number of medical off- icers end enlisted sen vers assigned to the Twelfth Airforce In order to complete the f/o for Its various headquarters. Fortunately the eltuaftm vat somewhat alle- viated, but aot entirely solved during 1943 by aa apparent change of policy aad a marked increase la Medical Department personnel. The Airforce Build-Up Plan of 1943-44 permitted a certain percentage of Medical Department personnel Section at Replacement Depots and assigned to units according to their qualifications. If aot so interviewed, personnel forms and the recommendations of the surgeon of the Re- placement Control Depot were used as a guide for assigning them either to the Mghth or Blath Air Force, depending upon the respective requirements of each air force at the time.*♦•*♦•••• COT.OHXL* MC txtffiet of Statements made by Brig Qon Robert C* McDonald, DC, USA (Retired), 21 April 1948, before the Subcommittee on the fcop oyment of Military Medical Heeouroes* «HMH»Qn the cubject of "Replacement Pool* for *edicel Department Personnel," Z agree that we should have replacement pools for Medical Department personnel, bat those replacement pools should be located so that special qualifications of the personnel may be utilised in the interim while they are malting* X think that was fairly well handled in World War II* For example, the Amy Medical Center here was the big pool for medical officers* We had a large pool at Laesson General Hospital in Atlanta* I think that we Should have that well developed, and time in the pool should be reduced to the minimum* The medical personnel, particularly those that have special qualifications, don’t do well when they are held out of employment simply sitting around waiting for something to happen* *nd too often they may be called upon to fill assignments which do not require their special qualifications* "Do you favor replacements pools of medical department personnel in each echelon from the field army upwards? If so, how would you surest administering them to avoid wastage of personnel? Should they be a part of a repl cement depot or separate under medical department control? If under medical department control, should we recreate a medical department T/OStE .Unit for this purpose?* I think that replacement poolk should be territorial and not organisational* I believe they should supply what organisations may be in their territory* I think a great deal of medical pars rmol would bo wasted if we established mul- tiple pools* I think that a replacement pools should bo at a medical installa- tion, if possible, and under medical control* I think the medical departnent sh u d operate its own units'* It certainly- worked well in World War II* Brigadier General llartim It didn’t work well in World War II* A lot of the disaffection wo are hearing today was as a result of that personnel policy which placed all Replacements under 0-1 control re .aidless of service* Brigadier General McDonald* He night keep a record of what vvo have got* dut as far as controlling it, I don’t think he sh uld* "Do you favor replacement pools of en istod men of the medical department? Nurses? vi>C, etc*?" Tea, I favor the establishment of those under medical control, and preferably at medical installations for territorial areas* "Should the Surgeon General establish pools at training camps for his needs? Com Id we avoid that diet In the ZI by a bettor system of calling medical officers to duty? alerting them in sufficient tire?** So far as an enlisted man is concerned, 1 tlilnk that is all right* 1 think officers are better placed at sons general hospital or medical installation where they can be doing something* Thay should be left at homo as long as possible*"**** Vff* nrnum pflPT. (Extract of atetonenta made by CoIoobI Thooaa J, Hartford, W9 USA on 23 April AS at interview with Subcommittee on tin Employment of Military Medical Resources) ***** «d. I think tin motor of people kept idle should be kept to a Binizsam, but thane are administrative difficulties and X still believe that ws should study and make every effort to properly utilise oar human resources, but that pools may be rooecscry* Nobody bee i roved to m that they ore not* 1 think tiny should certainly be kept to a mirdrm* Nobody likes then* Evonthe term "replacement depot” is a little repugnant to practically everyone* X think we most face reality that ear in wasteful, end while that is not an excuse not to do anything about it, that we ought to obviate it as possible by calling the people just as late as we can and still have them trained to carry out their mission* ****** U K« Pcshl |\MD Colonel, U S Arjjgr THUS COPY HXTHACT (Captain W, D. Snail, (MC). U. S. Hnvy, dated 5 Hay 1946) ••••• N4. Replacement pools are a necessity but the personnel thereof should be properly employed while constituting such pools. If enough rapid transportation is available, a system of replacement pools stretch- ing from the sone of the interior to advanced activities, pools to be located preferably in hospitals, could be eet up where officers and men of required professional and physical capabilities could be progressive- ly advanced from rear to front areas in the number and categories required. 266 EXTRACT OF STATEMK8T5 SIADE HI COLONEL OSCAR S. HFFDFR, SIC, OS A, OK 15 APRIL 1948 AT IETERVIFJ WITH SUBCOMMITTEE OK THE BCPLOYMFST OP MILITARY MEDICAL RESOURCES. ***** *(D) 1* X would bo In farcr of a Medical Department replacement pool eeperate free the depote now In toe tables of organisation of the Amy. *2. Ted. I think they could be included with toe officer replacement pools and adalnletered separately from the replacement depots*”***** 1. K* Pohlf Colccel , MC TRUE 3XTHA3T OQPT (Ltr Brig. €Hm* D.R. Eennebeck* Dental Oorps, did 7 Kay 43) •«««»«•» D* *ln ny opinion, denial officer* should not to assigned permanently to smaller organizations* Ho re efficient operation is possible if all such officers available are pooled together and assigned to the headquarters of larger military otaff duatwl ofriewr aautd utilise" theat"Whifa'ihey wore «ost needed in his command* Dental officers should never be permanently assigned to the organizations as snail as regi«ents» battalions* Air Force Wings or Air Force Groups*" 'L, POHT», JSC TRUS SDCTHaCT COPY OF IBTXRVnsw VITF COL MARY 0. PHILLIPS. ABC, 27 Apr 43, ******** d, »The next problem was the holding of nurses in pools tn staging arena. Whan I say nurses, this applies to all the groups in the Medical Department, They were held for long period s of tisae in pools waiting shipment overseas, and then overseas in staging areas, That brought criticism from civilians and com- plaints from the nurses In hospitals in this country for both military and civil- ian hospitals were greatly in need of professional dursiag personnel. The nurses overseas, not knowing the overall picture and the planning that was necessary, woulld write to their friends back home that the Army doesn't need nurses became they were held in pools. Ve had difficulty explaining to them that we couldn t move people in quickly; we had to do it by planning; ve bad to get them over there and have them ready In ease of need; and it was a fine thing if we didn't need ae many nurses as we had to plan for. However, all that damaged our procurement efforts. REAR A3KI&AL AHDEE OH: Do you have any questions that you would like to ask. GeneralT BHIGADISli G1IT HAL MARTI£: Tea. Colonel, you have criticized the replace- ment pool system as was operated during the World War. What is your recommendation to improve that system and still take ears of the vacillating needs for nurses in theaters of operation? COLOSjSL PHILLIPS: I do a * tknov how. I really don't know the answer to it. We all felt that they were brought to the ports so far in advance of shipping. The transportation corps dldn'tfcnow when shipping was available. 1 remember a group of nurses that was kept at ths Charleston port for weeks when we were so short in the hospitals at home. Had the transportation corps been able to say* "Vail* we can have a ship going at such and such a tine that will accommodate women; get your personnel in, let's say —Well* it would have to be longer than 72 hours during the war* X guess* but not make it weeks and aonths ahead of time. How, I know the situation overseas. You had to get them over there; you bad to get them overseas; and it was necessary for then, I suppose* to be in pools because hospitals were not set up. When I got over there* the war was Just about ended. So I can't speak on what night have been done over there. But X do think that, here in the states* had we been able to hold then in our hospitals a little bit longer and sent then out closer to the tine the ships were ready to leave* we would have had the benefit of their services here in the hospitals* and they would have felt a very real need for their services." THUS COPT miUgT (Utter from Captain K, J. Aston (MO), DSM Portsmouth, Virginia, dated 23 April 1948} ***** *(d) Replacement pools of Medical Department personnel. Certain of these pools were established in sereral strategic areas of the Pacific and they undoubtedly served a useful purpose inasmuch as ■sabers of this group were laaediately available for emergency replaces "■eat purposes* Such pools should be located whenever possible la large hospitals or other nodical oenters where the professional services of thess doctors oaa bs utilised and where enforced idleness and inactivity can bo hold to a minium. The Morale factor hero Is important. A busy ■on has little tlae or Inclination to Indulge la carping criticism or unreasonable complaint.* ***** L. K. Pohl, Colonel, NO 269 TRUE COT (Extract Itr II* C* Stayer, Major General, U*S*Anay, Retired, 19 Apr AS) ***** (d) Replacement pools of Medical Department personnel# My experience with replacement pools had to do only with all troops# I found the replacement pools very liesitant about giving up personnel# The thief of the Medical Service should have authority to go into the replacement pools and take whatever medical men awaiting assignment he needs, notwithstanding the purpose for which they weresent to the Theatre# Sometimes they stayed for months, and nothing was done to send them to other places where they were needed#"**** Colonel, VC B«g cm mm (WW, Rear Admiral C. L. Andrus, (*C) OS* datad 27 *prll 19*8) *(d) It is believed that raplacement pools of medical per* sonnel would be highly desirable and that by maintaining such pools urgent replacements could be made without disrupting individuals and organised staffs already assigned to an established activity. For most effective administration and operational function personnel assign* ed to any given activity should not be moved except when due for normal rotation. Replacement pools would obviate the necessity for undue shifting of personnel. Replacement pools should be so located that educational and training facilities are available to fully and pro* fitably occupy the time of personnel awaiting orders to active duty.* t. K. P«bl, Colonel, K 271 TRUE COPY (Extract fro© Hr Alfred W* Ejrer, Captain (S€)f USN# 17 April 1948) «*»* *»(d) Replacement Pools of Medical Department personnel# •Replacement pools are not considered essential In the peace* time service organisation where conditions are relatively"stable and due consideration can be given to assignment# In wartime, however, they are believed to be quite essential in order to provide greater mobility and freedom of action for the forces in the field# •Probably, one of the most pertinent factors relative to idle medical personnel in pools is the lack of decentralised authority to make shifts by local commands in accordance with their requirements# In the latter phases of the recent war, much was accomplished a such decen- tralisation of authority with consequent smoother functioning# It Is ay impression that this did not apply in the early phases | particularly in the Southland Southwest Pacific areas# ***** SC 272 TRUE COPY EXTRACT (letter, Colonel Earl Maxwell, MC, Air Force dated 19 April 1948) ***** "10, In conclusion, every effort «nould be wade to keep medical personnel occupied from the tine they are taken into the service until they are released• Replacement pools had definitely a bad effect on the morale and it is believed a wore efficient Method night be utilised in the future*" t, K, Pohl, Colonel, HC Tim COPY 1XTBACT (Letter, Colonel C* J. Baker, BC, Air Force dated 22 April 194 S) **•* *d, Replaceraent pools of Kedleal Departaent personnel should be aalntalned, but a short tine Halt should be established and personnel sored out rapidly, eren though to temporary assign- ments.” «*# L, t9 Pohl, Colon*!, MC TRUE COPT (Extract fron Ltr H* Michael, Bear Admiral (I*C), USN He tired) "Replacement pools of Nodical Department personnel can best be made at hospitals - general, special, or field - utilising the ones most convenient to the prospective need* The training under above paragraph (B) raay be continued there# But assignments form the pool should be made by the Force or District ISedical Officer, not by the C# n. of the hospital#" 'L. K. POKL Colonel, yc 275 mz COFt KffaSfif (Letter, tear Malral C* 0* Ctwnr (?&), S*5*H*, Retired dated 21 April I$t8) *#*» *(d) /.gala in gaoeaw.1 aloic the line* successfully pursued la World War II, influesced, of course, by existing Service needs end conditions, ailitary aspects, etc*, ©specially in acre etwmwd areas* 'ledlcaX Uffleece, as fast as priaarily staid be ss» figrsad to hospitals cr large concentration areas - El EXCPSS of auth- orised caspleiasat in order to os alseve lawMIatsly aealla ls ss replacements *np front11 so thtdr detaobosnt would not occasion a critical situation ia the activity fees* which wltbdnsra, tieretgr crippling the activity free which they are withdtesna, a regrettatls occurrence X bad occasion to note at different tlass daring the pm~ gross of World s«r IX** ***• r\ 1 Jan y&kt&fc&Xf 276 TRUK COPT EXTRACT (Letter, Captain R. P. Sledge (MC) USH dated 26 April 19tf) ***** «(b) Replacement pools of Medical Department Personnel. "Experience with pools of both Medical and Dental Officers and Hospital Corpsmen at Paarl Harbor emphasises the importance of such pools. On numerous occasions it beease necessary to replace or aug- ment Officer and/or Corpsaen on very short notice and if such a pool had not been present neither replacements nor augmentation could hare been effected. However personnel in the Pearl Harbor pool were not happy even though they were assigned to the area hos- pitals for duty while awaiting further assignment. Unhappiness becase more pronounced if an individual remained in the pool too long especially If more recant arrivals were noved out in advance of his turn. # Personnel had to be assigned not in accordance with seniority in the pool but in accordance with the specialty required* "Pools should always be available to those responsible for emergency replacements. The pools should not be large* the personnel should not be allowed to reaain too long* and they should be usefully employed insofar as pcsaibli." ***** 1/ L. K. Pohl* Colonel, MC TTO5 COFI OTHACT (letter. Colonel T. k Blew., WC, OS* dated 19 April 1948) **“4. »t Poole ef »«dleal Peoertaent nereomel. ■a. Replacement pools toad to become stagnant and aro tho source of numerous complaints. Tho nood for pools of personnel is regognltod but it would perhaps bo an advantage to accomplish the sane purpose by over-assignments at installations where sene nee can be nade ef their services daring interim periods. The necessity for larger pods would probably be eliminated by a high level centralised control for all three services. •b. There was considerable complaint received from hospital com* sandera regarding the excessive number of neurepeyehlatrie seat to thee ae wed eel replacements. Personnel beards meting on sash eases, which have been marked fit for non bembet doty, sent tee many each oases, to nodical wits for duty. This was perhaps due to the tern 'noneombet* whieh wae apparently associated with medieal waits. This redwood the efficiency of nodical wnito to whieh they wore as- signed. Boards most bo acre thoroughly instructed as to capabilities ef United service persoaad and their proper assignments.e**e» L. K. Ml, Celwl, WC HRUOT OF STAHMSITfl aaBS an jyiffi oo tlso or Military Sfedtloal Hesourc«TidM can Balm an Impossible situation* Honever9 It is hollered that Indoctrination of tha public through soil controlled propaganda sources during a nr can dliinidi greatly the urgency of such demands** •*** ri£ toil\ MS 305 SXTRACT COPT OF PERTINENT MATERIAL CONTAINED IN AIR FORCE STOICAL DEPARTMENT HISTORICAL RECORDS OF WORLD WAR II. (Ltr. 31 July 19A3 fr Col. M. C. Grow Surgeon 8th AFf to Brig. Gen. Grant TAS) ***** »a plan which might be put into affect to giro the deferring officera a chance to get ahead would be to hare some rotation policy worked out whereby outstanding group surgeons and squadron surgeons could be re- turned to the 7one of the Interior to head a wing or another group. It appears that these men with six to twelve worths foreign service under their belt would nake good officers to organise another outfit destined for this or another theater.****** (51 At, Sq, - MTOt Personnel) ***** *At present the biggest factor in any such problem has been the lack of promised rotation. The squadron has been overseas twenty-six months. Over ten months ago two sen a month were selected for rotation and with the submission of their nesses they became frosen in grade. Occasionally orders would cone in for rotation of men but with no sequence of transmittal what- soever, Subsequently the men became somewhat sceptical and comparing the advantages of having their names sent In for rotation or refusing It and not being frozen for promotion, chose the latter. The plan to afford key personnel a thirty-day furlough in the United States was well received by the men but after three months have elapsed and we have returned no men, the personnel have become doubtful.* ***** L. K. Pottl, Colons!, HC OfttiiCT OOFT OF PJQICAS* a5 FORT OF 7H* HUUF IS TiUT SOaOPMSl 78SAT H OF OFXH- AT|OXS» HISTORICAL SltTJOS - AFCA3. g. ratio for tha Air Fore# at that tlao vao X Antal officer to 1,300 an with tha expectation that it would grow Increasingly worn because the f/O did aot provide for a sufficient awater of diaHila It «te ootioatod that a total of 178 dentists over and above those allowed aa the existing f/o would bo required to bring the ratio up to 1 to 860. The dental eltuatloa was probably amusing the Mod* leal Sopartaoat *»» so aura* than other probloa during aldouawor 1943, Tha datioe imposed opoa the dental off leers la the IK were observed to bo •particularly* heavy in October of that year* lone of the 98 dental officers and 98 dntal as si et- na ts who, according to VO How Chart for MT, 890, dated 8 lovoabor 1943, wore eohodulod to bo shipped to the K by daauary 1944 hod arrived by 80 Socwater 1943. A study booed upon previsions of the nr Sopartaoat How Chart revealed there was a shortage of 807 dntal officers and 187 dental sails tod an in the Eighth aad Hath Air Force# ia Fobmvy 1944, notation of Xodieal Officer Personnel. Heeppointaaat ever bank and pro- as tions was aot the only cause of the laateatable state of aoralo scene Air Force nodical officers* They wars consoleus of the obvious dl serial nation prnetieod e- gainst thus ia tha natter of votatln to the Sons of Interior* fho conditions under which the •ndgooa* worked, * including particularly the inability to do aa! real nodical study and practice#* produced states of depression nod frustration that led to •understandable attitudes of Indifference and some loos of efficiency*** After twenty-four to thirty uoatho overseas wadiral sad dntal officers would invariably got ia a rut, less Interest* sad suffer a decline in efficiency* Escape through rotation to the Sous of Interior was a universal aspira- tion of nodical officers ia 1944* It was sc strong aad widespread that the First Bonhardasat Division requested •that authoritative information on the planning for rotation and professional opportunities be disseataated acre fluidly to the ued- ieel personnel ia ardor to effect any unfewMed ruuere* la harsh it sue suggested to the Air Surgeon that channels should be provided sherety surgeone, particularly those ia the Tactical units aad the Central nodical Setabilshmont, could be easily rotated shea such a eeuree wae domed useful* At this tins there were ussy nod- ical officers ia the states carious to fill tha placet of these vhe had carved uany ooaths overseas. Aa exchange, it was said, would be to the beet interest of the flight surgeons aad tup rove tha ears of tha film* fee months Inter, ha assusutsd on the *uarkad degree* af difficulty which had devolaped ever the quest- ion af rotation af Medical Department officers* 8s said there had been as •legal- ised rotation* la the theater slue* its iueeptiea* Kedleal officers could only be seat hack to the states for training at the School of Avtatiea Medicine, ea account of 11 lasts through tha hospital or by what eight be termed *sMght of head** On tha other hand, eonbat aircrew personnel due to lassos aad esep&stiea of tears of duty had changed four or five tines at sees stations during opprealnetely three years of war* Aeagth of service overseas, act the shortage or availability of nodical personnel wae, it appears the principal faster la determining the policy of rotation or deployment at the cessation of haatilitiee la Saropo. soeeeooeeo 307 Extract c itateaents mads by i3rlg Ooft Hobart C* Hcronald, MC J3A (Hetired), 21 April 1948# befers tbs Subcocaatteo on tbs Employment or Military Medical Resources* «***eaedeploy»ent and demobilisation of personnel** ■DmeoblIllation of specially qualified nodical personnel was too rapid in tbs last war* Efforts to balance demobilisation so as to retain sufficient specialists to maintain proper nodical care and treatnsnt were only partially successful" So far as I know, redeployment was fairly satisfactorily handled* Z know that my consultants disappeared pretty rapidly after the defeat of the Jape, end we really needed then to take care of the large number of wounded end special eases that ws had in our twelve general hospitals* Ve needed thwa for at least an additional six months* "Redeployment and demobilisation should be on a balanced plan eo that overages end shortages of skilled personnel will be avoided* There must be a lag in the demobilisation of medical personnel since the sick and wounded must be oared for until mairfmaa liipvorewsnt is attained** A great many of our medical special lets'wore in a hurry to get back to their work in civil lift* We can’t hi saw them for that* but they left us pretty high and dry as far as that oonsoltaotlon service went in many instances* Bogardlng the subject "Msdlcal Department Organisation* Iron tbs standpoint of personnel, equipment, training, and mission or tactical employment#" "How ean wo prowont physical examining boards Ikon booonlng disgruntled during tho demobilisation period?" X don’t think it can be avoided entirely* X think careful consideration should be given of personnel that would be assigned to these Boards* Those who are more worthy should be released • But keep m duty those Whom we have to have* There is no solution to that* "Should the speed demanded by higher staff in a demobilisation be accepted by the medical department with its consequent poor results in the final typo plymical axaodnations? Should we insist on more ties and a moors thorough physical examination to prevent unjust claims?* There should be time enough for thorough physical examinations* It would •are the Oovemeent money and would prevent acne unjust claims* There would •till be plenty of then****** — "W R* rfwflt Oelonsl, |C( true kttracT CQFTi (Kxtracto of atateawits nads by Colonel Thonao J * Hartford, MC, USA on 23 April 48 at Interview with Subcocrdtteo on the Smploynent of Military Medical Resources) ***** «o, ■KadeployttDnt and demobilisation of personnel,* ay Ideas are so old-fashioned on that. I am aftreld they wouldn’t fit in* 1 still believe there would have been less bool and better feeling by everyone if they would hove been demobilised by units* In other words, if I oculd have told the 35th evacuation hospital, "Sorry to have to pick on you boys, but yen have been a good outfit* Z m not going to be able to send any of you hone regardless of how lone you have been over hero, until the 15th of March, * Z would have had a lot lees howl that Z did with 6,000 • patients in beds and getting doctors in and out so fast we didn’t know whether they had been sent to us for doty or whether we were supposed to have put then to bed* Z don’t thiiik that’s going to change the situation, bet it’s shat Z think* sees sees 1—/ !>• K| Pohl Colonel, BO 309 npiao?T reraAOT (letter mm «. d. s«*n. («c), c, s. h.tt dated 5 fey 1948) ***** "5. Redeployment and demobilisation as managed In World War It left much room for Improvement. It Is «gr opinion that demobilisation was conducted mainly by hysterical a# political expediency without much consideration for the welfare of thoee requiring medical treatment and resulted in premature disorganisation af major medical installations. It took ue nearly two years to recover in our Naval Hoepitale from the effects of this hasty demobilisations. To avoid a repetition will re- quire (a). A careful and effectual macs education of the cltisaary. (b). A firm stand by the Congress to resist pressure for toe rapid demobilisation. The Armed forces alone cannot accomplieh an orderly eocodue of personnel without full hacking from the highest mthorlty. L. X, Pohl, Colonel, KC t»ua SXTKAST COFY OF MSDICaL SUPPORT OF THE U3AAF |S ffifc MSBXISmUCSAS *H8A*1X historical s:o THUS XXTHACT COPY OP INTOTISW WITH COL KART G. PHILLIPS, ARC, 27 Apr 48. **««*•««. X. ■ The method of demobilisation adversely affected the operation of cur Corps. Rather than being allowed to demobilise according to the desires of the nurse officers which would hare allowed those desiring to he separated to be separated from the service, with retention of those who wanted further Ansgr service. We, of course, had to demobilize according to the point system as was set up for the entire Arsyj but X think that, had we been allowed to do it the other way, many of our problems that wo are having to meet right now wouldn’t exist. Many of our people were forced out because of the point system. Some of them have become settled in civilian positions, and they are not interested in coming bade to us in an organisation which is again going to force them out as our needs are decreased. Ve felt, too, that the establishment of a counseling service at demo- bilisation centers for women*s professional groups might, in the future, be a forward step to maintaining good personnel relatione because many of the nurses who did get out felt they were forced out, and then they felt there was nobody there to give them any assistance or advice in nursing matters, they had been out of the country for some time, and they f«lt they were away from the nursing situation. MIGADDCR GXXSHAL MARTI?t So you fever reasonable rotation for nurses during war between theaters of operation and the sene of Interior? COLORSL PHILLIPSj I do if It can bo arranged. I think it** n mistake to keep people overseas, particularly In isolated areas or where living aad work- ing conditions are difficult, too long a time, but I don’t know what we would have done or how we could have arranged it during this Inst tar with the trans- portation problem in the areas we had to cover. X Mnk some of the complaints that we first received frem people wanting rotation could have been taken care of had we been able to orient all our people before as to what they could aspect in the way of service and the needs of the service. It was interesting, after we did set up rotation policies, that many of thsm that ve thought wanted to get heme so badly found out they weren't so anxious to leave.seoooeoee i MS EXTRACT OF STAIFTTHTS MADE BT COLONEL OSCAR S. REEDER, MC, USA, OH 15 APRIL 194« AT IHTFRTIER WITH SUBCOMMITTEE OS THE HJPLOIMKJJT OF MILITARY MEDICAL RESOURCES. ***** "(I) 1. X believe the lade of transportation was on® of th« k«y block® In iwplcp.enting th® plans. Another factor no® that a certain nnnb®r had to ranain in th® theatre to toko ear® of sick and wounded still ther®. Another had to stay for occupation troops. Tt vaa in th® selection of th® personael that a let of th® trouble can®. In ETC apparently the nodical admin! strati*® officer had a lot to do with the s®l®cticn. It didn't do the good nano of th® Medical Department any good# *2. I think on® solution would bo to assign a doctor to the Board for a United period of tine, say, 45 days or 60 at th® cost. *3. Z belle*® it was. I think th® important part of it was th® overseas asrrie® which meant separation from families, etc. The ones over longest should haws cone back first# *4# I don't see where it makes any big difference because they can apply to th® Veterans Administration anyway. Make it as fast as they want. *5# From where I sat I couldn't tell# 1 felt the Surgeon General's office had its way pretty much. *6. Answered above. Also, remember the clamor in Ground Forces Units# They were kept cm a training status for quite a long tine. I don't know how that can be avoided# Public opinion eliminated all those units."***** It* MO TRUK COW EXTRACT (Utter, Captain H. D. Tenpleton, KC, DSR dated 23 April 1%8) *•****(*) KrotPLOTOTUT AKD DHTOBlLIZATlOg OF PmOHm. •The eudden cessation of hostilities was followed by a general lowering of the norale of all troops, especially those in the for* ward areas, and It does seen entirely feasible that a quick evalua- tion of the situation in light of the personnel required to garrison occupied areas should have been nade. Those whose services were not urgently required should have been demobilised as quickly as possible. Much unrest and 111 will was engendered when certain professionally qualified personnel were retained while others were separated. It is believed that the point systea was quite effective, but the preference shown those who were not urgently required in the separation proceedings, caused such unrest awong those who were retained for a longer period of tine. Had the flow of separation been Bade slower, the burden of this duty could have bean accomplished wore expeditiously and acre thoroughly," ***** L. K.NPohl, Colonel, HC TRUK COPY EXTRACT (Uttar, Colon*! O. F. Melina?, MC, Air Foroe dated 20 April 1948) ***** *e. Redeployment tad demobilisation of professional porao—al ehonld be handled aa expeditions 1? as possible ia order to obviate an- ompleymant of medical talent* Whenever it is diaeoverod that there is an exeeaa of professional personnel in an? Theater of Operations or within the Zone of Interior and whenever redeployment of this pereonnel is not essential, such personnel should be returned to their civilian communities and the overall polio? of demobilisation should bo • first in, first out1* It night become necessary, should the military situa- tion change, to recall this personnel, but it would be far batter to permit them to return to a community in which their professional ser- vices vers required than to waste their professional talent*• ***** P- L. K. PohlV Colonel, MC tana car sauna (lattw, 3a«r ustni c.a. caam (ac), o.s.s., itsUred datad a April 154*8) *****(•) % allBBans this should be accomplished 081 DUALLY and OBU whan their services can be conveniently spued without tmdie hardship to the Service* This and recklessly hurried dwwiMlIsstlnn of Medical Personnel practically wracked way as is wall and painfully recalled by aU# mad should WSTBSL he permitted to recur in the future. The greater amount of adverse criticism directed at Service Medical care stems fTen this pemloloos practice* which is not only wholly uncalled for but readily avoided ty merely retaining essential personnel 13HTH 7WX CAN m CCSI7SHISHTLT SPAIKB 31 THE SSSYICES.* •g.x w TRUE COPT EXTRACT (LetUr, Captain C. D. Kiddles tadt, (MC) USH dated 17 April 1948) ***** “Referring to paragraph 3(e), there i» need of better cooperation in denobilizatlon of personnel connected with Fleet Hospitals* At Fleet Hospital #114, there was no regard or con- sideration given by certain line officers to the needs of the side and wounded. Personnel required for services such as elec- tricians were withdrawn and had to be taken over by hospital corpemen who had no training* As a result the electrical service and refers were out of order and the care of the sick and wounded laparallelod. The hospital finally bad to close for the want of necessary repairs* This was chiefly the fault of a bullheaded line officer in charge of assigning enlisted ratings* This individual had no use for the nodical corps*” ***** 0 L* K. Pohl, CoXoxmiIp MC 317 TUBE COPT EXTRACT (Letter, Captain F. C. Greaves (MC) USX dated 17 April 1948) ***** *(e) The high norale among 0, S. Mary nedieal personnel in the Mediterranean Theatre of Operations ess a source of satisfaction. It is believed that one of the principal reasons for this favorable at* titude was the earl/ establishment of a policy of deployment* Medical Department personnel coning into the Theatre for assignment were in* formed that they would be returned to the United States at the end of 18 months and the policy was carried out, except in individuals who requested extensions* It is believed that a similar policy of fixed tours of duty for all nedieal department personnel in any future war, provided of course that the exigencies of the situation will permit, will make the duty seem less arduous and will permit a certain amount of family planning which all normal individuals appreciate** ***** I. t. Pohl, ColeMl, K 318 IBB fifl« HIMg (htttr.UptaSa o, a. Uooeium, »r„ K, « dated » April IMS) ill BfdiplognHot (uaA draoUUsatiai of pinMB&il« T1)S phage OOOQT0 btltWiB OMI tOjtibut mtA || usually 8 period of Inactltlty for neay of the nodical persoanel* After the straraooa days of cceSbat# this period of foreod Inactivity end ldXer»e« li deadly for aoralo* Corps Surgeons have authority to redeploy each pereooeel so that they could be assigned to float or base hospitals, This period is a busy tl» for these hospitals sad they need astro help to ears for the eaeaeltioe* tpA the individual aMSad offloar finds stinuXatlng prefeseioBal work under pleasant conditions# ftm* the fighting Is over, it li UtVll hgaaai trait tO wish to retnm to one*# loved cnee and to the ease end eooforta of e&vil pursuits# Hcwverf the rapid end hysterical type of demobili- sation shioh followed W day is a dangerous prooeduraf shied) era easily tom victory into rad if not cheeked, is sore to load to national suicide * * aseessees I lilfl WfT .W.WR (Letter trim Colonel Bobcrt I. limn, m (Bet.) «tM I Kay 1948} **••• *<•) Sodeploynimt and demobilisation of personnel. Vo ewnnl other than apparently the *pol»t" OTtoa appears to bo satisfactory, boro effort, probably, should bo exerted to pseronado exceptionally eapablo yonay offioort to consider permanent oomisslon la tho Arnod forces as a career.tt eeeee mM tl *. WmwI, NO 320 MW QQPT KTBACT (Ultir fm Dr* *a. C. Keanlager, Topeka, Kauai, dated 22 April 1948) ***** *(e) aad demobilisation ef personnel— from a aent&l health steadpoist ve vere confronted repeatedly with the fait that asm froa the WOvere hreaght haek te Aaeriea, presanahly te he trained for the Fulfil hy aea vhe had merer had any expertenee la the Fulfil and vere regarded hy the trainees u "firing orders eat ef a hook, * I merer kaev for sure whether this wi true or not hat ve hollered that It was u extremely important faeter la the Xeea of aaapower la redeployed treepi.****** wm L, X. Colon•!, HO 321 TdUE COFT smiCT (Letter. Captain iiightoeer (MC), U. 3, Navy da tod 21 April 1^1*6) *»*»* • (e) AH excess nodical personnel should oe reiaoved frees ocubat and auxiliary vessels within a few weeks after cassation of hustilitioe and assigned to hospitals* In addition, an effort should be taade to assign the above personnel to duties as hero oetaroen operations, where ~ractioaole*,f ***** y-.JP'yy-• L. Z. Pohi; Cdarwl, M3 fiwi. Cui t or m\*7|Sr- WITH COLO' ‘7X ririOIL .ajMHBLL, *C, USA, 30 April 1948 E. •‘Certain specialists suffered In this respect more than the general run af officers th?.t v?ere redeployed to another theater after tvo or three years overseas, There were doubtless others In tie ZI with excellent general hos- pital training who could have been replaced by these men. Do act demobilise those bone units and redeploy oversea* units. Use the ZX units as replacements. I know there are many rabbling ideas on that, ,bu.t you hear that brought up so often, and there axe concrete examples and Z than t try to enpaad on li. *hat»s lust the general idea th t many psopla have, I a* sure. THUS COPT EXTRACT 0T UTTBETIEW tflTfl m*& AEKIBAL KOHTOW D. WIL&CUTT8, («C> USE. 4 May 1948. • •********2' next item Is redeployment and demo1£ixatioa of personnel. Agood deal of complaint was raade by Individual officers, partiru1 rly during the demobilisation period. Do you have any comment about dm fixation officers? HmAR ADMIRAL WILLCUTTSj I think we here seen nothing compared to what we are golnc to see next time. It is going to be total war. In the old days* in the Spanish-American War demobllisatibn was easy. The war was ever and we went back horn. In World War X we had our problems, I well remember how ererything and everybody was liked and Itching to get back home, I came back from Trance hoping to go home right away. I couldn’t for I war held up someplace, Qosatlco, for 60 to 90 days. We must hare an orderly demobilisation program. In World War XI no tried to get it, Coaing to' this next war, |hls total war, ve will hare mass destruction. Ve know ve vlll, We Just can t hare a war without shooting these veapons off that are so efficient. True they said that you had chemical warfare and didn’t employ it to any great extent, X don’t hell era we can he able to control this bomb to that extent* * maybe not the atomic bomb but these other bombs which they say are Just as efficient, or almost so, as the atomic bomb. If we hare these guided missiles you will definitely hare mss destruction of towns and cities. Just like they had In Japan, As to demobilisation, we will be all one American fadily, and the seeds will be such that I definitely believe that it will answer itself, the probhoae will have to be soiled at that time. There is nothing In var today that gives us a pattern as to what Is going to com the nest time. I think it is going to take open sdadedness. The needs of Civil Defense as well as our Services will be bal- anced off at the moment. It is Just too terrible. 1 have gone Quaker. Ky dad was a Quaker, and X understand hat. SEAR ADMIRAL Are there any questions on this subject} imam) z, C pbHL,\coLomf m 323 T8U1 COPT BXTKACT (from addrsss of Major Osnoral Alport W, Kumar, MO, USA, 13 May 1948) MAJOR OBBTKHAL 83HH1HU ***** "Going to redeployment and. demobilisation of personnel, it should be la consonance with that of the troops* vlth retention and rotation of key personnel aoooaplished by surplus declara- tions as reqnirsnents indicate. In our last redeployment we suffered an almost complete disintegra- tion of the medical serrloes. The personal equation — the personal desires were paramount* to the detriment of the obligation of the medical offlder to the Army. Ws were hard put to maintain any semblance of a medical service. On the one hand the Beserve Officers were counting their points and wanting outj and on the other hand* In ay theatre* the surgeon general was calling by name for the remaining Bsgular medical officers who were key men and all that 1 had to run the medical service with. And X believe* therefore, that the major requirement* which Is military* should determine when any medical officer may be separated. That again places the authority for that within the province of the senior surgeon* which he accomplishes by stating that doctor so and so Is surplus within this theatre. In that way he can keep his hands on a doctor. We had units we deployed and every doctor going back* some of whom did not meet separation criteria. And they were held on duty la the 2X until they did meet the separation criteria. We were denied their serrloes during that period. They got aboard boats due to administrative errors and complications* without the knowledge of the surgeon. And the surgeon would find that Instead of having so many doctors 300 had gone without his know- ledge. BJUQADXXB OWXBAL MABTXVt Do you consider It feasible to write late plans for ths future* In thd event that the ASTP and Y-12 programs are to be continued la future emergencies* a provision that a specified term ef service will be required upon the completion of their Intsrnsshlpt MAJOR 0M3BHAL KBBHXRt X believe that the AW Medical Officer hat a distinct obligation to serve la the military services for a period net In excess of five years* as nay be determined In conformity with military requirements. X believe* in view of ths faot that he was exempted from the draft while his contemporaries were being drafted ts be shot at* that he should be available for whatever assignment may be Indicated. L. X. Pohl, Colonel* NO D-lf, Kodloal Department organisations ftm tho standpoint of personnel* equipment, training, and mission or tactical requirements. x. mmmi 1, Review of the commenta on this subject received by the Sub- committee indicate that in the there Is little basis for contro- versy regarding the effectiveness of Kedioal Department organisations in carrying out the mission of the medical services during World War XI* Hie numerous medical unite represented careful thinking* planning and execution. There were no fundamental or basic faults in the types of these organisa- tions* in their personnel* equipment or training. Changes te adopt such organisations to demands of their operational activities progressed more efficiently and expeditiously as oxpsrience was gained during the progress of the war. There were* however* naay instances which should come under constructive criticism and should be taken ihto account in current planning. 2. There has been much criticism that Nodical Department organise** tions were often overstaffed with medical personnel during World War XI. This criticism is based on the fact that many medical officers spent con* ciderablc periods of time in idleness and that madieal officers were fre- quently employed in non-professional duties. 3. Kany Nodical Department organisations were assembled in the United States for long periods before they were actively employed. Naay doctors were idle at staging points In the United States and overseas pend- ing shipment of their organisations to areas of operation. These delays were caused by temperas? postponement of or changes In contemplated oper- ations. Medical units were often shipped overseas long in advance of the expected time of their employment. Because of the shipping shortage theater surgeons could not otherwise be assured that these unite would arrive when needed. These difficulties could have been obviated* in part at least* by a more adequate liaison between the offiees of the Chiefs of the Nodical Departments and planning ageneies of the War and Savy Departments. 4. Medical talent will again become n critical item in the event of another national emergency and should not be dissipated by requiring medical officers to perform numerous non-professional duties. A groat saving in professional personnel could be accomplished by changes in Med- ical Department organisations aimed at permitting medical officers to de- vote practically their entire effort in the professional care of patients. Properly qualified senior medial officers must be employed in certain ad- ministrative positions such as commanding officers and executive officer# cf hospitals and ether medical units and as members of command staffs. With these and certain other exceptions, medical officers should be relieved of all administrative responsibilities* These non-professional duties can be offeotively performed by properly qualified medical service corps officers and other non-medfcck personnel. Treeing physicians and surgeons of those duties would permit them to assume responsibility for the care of many more patients and would result in a much mere economical use of medical personnel resources. 6* In tha oront of another war tho need for oonoorring denial and nursing personnel vill again become urgent. Their service* should he restricted to professional vork. Medical Service Corps officers and non- commissioned officers should he trained and employed in relieving dental officers of administrative and other non-professional duties. Members of the Women*s Auxiliary Corps should he considered with a rlev to relieving graduate nurses of many duties they now perform. If given a short concen- trated course in practical nursing, these women could accomplish much of the administrative work of the nursing service, and assist the nurses in their professional duties. C. Greater flexibility in medical organisations would result in hotter -adical care and a saving in professional personnel. In the pact, medical personnel have been assigned to organisations where there was little professional work for them to do on the grounds that their services must he avilahle in case of tome type of catastrophe. Tables of organisation should ho studied with n velw to adjustment of the number of medical officers on the hasie of the professional vork which the organisation usually and routinely will he called upon to perform. Provision should he made for the expansion or reduction of medical units by the theater or aroa surgeon ns the situation may demand. Medical Department personnel pools employed at hospitals within the theater or area should ho availablo to the respon- sible surgeon for aoslgnmont to medical units where their services are needed. The more general employment of combat surgical and other specialty teams would contribute to better medical care with less wastage of prof- essional personnel. 7. In the Havy many doctors vers employed as medical officer* of small ships whore there was little professional work. These vessels lack facilities fer the full utilisation of n medical officer** talent. In gen- eral these ships operate in company with larger vessels where adequate medical facilities arc available. The mors general employment of hospital corpsman qualified for independent duty uhder the supervision of n medical officer on the squadron flagship would release many medical officers for other assignments. 3. field nodical equipment supplied during World War II was la general well adapted for the purposes for which it was designed and served adequately in most organisations. However, there- is ample room for improve- ment. Continued research and development are essential to correct defic- iencies experienced in the field and to keep abreast with dew materials and designs and with the contemplated tactical employment of troops. Responsibility for the study and development of medical equipment for land warfare should rest with Surgeon General*s office; for naval and amphibious operations, with the Bureau of Medicine and Surgery; for Air force opera- tions, with the Air Surgeon's office. Arrangement for coordia tioa of this effort should be made. 9. field medical equipment Is toe henry and should bo redesigned in the light of modern air and motor transportation. Improved housing of a light type should bo developed for medical units lu tha ©ommrMcation so no. Tentage is vexy little different from that employed during the Civil War. Stating and lighting facilities for nodical units at advanced bases and In the field require further study ahd development. Special attention should be given to adapting medical equipment to atomle, bacteriological and Arctic warfare. 10, Prorlsioa should ho a&do for tho construction of saltahlo 326 buildings for Army hospitals ml onrMu after the teat stage of the campaign it couple ted. These hospitals frequently functioned in tenta without floors long after headquarters personnel were Bring in prefabri- cated buildings, law/ hospitals sent overseas were not designed to operate in teats and were unable to function during the several months required for the construction of buildings. These hospitals should all have ten tegs and be prepared to eot up end oporato Immediately. Construction facilities for 8sal-permanent housing should be made available as early as possible for firr,d hospitals in the eozmunlcation tone. Buildings supplied medical units at advanesd bases should conform in general type to those used through- out advanced base areas. 11* Hospital ships were not available In sufficient number during the early years of the war. There was one hospital ship only in the Pacific during the first dixteen months of the war. Troop transport* necessarily employed for surface evacuation lacked adequate facilities for the car* of casualties during amphibious operations. There was not sufficient room space for examinations and operations, for the care of officer patients, convalescent patients and other special types of eases, three specially designed hospital transports served most satisfactorily in the Pacific, Additional hospital ships became available as the war progressed and by l-j day the number of such vessels was adequate. 12, greater attention should be given to training in amphibious operations by the Army in conjunction with the levy. Casualty handling on the beaches and seaward should be given further study. The medical sections of beach and shore parties in the Pacific mere assembled from transports and from vaious units of the Kerins Corps, It is essential that the shore party medical section be organised and trained as a unit. The use of the LST (Hospital) off-shore for the earn of non*transportable wounded and as an agency for routing casualty laden bents to the transports proved the value of such a vessel in casualty evacuation. 13, Xavy Organisations sad Army and Air fores, as well, charged with the responsibility of preventive medicine in overseas areas ware handicapped by the lack of sanitary companies under the control of the Medical Department, Malaria control and epidemiological units relied on sanitary section* of construction battalions to carry cut recommended measures for the prevention Af insect-borne disease, higher priority for the employment of engineer personnel in the eons true ti on of bases, ports, air strips* reads, etc, led to failure to carry out measures which would have prevented thousands of side days among the troops. The solution of this problem sects in the organisation of sanitary companies under med- ical control whose primary function would be the work necessary for epidemic disease control. 14, Air force organisations during World Mar U consisted essentially of the following! (a) Air Droop and Squadron intrinsic Me4» leal personnel and equipment. These were present in Headquarters, combat, service, and air depot groups. The strength edjnstmeat&etveea such units and frequent necessity for advance air'echelon and rear surface echelon movements resulted in many varied requirements so that at times personnel and equipment were more than adequate and than later with complete gross) dispersal by Squadron, the coverage available was scarcely sufficient. (b) Approximately and not less than 20-25/j of all Air force troops la any theater were present as small units without attached medical per- sonnel and supposedly to be covered by other Air force unite or Ground force units having .Medical Department service. Such did not obtain con- stantly, and the problem was of such degree that the Air force Aviation Medical Dispensaries were evolved of Seduced Strength and full Strength types. Their extreme usefulness and service value were proven repeatedly and provision should be made to continue their existence la event of an- other emergency, (c) The Central Medical fistablisheent as developed for many Major Air forces was an essential structure, the provlelon of which Insured adequate handling of those problems peculiar to flying and including} Air-Sea Beseuc, flying equipment indoctrination, physiological and psychological problems peculiar to flying, medical requirements of flying evaluation boards, studies of special aero-medical equipment and rest camp supervision from Medical aspects. The Central Medical Establish- ment in proportionate strength as required by the else of the Air force Command should be considered a unit evolving from World War II which hat been tested and proven Invaluable. They should be provided for la future Air force planning 7/0*6 and B*s. (dJ The field Hospital (Army) was most adaptable to the needs of Air force hospitalisation la the immediate vicinity of less permanent and somewhat concentrated Air fidAs, In concentrated areas the Station Hospital (Army) both 260 and 500 bed, were successfully operated by, Air fore# Commands. The movement by air ef personnel and equip- ment for 100 to 200 bed unit hospitals to cover large bomber bases la iso- lated areas from Army and Communication Zone operational activities was not infrequent. The development of equipment therefor ee as to facilitate air movement should receive adequate planning, consideration and action. (e) The Medical Supply platoon (Avn) was a most useful unit adaptable to Air Depot Group and Service Center operation for Air force units on one hand and to independent area Air force Medical supply distribution on the other. Inexperienced and Ill-advised individuals observing such install- ations in the vicinity of main army or base section depot* undoubtedly considered such activity and speak of it now as unnecessary duplication. Such was not the easel The main depot requisitioning, receiving, storing and forwarding medical supplies from the sons of the interior could in no way provide the medical supply distributing service required for dis- pensed end multiple Air force units. The effective Hal eon in use of air transportation for critical medical supply items to Army, Savy and Air force echelons was provided with consequent avoidance of loes of many medical supplies, prompt air shipment to proper unit destination and with almost complete discontinuation of earlier practices in which Air force unit Surgeons in particular, had to and dll utilise combat aircraft and critical gasoline to return to bate depot areas for replenishment ef exhausted critical nodical supplies. Air force medical supply platoons (aviation) were most adaptable to usage by expansion for main depot oper- ation when Medical Supply Depot units (Aray) were unavailable for that pur- pose. full utilisation of Medical Supply Platoons (Avn) by Air force agencies was not slewed in all instances In world Mur XX. Their reten- tion and eenversten for nervine t» e«h*r troops as occurred in many in- stances is condemned and should not be countenanced without fulfillment of the Air force Medical supply needs as concurred with by the Air Surgeon concerned, except in most serious emergency relative to Theater Mediae! Supply. (f) Other Air Veree Medical Department ordeal sat lent which were utilised to fill particular needs were the portable surgical hospital for Airforces; the Veterinary Platoon (Am); Central Dental Unit and Dental Operating De- tachment (Mobile); Medical Sections fer Aircraft Bepair Unite Pleating end Aircraft Maintenance Units Pleating. Other Army units utilised successfully by the Air Porees in World War IX under Air force administration and oper- ational control included the Malaria surrey and control units and ftcneral Hospital (1000 bed unit). 15* It has been ascertained that Air F orce Medical organisations are now undergoing careful scrutiny and proposed revision for anticipated future needs* It it believed the experiences occasioned by world War XI will be invaluable for such dotominatlons end the requirements deemed necessary should receive fullest support fer authorisation in view of the present international situation end the extreme livelihood that in the event of a sudden war. Air force participation will be required initially prior to the possibility of movement or involvement of any significantly large bodies of troops or seagoing vessels other than aircraft carriers, submarines and major fleet battle units* 13. In view of the smphnsis new being placed on the prevision of Air transportability for around force unite, the redesigning of ell equipment of combat medical unite th&t will be necessary to support oper- ations of that ty$e it indicated* 17* The communications between medical field units end the Chief Surgeons Headquarters in large force was inadequate and faulty during world War IX* It varied et times from standard wire system to she use of pigeene*> Much confusion and needleee effort resulted, the British nodical unite of comparable nature are equipped with radio systems of iater-cemmunie&tion* Xt is believed that the efficleuey of all field Any medical Installations would be immeasurably Improved if oar units were sc cqtuppe^ XI* ggflMg l« That Medical Department unite require continual study and modification to meet current operational demands of troops fer which they render combet support, and the experiences of World War II Miould bo util* itod fully to avoid future errors ouch ns overstaffing, understafflag, in- adequate training, and premature staging ever long periods, with full eoaplemente prior to shipment. 2* That staffing of Medical Department units at nil timet should be suoh as to utilise only those professional personnel on professional duties to the greatest possible extent and ns are absolutely required for the present or immediate mission or projected tactical requirement of ouch unit* 3* That much flexibility in personnel and equipment fer all medioal units is a must requirement and should be allowed and provided practically at all times when deemed necessary by Chief Force, Command and local Surgeons concerned* 4. That manning of Nodical Department units must contemplate increased utilisation of responsible and adequately trained KSC officers and enlisted personnel so that professional use at all times of doctors, dentists, nurses, etc., may bo more attainable. 5. That redesign of units and organisational medical equipment should consider its adaptability for air lift, further, that this bo subjected to coordinated and Joint effort. 6. That housing facilities, of a temporary nature for dispen- saries and hospitals as were provided in World bar XI were unsuitable and should receive Joint coordinated intensive study and revision of design, construction material and for the provision of adequate utilities and maintenance. 7. That now units developed during World War II and of proven great value, should be used as basie planning models for units and organ- isations new under study for utilisation by the Army, H&vy and Air Force and that the Force concerned should be allowed every possible opportunity and be extended all cooperative assistance for determination of specific needs of each of the three Armed Forces. 8. That Nodical Department units subject to mutual or similar utft by each Armed Force concerned, be organised, equipped and considered for standardisation In every possible feature. 9. That there is need for improving communications between large fiftld medical units in war. That the use of radio would solve many of the difficulties encountered in this field during past wars. ni* m&mMiim I. That saoh AiMd Tore* planning agsney for tho Medical support thereof extended coordinated end Joint effort to exfeet the following; \ a. Designation of Medical unit* necessary for immediate support of their Cosibat and Service troops in the 21 and in Theaters of Operation. b. Determination of units and organisations with their •truetore, which any be standardised and subjected to mutual interchangeable usage. e. That Army, Navy and Air Yore# approval and necessary allotment for medical units and organisations peculiar to tho needs thereof bp insured during peace in preparation for war. 8. That necessary appropriations bo proeared to insure the development and earliest pcsBible procurement in event of war of standard equipment for Nodical Department use. most suitable for air lift. That the agencies new Involved In such work bo provided most able and caper* lozxood personnel. fhat coordinated Joint efforts in that direction be stimulated to the utmost by each of the Nodical Departments, fhat the Air force facilities, their previous experience and cooperation in effort should bo utilised to the mart was by Nodical representatives. 3. fhat teat see, construction features of Nodical Installations ' utilities and their maintenance, receive Intensive study end effort to prevent deficiencies ns occurred In connection therewith during World War XX* 4m That suitable radio equipment and personnel be added to the Tables of Organisation and equipment of all field medical units which normally opsrate In the Aimy Service area* TRUK COPT EXTRACT (Latter, Colonel Earl Kaacwall, XC, Air Faroe datod 19 April 19A«) ***** "5. The vain fault found with Amy hospitals aoat overseas waa that provisions ware not nada for construction of suitable buildings after the tent stage of the eanpaign waa over* Without theae provisions heap!tala were atill functioning in tenta without fleora long after head* quarters personnel were living In adequate prefabricated buildings. On Okinawa this waa particularly true of Arwy hospitals While Wavy hospitals had axeallant construction before they were occupied. In ay opinion hospitals should all have tentage and be prepared to go in and aat up ianadiataly in their tentage, hut have construction facilities available in order that suitable buildings night be constructed as soon as possible. In Okinawa, particularly, the Any hospitals wore able to set up in their tentage imediatcly and function very well ehereas the Wavy hospitals wore not sot up to function within several Booths, indicating that there waa acne thing deficient in the levy setup as well as is the Any setup. *6, Of utnest importance in any hospital Is the presence of trained planters, edrpenters and electricians* These wore woefully lacking in all Any hospitals. Tbs nodical officers could train corps nan satisfac- torily on the job but they could net train the above ■nantioned, very neces- sary personnel. *7, The nodical records being disalnilar caused nuch confusion sad necessitated placing Wavy personnel in Arny hospitals and Amy personnel in Wavy hospitals la order that Sick and Wounded Records night bn kept properly. These records, of coarse. Should bo standardised so that hospitalisation could take place as vail in one hospital as in the ether,' TRUE COPT (Extract Hr U C Stayer* Major General* U* S* A nay* Retired* 19 Apr AS) Medical Department organisations from tbs standpoint of psrsonnalj •quipment, training, and mission or tactical requirement* In mj experience, I sear not only the Allied Force*, but such of the eneaey Medical Department organisation* • I believe our personnel, equipment, and training were of the hipest, and If no continue our present high stand- ards, we dll again be the leading Medical Dep&rteent of the world*" Colonel, UC TRUE EXTRACT COPY (ttr Colonel Robert ?, fillisns, RC, StvgMO, 16 Apr 19t*> **««* • (f) Redleel Department organisations from the standpoint of per* sonnel, equipment, training, ahd elision or tactical requirement* All Radical Departs ant organisations to be staff ad with minimal iraaber of Red* leal Derps Officers, Bat it most be recognised that some administrative er executive experience is necessary before officers sen be assigned to eeenand positions,* Colonel, V gggl COPT SITAACT (Lotto? fro* Colonel Robert I. 8i*p»on, USA (Bet.) dated 1 May 1948) (f) Medical Department organ! sat lone fro* the standpoint of personnel, equipment, training, and mission or taetioal requirement. This eorert a Multitude of problems that will change fro* day to day. Zt is suggested, hoverer, that organisations bo made as floziblo as praetioablo, capable of being expanded, or reduced, as occasion nay doaand, and not rigidly bound to "Tables of Organisation", oto. Training in tho transportation of poroonael and eouipaeat by air nay be stressed - equipment for tho field nay bo do* signed or eeleoted that any bo airborne easily. There wore aaay serious errors in ths design and construction of tsnporary hospitals In tho Zone of Interior during tho recant conflict, for example, tho plans for hospital buildings at a Ounnsry School at Harlingen, Texas, would hare been suitable for such an installation in northern Mains. This location is almost in the tropics, yet an enormous heating plant was installed including a res err# boiler. A few gas stoan radiators in each building would hare boon adequate* According to the original piano of tho Surgeon General1 s Office for 180 bed, temporary hospitals, there was plumbing, etc., for dental unite in the Administration building, ths Infirmary building, the flight Surgeons build- ing and, in nany instances, in addition, a separate dental clinic building. The cane wae true as to l.K.V.dT. Installation, loons wore efton toe small to accomodate tho equipment provided for them. Changes were net permitted during construction, regardless of how urgently indicated, bat after com- pletion, partitions had to bo removed oto., and nany (and expensive) changes made before the installation could be used satisfactorily. Those comment• perhaps should be made sub. par. (i)."••••• L. I. Pohl, Colonel, MC fUa QOPT mCTBACT (Uttw fro* Dr. V*. 0. Nsaniager, fepeka, Kansas, dated 82 April 1848} ***** "(f) fhs medical department organisation fro* the standpoint of per conns!, equipment, training and nice ion or tactical requirement Che Surges* General ought to hare full sad complete charge orer hie median! personnel regardless ef the nr*' or service in which the individual is placed* Zt makes as sense te have everyone else control asdics! personnel except the Surgeon General and yet again and again this seemed to happen. Oeaaanders of tactical forces had to decide on what kind of equipment they could take and invariably the medical equipment suffered because there use no one at a high level to speak for the nodical depart- ment. I know first hand ef no facts but more than once recall the widespread impression that the medical facilities available in certain campaigns wore extremely Inadequate and this was due to the boll-heededaees ef somebody in eharge who would not accept the requirements for the medical department. Again this seemed to apply equally in the area ef equipment and supplies which wore under various author!tits and not left to the management of the medieal deportment. ***** %ilisted personnel, it teemed te me at least, if ef marginal use- fulness because of physical, mental or for emotional handicaps were often sloughed off into the Medical Department. It teemed to me that we got all of the individuals who were illiterate, incapable of even counting the amber of sheets on the ward, etc. Z may be paranoid about this bat again and agalm it was apparent In my many hospital inspections. Bssausd of a blind spot someplace at high levels, seas ef our top flight medieal officers were never able to admit that the greatest less of manpower in the army was because of personality problems. For this reason the Air Corps snuffed out all of the Mental Hygiene consultation services in contrast to the increasing effectiveness of these in the basic training camps under the AS? and the SXT. * ***** U K. Pohlt CoI«n«l# rn TREE COFf EXTRACT (Utter, Colonel F* A. Blesse, MC, OSA, dated 19 April 194?) iltdleal Deportment organisations from the standpoint of Personnels eouiramt. training, and mission or tactical recmireaent. "a. Established principles were proven to be sound during the lest "b, Tables of organisation must be constantly studied to avoid any waste of personnel• Such studies will no doubt be primarily concerned with reduction In Medical officers and it must be remembered that the requirements of units in the combat sons must be based on nonaal casualties expected during combat* It is usually Impossible to predict when combat will occur, attacke normally depend upon the element of surprise and secrecy, unpredictable enemy action or other unexpected events nay re- sult in combat at anytime in the combat area* Therefore, the proposal, which was given wide publicity several months ago, that we should save doctors by establishing major pools of such personnel and "when combat is to take place* to promptly fly such valuable personnel te the place where they will be needed, is based on ignorance of military organisa- tion, tactics and procedures* “c* In an attempt to obtain greater flexibility in organisations, there has been an over emphasis on the organisation of small cellular temps in the 8-500 series table of organisation* These numerous teams often consist of but 2 or 3 men and not only take considerable space on any troop basis but are easily forgotten and omitted* Units not ap- proved and entered on the troop basis cannot be expected to be where re- quired* Such units are impractical except for highly specialized person- nel and should be included in Tables of Organisation to insure their availability. ”d* Advanced training of Medical Service Corps officers should be considered with a view toward their possible replacement of medical officers in certain selected positions* •e* The training of selected members of the Womens Auxiliary Corps should be considered with a view to their replacement of nurses in sel- ected positions* Nurses will again be in a scarce category and a study of this subject will reveal many duties now performed by graduate nurses which could be accomplished by VACS if given a short, concentrated course in practical nursing* Zt Is believed that a larga number of nurses and > also hospital corps men can be saved by e more proper, and more fe®Inina use of the VAC organisation* There was considerable criticism of thier use as officers* chauffers, etc* during the last war* U K« MC IHTE COW EXTRACT (Uttar, Celon.1 T. *. Bl.«n, HC, OS*) - CoBtlaw* *t• The standardisation of medical equipment for the Amy, Xavy •ud Air Corps has boon undor oonstant study since tho lost nor* Tho nood oas recognised by all thro# and tho eeocmpliehments of tho Joist Coaodttoo on this sattor aro an example to others so to ohat eaa bo accompli ehed In tho unification problem. Continued study, rosoorch and development aro osaontial and tho naans should bo provided on a high priority• Istabllshaonts for such pwrpooo should bo unified* It would soon possible to soooeplish a similar unification and stan- dardisation of supply depots in tho ZI and Tboatsr of Operationst •f* As a policy, the normal idasion of any organisation asst bs tho guiding light as to its roqulronsats of personnel, supplies end equipatent. Recommendations for additions sad Usages in organisstion tables are frequently based on unusual expert anoos and a disregard for the aornal nisaion of the unit,*****1 mug srrakCT cqpt (ttr Brig Oea Buy B* Dealt, HO, Surgeon, Id April 1948) ***** "Medical Department organisations fro* the standpoint of Personnel, equipment, training end mission or teotlcal requirement - It will take a so*, elderable amount of imagination and pressure to convince those who hare had experience In World Wars 2 and II in the B£p that the next war will not follow the exact pattern of the last one* Therefore, the tendency will be to build all of our Medical Department equipment, training sad technical literature along the lines of that experienced la France. Xa this connection it is be- lieved. that advance thinking should be initiated now and that wo should keep In dose touch with those who ar# planning tho strategy and the tactics of the future Arm d Forces In order that we may not lag behind in our concepts of medical units end equipment. Vo do not now hare suitable equipment for arotie warfare. Tentage la very little different froe that employed during the Civil War. Hew and advanced designs are needed la practically every phase of Medical Department equipment.* $•*•* 1. K. Pohl,Colon»l, K 337 IIbV > J TRIP7 ropl EXTRACT (Letter, H, Foraee, MC, USA, dated 20 April IW>) ***** »(f) Medical Department Organisation from the Standpoint of Cortona el, Squipaeat, Training and Mission. file only comment on this overall problem it at follow Bio establishment under the Secretary of Defence of the Office of the Surgeon General or probably hotter a Medical Director for D of onto. Thie office should he a taall one and function at the Secretary of Defence Level. Xt would not he operation#!. It should he policy asking regarding in natters of personnel, professional policy and training. During Vorld War Z the Advisory Oonaiesioa of the council of Rational Defense had a Maher from the nodical profession. Biis plan eeeaed to he a satisfactory one and the Medical Director or Surgeon 0sacral night fulfill the desira- bility ef representation of the profession in an advisory capacity at a cabinet level insuring that the voice of nedicine could he heard.* ***** TME COIT EXTRACT (Utter, T. F. Cooper, DW, dated 19 April 19A«) ***** "During the last war some twenty-odd advance bee# medical (fi) components were developed and ranged from a 600-bad dispensary down to s rodent control unit. Each component was, tailored for a certain mission. Material vac assembled and each component was assigned n number. Specialised personnel wore ordered and assembled at required. This greatly facilitated planning and tha spaad with which given opera- tions could be accomplished. These should be farther expanded. Dur- ing the last war, ae in all pact vara, fiald sanitation in particular lagged far behind.* ***** :oypp i. i. am, oo«mi, no (f) TRUE C0P1 EXTRACT (Letter, Colonel John A* Rogers, MC, USA (Ret*) dated 19 April 1948) ***** "*• Medical Department organisations from the standpoint of n^onn^l, walpp«rt» training. and, algglpn cr facUgal rmuireftaat* "l* In general it la believed that Radical unite of divisions and arvlea are excellent, providing the necessary degree of flexibility to fit in with a tactical situation. •2, The Field Rcapital, with three 100 bed platoons, was a particularly useful unit* It could be used in nary ways* By the addition of surgical teams and certain additional equipaent, notably of a surgical nature, they were utilised aa the first major imy medical units shore during the Normandy Invasion* Upon the arrival of the larger Evacuation Hospitals, these units ware used as Surgical Hospitals immediately adjacent to Division Clearing Stations for immediate sur- gery on non-transportable wounded* During the pursuit of the German Any serose northern France, they were again used in effect as small Evacuation Hospitals because of their great mobility and provided very satisfactory service during this period of relatively light casualties* As the resistance of the German Army increased, they were again used as surgical units in Division areas* There has bean soma discussion of substituting the Surgical Hospital for this unit* It is believed this would be an error since the Field Hospital, as con- stituted in World War II, provides an all-purpose small unit which is suitable for many functions* ”3* The 400 bed Evacuation Hospital was eminently satisfactory* ”4* The Auxiliary Surgical Group, composed of surgical teams of various categories, was eminently satisfactory* *5* The organisation of a group of collecting companies and clearing com- panies at the rate of one per corps was satisfactory* During the lattvir part of the campaign, the commanders of these groups were meed me direct representa- tives of the Amy Surgeon, providing reconnaissance service for the forward employment of Evacuation Hospitals* The Field Hospital platoons were placed under their direct command. This provided e flexibility within the eorpe area which is not possible by the assignment of medical tmlts under the direct commend of the Corps Surgeon* The Important fact is that it Is not necessary to go through Corps Headquarters for the transfer of medical units which may be out- side of a particular corps area* Clearing companies are utilised In various ways* Some are trained to handle neuro-psyehlatle casualties* Others were used for eontageons diseases and special situations* •6* It is believed that the 3000 bed Convalescent Hospital would have mere flexibility if it was reduced in else to 1500 beds and two provided for each unej*9 ***** bolonel, KC TRUE COPY EXTRACT (Letter, Colonel C# J, Baker, MC, Air Foree dated 22 April 1948) ***♦ *f• Enlisted personnel of Medical Department should be turned over to the Medical Department after their indoctrination in the School of the Soldier or basic training. They should be selected and earmarked upon reporting to a selective service board. There should be an educational minima requirement. Equipment should con- fore to that of the service to which they will be attached. Their training, other than basic, should be conducted by the Medical Depart- ment of their Branch assignment. •Officer personnel should be trained entirely by the Medical Department. As to Medical Department organisation, the Surgeon Gen- eral should be the general coordinator aid policy making power for the Air, Mavy and Ground Forces, each of which should have a Chief Medical Officer or Air Surgeon, Havy Surgeon and Ground Force Sur- geon. Medical personnel should be allotted to each Brandi in pro - portion to their strength. Each Branch should havb their own station hospitals, and each Branch should have their own general hospitals. Admission of patients from one Branch to a medical facility of any other Branch should be routine and simplified. Location for the establishment of a general hospital of one Branch near a general hospital of another should be a matter for the Surgeon General to decide. At certain locations where more than one Brandi are closely stationed, the establishment of a station hospital at each station should be decided by the Surgeon General. Medical personnel for the manning of a common hospital should be furnished by each Service, proportionately, but placed on detached service with the Branch having charge of the installation. Each Branch should have a Supply Division, and regardless of Branch, each medical supply point should receive and fill requisitions from all stations in the vicinity. •Where possible, all forms, reports, requisitions, surveys, etc, should be identical for all Branches. Medical personnel should not be transferred from one Branch to another except upon their own applica- tion, approved by both Branches concerned, and then only after a per- iod of probation. Exception being the placing on detached service of personnel with a common facility or to meet a grave emergency,"**•* •*»«»«Medical troops cm duty with tactical units should be 1attached* to those units and commanded by medical officers. Mo line officer should exercise command over medical troops and Efficiency Reports on medical department officers should be prepared by medicel department officers end Indorsed by next higher medical authority,•**♦* ***♦ *4, It is ay belief that nest of tha transportation of troops and equipment in tha next war will be rla air, and. to that and nodical equipment should be designed with a riew to tha feasibility of it being transported by air** " L, X. Pohl, iDelml, 1C TRUE COPY EXTRACT (Letter, Colonel R. E* Stone, HC (Res.) Air Force dated 22 April 1948) ***** "Reference Par. 3 (f) Medical Department organisations fron the standpoint of perconnel, equipment, training, and aisaion of tactical requiremant. •Always felt that the Medical Organisation of the Armed Forces not sufficiently elastic to meet adequately all the exigencies of the Service* •For Examples If the Surgeon of a large Command was compelled te rely on Medical Department Personnel authorised by Tables of Organisation as used in the last mar, many of the units mould be without adequate Medical coverage. In the E. T. 0. there mere many small unite attached to the Air Fores for which no Medical Personnel provided by current Tables of Organisation. The aggregate of these units added up te a siseable force for which some provision for Medical coverage had to be made. It mould be mj reeosmendation that acme provision by made in a Task Force whereby the Command Surgeon mould be furnished a reasonable number of Medical Department Personnel over and above Table of Organisation authori- sation to moot these requirements. This could be in the form of a Casual Pool directly under the control of the Command Surgeon. In this way ho could shift his personnel expediently te meet the day to day demands. Such a pool mas provided the Air Force in the E. T. O. but this mas net a recognised unit, there was no Table of Organisation which allowed for promotion of these worthy of advancement with the inevitable development of poor morale in this group. •Serious consideration and study should ba given to tbs Medical Ser- vice as organ!sad In tho Royal Air Tores* In that organisation ths Chief Msdioal Officer could place and transfer his personnel about as be saw fit* This made a very flexible organisation and I feel that personnel generally utilised to better advantage* An also of the opinion that saoh a syaten in the long run would actually conserve personnel* Toe often an individual with certain qualifications was seeded by the Surgeon for special duty but when his services requested wore often than not he was deeliured by the lower echelons as net available* Certainly a surgeon with the ever all picture in wind should be in a better position to judge where any one nan's service best utilised and his desires to get a jab done Should not be blocked by so called 'Coonand Prerogative'*• 7uZ.Q-'_" L* K. Pohl, "m 341 SSSLCftn OTftCT (Utter, Colonel Robert S. Payton, «C, 1JSA dated 19 April 1W) lafrlsa, of. ft:gaclza.Ugfi and frmlnfffint* it is recognized by all thoughtful persona of experience that there is much that can be accomplished in improving tables of organisation and equipment• We can aake many improvements, thoroughly and gradually, with the full knowledge that everybody will not always be pleased. Only the novice with narrow perspective has the addacity to admit that he is endowed with superior knowledge on this subject, and he usually further con- fuses the Issue by contradicting himself by every other criticism he maksst A realistic approach to this problem is necessary! first, because the ambitious T/O&E reformer ascribes to the unit commander only the negative virtues; second, beeaure no table can be made to suit the unknown individual personalities who fall by change into its organisation; and third, jockeying for position will occur between the medical, surgical, neuropsychiatric, and laboratory specialists, and even within these groups, Mobilization troop bases (and the tables of organisation and tables of distribution or bulk authorizations of which the troop bases are corposed) require constant study and revision In the light of the national manpower resources to be made available to the armed forces. If it is found, for example, that the number of doctors made available to the armed forces is less than that which will provide for adequate manning of the tables to Insure acceptable mili- tary medical standards, than it is necessary to sake the fact known* That is a matter of national responsibility.***** * (f) rilU;£ COFY (letter, Captain 0* B« Morrison, Jr., t€, U3M dated 23 April 1%8) "f * radical Department organizations from the standpoint of personnel, equipaent, training, and ndeeion or tactical require* nests# Thera aeorao to he a tendency to maintain in tim of peace, the sane types of organization &s was used in time of war* There nay be a cob logical reason why this la considered necessary* hot there are nany reasons why it should not he done* As an example» a Marlng division at jreoent has to have a Medical Batta* lion because it is c la toed that the Division oust he organized and available to raove to a trouble zone on short notice* However* the nodical personnel have little or no professional work ether than routine side call dispensary duty* The result is deterioration and discontent of such nodical personnel* Zt is suggested that such personnel could be nose efficiently employed in nearby hospitals where they are needed and could he employed in accordance with their nodical training* The medical officer in command could assign the personnel required on a rotational basis so that sick call could be properly covered in the area dispensaries* In tins of emergency the, Medical Battalion could easily he foamed by drawing Sroonael free* the hospital staffs* Equipment could he kept up tier he cause it could be utilised sad replaced as swqpirsd instead of deteriorating in storage* • ******* , B* TRUE COFT EXTRACT (Utter, Colonel Arthur B. ffolah, MC, USA dated 19 April 19A8) f , There were too few mobile hospitals of the 750 bed evacua- tion hospital type. The Aray Ground Forces were responsible for getting such units into the troop betels. They failed. Urgent pleas of The Sur- geon General and the Any Service Forces for additional units never get into the troop basis! There were also too few 400 bed evacuation hospitals. Such planning forced theater surgeons to naleeploy general hospitals. They had no other alternative for Advance Section hospitals. "Kobile surgical hospitals were non-existent until the end of the war and during the war had to be improvised frost platoons of field hospi- tals reinforced with special personnel and equipment* This was a planning failure of Any Ground Forces that The Surgeon General could not correct which was equally true of the two platoon divisional clearing company* "There was no suitable hospital for the Advance Section of the Con- iranication Zone in rapidly moving situations except possibly the field hospital which was not designed for that purpose* Suitable construction for Advance Section fixed hospitals was not provided* "There was insufficient holding capacity in the Combat Zone and units for holding purposes st transfer points came too late* "Numbered station hospitals very frequently bed to be employed as general hospitals* They were not staffed qualitatively to do that job and there was very little that theaters could do about it* Thought should have been given by The Surgeon General to melding numbered station and general hospitals into 'fixed hospitals, communication sane* and staffing thorn quantitatively and qualitatively to handle their indicated patient capacity* This was a problem in the Pacific* "Insufficient attention was given by the Any to amphibious train- ing in conjunction with the Navy* Casualty handling should have received greater stress* It seemed as if the Engineer Special Brigade received too much attention at the sacrifice of other units that might have been employed in Joint medical training* "It was s mistake to break up medical regiments and battalions and activate separate companies for hit and miss assignment to various group or battalion headquarters* The pries was paid In leas of morals and esprit ds corps among medical troops* Field medical berviee suffered* We hear little today except about evacuation hospitals in the combat zone* : L. K. Pohl, Colon*!, KC TRire COPY EXTRACT - Continued - Colonel Arthur B. Welsh, VC, USA "In the eagerness to save Medical Department personnel too many non- medical separate companies and battalions were shipped to theaters with- out accompanying medical personnel. This placed a burden on theater surgeons who had to supply medical personnel from other units for dispen- sary service. It's true that B-500 series cells night have been used had bodies been made available. "There were too few doctors authorized for numbered general hospi- tals. The authorised grades were too low ranking for the professional caliber personnel required for such duty. "It was a mistake not to give theater surgeons Medical Department personnel pools. It's questionable whether evacuation hospitals should remain fully staffed when not actively engaged. Pools and theater con- trol over technical means would have assisted in solving this. "The pre-activation training of personnel for numbered units as originally conceived and employed by The Surgeon General is the key to meeting overseas damends for medical units. A communication zone medical unit, for example, can under such a scheme be put together, enlisted specialists ,dbetocrs and nurses , added (quantitatively and qualitatively) and shipped to the port within thirty days and function creditably upon arrival overseas. Had such a schema been universally followed less criticism of doctor wastage would have arisen. "Too many oversea theaters asked for units before they were needed. This is understandable in long range planning. Too, theater surgeons weren’t stare such units would be shipped in time. This explains in pert that often heard remark — toe many doctors with toe little to do. One can't afford to be critical because the medical job was well done. There were many intangibles. A better solution is hard to plan in vise of World far II armed forces structure. It's inconceivable how a better theater job could be done. If there had been an Armed Services of Supply setup in the zone of interior with top side guidance and definite medical responslbilitlas for all Sarviees inherent therein and liaison with ) 'f# Uodical Department Draani nations froo the Itafrdooir.t of \(3U Igrecni «'''training* and iss Ion ' or iTnaaont* (X) DefectsI (a) medical Department organlaatl n too rigid# (b) Equipment in general, too hsavy* (c) Training inadequate for conditions met in actual combat* (2) J teas dies* (a) Use pools of doctors to cov*#r medical requirements by naans of airplane transfer* (b) Proportion dental personnel to population rather than T/O* (o) Modernise medical equipment* (d) Specialised training of personnel for specific assignment! only, such as atonic blast casualties, or BV«» Colonel, MC 351 TRUK COPT (Extract from Ltr Alfred S# Eyer, Captain (iL), USH, X? April 19*8) **•* *(f) Medical Department Organisations from the standpoint of personnel, equipment, training and alas ion or tactical requirement* ■Specialist training for medical service personae! recently graduated fn» medics! schools is not regarded as soiaed from a terries standpoint* It tends to bracket the young man In a relatively narrow path prior to development of his capabilities as a physician* Such development is gained only by general nodical and surgical experience with a elds variety of patients* Further, the utilisation of a young specialist without breadth of experience and development of his full capabilities imposes a serious limitation upon the freedom of action of the respective medical services in meeting general service requirements* Brcsd Bureau policy with regard to personnel, equipment, training, mission and tactical requirements should be clearly enunciated and not subject to frequent major fluctuations* An effort should be mads to Indoctrinate, not only regular service personnel, but potential inductees as sail* This latter might be accomplished readily by Joint service efforts through lectures delivered at medical training institutions* More emphasis shou.d be placed on training all categories of medical service personnel for mar* It appears at the present time that emphasis is being placed on peacetime service* Mach could be accomplished by thor- ough indoctrination of personae}, in the added responsibilitee that are en- cunbent upon in various situations during ear service* Particular reference is made to sanitation as applied to forces In the field* Tbi* function showed many discrepancies during the last conflict which were due to lack at appreciation by both general service and medical personnel of its importance**1 TRUK COPY KXTRACT (Letter, Captain Robert M. Gillett (MC) DSN dated 15 April 194«) (The nodical department organization daring World War II was severely handicapped by lack of adequately trained personnel on staff, jobs, who had little or no knowledge of the military problems, and were not taken into confidence by their Commanders during the planning stages.* ***** ' L. K, Pohl*Colonel, MC TRUE COFI EXTRACT (Utter, Captain J. H. Robbins, (MC) DSN dated 26 April 1948) ***** "It is believed that there was toe Mefa ovwr-enphasis placed on specialisation of aedioal officers • Basically the staff of these hospitals should he regular officers for ecnand and executive positions and in hospitals of 1000 to 1500 beds a third regular officer of suf- ficient nude and experience should be Bade available as head of the Pro- fessional Department and under him a Chief of Medicine and a Chief of Surgery, (specialists in their line). X-ray specialists, akin specialists, Xye, Ear, Rose and Throat specialists. Psychiatrists, etc., while the remainder of the staff be cade up noetly of non with general experience. The lack of general men throughout the entire South Pacific was especially noticeable as the Bases decreased in sise and the personnel were aoved forward, it be case an eztreaely difficult natter to find an individual who was capable of doing an appcndectony and looking after the general run of patients seen at side call. This necessitated keeping two or throe specialists tied up on a snail Base at a tine when their services were sorely needed in the forward areas* •The policy of turning trained nalaria control and sanitation units lease on their own in an area was especially bad as they net considerable opposition in certain units where their services were badly needed. It is reooeaeaded that these units be placed under the direct com and of the Senior Medical Officer of the area who had authority to aea that their work is carried out by the unit and overcoat any opposition.” ***** , WC 353 jmjmjsmtsi 0*tWr, Colonal 0. F* Melina j, MC, Air Fore* datad 20 April 1948) ***** *f* It la considered that a groat oaring in professional personnel could be accomplished by a change in Medical Departaent or- ganisations , aimed at permitting physicians and surgeons to derate practically their entire effort to the care of patients* It is the firm opinion of the undersigned that proper organisation would permit these professionally qualified Individuals to be taken from civilian life and placed directly into medical facilities with little or no military indoctrination• In fact, the prospectire shortage of medi- cal officers makes it appear that some such reorganisation will be necessary during peacetime In order that the si salon of the medical service may be properly accomplished* This scheme involves the employment of non-professional officers and non-commissioned officers in such a manner as to relievo the majority of medical officers of all administrative responsibilities and place them in much the same position as thsy occupy in civilian hospitals* It is realised that some experienced medical officers most be utilised in administrative positions, such as that of Commanding Officer of a hospital, in order that the organisation nay profit from hie professional knowledge* It is believed, however, that with these and certain other exceptions, the medical facilities can be efficiently administered without in- volving physicians and surgeons who frequently have no liking or ability for administrative duties* Freeing these Individuals from administrative duties in order that they may devote their entire ef- fort to actual care of the sick and injured would permit them to function efficiently with little or no military education, would per- mit them to assume the responsibility for the care of a great many mere patients, and would thereby produce greet economy in the use of our medical personnel resources* In order to more fully clarify the concept of the undersigned, it is added that this organisation would free the average medical officers of any responsibility in regard to the operating or care of medical facilities* Tor example, in a peacetime hospital no doctor weald have anything whatsoever to do with the ears and cleanliness of wards or with the supplies and equip- ment* All such things will be responsibility of non-professional per- sonnel* This same policy applied to wartime medical facilities of all types is the concept of the undersigned* The resultant saving of pro- fessional personnel oould be increased by extending this concept to •front line9 medical organisations. In ths past, mush professional 00*1, WC 354 TRUE COPT EXTRACT - Continued - Colonel 0, F. Mcllnay, BC, Air Force personnel has been wasted through the assignment to military organiza- tion* where their functions are somewhat similar to those of a fir# department. In other words, they are often with ixceedlngly little to do and the excuse for this la that they must be there in ease of son# type of catastrophe. A greater utilisation of non-profes*ional Medical Department personnel for first aid functions, improved sys- tems of evacuation, and the organization of combat surgical teams which could be rushed to places of need, would accomplish the same task with expenditure of much less professional personnel.1* ***** TRUE COPY EXTRACT (Colonel Her**? B. Porter, JK, DBAF, 23 April 19*8) lf * Greater flexibility from Central Poole of pereonaal and equipment for loan to Goosanders concerned under conditions requiring greater resources than their own T/0 & E,“ ***** L. t. Colonel, K TRUK COPT (Extract Mar 'Sainton k. Sanger, BUHED, US SI, 7 April 19A3) •*****As long as Uedical Corps assignments arc primarily determined on the basis of fuli-cocipla-nent ratios, CGD.Colon*l, BC (f) EXTRACT COPT Of* PERTINENT MATERIAL CONTAINED IK AIR FORCE MTOICAL DEPARTMENT HISTORICAL RECORDS OF WORLD WAR II. (1st Bombardment Division U) Continued with, soon have removed that incentive to combined effort which aspiration to higher rank supplies. This fact coupled with the absence fro* definitive medical activity, continued long absence from home, and the placing of too much stock in unfounded optimistic rumors all are responsible for the lowered morale and efficiency. To combat this lowered morale and efficiency and to improve the character of the medical service to the Any, the following suggestions are offered. •First — That medical and dental officers on duty oversees be rotated bade to the a one of the interior after one and a half years overseas duty and be given a hospital assignment in their preferred specialty for a period of six months and at the end of that period they be reassigned to a position similar to the one they have occupied, overseas again, if in keep* ing with the strategy of the Air Forces. •Second — That the T/O rank for Medical mod Dental officers be Increased in the tactical units to correspond more closely with the dignity and respon- sibilities of their staff duties. "Third — That authoritative Information on the planning for rotation and professional opportunities be disseminated more fluidly to the medical personnel in order to offset any unfounded rumors," ***** ***** "If an officer, after two years of Army service in the rank of captain, is not worthy of promotion, then It would seem that he is not even worthy of the lower rank, and should be reduced In rank or discharged for the convenience and better functioning of the Army, If an officer ia deemed worthy and deserving of promotion, than it night be considered whether the Any would not profit by allowing the promotion, and thus encouraging said officer to further effort in the conscientious execution of his duties. Delegation of responsibilities and duties commensurate with an officer*a capabilities might also be expected to stimulate in him an efficiency engendered by pride in his work. It is conceivable that rigid adherence bg prTdhle of Organisation, for officers and enlisted men, may not always work to the best interests of the Amy." EXTRACT COPT CT PERTINENT MATERIAL CONTAINED IN AIR FORCE MEDICAL DEPARTMENT HISTORICAL RECORDS OF WORLD WAR II. (Ltr. 31 July VH3 from Col. M.C. Grow, . Surgeon 8th AP, to Brig. Gen. Grant TAS) ***** "In the pa«t our groups and wings have most always arrived in the HJ?. with, the medical officers promoted to the grade celled for on the T/O, When that is the earn it gives us little or no change to make re - (r) EXTRACT COPY OF PERTINENT MAT PRIAL CONTAIN?!) IK AIR FORCE MEDICAL DEPARTMENT HISTORICAL RECORDS OF NORU) WAR II, (Ltr. 31 July 1943 from Col. K.Ci Grow, Surgeon 8th AF, to Brig, Gon. Grant TAS) • Continued • assignment within the Air Foret which nay be indicated* ***** I Frilly realise that it is the prerogative of the commanding officer to promote hla officers but anything you can do to discourage the practice of pro- moting medical officers as high as possible before going overseas would be a great help* Many of the officers appear to be tinder the impression that promotions are haphazardly mads overseas with regard of Table of Organisation vacancies and as you know that la not the case* Ae soon as they find that they are promoted to the top of the ladder in their unit they tend to become disgruntled and apply for reassignment, bat there Is no place to put them which cells for a higher grade* Conse- quently their morale suffers quite a blow." ***** (Memo. 22 March 194A from Surgeon, Air Service Command, USSTAF to Gen. Grant; ***** "1* The allotment of grades for nodical department enlisted men in combat units is too low; morale among deserving enlisted men in this category would be greatly improved by boosting the allotted grades both in headquarters and squadron medical sections* •2, In consideration of the responsibilities and usual professional activities of group and squadron flight surgeons as compared to the re- sponsibilities, training, and activities of their line officer colleagues. It seems definitely indicated that grades for group and squadron flight surgeons should be elevated." ***** (Liar* tot Whomever It may concern dtd 6 Feb* 1943 Unsigned (submitted by Col* Robinson, but probably prepared by Maj. Bargeman) "The provision made in the original T/0, Allotments and GradeSvfor Radical Enlisted Ken, were grossly inadequate for the men who are now filling the various positions and responsibilities that have been placed on them* This has resulted in unrest and discontentment amongst the medical soldiers since they have no possibility for advancement. There- fore, it is felt that their reason Is entirely justified and that sons correction should be made."**♦** L. K. Pohl>Colonel. ISC (f) ETPRACT COPY OF PERTINENT MATERIAL CONTAINED IN AIR FORCE MEDICAL DEPARTMENT HISTORICAL RECORDS OF WORLD WAR II. (31 Ftp. Grp.) ***** »,,, nodical personnel have not baan able to riaa beyond the gr&da of corporal or sergeant because of T/0 limitations while their aeeoolatee with whoa they lire and aat and who are Air Corps troops hare frequently risen fron Pvt. to T/Sgt. or M/Sgt. in the sane length of tine. It is felt that the promotion policy for Air Corps troops if continued should be extended to cower such assigned personnel as Ordnance and Medical Department troops rather than bare then under a separate and relatively limited T/0. It is likewise felt that there should be eone flexibility in T/0; e.g. instead of a T/0 calling for six privates it should call for six privates or privates first class.♦*♦• Suggests rotation of KC officers between field and hospital duty of perhaps aim months." ***** (1st At. Sq, - HTO - Personnel) ***** "It is felt that the grades of the medical personnel as set forth in the T/0 are inadequate. This discrepancy is all the more noticeable when compared with the grades in the other sections or departments of the Squadron. The nodical personnel in this squadron are well trained and specialised in their work as nuch so as an airplane inspector, welder, etc., and grades should be eonmensurate with their ricIlls.•♦*♦** (IASAC), 1-17 - MTOt Medical Supply) •At Casablanca, a similar problem was developing with regard to air force casuals as had been experienced at La Sonia. In order to give the personnel medical oare, medical personnel were node available upon recommendation of the Medical Section through the 37 Air Depot Group. By March 1913 the problem that was to dog the Medical Section, throughout its existence, had presented itself. This was the problem of distance, of many miles and the many hours between sir fields end hospitals and hospitals and medical supply depots. The first two fields to present the problem were the ones at Marrakech, and the other at Rax El Ma, just west of Fex, both places were about 150 miles from Casablanca and therefore that distance from hospitals and supplies. To meet the situation at these fields as they it was frequently necessary to act first, and later to obtain authority for what was done. Cots, blankets, microscopes, bed pans and other essential paraphenalls were issued on the order of the medical section by the 2nd Medical Supply Platoon. The same principle of action obtained for ambulances. It was possible, therefore, to give good quarters treatment locally at isolated fields, to evacuate promptly, and yet to have the landing stripe adequately covered at all times.•*♦*♦* ■ ■ L# Pohl a vgIgmIi KC *ms bubac-t cow (Mr or. dU 18 itojr«) ** *nmu m CMUftiiUi jaiim m Iquipaemts late all eat fraiaiaci C Klaaiofi A ( Ysctleal laqnJjra&ftAttt ilnpaMy art* Q*t»lda the titer*! Ktiml« te lartft or*aai*atloa» c lir««aaAi tool Huipwii SteUts* training; Oocd ( Mittlnn A ( tactical teftmwtot tegaatolj Mi. a«n«r nmrit.UM.. WkmIi Tr*r»my Ixtaati tram the point of View of MlMttu, W nUtttt. U W>lt. Iquiprant; Jxoallant training; Definitely Inadequate aarljr U wr, M * woke* mm cffNitt late* Mission * tetlcni ItfiiNMitn Adequately **t* fra^nslS/ voter difficult ftoaiitlm* Afloat- Hospital shiptt oat Oats leading Deficiencies l»MU 1) ftmud, training «i special equipa-t for Sanitation and Public Health la captured Pacific loUalt} It «m act «ktt 1944 that those activities roes to approximately adequate levels la the pleasing aad preparation phase* Bowover, eascatioa of pleas frofooatly Uo«i iprflrtiWjr hoeaase of the failure of the Mao to cooperate, la this setter 60—sndlng Officers (Mae) were almost wholly responsible, la oao eaapalga the oeevp alien ferees lost approxiaately 80,000 aaa days fro* Bsagoo aad Ifcrsoatefy ia tha first Math ashore, hater, vhaa the Oecapatioa 8oa*aader «m lafoxBOd of this ftjppo, plea the feet that conservatively 79} of tMs loos coaid hare hast prevented If ho hod approved the reoonmoadatioas of Mo aodleal departseat dart sc the fits#* lag period, aad after arrival oa the target had ho act preveated hie medical staff officers from fsaotioaiag la the first two weeks, ho aerely shregged his Mttvrt* 2) dasigpaeat of aadleal officers for Civil Affairs sarly lh the occupation phase of pacific Islsads was inadequate* la oao lolaad, with a known pre-war native population (iaarleaa S&tloaalo) of between 23,688 aad 35,000, oaly two medical officers were assigned, despite tho protest of the staff oodtoal of floor. *000000*0 370 TSU2 EXTEACT COPY Of MEDICAL SUPPORT Of «HX USAAf IS THE SUBQPXJUI THSA7XR Of CPXBASIOSS HISTORICAL 8BCCIOE - AfCAS I. •fhmes general problems of organisation and administration con* frontod the Eighth Air force during the immediate Months following the arrival of the first omits In England. They ivrolTed issues concerning the suparrisIon of tbs sehelon medical perries; the establishment of medical policies and pro* Jccta relating to eracuatlon, hospitalisation, and supplies; the failure to pro* Tide casual Medical personnel for assignment by the surgeon to units that wore without fables of Organ! ation; and, finally, the difficulties associated with the assignment of key Medical Department officers to Medical Section, Head quart* era, Eighth Air force, and the four Air force Command Headquarters for duty as special staff officers. ' Che lack of sufficient experienced personnel for the organisation of the medical services of the Eighth Air force was due to the failure to provide early in the war an ample number of qualified medical officers for any other than the major key positions and the policy, made aeeeasary by the projected site of the Air forces, of delegating detailed control of medical mat term, in so far as possible, to the various command surgeons * offices. Che major peal* tiona at this level demanded the highest typo of trained and experienced per* eonnol and as appointments were made to fill them the experience level gradually declined. Eventually, it became necessary to train capable officers in* the theater in order not to prolong a delay in the functioning of the surgeons* offices in the commando. from an administrative standpoint another personnel problem of «eo»* oidorable concern* developed. Before leaving the US, the Surgeon of the Eighth Air force made n study of the units involved in the Bel ere flan whieh forecast the sending of 230,000 troops to tha European Cheater over a 10 month period. It reveled that of this number approximately 60,000 service hoops would event* ually be sent overseas without attached medical, veterinary, or dental personnel. Che plan proposing a Beteriaary flsttoon. Aviation, received favorable consideration. St provided a headquarters and one detachment consist lag of cam veterinary officer and two or three enlisted men of the Medical Department (Veterinary Service) for mny air force consisting of 26,000 troops or more. One detachment would be added for each additional 25,000 troops, Che chief admin- istrative offleer of the organisation, the platoon commander (later designated as Eighth Air fores Veterinarian) was gives command and staff responsibilities. In the latter capacity he would have supervision of the Air force veterinary service and serve as an assistant to tha surgeon. Che detachment commander would be responsible to the platoon eamaonder for tha technical administration, training and operation of the detachment. As attending veterinarian in the area, hi would be required to inopeet the feed cad all sources of such feed of animal origin issued by tha units under his sopor* vision. Che Platoon Aviation Detachments, according to the plea, would function on an area basis, their personnel being attached to tone centrally located station for rations, quarters, and supplies, from this point they would render veterin- ary service to all stations and airdromes within the area regardless of whether they were eeevpled by bomber, fighter, or ether commend unite. 371 THUS SXHUCT COPT OF HXDICAL SUPPORT OF TH2 GSAAJ 13 THS SUROPiSAK THaAT Jt OF OfAaATlUJIS. HISTORICAL S5JCTIOS - AFTA3, CORTIHiai) fit* dental officer personnel ret to stood at Is 1300 on the first day of January 1944. This "gross inadequacy* of Dental Corps officers was partially corrected by the establishment of a Dental Detachment at Large, hut the ratio of total personnel strength to dental officers strength was etill too high on 31 December 1944 to pemit the degree of dental strength of serrlce desired by the Xlghth Air force* The morale of the Dental Detachment at Large was soaevhat low* The personnel was on detached serrlce and attached to the various service and tacti- cal groups for rations, quarters and duty* Often they were not considered as being me&bers of a pemaaent organisation* Since no provisions were authorised for the administration of the Detachment, it was a constant source of annoyance to the Machine Records Units, to station surgeons, and all administrative channels with which Its personnel came in contact. The circumstances responsible for shortages of medical and dental per- sonnel during the first half of the war period were of early origin. The scatter- ed evidence, though at times somewhat confusing. Indicates improper utilisation in several instances of the medical force in the theater itself, the existence of questionable policies, and a lack of trained personnel* The allotment ef medical officers and enlisted men in the Air forces wee governed primarily tor three basic considerations. In the first piece. The Adjutant General decided in February 1942 that the Array Air forces would he res- ponsible only for the medical service within the Armjr Mr Force unit in the theater of operations. Secondly, the supply of eedi al persounel for the anted forces wes Halted; end, finally, the medical needs of an Air force unit were not commensurate to that of the Ground Forces. The latter, it was pointed out, usual- ly engages at least two-thirds of its personnel in close combat for prolonged periods. Consequently, the casualty rate is high, frequently amounting to 16 percent or acre in a period of twenty-four hours. The assignment, therefore, ef e large proportion of the medical personnel end equipment to them was regarded as necessary. On the other hand, the Mr force units fight enemy piecemeal for short periods and seldom engage more than 10 percent of their personnel. The casualty rate it correspondingly lew. In the far fast it was less than 1 per- cent of the total strength in a period of twenty-four tours except when the units were caught without preparation and warning. Therefore, the Commanding General ef the Army Mr forces directed that a minimum cut of 35 percent he made In the medical personnel and equipment for all arms and services with the Any Mr forces. The Office ef the Air Surgeon in pursuance of the order reduced all tactical group headquarters and headquarters squadrons from sixteen enlisted men to three, eliminated group headquarters aid station equipment, and disbanded all medical detachments ns signed to the air depot group for the purpose ef operating a dlspeadaiy* The execution of the reduction in force order explains, in part, by the request of the Xighth Air Force, in fume 1942, to iurease the sotder of its medical officers from 479 to 733 and its denial officers from 146 to 293, and te provide one veterinary officer and one veterinary assistant for each of the 70 airdromes scheduled to accommodate approximately 3,000 troops, was turned down by those preparing the Bolero Plan for Sngland and regarded as being "diametric- THUS 1XTHACT OOP! Of KSDICAL SDPiWf Of TliS USAAf IS IHS J£USQPii*M TH&Afia Of OPERATIONS. HI STOSICAL SSOTIOS - AmS* ally opposed to Bar Department policy*. Aa effort was pat forth to justify on other grounds the denial of add* itional nodical personnel to the Eighth Air Force, It was suggested that the re- duction of nodical personnel and equipment, as authorised by the revised Tables of Organisation and Tables of Basie Allowances, would not lap air the medical ser- vice because operations in Bolero would most likely be of a more stabilised a&ture tiian those in the Far Seat and Australia. Here, the aedical sections, as staffed* were functioning satisfactorily. Dental Officers, it was explained, had never been procurable at the ratio of I to every 780 nan. furthermore, the need for them In this proportion would not exist in combat cones where dental service should be restricted to eaergenoy treatments, the reception and replacement Centers were the proper places for eoaplete dental care. the unavailability of aedical personnel furnished by the Manpower Cesia lesion during 1983-43 was the "basic barrier* in providing the Air Forces with suitable nodical personnel. On 23 February 1943* Gen. D.B.W. Grant, the Air Surgeon, wrote Col. IU6* Grow, Surgeon, Eighth Air Force, that "Because of short- age of nodical personnel available to the armed forces, wo were required to cut out requirements (as of December 1943} by approximately 5,000 nodical officers. With our rate of expansion, in the future 2 can see a shortage of radical per- sonnel alnoet as bad as when you wore in the Air Force. The point has been reached "where an increase la one place had to be balanced by a decrease sonewhere else*. the suggestions end proposals advanced to alleviate the shortage of nodical personnel in the theater involved the training of personnel, the provid- ing of casuals, mobile dispensaries, had flexible Tables of Organisation. Thdr primary purpose was not only to increaso the numbers of qualified aedical officers bat to introduce an element of elasticity In the medical organisation of the Ughth Air Force la order to effect a better utilisation of the existing supply ef train- ed personnel. Some wore approved, others rejected end subsequently approved, end e number definitely disapproved by higher author! ty. Two proposals wore made by the Surgeon, Ughth Air Force, to allerlato the situation of those isolated groups In the theater without medical service. Bis effort® to secure a casual pool from which to drew medical officers for appoint- ment to these isolated groups wore continually turned down, me stated earlier, by higher authority on the ground that they wore *m grouped as to receive medical attention from othpr Any Air ferco units. On the other hand, his suggestion that small mobile dispensaries oe the basis of 1 to each 5,009 trooparbe provided to reader them medical service resulted in the formation of the Medidal Dispensary Detach®oat, Aviation, for nse in the theaters of operation. Bren though the units were partially motorised, ihsir personnel end materials were ef nob s nature ns ' to permit easy transportation by air. H» ftftod f«r ft aoro flexible Heaping fahlo which weald allow tho mm of discretion on the port of the wurgeon. in distributing hie personnel was continu- ously urged aad supported tgr facto. ~\ UL.iv cwie«eit Me T88S COPT XSBUCT F&ht AX5 STALOA?|0« DOAkii S*PA KSPOItf SO; 35, fSB MXO|CAl> SUPPORT OF AJ» WABFA&I IS tWS SOUTH ASi) SWPA HtOK T, 1341 to AUGUST 194ft, «*•««•*• f,*ffeo organization of the medical eerriccs of the Fifth* thirteenth sad For hast Air Forces followed the |et rsl patten laid down la For Depart- meat and AAF regulations and T/o'«. Sowersr, the rigid organisation Impeaed V the so direct tree did not permit the utlpent of modi «1 officers accord* lag to the requirements which existed la theme theaters. Certain isiti were overstaff *d with Medical Officers while other* were markedly understaffed. A wait operating as aa entirely la eae area required fewer nodical officers thaa whoa individual sections ef the wait were established la widely separated areas, la addition, there wee n> position authorised la f/o*s for certain personnel whose assignment tto the Air Tomes was absolutely necessary In order to fslflll the mission of the Medical Department In these theaters, there was no peel of aedleal officers free which personnel could he drawn la ease position vacancies occurred das to sickness, death or other SHigsasitt, It me hollered that cosh a pool would hare made possible the rotation of Air Fores Radical Officers into hospitals where they could refresh their aedleal training, Fersaaasl la the pool, therefore, would hare been employed at all times. 4 elunar deficiency is UnUl Officer* eecurred is these theaters* Am s result the dental health of Air force troops became progressively poorer* The number of dental and Medical Officers required te perform the necessary duties efficiently mas greater then the mother authorised is existing fgaw „ 374 TRUE EXTMCT COili (Extract of statements wade by Colonel Thomas J, Ikxtford, MC , USA an 23 April 43 at interview with SubcoLTidtte© on the Employment of Military Medical Eeoources) ***** "f • I felt that the unite were not too bad, and if J hod the Job tomorrow of creating new unite, 1 wouldn't need very many that we don't have, X think the ones we have perhaps can be improved on, I don't think wb have the answer yet to a holding unit| in other words, the installation that holds the people on the air fields* And I think that we ought to have sons type unit tliat assembles and makes eoae use of captured enemy equlpuent rather than be tossed nrouhd the battlefield like it was in this war; but aside from that, X don't have many recommendations on unite, unless Sanaa© has something they want to bring up* I don't think you would ever have enough personnel end installations without wastage to take care of certain peak periodsf and that you will'always hare surgical backlogs even when you are very well off in personnel. X would like to conaaent briefly an this question, "Were aedical units adequately trained on their arrival overseas?" I think our nodical department z<©placetrailing was good because I saw that training; but there are certain things* that you can get experience and training only when you are pretty doe© to that final line over which you start fighting each other, and it was common—I think we are all guilty of saying that everybody we got we had to train all over again, and so forth* That wasn't quite true* Via weren't very generous in that respect* I think we should keep in mind that there is certain training that we must be gotten a little closer to the battle front than in our training centers* Communication between medical units was not satisfactory* . Vie wasted personnel because we had so other means of oonamlcating it* It meant the establishment of many ambulance relay poets and other installations far which no T/O was provided in order to make the thing work at all* So I think « ought to write in to cur medical l/o's and bring it to the staff's attention that we must have communication and probably in the future conflict it will be even more necessary than it is now; probably should parallel the unit that is being supported* I still think ws need a little control* Presence ctf females in ndicaX field units Is definitely & wautMonnSts Tya sFis^'shiar “ KinAvniATrn CCHT’D ******* "f • a tribute it ought to be the nurses la field hospitals insofar as the Army is concerned. I didn’t hare any experience in soring females, Z don’t know whether they hampered the movement of units, or not, 1 couldn’t say, I think they probably do somewhat, but by and large it’s to be remembered they are all volunteers and they didn’t give us too much trouble, «****♦ Colonel, 1C 376 THUS SXTKAC SOFT (btr Lt. Col miter «f,i>euterfDental Corps* did 11 May 48) y# "Authorisation of Dental Officers, Deficiency - The number of dental officers provided by Tables of Organisation was daflclt-nt by approxla te- ly 50$, In 1944, Tables of Organisation for the Fifth Air Force provided den- tists at the ratio of 1 - 1941* In the 13Ih Air Force, Table of Organisation provided dentists at a ratio of approximately 1 - 2000. In November 1944, the Fifth Air Force had twenty organisations each having a strength of less than 200 sen, five organisations vlth a strength of lets than 200, three organisations with a strength of less than 400, one organisation with a strength of les* than fiDO, and one organisation with a strength of less than 300, none of watch had a dental officer authorised. They comprised 32$ of trie total strength of the Air force* The situation was similar in other Air Forces, In the Far Eastern Air Force, Tables of Organisation early in 1945 provided dentists at a ratio of 1 - 1909, In June 1945 this author!2 tlm wa? augmented by 62 offleers by the activation of 62 dental operating detachments. In the Eighth Air Force, In 1944, dental officers wore provided by fables of Organ!z tion at the ratio of approx- imately 1 - 2050, This was augmented by the activation of the Eighth Air Force Dental Detachment (At Large) in November 1943, providing for 10S additional officers establishing a now ratio of approximately 1 - 950, This inadequate provision of dental officers by Tables of Organisation existed in all Air Forces, la scute Air Forces It was compensated for by the authorisation of dental detach- ments. In some Air Forces this was achieved as hostilities ceased, £, Unfavor- able Effects - Those Air Forces ia which an additional authorisation of dental officers a bo e the regular f/o allowance was not obtained, or in which it was obtained lato i n the war, were very auch understaffed, Dental officers were grossly overworks 1 and were able to meet only the most urgent requirements. Many ©nail units and d . tcchsents in Isolated areas were without dental service for extended periods of time and larger units were understaffed, There is no doubt that uaay a tooth has been lost because the neces&axy attention was not available at the time it was needed, Sabarrasemont no doubt was avoided by the good fortune that there was not an outbreak of a serious epidemic such as Tlncent*2 Stomatitis, S, hccoawendttionft - Authorisation of dented personnel by one of the following methods* of which the first is much preferred! 1) In addition to the staff dental officers at the various Air Force and command headquarters* provide a blanket authorization of dental officers at a ratio of 1 - 1000 (or other predetermined ratio), the actual death! officer requirement thereby determined by the strength of the Air Force; dental officers to bo assigned not to units as groups and the like* but to dental detach- meats of various sizes with approved Tables of Organisation; dental detachments to b© activated and deactivated according to the fluctuation ©f the Air Force strength; nil dental personnel to be under the immediate control of the staff dental, officer of the command; dental enlisted personnel to be authorised and assigned on the same basis* This plan was employed in the Third division ka France during the war with great success* 2} la addition to the staff dental officers at the various Air Force end commend headquarters, a limited number be provided for in Tables of Organi- sation of tactical units and the remainder authorised in such members as will establish the desired officer personnel ratio; tfedee additional officers to be assigned end wider the control of the staff dental officer as in 1) above; an- TXBX SURACT COPT (ttr LtOol Valter «T. Beater, Bontal Corps, Aid U Nay QQHT- listed parse anel to W prorldod la the tern maansr* This plea war. utilised successfully la the Sighih Air Fores, with the exception that offloars assigned to the dental detachment and on detached service with a wit knew and felt that they did not hare the prlrileges the wit dental enxgeoa had and therefore felt they nere feeing discriminated against* This was a a nor yet a definite persenael problw. <5^^^^oIonel.l« 378 KR COPT BXBUOI (Latter, dear AdgdraX C, 3>C«imffir (UC). U.S.S., JattTMt dated a April 19U8) •eas •All acceptable l&wUcA personnel should be carefully and thoroughly screened PWICALLT, PaDFESSIOMALLI and RACIALLY and only assigned sccordinjjly, following the standard course of in- doctrination* In brief, Hhe nan for the right job* insofar as experience and exigencies dictate# Sfcich cm be accomplished and gained by the adoption of such an war-all policy** ***** aa; 'sg • 379 fBSX COPT (Xxtract btr Ja»ee S« Hix, Lt col#, lie (Resigned) 11 April 19AS) tactical organisation sill have to change with the change by the tactical boys* I visualise the next as almost entirely air until occupation tine arrives* Get you a good air transportable unit*-"keeping It snail and plan air erac to the specialist centers Ip the £one of the Interior* Use only that portion of logistics vhich reflect on experience by alrf tool the rest by the board* True your'e gambling* but la the next one*-~ybu better be right* There probably won’t be time for eery changes**####* 380 TRUE COPI EXTRACT (Letter, Colonel Hobart I. Payton, IK, OSA dated 19 April 1W) ***** Thin in certaini Within a theater of operation* the chief surgeon vast serve hie commander. Be cannot serve two ■asters — that sort of thing has never been possible and never will be* Failure is inevitable if it is assuaed that the desires of a chief surgeon are to be paraaotmt to all other considera- tions of the theater cosnander. The Medical service cannot do just shat it pleases and when it pleases with complete disregard to what the theater oonmander determines to be necessary to win victory in battle. ***** L. I, Pohl. Calm hade m dolonoi MG. U» ■->« A. on 22 April lj?U8 at in.tenn.gg with duhcoisaoittee on the of UHitary Nodical ” Most unite, 12 psrtclttad, get heavier by the minute* They pick up everything they can to make themselvos cooforta le and hajey, and as long as tiat doesn’t interfere with the logistics * e ffort of the cOQuarod, I an heartily in favor of it* M (?) 5* I can’t think of any specific now units* X have given this a lot of thought* I iiavo talked it over with ctlier people* As you linear, tier© are isodifications being :aad© in siaos of units, in certain specific functions of units | I can’t think of ary particularly new unit that should be added* M(F) 6* The planning figures for a specific task was den© by specific iieadquarters, As far as I am concerned, the laedical head- quarters or th© medical agency in the headquarters planning any task in which I had ary connection whatsoever planned adequate medical sup- port* That medical support was not available, therofore, I assume that that reflects planning at the top level Cor the cvor-all tasks, I assume that there was a 'creakdcwn or an inadequate amount of planning or inadequate result of planning at the highest level duo to, I am sure, perfectly unde 'Standablo factors which I ieve no knowledge of,**#**” —c2 'Coi^er.-ar- fmm copt aje«aCf of msmiw with seam Kins & nuouns (nc) rar 4 nay 1343* ******** f, •in botb your it San dago usd is the what wes your sstinnte of tbs efficiency of the different nodical departeent mils to far m miow eoepoae&t fn(«r«« wore eoacemsd for the J»l BMtiicsgr lo dot So you Mr* any suggestions about nodiflections? ESAfe Alhllbjtu VILLCmsi Ilf reaction ©f the Son Plage Hoepital * aad Z ©peek egala of or hospital - «u< that ve tan a hospital that was efficient because we had snob alafge patient lead* Satarally the bigger the lead the acre the per person lead will be out down, Ve ran a hospital thrt east as low as $!•!#• I am set sure of that figure* but it wee the lowest fer hospitals* that? Vby? Because the bigger the formula. the lesc. It oeet* So t think the hospitals en the Vest Gem* were meet efficiently run* Certainly seas of the convalescent hospitals were expensive* But these pear devils rated everything* They west to these beautiful htlda and Cusps tb; t ware provided them fer eenmlesesaee; and Uhlak It probably was mousy well spent***•*••••*• turn copt sxtaACT or ismrav vm colohsl nMsn. cw., hc, m, so April im»* eeeoeeso f. * Basically X believe there should be sere elasticity as to —her and rank* Static f/o>s do aet vary with eireaestaaees enough* Z know they ere necessary for allotment of ssnpower, but I believe that within a theater ability to deviate £rcm that t/o occasionally should bo pern!tied* Greator use of IlmUsd-serrloe personnel la medical «oU»} teat is* net 1a ll« frost line, but In rear wUs. Bat that nee met start at home is the period of organization and training, not overseas la a woifcisg outfit* ¥« could hare used 75 percent Halted service personnel* the mater varied from 3B to S3 per ec&t. 2he. difference we could wall bare spared a« good husky aea* bet ttaturaliy as/ eoaaaadlag office it going to resent baring Me vnll broken » after be has spent a year or aore trailing technicians, and they bad to be protected* yet w« weald Jnvo welcomed Hal tetb* service personnel when re were training the mem to begin with* Continuity of the wait in personnel is a great soralo footer and tho earlier a group can bo welded the better they faactliu training of watt* with all officers and enlisted am present Is coot Important* Sons of our officers did act join until later* they cover wore through tho training period with a group* I think any wait that can be should be welded together la thekwlAing period* MXQMSm. GSaO-liAh hjkimsc Should we increase the ftaenlo component in ear field and fixed mite* particularly in the field of nodicinof COLOSSI COSSSLU I would hero boon veiy glad to have bed about one* third of *y unit feeble technicians* In fact. In 1936 sad 7 when I broke down the f/0 tbr the first general laboratory while I was up in if* I ebesteeexfced ee*» tala squares for the Individuals and it wotfecd cut to be Just about 93 or 96 per** cent, and X sad* a little not* on the fore that these aoy be feed# techaielsne* 385 tsm s&m&f of wmv vita cay?s& co&aau* *c, vm* » aaagraaaat I wouId like to 0*3? tfclet I would hare Im rosy glad to hawe bad thoa soot to woirtc ctrch day in ay laboratory ad returned to their barrack* at alght, so that their ccatrol, living conditions sad everything, wore apart fnws the salt. X thought that could hare been vostead particularly la ear aed» leal center, I think girls could hare bees meed in all of those unit*. ve needed stenographers and typists. 2 h&d none. There verc girls that could hare done It mry well and there wore girls who uadoubtodlp could hare done • lot of ether technical cork la all of osar laboratories* Of conran, we art go tag to atrip th* laboratories off anal a technicians in civilian lift and at would V* stripping than If wa took them in wartime fron these boepltfJLi which rw in Med of than «ov. tfa did that in World War I* Wo a tola technician* fro* iff State, City Board of Health, and oil around the port of eafcerfeatloiu Vo seat than a round and found that sons of than did not stand - exposure to the distant points ne wall* 1 9dA on# reason wot that to war# toad* Ing tea or two girls to a peat to work is a laboratory. Thtjrjf woro not mm nor did they lire la aaraaa* . ML* &« PCHLi Colonel. 1C D-lg, Msdics! logistics In military campaigns. x* mouzmi 1* The shortages of bommu Umi of stdlMl equipment Md supply la all theaters during the early war jraan haw* given fin it each criticism of the medical supply of fort, The look tff adequate •took pilot aad the tint required to expand production, the relatively mall group of offloert trained la medical supply procedures, other than otatloa supply, the lade of equipment lists except those loft over froa World War I, which would supply infensatien aesessary to ootitfato rsquiremeats, insufficient shipping aad tho confusion of omharkatiom aad dohaTkatioa all contributed to equipment aad supply shortages experienced ia Medical Deportment organisations at hoao aad ovsrseas. Hat encouraging feature of the nypl; situation wae that progress ia every dlreotiom vat aade as the var west oa and la tha latar stages a medical supply system vat developed which wae second to none. 2, The problem of short supply of aedioal material ia the Uhlted States was finally solved by expanded production though a author of items remained 0critical* throughout the war. There is meed for a study of the overall aedioal eupoly roquiremeats of World War II upon which estimates of these roquiremeats in a future conflict may Wo hated. Such a study it a Joint Amy, Wavy aad Airforce responsibility aad should We undertaken Wy a hoard of selected experienced aedioal officers. The findings aad recommendations of this hoard should ho submitted to tho Joint Army* Vary Procurement Office where plans should he laid for the crderly procurement of the aaterlal needed by the Medical Departments ia the event ef a future war. In developing such a program, attention met he givaa to civilian defense requirements. 3. Tho lack of a sufficient nuaher ef trained medical supply effleers handicapped the development of an affective medical supply system. There are at present a large nuaher of officers who had a let ef aedioal supply experience during the war. It is essential that this group of of"icars he maintained by the intensive training of new officers In the system developed ia World War XI, 4* The insufficient chipping tonnage was an important factor in nodical supply shortages during the early years of tha war. It was extrema* ly difficult for tho Medical Department to secure Its required there of the available space. It was mot until lata in the War that this situation was relieved. 5, Until the summer of 1943 Air force units frequently arrived overseas without their exgaaio medical equipment, Kedis trihut Ion ef equipment of other medical units In the area led to overall shortages. The obvious remedy is the shipment ef organisational equipment with or ia advance of the personnel ef ths unit. Split ohipaeat* of hospitals to the ISO aad the Southwest lie&fis was a source of such difficulty, Material of a given wit vat frequently unloaded at widely separated potato and had to he aoeewHed within the theater. It ie not practicable always to lead all the equip- 393 Mat of a given unit on tho uni ship. It Is essential that later ship- ment* he delivered at the same destination. A proposed system would charge the Medical Department with the responsibility of assembling all hospital organisational equipment, except motor vehicles, minimum essential and per- sonnel equipment, of packing, marking and preparing complete documentation for overseas shipment. 6. Automatic medical supply in use at the beginning of the war led to heavy everetookage of many Items at overseas bases. Some of the supplies were not needed at all, ethers were not used at the calculated rate of consumption. To avoid waste of material up-to-date medical supply tables are essential in making up automatic or block shipments, tables based on actual requirements of overseas organisations should be worked out and kept up-to-date. It is recognised that an automatic supply system is also necessary in supplying combat ships while underway in the course of pro- longed operations at tea. Medical supply on the baeie of requisition by all Medical Department organisations should be adopted as early in the campaign as possible. 7. Medical supply officers in some theaters reported difficulty in obtaining information aoout the arrival ef troops in the area, upon which to determine medical supply requirements. Hot infrequently it was necessary to depend on estimates which proved to be grossly inaecurats. Serious supply shortages developed and excessive inter-depot transfers became necessary. Instances of this nature did not occur where competent medical staff officers were present and the medical service received command support. 8. Hard won experience in the last war demonstrated the urgent need of an ample supply of whole blood in the combat area and In all hos- pitals. Troops in the overseas theaters can not be expect*** to supply the quantities required. The system developed in the last war of collect- ing the blood from volunteers in the United States and shipping it in chilled containers via air to blood distribution centers at advanced bases proved eminently satisfactory. Plans for a similar system to be ready for operation at the outbreak of a future war should be adopted. Responsibility for collecting, processing and shipping whole blood should be assigned to a special unit under the immediate direction of the Office of the Surgeon General. Shipments should be given highest air priority. Consideration should be given to the demand for enormous quantities of whole blood by civilian defense agencies Inthe event of an atomic war. 9, la the past war* the operation of separate Aray and Savy medical supply eerrioet la over teas theaters was uneconomical and wasteful of personnel and supplies. Since there Is a Joint Aray-Hnvy Medical Pro- curement Agency and an Aray-Havy Catalogue of Medical Material* either sertice could provide medical supply support for a theater or area through common Medical Supply Depots. The medical service having the larger force to support in any given area would establish and operate the depot from which all medical units in the area would draw their medical supplies. Responsibility for keeping the depot advised of the medical supply require- ments of Army* Davy or Air Forces In the area would rest with staff medical supply officer of each of the Armed forces. The principle of Joint operation of medical supply services shod d be extended to overseas theaters. 394 II, OOIOLP8IOH8 I, Adequate stockpiling end pleas for expanded production are essential for off so tire nodical supply of the Anted forces at the cutset of a future war* 3* the leek of a sufficient number of trained nodical supply off- icers handicapped the derelopnent ef an effective medical supply ays tea in the early part of World War II* 3* Insufficient shipping was a factor in nodical supply shortages during th# early war years* 4* The arrival of Air fore# nodical unite overseas without organic equipment led to acute overall shortages. Split shipments of hospitals to the BfO and the Southwest Pacific gave rise to much difficulty in assembling the materiel from widely separated unloading points* 6* Automatic nodical supply resulted In heavy over stockaga of numerous items at overseas bases* The automatic system of supply Is necessary early in a campaign but should be replaced by supply on a requisi- tion basis as soon as possible* 6* Experience in the last war demonstrated the need for whole v blood for the care of casualties in overseas theaters* Plans for a system of whole blood supply similar to that used during ths last war should bo adopted* The system should be ready for operation at the outbreak of hos- tilities. BesponsitfLIty for its operation should be assigned to n special joint medical unit* 7* The principle of joint operation of medical supply services by ths Armed forces should be extended, to overseas theaters* Under the present organisation of the jointly operated medical supply system, any service could provide medical supply support for all units of the Apssd forees in a given area* in. msmmmm 1. That plans be developed for the orderly procurement of nodical equipment and supplies needed by the Armed forces intho event of a future war, 2. That the preseat croup of experienced medial supply officers ha maintained by the intensive training of a«w officers ia the system do* ▼eloped in World War II. 3. That the Medical Department ho assigned the responsibility of assembling, packing, marking »ad completely documenting unit nodical organ- isational equipment for shipment overseas. 4. That aa Army-Savy-Alr fores Medical Department board bo organ- ised and assigned the responsibility of formulating pleas for the supply Of the whole blood from the Palted States to overseas theaters la theeroat of war. 5* Shat action W hkm w extend the Joint operation of tlio Mod* leal supply services of the Araed Itorees to overseas theaters in a future ear. X278ACY 07 STATSMETTS KADI BI CAPT. B.B. ES81KG, JR., (KC) USH OH 22 APRIL 1948, At imiTZXV WITH SCBOOMMZTTSK OB THS U4PL0TMSBT 0? MILITARY MX8ZCAL 8SS0U8CSS. •••♦• 8. *1 hare not prepared t statement, Bat Jfttt toa»Udi| to cal4* ao aid I would like to say, first, that ay tzptrisaee was principally with the aaphlblous forest. By that I aoaa Both the forest afloat and the forest ashore, with not only the Marines hut the Any* I was la the Central Pacific. I was astounded when I returned after the war to find la plates the thinking regarding the efficiency of our forces. Ireryhody seated to think wo did a wonderful Job and that ao changes were Indi- cated. The points Z hare node hero are fairly gaaoral. Z Male our greatest lack. Both afloat and ashore, was the leek of aodieal officers trained la staff work for aaphlbieu* warfare to understand the overall concepts aad could direct the planning of the amphibious operations. I think that exists today; aad cer- tainly we aren't training anybody in this employment. As an oxaaplo of what happened, Z would like to point eat the enploy- aont of hospital ships and the LSfH's at Saipan. Wo were assigned for oar ex- pert ashore throe LST8S. fo ay knowledge the designation of those vessels was changed six tines Between the fighting phase and the actual assault on the Beach- head. The LSTH which I observed personally did set isles station si 2,000 yards off the Wash so she was supposed is do shortly after B Boor, bat eomeoo- ed taking her casualties about 600 yards free the Monrovia, is the transport area 22,000 yards off the beaeh. When Z saw what she was doing, Z attempted to get the transport squad- ron eonaandor to leave the casualties which oho was loading, eons to the trans- ports, which was their eventual destination, and have that ship proceed In whore oho could distribute the casualties off shore or give treatment to thoseeasual- tias which couldn't safely Be evacuated 22,000 yards. It was impossible to got any action. She took 100 casualties aboard By cargo net. By individual litter hoist. By dragging then up with heists, Boat- swains1 chairs, aad as en, end then, after two or three hoars Brought her whole 100 casualties over to the Monrovia, cam alongside lt,ond it took two hoars to transfer then. Because there vat no Brew. VO had to Build one. Of those 100 casualties, 15 wore dead By the tine we get then aboard the Xoarevia. They had received absolutely no treat neat, not even plnsna, en that ship. 7our acre subsequently dies that afternoon. Z knew that. Because Z knew where they were Buried, Vo Brought then ashore the next corning. the first hospital ship arrived at fr-Flua-S, and thereafter hospital ships arrived at only Irregular intervale. Aad our first iatlaatlon was whoa we saw eaa pull in at thetarget. If a hospital ship is to Bo utilised at all on anphibious operations, it should Bo utilised at HkReur, Because with the element of surprise there la no core danger to n hospital ship at 8-Bay than there is at B-Plus-3. I an happy to say this was rectified, and the hospital ships at Okinawa aalntaiacd 396 KXTfACT 0? STITEMSHTS MADS BT CAPT. B.R. HER I SC, JR., (MG) USH OR 22 APRIL 1948, AT IHTSRTISW WTH SURCOMMITOS OX THX KMPLOTKSXT Of MILITARY MJQIOAL RESOURCES, COST, a ‘beautiful schedule sad were certainly active. I don’t knew whether we didn’t hare thass avail able at that tine or whether it was due to poor planning, but they *ere certainly inadequate at the Battle of Saipan, la an attempt at Tinian to provide adequate facilities afloat for in- itial casualty impact, we put two of ay nodical companies on APAs and designated then as casualty receiving ships. There was no medical officer oa the staff of the amphibious force eoaaaader, with the result that those two ships were need for demonstration and were not available off the beaches. So we actually dis- seminated what medical support we had. The lack of properly trained medical officers on staffs resulted in extremely poor coordination of nodical resources ashore and afloat. Bor instance at Okinawa 1 attempted to get an L3TH to evacuate directly from Xaha Harbor. Our advance there had been eo rapid that the hospitals couldn't keep up. And, because of the rains, evacuation over the roads were absolutely impossible. Me couldn't do it. 1 don’t want to go into all the details of difficulties I encountered in attempting to get a LSTH down there. But it was five days before we were able to get a LSTH in to get those casualties out of Saha Harbor. k classic szaepls which occurred early ia the war tbrough lack of cooperation between the focee ashore and forces afloat was the Xiska operation, although there were ao Japanese there end the results did now show up. I was present there during the planning phase and actually knew that the Amy intended to take care of all their casualties ashore. 'Kay had three field hospitals, and they were going to set then up and take care of ell their casualties, for an operation which involved 148,000 men la the assault and follow-up* we had one hospital ship. Maybe the Amy was correct la deciding that they had te take care of the casualties ashore. As 1 say, fortunately we didn’t have casualties. for coordination of air evacuation at Saipon, ay first knowladge of air evacuation facilities cane on about D-Plus-7, whan I was instructed by the corps surgeon to send 17 patients up to the air field. My concept of air evac- uation at that time was very erroneous; and I seat some patients up there which X realised should not have been evacuated by air. 8c did two other Divisions. There were no screening facilities at the airport. There were no nod- ical personnel to accommodate the wounded. There were no medical facilities aboard the planes for treatment. Ve actually sent some of our corpenen and doctors all the way back to Pearl Barber, doctors and eorpsaen that wo needed for the opera- tion. As a result, six of these patients during the first week diet In transit, end we got a tertfflc blast. As I say, X feel it was ay fault for the ease we lost, la that X didn't know the type of patient which could stand air evacuation. 397 EXTRACT OF STAT1K3IT5 MADS BY CAPT, S.H. H2RIB0, JH., (MO) US* OS 22 APRIL 1948 At INTSaVXBV WITH SUBCHKITTSJ3 OH THE SMPLOTr.SIT OF MI u I TART MSDIOaL ETioOUHCSS, COST, Likewise, after &lr evacuation wac set up with good ambulance planes* ve were forced to suspend air evacuation for a period of 10 days Because they could not handle the casualties* Ve received instructions to delay our exaca- at ions, which were vitally needed. The status of offshore evacuation la, I night mention, hack to where it was before the war, that is, they are attempting to distribute casualties from the beach, which, in the initial phases of the operation, cannot he done. It can* t be done because you can't direct a coxswain to take casualties to ships off* shore, because we don't know their status at the nonent, Ve don't have coamual- cations. Ve hare no assurance that the coxswain will carry out the directives. And, there is absolutely no provision for evacuation at night. X wrote a little bit ea what I would like to make aa a recommendation, Perhaps that is prenature at this time. B-iiAR ADMIRAL ASD2RS0S; So. I think ve would like to have your comments your ideas on it, of receiving offshore evacuation, or the whole subject. GAPTAI3 iBRISCt I an speaking of the whole subject because it ties in. The lack of training, the leek of modem doctrine which keeps pace with our changes In organisation * the major reason for this is that there is no strong Department f Amphibious Medicine anyplace. There is one In the Bureau of Med- icine and Surgery. That is on paper only. Captain Haynes, who is a very well trained and excellent officer, has been loaded down with other duties so that we eanlt give any time to it. Be has been, and will be, for the next four months, engaged in an operation out- side the States, and there is just nothing being done. These problems are never even referred to that section. I think this should be a joint medical section, because we mast have the forces ashore and the forces afloat in the closest liaison and coordination. I feel, further, that this section should be in the Bureau of Medicine and Sur- gery, under their cognizance, because Initially the ships afloat must bear the initial load of casualties. Vs must depend upon them initially in these violent amphibious assaults. But 1 feel that the Army must be represented because of the coordination necessary and also because I fee I that the Navy should keep out of the field of temporary and semi-permanent hospitals. The Army knows how to do that much better than ve do. They are trained from the time they are second lieutenants, or are being indoctrinated in the field, whereas ve have relative- ly few ihat are assigned to our field medical forces — the possible exception, of course, is the medical sections attached to the organic combat units, in other words, the dlvisione, or possibly corps. But asgr back-up of hospitalisation ou the target, or in the immediate theater, should be aa Army responsibility. Ve should utilize their great knowledge and planning facilities along this line. The Air Force should be represented because we know, especially in the last op- eration which I observed, Ofcinowit, our air evacuation; and that must be coordin- ated into the picture. The whole subject of amphibious modi cine is dormant at the present Use. jb*. .rftTmnTrn1 EXTRACT 0? STATEMENTS MADS BY CAP?. E.R, HSEIM3-, JR. 0 (MC)USB OS 22 APRIL 1948 at interth* with subcommxttsb os the employment or military medical resources, cost. Again referring to air particular employment, actually i oannot dlieui tho picture of nodical resupply and initial supply prior to Captain Jordan* s arrival la the Pacific, Because it was to confused I didn't underttand U. I aado oat requisitions, cant then la, and they patted through a lot of hands that were not 1st!natal? connected8 or real!tod tho taotloal or strategical situation* At a result, the urgency of those supplies vat not appreciated tgr tea# of tho el&dioats that wore supposed to retuppl/ us. Brentually, Captain Jordan did sat up a srstaa of supply Blocks; and while tho? were mot as accurate ae the/ might harm Wan, because no hod/ could ho neourate on than, nevertheless from that tine on our nodical resupply was •> eel lent. Since that tine wo hare had a Medical Held Material Board at Camp LeJuone sat up as a permanent hoard. We have wprfeed vary closely with tho Army. Vo have had two excel lent neatlngs at Louisville and Canp LoJuens and are contemplating another on nt Ban* dolph field. Vs have gone over, from our standpoint, h£s*ck retirements, the initial mounting out requirements, and our rohahilitatien requirements following ooahhft* Vs have developed, oven listed, the items their way, sad wo have designated thd responsibilit/ for various command chains in tho actual furnishing of this ant* oriel nt tho target. Vo worm not able to oomo to agreement with tho Amy on this particular system mad did mot doom that too Important at the time, Because they are determin- ing It for, more or lose, large operations where they have largo medical supply chains cf thoir own, and vs saw no wny la which wo could compromise tho two. I fool that for short, violent campaigns our system is aad I think, should Bo employed for that type of an op ora ties. Thom again it shows h tho noeossity of a high level Joist planning hoard to Boko cegn&snaoo of tho typo of operation on which tho military embarked and to sot up n system ef logistic support which fits that operation the host. COLONEL POHLi Do you hmro n special medical supply unit that accompanies on tho smaller scaled operations? CAPTAIN BZEIBS: Ten sir, wo do. It is a section of our combat service group which geos along with us to tho target, receives our materiel for resupply ns delivered hy tho service forces of tho fleet end la turn segregates it and passes it to ns as seeded. Our one weakness at tho present is that wo have no nodical supply sec- tion for field units which works in conjunction with n Karine supply. This has oo» oaoslonod a wastage of nodical supply. In that tho Merinos, especially In those unsettled tines, are continually changing thoir logistic directives as for as tho 399 [EXTRACT OF STATSMSKTS kADB BY CJLPT, S. H. HSRIDC, JH,, (KC) USI OK 22 APRIL 1948 AT mSHVXSS WITH SUBCOMMITTEE ON TH3 EMPLOYKSST 0? MILITARY MBICAL RS30USC3S, C03T. number of dayt and as far as supporting the masher of sea. There is no hardship for the Marines because they hare, right there at their sedating up place, their own depot. So vhen they change their logistic directive it le really a paper change. A stock lore! is maintained of those Karine Corps itese, such as cloth- ing, aasmitlon, and other things of that nature. Aa I hare no echelon between myself and Brooklyn, I hare cose, by necessity* to ordsr nodical supplies sufficient enough to cover the gre&tdst contingency that I can anticipate regardless of logistic directives and right now I find myoeXf in a position of having, roughly, 30 day’s supply for 13,000 sea too ouch on ay hands. 1 aa reluctant to let that go at the present tise because t don’t know which way we are going tc Juan, and it's really ay see in the hole. l£ we had a nodical section in the snap supply depot where these requisitions on paper could he given to thee as their responsibility, they could store these medical supplies for the greatest contingency, and they could cooper- atively use them for ell medical uses. The naval hospital could use up our x-ray film as it becomes outdated; the camp dispensaries with 18,000 ailitary and civilian laborers, plus all the dependants, can use a tremendous amount of med- ical supplies. This could be continually turned over without wasting this med- ics! supply, without allowing it to grew eld in service. This has also been recossonded but turned down once, because the par- ticular personnel allowance did not allow sufficient personnel for employment with the Continental Marines; and the compromise was reached, attempting to sat this up with our elosent, the Second Service toabat Company. However, Captain Jordan has Just recently recommended this again, and we hope that this tise we will be able to set it up. It is only common senes. It has another advantage, in that our strategic material should met be centralised all in Brooklyn, especially in view of atomic warfare. 1 recommend that we put In a medical section in the camp depot which will hold a stock level of supplies, or maintain a stock level of nodical supplies, which will take care of our logistic requirements as they may be ohanged or come up for different organisations, or as we have echelons of troops going out* The advantage is that we will have new supply. They will be con- tinually rotating It, rather than taka and store these things down here for years and be of no value. That refers, of course, especially to certain items which do have s deter!able day on them — m-r&y films, biological*, plasm, sad things of that nature. BEAR ADMIRAL ANDERSON: there are the reserve supplies stored newt They are under your control, aren’t the^T CAPTAIN HXRIBBt As Tint Marins Force, Atlantic, they »•. Vs hove this 30 day mounting out and this excess which, as I Mgr, X aa maintaining. SXBUC* Of SSkTSXm* KA2E BI CAPS, £.£• Jii., (*C) USB OS 22 hey 194ft AT IITIHVISW WITH SdCOMMlfTXh OH THS IMFLOYMSHT Of MILI1AJIT MSDICAL H2S0U1CKS. COST. We hare, on authority fro# Captain Jordan, taken the aajor it«a« which are deteriahle and suhaitted to hi a a requisitionwhleh ha hopes he will he able to fill within fire days and delirer to ns at the aount&ng emt area# that will he difficult, because they will Just hare to he bought supply rather than die* trihated eeong the units. We won’t he able to distribute it aaong the ships tee well. Bat it is the only answer at the present tine. Boeaoso of tho shortage of »>ray fllos* w hacro got authority to fTX to ths oaap dlspoas«ry at ths naral hospital la an attaapt to eonsorro that* ha* cause it Is worthless after six noaths»r MP 401 T88B COPT STRUCT (Latter, leer C. 3* Caaarer (MC), U.S.N., aetirod dated 21 April 19U8) ***• *(g) Provide for m sepia and continuous flow of all nodical logistic support by surface and air with high prioritise for such transport in active combat arses* large depots to bo organised as naor forward as practicable and to be M07S0 on fcoward as eapedl» tiouoly as the military situation penalta in order to have an over oapl* supply of essential* within convenient range of forward activi- ties at all times| a definite factor in strengthening morale. If for no other reason* Uniform procurement of supplies is strecoed. ****** mumjasma fc*ttor, T. ?. Cooper, MBI, dated 19 April 1948} ***** led! cal lagiatlea m the ehels rated high during the lest war. Madioal oateriel was fund abed to the Pacific Pleat end bases by neat ram share based storehouses, wadi cal stores Issued sections on 28 AS and AXS type vessels plus sight barges. Severer, weaknesses in the aystoo were obvious. Lessens learned during the war. Insofar aa practicable, should bo plaood In operation during the pesos loot they bo forgotten.* ——»• mLSmjSSOISl (Utter, Brig. Can,.Robert C. McDonald, SC, USA (Bet.) dated 15 *£ril 1948) ***** »(g) Medical Logistics in Military Campaigns. "Medical traits should have initial equipment and supplies sufficient to enable then to funetion 30 days under eoobet conditions. Boer echoices In the ooobat tone should have another 30 days9 supply for each nodical unit, and the oeonaaications sons should have an additional 60 days' supply for all units. Autooatie nodical supply for naintonanes should ha uaod only In the early stages of a campaign and until depots can bo established in the Theater of Operations.* ***** 402 TRUE COPT (Extract from Ltr Alfred W* Eyer, Captain (Ifc), USS, 17 April 1948) (g) Medical Logistics In military campaigns* In general, medical logistics in the last mr functioned on a basis that it was bettor to liavo too much than to chance toe little* As a resultant, considerable wastage of effort and materials occurred* In the South. Southwest and Central Pacific this may be attributable partially to the inability of the planners to foresee the rapid shrinkage of active combat into a relatively restricted area* In the present day, all indications point to the fact that the wedding feast with natural resources Is over) and that the consuamatdLon of marriage will- be conservation* Hence, in tbs future. It will be important to have enough where possible) but not too much* This will call for careful, accurate preliminary and concurrent planning* However, it is believed that many of the difficulties arose from the conception, widespread but without official confirmation, that all materials leaving continental United States were expended or expendable* It is suggested that the maintainance of stock records, and accountability are prerequisites to good housekeeping* further, the delegation of material surveying authority to Area or Force Commanders permits maintainance of a stock situation picture not otherwise obtainable, and the rapid accomplishment of business* From the standpoint of conservation of medical personnel, it Is not believed that medical officers should be assigned to small individual Ships* usually, these vessels lack facilities to enable the full utilisation of a medical officer's talent* However, it is realised that this situation contains a definite morale problem which requires consideration* In general, the smaller ships, destroyers and destroyer escorts, are operatic with larger vessels which have adequate medical facilities* Intensification of training of Hospital Corps personnel for assignment on such ships, and Departmental enunciation of policy regarding medical personnel a loes* tlon might help to solve this problem*" *hh*s — r-> j—v r Colonel. 10 403 (g) RESTRICTED TRUE COPT EXTRACT (Latter, Captain J. H. Robbins (MC) USH dated 26 April 1943) ***** "(a) Original hospitals of the entire Pacific area were entirely inadequate as to else, personnel and equipment for the lead placed upon them* Hospitals were originally of 400-bed oapaoity, but it is recommended that in the future all of these hospitals have a minimum of 1000 beds, preferably 1500 beds with standardised equipment* "(b) Practically every one of these hospitals were erected by Eedicol Department personnel as no Seabees were available* Although Mobile Hospi- tal 01 was erected and equipped in exactly 2? working days it was still a waste of valuable manpower, but shows what can be done if the proper spirit prevails* It is recommended that in the future erection of hospitals be done by Seabees* *2, The Mobile hospitals mentioned above were prefabricated buildings of a separate and distinct type* In the event of future campaigns, it is recommendsd that the buildings assigned to Fleet and Base hospitals conform in type and construction to those used throughout advanced base areas* In other words, that all buildings be standardised* *3. Many of the medical applies such ae drugs were in an extremely dkhort supply and at tines wholely inadequate for the patient load* While this shortage was partly due to lack of shipping, it Is hollered the baste error was in maintaining large amounts of these items, e.g* atabrine, quinine, merthiolate, sulfa drugs, etc., in the United States, as when enough pressure was brought to bear by the Area Commanders, this material arrived in adequate amounts. *A. Surgical dressings (bandages, adhesive plaster, etc.) fell Into the ssms category as the above. Surgical instruments were adequate with fee exceptions. Hone of the Mobile hospitals had a Boris electrical surgical uait* Most of the Any hospitals were equipped with this item. (Motes An individual attempted to donate an electric surgical unit to one of our Mobile hospitals, but was told by our Bureau that we had no use for such a machine and they would not authorize transportation)• Another item of vital importance that was lacking was a bullet locator. Although practically every Army hospital in the area bad toe, of which luckily levy was able to borrow one* *5* Medical personnel in the hospitals was considered adequate for the authorised patient leads, but with the overloading, it was entirely inadequate It is recommended that a proportionate increase of ell medical personnel be indicated* *6* Special equipmentt All special equipment such ss boilers, meter generators, galley equipment, ete* with their necessary appurtenances should also be standardised to conform to that used on the rest of the Base, in order that spare parte may be available and repairs easily and quickly made***** In any future campaign it is recommended that each medical depart* sent unit be limited to a standardised list of supplies and material especially when being moved to another area* (Motet During the redeployment from South Pacific Basse to the forward areas, practically no hospital unit could get their supplies and material deem to the shipping limit allowed them for cargo space***** *]*> X. Fob!, Colonel, HC TRUE COPY (Extract from Ltr Col# Harry G# Armstrong, MC, 16 April X9AB) g* Radical Logistics In Military Campaigns# (1) Defects* (a) line officers act up medical requirement*• (b) Failure to uee etaff surgeons in planning* (o) Medical supply system hooked into normal supply channels* * (d) Medical cargos on vessels not properly placed, (bed nets might be in the bottom of the hold)* (2) feedleti (a) Medical personnel establish medical requirements* ' b) Medical personnel supervise loading of cargo as far as medical equipment is concerned* (e) Medical Supply mads part of tactical organisation*1 Li K* Colonel, VC miMJMX (Letter, Or# Sssssl ▼. Lee, dated 18 April 1%$) (f) Kidiwl losiatiei in Military oampaigaa* •the eld ccmeept ef 6 dec tars per 1000 mas is certainly outmadsd and should ba revised# Bars again the re-organlsatlon ef tha Medieal Dapertmant to ba eompletaly airboma mould mako possible ea entirely now and economical (in terms of medical personnel) concept of nodisal logistics." *mw Colonal, IC (g) TRUK COPY EXTRACT (Letter, Captain Robert K# Gillett (MC) USK dated 15 April 1959) ***** "Frequently higher echelons attempted to prevent the free exchange of strategic materials between services in the combat sons. Such practices, at times, severely interfered with the proper handling of casualties#" ***** L, K * Pohl, Colonel, MC TRUE COPY EXTRACT (Letter, Captain Lewis T. Dorgan (MC) DSN) ***** *(g) igaicaiV IftgjgUc* In will tor cmpniow •The prevalent plan so often employed by Tarim* staff organisation* of subordinating the medical department activities to a sub-group tinder general military logistics proved inept, and often, tragic. In formulating operational plans, line and supply corps officers often attempted to write the medical plan, including air and surface evacuation of the wounded, without consulting the Medical Officer until they ran into difficulties which their limited knowledge in that field could not surmount. They would tlunconsult the Medical Officer, often too late for him to take the proper remedial action. ••Medical stsoea and supplies in the Seventh Fleet area during tha New Guinea and Fhillipine campaigns were practically non-existent. Almost all supplies were drawn from Army activities. It was late in the campaign before medical supply barges and *AK" block loads became available. "(1) All stores and storahousas should be joint Army-Navy. The Army should establish adequate facilities ashore and the Navy should move floating stores, either in barges or aboard supply ships, with each Fleet train. "(2) The Medical Department should always be a separate department directly under the area or Fleet Commander, and never be subordinated to another department. "(3) Medical logistics should be carefully planned in advance and senior officers should be responsible for coordinating plans between areas apd fleets. Such officers would preferably be responsible only to CinCPac or CinClant." L. K, Pohl, Coloaol9 MC 406 T3XTS COPY 2SCTHA0T (Letter, Captain H. D. Teiqploton, MC, tT3N dated 23 April 1948) (0) WtalOAL MOHHM - HIMTA8T (WHM1CT. At no tine during the past wur wae Z acquainted with any occasion la which there waa not adequate medical logistical support. There were Instances, however, during the planning stage that adequate hospital had facilities were not being provided ashore. However, this situation vat provided for by the employment of additional hocpital ships and casualty beds on the troop transport) this method of support was aors satisfactory than field hospital facilities ashore. In this operation It was folly realised and appreciated that the special augmented hospitals were not tho typo to bo included in tho early echelons supporting the invasion opera- tion because of their tonnage and construction. I mention this typs of hospital only to recommend against its employment on future oeoaeion, because their construction demands the services of eonstsuotion battalions whose employment is greatly needed for aero Important dot lee with the coabat troops. The tannage ef this hospital is practically twios that of a field hospital whioh can bs sstablishsd and spsratsd with oonsidsrably aors east and provlds equally as well for tho battle casualties. The palatlsatloa of nodloal supplies Is an Ideal method of providing a flew of standard drugs and first aid equipment which wars need in large quantities and to very good advantage. Aa previously stated, all nsdloal suppllss and equipment vara meet adequate la quantity and quality. She sudden ending- of hosillltlee resulted in largo at oak pilot of nodical supplies, hut they would have toon sorely needed had the war continued, and should ho regarded as one of the losses of war which was In no nan nor preventable. * ooooe &* X. Colonel, HO MLMiSMI U*tter, Colonel Arthur B. Welsh, 1C, MSA dated 19 April 19*8) ***** *f • Medical logistics was a cooperatively new ton in World War IX. Many fought the war without using it. Is getting the right patient, the right doctor, and the right facility together in the shortest possible tine nodical logistics? Toe nany people were inclined to be cone supply winded when they associated nodical service with logic* tics. The problen that was najor in scope for the Medical Departnent was personnel and personnel nanagenent. Medical logistics should have included personnel. World War II history nust be studied carefully before criticising the nodical legist!os of campaigns. Instances are few in which the nodical service failed when there was ennnend support — provided competent nodical staff offioera were present. The Medical Field Service School can bo proud of the World War IX records of ite graduates. They node nedioal logistics work. This lessen should net be forgotten end there is a tendency to do it. Possibly a •board* can be established for the Military Surgeon if the nedioal profession of the country eon be node to recognise that nilitary nedieine is a definite professional specialty. In addition to Regular Any Medical Corps personnel nany civilian doctors eeuld qualify. To farther neglect training each individuals in greater numbers for World War XIX is a nistake. Sene recognition night encourage doctors to voluntoer for each eseigneente or for advanced training. Doctors desire to have out* standing doctors leading then in war. They abhor non'nodical loader* Alp. So let's develop sufficient leaders. Perpetuation of this ays ten Of developing nedioal ooemandere, logisticians, staff coordinators and planners ee exenplifled by the creditable perfernanee of Hedieal Field Service School, Ccnaand and General Staff Collage, Industrial College, and Aray War Collage graduates is the key to succoee in future warfare ee far as the Medical Departnent is concerned. The Arned Forces Staff Collegi has sines been added. More doctors should attend these schools .' L. K* P«hl> Colon*!, WC 408 TTHTS CQn EXTRACT (Letter, Captain 0# D. IJorrlson, Jr., IX, U3N dated 23 1%8) "g# Ltedical logistics In cdHtary cerapolrns. It Is believed that the logistical support during the war was one of the moot outstanding jobs done by the Medical Department. The use of a caeblnad iinscr, Navy air force supply table should add to this efficiency l, K. Fohi; Colenol, IB TRUK COP! EXTRACT (Utter, Colonel Hervey B. Porter, «C, BMP 5 dated 23 April 19A«) "Lack of materiel resources end the heartbreaking effort necessary to neke wants known through normal channels, and receive the neeeesary material through normal ahipping sources (6 to 9 months)* ***** *g« Medical Xofistioa war* astple if malarial mas araiiaiue, Under certain situations stoppages of certain lions as piaster gauss booano necessary," ••*»# — t. K. Pohl, ColonU, MC 409 mat COW EXTRACT (UtUr, Clowl P. A. BI.m., HC, OS*, JiW 19 April 1948) gtdlfiil IwliUci,, la.j&Utonr cftiatlraii ”t« The logistical requirements for military campaigns cannot bo properly aaeortainod without a careful study of previous campaigns, experience tables and their correlation with future plans, Material and transportation capabilities, lore thought should be given to such studies in tine of peace and they should be incorporated In our advanced school curriculun as eoneittes studies* •b* In the past war the presence in overseas, theaters of separate dray and levy medical services was uneconomical and wasteful in personnel and supplies* If sene centralised agency could be established in the sons of the interior to support oversees forces, nodical logistics in Military campaign! night be much nore efficiently operated* The present syaton of Joint dray* levy nodical supply procurement night well be expanded to all aspect# af the nedieal services of tho Armed Forces. *e* There le a definite need for a board of selected, experienced nedieal officers for the over-all study of lessons derived free the last war* They should be free fTen ether duties end he eleeely associated with the Flaming Division of the Surgeon General's Office, the Office, Chief, dray Field For see, and the Field Service School* Their recommendations ehonld go to the Flaming Division for further consideration and action whan indicated* The present central Radical Department Board has no apparent function and should bo reorganised and given a definite nlaaion along sash lines* ■d* Stedcage of supplies end equipment for evereeas operations Should include the eenplete unit aeeenbly of certain mite to cover the oonplete lees of a unit, lass personnel, due to enemy.action. It was found to be impossible to nako such complete assemblies from usual stedcage and considerable tine is lest before replacement eon be received* •e* Personnel edit be better trained in maintenance of medical equip- ment* Much equipment was unserviceable because of miner repair problem* which oeold heve been corrected, or avoided, by properly trained mechanics* •f. The, percentage of hospital bade required far support of a field feres in a military eempaign is a subject which has caused considerable mis* understanding and difficulty. This should bo clarified and a definite, top* level palley announced for the purpose of obtaining uniformity in all future planning and instruction* Xt is believed that the following fasts meet be *1 curi TREK COPT EXTRACT - Cortina*) - CoOomI r. 4. BU,m. «C, OSA established at a basis for policyt (1) That, ’hospital hods1 Mans ’fixed* bads* (2) That, ’fixed bods’, for the purpose of this computa- tion, includes only General and Station Hospital beds at their authorised bed capacity* To arrive at a percentage requirement of beds for a field force, experience tables were compiled after World War I by Colonel Albert C* Lore, Medical Corps, USA, and this was published as Amy Medical Bulleton So* 24, antitied 'War Casualties'* This Indicated a requirement, at the end of that - war, approaching 15% of the strength of the troops* It was found, in the last ear, that this estimate was excessive* This partly due te reduction in hospitalisation time due to advances in medical treatment of casualties* From personal experience, I believe that 6$ is a reasonable percentage of fixed bed requirements if all other nedieal unite are excluded from tills com- putation* This would place this estimation of requirements on s firm basis and eliminate existing misunderstanding* It must be remembered that consider* able temporary expansion of these hospitals is possible without appreciable lose of efficiency**###•, I. I. Pohl, CoXomX, K 411 Sxtreet of Statements made by Brigadier General Raymond Dart* IC, 79 April 194S before the Subcommittee on the *mployn»nt of Military Medical Resources* It another thing that it vary important that ooatt to agr mind and that it that oognitanoo bo taken of tho necessity for training the civilian component in staff da tint* Today ovary emphasis it pvt on tho professionaX aspects* Important at they are. you ttill have to hart a certain nuabor of non in the regular eerricet at toll at in the eirilian components vho have demonstrated administrative ability, #10 till bo osnarleod for early planning to go on the ttaff and got that out and got the* trained In ttaff vorfc* Fran ny standpoint to taka a pathologist vlthovt any of this administrative training and go through vith the responsibility for planning for a theater vlthovt this training, it the moot effl* eisnt sty of handling it, and that faaa got to be reeogniaed| and nan vho art going to do this planning should be training right nos* There axe a number of things about supply that oeeur, the loading of ships, things of that kind that oemo up-—If ve axe going to use Alps* Thoee are thlnga that, as Z sty, nay have bean only In ovr theater-bo- eaase ee vexe sort of poor sad benighted, but that is scat of the things I vould like to pvt dtim#*ee«* T-sm L« K# PC& Colonel, VC 412 7m.mMSi.Smk tetter from Capt# Warwick T. brosn, (W), CSS dated 20 April 1%S) "g* Medical logistics in military campaigns. The basic logistical functions of supply9 transporta- tion, construction, maintenance and repair as applicable to the Medical Department In tte combat zcne and tha conramicatlon sens need a great deal of study, development, and codification, during intervals between wars* Nodical supply tables baaed on the require- ments of tha combat zone should be worked out and kept up-to-date. During the last war in tha Fleet Marino Force in the Pacific, nodical supply tables based on tha requirements of 3000 men for 30 days sere developed for initial supply, combat r»suppll©»> malarial control supplies, and dental supplies* These tables should be brought up to date. Construction, maintenance, and repair units, such as the See Bee units, assigned to advance base hospitals and hospitals of the else corps evacuation hospitals in the combat sene would save an enormous amount of time In the setting up of these hospitals* Proper direction of medical logistics in the combat tone will be afforded If the training referred to In sub-fmra&raph (b) is carried out* Medical officers la general do not understand the administration of medical organisations in the combat sens* ****** ‘X'loSr Colonslt U* S. Amy 413 mm O&T OTH4Cf (Letter from Colonel Robert I. Simeon, USA. (Bet.) d&M 1 Key 1948) **«•* Medical logistics in military campaigns. I do not feel fualified to offer any olrltioisa nor suggestions other than to express an opinion that aircraft and the parachute eoUld here Been employed in the delirery of nedioal supplies to unite within the theatre of operations aore than they actually were.■•••*• X.. I. htt.WtMl, MO Uffll ffftPT IKIASI (L«Uer Oapt ».?. Bankel, (MB), USB, dtd 31 Apr 48) \ ' •d. from sgr observation during World War II, medical legiatioe wore voll worked out, excepting whore the medical department was sot kept akmat of planned campaigns. this it a wrjr important factor. It io UJT opinion that the staff work of the medical department could Wo improved upon. Whenever campaign* are koine planned, staff medical officers should >o in attendance. I understand this was not alwars the ease whan cam- paigns were planned during World War II.* L.K. POHL, NO YRgS SKTTiACT coyii (Letter from Colonel Richard T. Arnost, Ret. dated 19 April 48) 'g* This is a highly controversial subject and a ready solution is not available* The nave neat of medical units and supplies t»re given a low priority by certain commanders , thus rendering the nodical situation acuta at times* The medical service in a tioater of operation should have control of sufficient transport to handle the movement of its tactical units and supplies* The logistic of landing operations is particularly difficult and no set pattern can be proscribed* ftben establishing a new theater of operation a system of automatic supply is essential for the first 8 to 12 weeks until a definite requisition basis can be ******* Colonel, U, S* A nay Tm.MnJimSt ly were overrun with supplies* They weren't using them at a rapid pace* And X think we got down to the logical way- of getting supplies as they were needed by requisition of semi-automatic, or simply by requisition* "Should equipment of medical units always accompany the personnel of that unit in overseas movements7* It certainly should, if practicable* But I don't think It Should be essential in a well organised transportation system* Me did have a lot of difficulty in World War II in getting medical equipment of the unit sent altogether* The policy was, of coarse, to put all the equipment of a unit on the same boat* But the longshoreman took It in hand| and when they finished up a boat, they put the rest of it on the next boat, even though the next boat was going to another port* We had great difficulty in Australia of getting parts of a unit in one port and the-rest of it in another* I think that should be handled by adequate supervision of port transportation* I think that was the fault* I don't think it should be. necessary that the unit equipment has to go right on the same ship* If practicable, I think it would help* Bat certainly if seme thing has to be left out from the ship where the personnel are, it seems to me there are many other things, perhaps of more importance than the medical equipment of the unit* Perhaps in planning you could get that equipment over there before they got there* In many Instances you can get it there and have it at the point they have to be* That would be still better* "Will atomic warfare Increase our total medical requirementsV Do ws need ary special units for this or a general overall increase of present units?* Me may need some special unite* But I think that we would not need a general overall increase of medical units* Strangely enough, the casualty rates in combat units having' varied very much from the time of the Greeks to the present time* I don't ihink that we will have so mazy more casualties among the armed forces than we had in previous wars* Maybe we are going to have the casualties , maong the civilian population*' , "Did we have sufficient hospital ships? Should we rely mors on air evacua- tion especially early In any future war? Should the medical departments have control of air evacuation units in all echelons including that of returning oases to the £I?» i We didn’t have any ships for a long time* In the later stages of the ear* 1 think wo had sufficient hospital ships* We did not hero an ade*» quate number of hospital ships until later in the war* I think air evacuation Is very, very important, and will be used to large extent in all stages of future wars* I an not qualified to consent on the control of those units* ■What can we do to assure air evacuation early in any future war7* arrange for the use of modern c cense rclal air lines converted lot# ambulances; I feel sure that air evacuation will be used in any future war* /Qf course if m have adequate planning by the Air Force and these transport planes can be fabricated to be reacty, it would be the best way that I know of to be ready for It* ■Was cctanunication between medical units satisfactory in the combat sons? Do you advice radio in all field medical unite? If not, why not?* X don’t know how that worked. — I wasn't fortunate enough to be over there* But I certainly do think that important medical units should have the advantage of radio* ■Should the supply of whole fresh blood be made a responsibility o£ our medical supply services? If not, who should handle It? Laboratory? Do you favor all supply of this item to come from the Zone of the Interior? If not, what suggestions do you have for a collection system in a theatre? Who weald operate this collection system? The supply or the laboratory sections?* X think. In general, the laboratory sections should collect*** and distribute the whole blood* I have had no experience along that line* If the Red Cross campaign to supply all the blood the whole country needs is developed, I don’t think we will have any trouble of getting plenty of blood from the Zone of the Interior* ■In what items were you in short supply during the war? In critical supply .to the detriment of the side and wounded? * ■ *hat is more for the theatre* We were very well supplied in the service commands* ■Did we waste medical supplies? How could this be prevented? *ere any items in constant over supply?* I think the automatic system used for a while probably caused a wastage Of supplies to Australia and perhaps to other theaters* But I know of no fasssl vasts ot supply in the Zoos of Interior* ■Is there say change indicated in our principle of placing the respond* bllity for evacuation on the next rearward echelon? If so, what do you recenmend specifically? Did air liaison operate adequately? If not, what change is 422 indicated? Should the medical department return recovered cases to their units? Should G*>1 continue to bungle the problem? What was the result of 0*1 fumbling in this responsibility? What is your suggested recourse in the premises?" 1 think that the primary responsibility Is on the rear echelon* But certainly the forward echelon has the responsibility of seeing that they get back, even to the extent of taking then back, if it has to Kfc. O') x • U K» POHL Colonel, kC 423 mm SATHaCT COPY OF MEDICAL SUPPOfiT OF TH3 CSJUf 15. TJ£8 mOPAttfi TiLAT£a OP OPSHAflUKS HlSTvJsUCAh 8B0TX0S - AFTAS. •*•«#*»« O. "The administrative difficulties engendered by the scarcity and im- proper distribution of medical personnel were intensified by the lack of supplies nod equipment and their improper handling or The severe shortage of organisation medical field equipment, such as Dental Chest «o. 60 end Flight Sur- geon's Examining Chests, was due either to less enroute or to the fact that such equipment was issued to the units prior to tine departure of the troops from the United States. For several months during 1942, 90-day medical supply replacements for 15,000 Mr Force personnel were secured from the United States and sent to the Med- ical Supply Platoon, Aviation, for distribution to the units which first arrived la Snglaad. Efforts on the part of the SOS to take over this depot were forestalled by strong representations on the part of the Commanding General, Eighth Mr Fore# Service Ooumand. Ve succeeded not only in securing the privilege of operating this depot under the name of the Slghth Mr Force Medical Supply Distributing Point but the authority to establish small medical supply distributing points at certain ad- vanced Mr Force depots. Fortunately, by the time of the invasion of Europe, air evacuation was out of the theoretical and controversial stage. It had weathered the objections of the skeptics of both medical and line. The two chief problems appeared to be communications and supply. For air evacuation to function efficiently. It is necessary for the coordinating off- icer to know the number of patients ready for evacuation at each forward area, the available hospitals la tbs rear areas, and the availability of planes in the for- ward areas and the arrival time of such planes. Then. It is necessary for the coozw dlanting officer to advise the forward areas of the somber and expected time of arrival of the planes, provide each pilot with the destination of his patients, and to inform the receiving area of the number sod expected time of arrival of the patients. In an amphibian operation, such as the invasion of Sicily, when ordin- ary swans of communication are not available, special problem a of communication exist which must be solved In order to prevent the breakdown of air evacuation. Attention was called to three major controllable factors which deter- mined the number of casualties evacuated by air. These were: the staff policy of limiting evacuation to returning freight carrying aircraft; the restriction on the use of tactical air fields by transport aircraft; the reception facilities in the United Kingdom. In addition to the controllable factors, there were weather conditions and the limited facilities of the holding upits on the Continent which had to be considered. On the basis of reception facilities In the United Kingdom it was concluded that daily air evacuation for American casualties could be increas- ed 500 percent. This study therefore recommended that air evacuation facilities be made available for the evacuation of the majority of the casual ties from the Con- tinental to the United Kingdom. This recommendation was approved by 0-4 and by the Cnief Administrative Officer* The facilities, however, were not immediately forthcoming, as will be seen later* For these reasons, General Hawley concluded that evacuation by air was the only "proper" method. His reasons for the unrelimbility of air evacuation to this date are quoted in fullt r———_______ /lOi THUS EXTRACT COPT OF KSDICAL SUPPORT OF THU USA/? 12 TH>' SUROPSAK Tfl 'AT Jt OF OPERA- TIONS. HISTORICAL SECTIOI - AFTAS, CONTI hlLvUt (a) The medical service has been unable to effect a liaison with the Air Forces which is effective. There are so a any echelons of cossmand Involved that it tokens more than a week merely to make contacts. (b) Evacuation of casualties by air has no priority at nil. Hxcept upon one or two occasions. It has been Impossible to evacuate casualties by air unless supplies vere being carried forward by air. Consequently, evacuation is complete- ly dependent upon supply. Where there is no etapply by air, there is no evacuation by air. (c) Evacuation by air is interrupted at such times as tactical operations by air are contemplated. (d) All planes engaged la air evacuation ere based in the U. 5. Consequent-* ly, air evacuation depends not alone en the weather in France, but also upon the weather in the U.K. There have been, and will be, times when flying is Impossible In the U.IC., but q>iite possible In France. However, no evacuation within France is possible at such times. To remedy the shortcomings in the air evacuation system as pointed out hare, General Hawley recommended that air evacuation be given & definite status; that air evacuation be male a separate mission which would not be entirely dependent upon resupply by air; that sufficient aircraft be made available and based in France for evacuation here when weather conditions prohibit evacuation to the Chlted King- dom; and that a chain of communications be established la which the Chief Surgeon, 2T0, could Inform the responsible commander in the Air Forces of the necessary re- Hplremcmts. The inability to get planes on a lover echelon of command, with the resulting threat of a complete breakdown in the whole system of evacuation of Casualties, destined the issue a consideration by the Supreme Compandor. As a result of the withdrawal of all 0-47 planes of the Troop Carrier Command from air evacuation without notice, according to General Hawley, the evacuation became critical immediately. In a memorandum to the Commanding General, Combat Zone, 20 September 1940, ha warned that '‘unless decisive action is taken without delay* the whole evacuation system would be stalled. Owing to the fact that the backlog of casualties was increasing at an alarming rate, he requested an assignment of 200 C-47 planes for evacuation until the backlog of patients could be cleared out. Again, he kept hammering away at the reason why air evacuation "had been most un- satisfactory* j the complexity of control of planet and the fact that evacuation had no priority. General Hawley advised General leaner on 21 September of the failure of his efforts to get the necessary planes allocated to relieve the evacuation situation. As of this date an estimated number of between 6,000 and 7,000 cas- ualties was awaiting evacuation, the majority requiring Immediate definitive treatment and whose condition *ls steadily deteriorating*. The Comraanding Gen- eral, Coraaunlcations Zone, had presented his requests for the temporary use of 200 planes and for the indefinite aGslgnmcnt of 50 C-47 planes for air evacua- tion to the Theater Commander, with the answer that it was doubtful If any planes could be furnished, and that other means of evacuation should be used. With ref- erence to *other means*, General Hawley stated that, with the exception of three TRUi JOTRaCT COPY OP MEDICAL SUPPORT OF TiS USAAF IS TH£ SUR0P2AS THXaTSR OF OPKSATIOSS. HISTORICAL SSCTIQ8 - AFTAS, Cj.ITIHULDi hospital trains of a daily life of 500* * there are no other means.” He con- doled his memorandum with this statement? "I do not know whether or not the Theater Coiaaisader folly realises the seriousness of this situation". Lt. Gen O.R. Bradley called the evacuation problem to the attention of General Biseahover on 25 September, 1944* The long lines of eosmmnieatioa In the US sector, he said, made air evacuation a necessity; that they bad not "been able to overcome the difficulties introduced by sudden and complete with- drawal of aircraft for proposed airborne operations,” because land transportation could not be efficiently and quickly produced; and, therefore, he requested that ”a minimus of 40 C-47 aircraft be ftally allotted to the mission of evacuating casualties from Twelfth Atmy Group, General Bradley was advised that the only C-47 aircraft which could be allocated to the evacuation of casual ties were those of the Troop Carrier Command or those of the 302 Transport Ving, Air Serf,lee Command, USSTAF. She mission of both of these agencies was operational and to reassign the function of these agencies would be at tha expense of operational needs. It was pointed oat that a large number of C-47»s from the Troop Carrier Command were engaged in emergency supply to army areas and would be available for evacuation until such time as they would be required by the First Allied Airborne Army. A statement on air evacuation policy was made as follows: Air evacuation of casualties must be considered as a bonus to bo avail- able from time to time as conditions permit and not as a scheduled lift to bo availablo tinder all conditions, Even if not interrupted by oper- ational requirements, it is subject to interruption without warning, and for indefinite periods, by the weather, and any evacuation system based on aircraft transport will break down. Although every one concerned was in agreement that operational requirements should have priority over the evacuation of casualties, experience showed that air evacuation played a very important part in the system of evacuation. If it were assumed that an evacuation system were based on air transport alone, it could reasonably be expected to break down under certain conditions. It should be noted, however, that there was never any intention of basing the evacuation system on air transport alone. Considering the SHAKF statement in the light of the actual number of casualties evacuated from the theater by air, it shove a lack of appreciation for this method of evacuation, to may the least. Lt. Gen. V.6. Smith, C/S SHASF, to Lt.Gon» John C. H. Leo, GG, Com Zone, 21 Sept 1944, subject: Medical Evacuation states: Although SHASF policy on air evacuation remained the same — that air evacuation must bo considered a bonus and was dependent upon resupply — there were enough unofficial variations In this policy on lover echelons to novo the patients who had to be evacuated. Although efforts to secure the allocation of 0-47 aircraft for ex- clusive use in tha evacuation of casualties were never successful. General Grow did succeed In getting a squadron of 20 IB 64 planes for purely medical purposes. TRUE j&SWCf C PT 0? MJ2DICAL SUPPORT OF THS USAAF XH TH1 SORDPiAK Tf&ATM OF OPSHAflOBS. HISTORICAL SLOTI01 - AFTAS, CObTLHISD; These planes had been relatively inactive because they were not Very satisfactory for resupply, nor were they particularly well suited for the evacuation of casu- alties. They were based at be Bo urge t Airdrome and used to carry critical items of medical supply to forward areas and bring back patients on the return trip* Bach plane was equipped with litters to accommodate three patients, arid there was room for two sitting patients, the pilot, and surgical attendant* Hot withstand- ing operational and structural difficulties with these planes, aucjh important work was accomplished with item. Boring the period from 22 September through 29 Bee- ember 1944, 36,003 pints of blood, 287,918 pounds of miscellaneous cargo, and 567,069 pounds of nodical resupply were transported, along with the evacuation of 1,163 patients. There were only seven patients who died in flight during the period from January 19-UU through September 1945. Bering the period from June 1944 to 22 June 1945 there were 291,0X2 separate patient movements. Although the 7 deaths occurred over a longer period, using the data for the latter period would make a ratio, of 1 death to 55,359 patient movements. Considering the types of casualties evacuated, the seven who died in flight probably would have died anyway* Mr evacuation Bade it possible to bring casualties to hospital facili- ties far behind the front* thus enabling nodical staffs and nodical equipment to be made use of in a far more economical manner* Bat, above all* the rapidity of the transportation of casualties to a hospital tremendously increased their chase* for survival* Vhen one considers that from the beginning of the war through 1946 there were 1*356*618 separate patient movements in all theaters and the Zone of Interior, one is likely to agree with the position of the former Mr Surgeon (MmJ Sen XhB.W. Grant) that "air evacuation of the wounded, as a life-saving measure* ranks with blood plasma, front-lino surgery* and modern medicines of the sulpha and penicillin types for* without the rapidity of movement which air transport provided* even these measures would have been unabla live# which were saved. Goloudl, MC 427 SE3UBS. iSHSU (attract of »tato»nto Bute bjr Colotel Thoau J. Hartford, MO, USA on 23 April A8 at interview with Subcommittee on tbe Enploymat of Military Uadioal Raeooroea) **** "g* 2 have worked on that a lot, of court*« The only thing Z would like to eay relative to supply la that you should go to a requisition method of supply aa soon as possible | that antonatle supply my he necessary in early operations of block supply mnA of that ia Just names *y»d nomnolatore) hut in order to oonaarvo supplies, that you should go to a requisition syoten Juat aa aoon aa possible* That*# ay only idea on that* "Did look of land transportation haaper the mdloal service during campaigns?11 X would say it was generally aatiafootoryi that you oaa*t give nedioal unite all the transportation they seed to make then fully sobils, and there would be a waste of transportation if you did* »»»****» L. I. Pohl Colon* 1. IB 428 THD1 COPT HXT8AOT (Letter fro* Captain W. D. Small. (MC)# U. S, Havy dated 5 Me/ 1948} •••••"8, (a). Hospitalisation in the combat sene vae most effectively iapleaented by the Amy evacuation hospital*. They were superior in equipment and staff to the Army field hospitals and should he the basic pattern for future develop saumts. The levy 6-6 was not adequate in either composition or personnel in comparison with the Army evacuation hospital. An extemporised version of the latter type was hastily assembled In 1944 for tho Narine Corps. Thres such hospitals were organised and functioned fairly vsll. They wars, howsvsr, too bulky and had too much heavy equipnent. Specialised professional personnel for such hospitals should be provided fro* appropriate specialist teams. (b). Hospitalisation in the supporting areas was nest effective- ly provided by the Navy's fleet and bass hospitals. Comparable Army installations while lees costly and of less weight did not possess the necessary facilities and equipment for maximum service to the patient or welfare of the staff. Army medical officers serving on OinCPac's staff vers at first quits critical of the levy's 6-2 and fleet hospitals as being too heavy and providing too much comfort at the expense of mobility and rapidity of construction. However, toward the end of the war, after th* Ssabsss had learned how to put tip these hospitals with efficiency and speed, the Army procured a large number of Quonssthuts for the construction of hospitals. In any future war, all such hospitals should be of one type of construction and it is believed the Quonset hut type is mors practicable. (e). Svactuation was grossly inadequate early in the Pacific Her* Th* delay in authorising and in assigning sufficiently high construction priorities to hospital ships was a glaring defect and but for good fortune could have resulted disastrously. The utilisation of APA'a as makeshift hospital ships should not be repeated. The personnel of such ships deserve great credit for outstanding performances and for preventing a very possible national scandal. The developement of efficient and safe air evacuation later in the Pacific Tiar gave us the most effective means of rapid evacuation vc had. Xt is, however, a very costly method but in the future, if planes and fuel are adequate, will probably replace surface evacuation to a large extent. Zt is worthy of note that many patients Interviewed by me, who had been wounded in the early campaigns and evacuated by ship only to be again wounded in later operations and evacuated by air were practically unanimous in preferring air evacuation. 429 Coloa#lt MC TRUE COPY EXTRACT (Utter, Captain F, H. Urban (MC) OSS dated 28 April 194$) ***** * (g) Medical logistic# in military campaigns* •(1) Should he revised to accomodate casualties of nass destruction weapons. »(2) Poor staff planning in relation to consumption rates of indi- vidual items of nodical supply, e.g., to© much cotton and gause, too little antiseptics, fungicides, etc#* ***** rXjktdj L» K. Pohl, Colonel, SC THUS EXTRACT COPT (Ltr LtGoI Walter J. Beater. DentalCons, dtd 11 May 48) ••♦•••• 6. "Dental Prosthetic Service. Deficiency - In foreign theaters It was generally the policy that hospitals and other dental laboratories (none Air Force) provide the dental laboratory service, facilities provided were generally considered Inadequate. Units too often were located too great a dist- ance from these facilities, or mail serUlcs was too slow to successfully utilise then. &. Unfavorable Effects - A patient admitted to a hospital for con- struction of prosthetic appliances occupied a bed in the honpltal for days although he was an otherwise healthy Individual. During this time his services were lost to his unit. Cases sent to laboratories for processing too often were returned after an interval of time which the usefulness of ths appliance. £. Recommendations - That Air Forces be authorised to operate dental laboratories - mobile and fixed. Field Bquipment. %, Deficiency - The HD Chest 60 provided an array of dental instruments for the dental officer, hut was sadly lacking in several essential items, chief among t.m being a good light, essential eleratora for ezodontia, a small dental cabinet and an electrified engine. To this a ay he add- ed a mall, lightweight cuspidor. These items are obviously desirable as they were almost invariably improvised In the field. Items furnished in the M3) Chest 60 were crudely packed idth apparently but one consideration in mind, that being to pack a maximum number of items into it. In the field, however, it served no useful purpose except for storage, and a dental cabinet had to be Improvised to hold the many individual items when not in actual use. b. Unfavorable Effects - Upon arrival in the field, dental officers are faced with the problem of oper- ating under severe handicap or Improvising the items mentioned in 4 above, re- sulting in a loss of operating time. Items Improvised at best were still quite Inefficient compared to what might have been furnished and the dental service correspondingly lowered in quality and quantity. £. JBecoamendatlon - That field equipment be developed which will include 1) an operating light 2) electrified 430 TECS XXS&aGT COPT (I*tr LtCol Valter J. Renter, Dental Corps dtd ll May 48. CuhT. motor, 3) a more complete set of surglcril Instruments 4) a ©Ball, lightweight cuspidor with tubing for running water and drain, 5) a small dental cabinet fo instruments. •**•*«*«* /p L*&^OHL^CoIoii«1# kC 431 TRUE COPT (Extract fr Ltr Albert T. Walker, Captain, MC, OSH, 26 April 1948) **** •During the last war, logistic problems is maintaining overseas hospitals were tremendous and used up a great deal of valuable shipping space* High-speed ambulance ships 'would provide rapid transportation from the combat area directly back to the source of all equipment and supplies (the sons of the interior) and scald be able to return to the combat area with such needed medical supplies* The setting up of so-called mobile hospitals should be kept at a minimum* U K. ?QHLV Colonel, VC THUS COPT Sim.CT (Ltr Capt. M.S. Mathis (KC)USS, Did 6 May 48) $. «| shall comment on this only frost the standpoint of supply. la the Pearl Harbor area the Medical Officer in charge of the Supply Depot had difficulty in acquiring information on which to base his logistics. Proa October 1943, when the Depot begnn supplying everything within its reach until the latter part of 1944, there was no one place or officer to whoa the officer in charge could go for necessary information. Information was solicited from the Fleet Medical Officer, Base force Medical Officer, Dis- trict Medical Officer, Medical Inspector for BuMed and eventually the District Supply Officer. Supply logistics were made from an estimate of the situation based uoon information received from all the sources. This method was inaccurate and on one occasion the results brought near dis- aster. feb. 1944 the force surgeon gave estimated requirements for the fie t and forward areas, by month for the year 1944. In May 1944 it was accidently learned that the fleet in Kay was approximately double the size anticipated for December. A rush request for a tremendous increase in supplies end equipment, produced consternation in Brooklyn and re- sulted in considerable shortages for about two months, fortunately the Army was able to come to the Depots assistants in meeting mod of it® lacking requirements. Another near calamity was averted by and rec- ived from the Army between August and October 1944 due in most part to three factors* X. faulty technique In forwarding of back orders on items out of stock in Brooklyn* 2* Logistics forwarded from BuMed to Brooklyn not keeping up with those In the Pacific and 3rd, Brooklyn’s faulty adherence to logistics based on past performance with insuffic- ient credence given to logistic support from the area, these difficul- ties were all corrected after an inspection by the Chief of Mat. Div., Nov. 1944 secret information was made available to the Depot and dependable information from the fleet and force Medical Officers began to be re- ceived from which accurate logistics could be made. Becomsendatioasi 1. Medical logistics be formulated by the force Medical Officer. 2. Medical Supply Officer be kept currently informed on medloallogistoce. 3, Medical Supply Officer formulate logistics for supplies and equip- ment. 4. Medical Supply Officer for area keep Mat. Div. currently la* formed on area logistics. 5. Alternative to 1, 2, 3 or 4* Give Med- ical Supply Officer sufficient rmak te. admit-him. to the sourer, of In- 432 TMUE COPT SXTBACT (Ltr Capt M.S. Mathis (KC) WSI, Dt4 6 May 48) COfflHVSDj formation. I believe all personnel who are to be assigned duties In connection with procurement and distribution of supplies and equipment and logistic support for same, should hare a minimum of six naontns pre- liminary training. Medical Officers not to be assigned such duties should bo briefed an the above during their indoctrination period in order that they became familiar with methods of procurement, places where supplies and equipment can be procured, quantities and typos required for the mission and lead tins required. Many difficulties were encountered during the early part of the war, doe to medical officers lack of in- formation on this subject."* /? WKT'POHL, OoIomI, KC 433 EXTRACT OF STATEMENTS MADE BT COLONEL OSCAR S. REBER, HC, USA, OH 15 APRIL 1948 AT INTERVIEW WITH SUBCOMMITTEE CH THE EMPIOMEHT OF HIUTAHI MEDICAL RESOURCES. ***** "(F) 8, No. 90% of all casualties were evacuated fro® the Mediterranean theater of operation® throughout the year 1943 in personnel ships. I think the basic requirement in hospital ships should be provided for during peace because it takes fro* one to too years to get any hospital ships off the lines and their priority for construction is loo, consequently it was over two years before hospital ships in any number* appeared and even then the number was inadequate. I do not believe we should rely on air evacuation early be* cause the nearer we get to the front the less llklihood there is of having air available. Re control, I learned in the beginning that you could not get staff agreement on air evacuation. That applies to Algiers. I believe the responsibility for air should rest in the N. S. Air Foroa and adequate provision should be made now to Insure definite provisions for evacuation of casualties by air upon call from ground surgeons in any of the theatres, etc. *9. By making provisions now for a definite evacuation schanie to be used in the future. *10. I don’t believe communication between medical units was satisfactory in the CZ. Only eomaranication was by telephone or messenger and very often medical units did not have telephone communication. I think radio in all field medical units would be an excellent idea. "(C) 1. I don't think any particular trouble was found in actual tonnage for Medical Department supply. The lade of shipping caused considerable delay in arrival of personnel of nodical units and also In the equipment of medical units. The Medical Department had to present bids for space in convoys the sane as any other service. This usually resulted in a considerable increase in the strength of personnel arriving in the theater with no accompanying nodical units. During the years 1942, 1943 end early half of 1944 in the Mediterranean Theater there were scarcely enough mobile end fixed beds in the theater to carry out the medical mission."e**** *♦*♦* "3, Yes. Movement by echelon proved satisfactory only by gathering trucks from other sources to move a unit. Denial of transportation was an obstacle. ■4. I will have to qualify that statement, I think acdical supply ser- vices should bo made responsible for the distribution of blood If the source is from the U, S, However, if no arrangements have been previously made for a supply from the U, S, a unit or a subsection of a laboratory should be set up to provide blood for a unit* I feel very strongly that It is a supply lien. '7K/4^J> L* K. Pohl, Colonel, MC 434 EXTRACT OP STATSanWTS MADE BY COLONEL OSCAR S. REEDER, KC, USA, OK 15 APRIL AT I8TERVIEK WITH SUBCOWHTTEE 08 THE EMPLOYMENT OF MILITARY MEDICAL RESOURCES. (Coat limed) *5. Fron the standpoint of supply, I don’t have anything in Bind, Is ware always short of enbulaneee.****** *•*•*•3. Under nedlun conditions of warfare the nodical waits were woMle enough. However, they were not during periods of heavy combat. The greatest lack was transportation. Mobility should be increased. Ho,****** ***** *One of the main difficulties encountered by Aray surgeons and arny group surgeons was the transfer of nodical units from one sector of tbs bonhet sons to another as an acecetpaninsnt to Divisions being transferred. In ■any instances as nany as three divisions were transferred fron ono any sector to another without any nedleal units whatsoever. This places a great hardship on the Amy surgeon late whose ares the units are saved and leaves the amy surgeon losing the divisions with extra nodical units on bis hands. A definite standing operating procedure should be developed which specifies what nodical units are to aeeonpeny each division when transferred «***•■■ 'L. K* Pohl, Colon#!, MC 435 tbci extract copy o? medical sup-oht of ths usaaf u le mediterrassaij thbatsr HISTORICAL SSCTIOS - AFTAS *»»««•** o, *»?h0 effiolcncy of the Medical Batachxaont Dispensaries, Aviation, that accompanied the invasion troops was somewhat impaired by lack of equip- ment. It was later learned that their equipment had been sent to the United Kingdom where it was dismantled and used for stoekage of dapots by the Service of Supply. As a result these unite did not receive their authorised equipment for approximately four months* Organized Air Ivaeuation. The informal phase of air evacuation ended on 14 January 1943, when a formal plan for air evacuation of wounded in the funislan Campaign was adopted. It was not until 10 March 1943, with the arrival of the 802d Medical Air Evacuation Transport Squadron in the theater, that air evacuation was under the direction of organized end especially trained personnel. This squadron was activated on 10 December 1942 and trained at the School of Air Evacuation, Bowman Field, Kentucky. Frier to the arrival of the 802d Medical Air Bvacua- tlon Transport Squadron, personnel for evacuation consisted ef an emergency unit composed of thirty-five medical enlisted men from the 61st Troop Carrier Ming, under the command of the Surgeon, Headquarters and Headquarters Squadron, 61st Troop Carrier Ming. The base surgeons at the various airdromes supervised loading and unloading of the patients and effected the necessary coordination with Crouad Force units. After the arrival of the 8 2d Medical Air Sraouatlon Transport Squadron, flight surgeons from this squadron wore stationed at the vari- ous airdromes to supervise all air evacuation activities. In the northern funislan sector, telephone, teletype, and radio coesnmications were not dependable. Message* were sent back and forth by air courier. It developed that air evacuation holding units located within 2 to 5 miles from an airdrome became a necessity. With these units able to accomodate from 200 to 700 patients, aircraft landing at these areas with supplies could pick up the patients without any delay eeoaasioned by the failure of getting patients to the airdrome or a breakdown In communications. Moreover, patient# would not be forced to travel long distances back to their hospitals when sched- uled aircraft failed to arrive. The institution ef this plan proved to be practical for nil units concerned with air evacuation of patients. With the period ending 23 May 1943, 17,216 patients were evacuated by air in the Earth African Theater. This Included an estimated 887 patients evacuated prior to the arrival of the 802d Medical Air Xmcuation Transport Squadron In the theater. ZfiV£* IdXSXCiMBBXCta Summary of Air Evacuation Experience la the Tunisian Campaign. That air evacuation was practical was proved during the Tunisian Campaign, when 17, 216 patients were evacuated by air without a single patient being lest on account of aircraft accidents. Also no injury was suffered by any of the flight nurses, enlisted medical attendants, or aircrews on any of the evacua- tion missions. It is interesting to note that during the 129-day period in which organised evacuation was carried on only twelve days were lost because of bad weather. Although this Interruption caused by bad uoathe? did not aa tori ally haaper the over-all pregraa. there was * a-djy period during engagements in 436 THUS EXTRACT COPT 0? MEDICAL SUPPORT 0? TEE USAAJP IS THE E'IDITERRASTSAS TKSATZB HISTORICAL S'CTIOS - AmS, Coat. the lasserine area, when all troop carrier planes were grounded. In which casual tiesere unusually heavy. This experience emphasises the fact that air evacuation should not he depended upon as the sole avaas of evacuation but that ether methods oust be available to supplesent it. The primary objective of the planes used in air evacuation was the transportation of supplier and personnel to the forward areas, with casual ties providing the load for the return trip. Therefore, It proved to be practical to plan air evacuation In conjunction with the aupply-by-alr program for the front areas. Operations. The success of the initial landings and capture of airdromes In Sicily proved that the planning for the beginning of air evacuation vae too conservative. Air evacuation was actually begun on D plus four from the (tela region. In addition to 1233 patients evacuated from the Tunisian area to make room for the Sicilian casualties, 8376 casualties were evacuated by air from Sicily to North Africa. Colonel H.3. HI vine. Surgeon, Twelfth Air force, evaluated the ex- perience of air evacuation in the Tunisian end the Sicilian operations In theue words: •evacuation of patients by air is the most efficient, reliable and rapid method ©f evacuation of patients from forward areas.® Although he pointed out that when planning was done in London for the invasion of Korth Africa, it was the official attitude of some of the tope level medical planners that the Twelfth Air force would not be required to evacuate patients by air "because ... this method (was) too uncertain, unreliable and hazardous for the evacuation of sick and wounded. So tvi the tending a lack of a definite plan of air evacuation for thie invasion, all 0-47 transports were equipped with litter racks in which both the American and British litters would fit. With the establishment of the beachhead at Ansio and Bettuno on 22 January 1344, it was hoped to start air evacuation immediately. It was not until the offensive from the beachhead got underway that it became possible and necessary to evacuate patients by air from the area. Evacu- ation by air actually started on 26 Hay 1944 and by the end of the month 2,024 soldiers had been moved to the Naples area. Air Evacuation of casualties eontineud to follow the needs of the tactical situation during the remainder of the campaign In Italy. That air evacuation in the Mediterranean Theater of Operations succeeded to an «ctent beyond the dreams of those who had faith in Its prac- ticability, to say nothing of those vho lacked the ability and the imagination to appreciate the possibilities of this ncm military medical concept. Is attested by the fact that during the course of the war in this theater, 212,285 patients were evacuated. During 1943, when air evacuation had to prove itself, so far as the use of it by the Allies in this was was concerned, and despite the obstacles confronted In instituting a departure In well-established patterns of procedure, there were 62, 405 patients evacuated by air? In 1944, 125,878 patients were evacuated, and through June 1945, 24,002 patients were evacuated, ; K)HL, MC 437 TiiUS COPT EXTRACT (Letter, Captain Snaaett D. Hightower (MC), U, S. Kory dated 21 April 19U8) «hh» 11 (g) Ho raodical service can function without adequate medical Xoristics, Baaed on experiences in the last war, I aa greatly in favor of radical supply ships, rather than medical storehouses, in the advanced areas. The number of ships required would he determined by the else of the theatre of operations. During the last war it was almost impossible for medical storehouses to fill and ship requisitions on tins because of the uncertainty of available bottom. This at least held good in the South Pacific, Very frequently requisitions sent in by ships ware not re- oeived for one year, Perishable supplies such as whole blood would ob- viously liava to be supplied by Air Transport,11 •**<• ' r" > / / rrwrtsps^srrm' m&jmxjaam cur o*i a,». huum. mo, «vh» dtd u Apr 49) ••**«**• 0, "Nodical logistics In ailitary campaigns* Mush of the loci*, tioal work can be performed ty MSO officer* Out this, at In all depart- ments of aodloal work, vast bo supervised by the Medical Oorpa. The new medical cm pply catalog 1c a bid atop forward* It should be followed up by unified procurement and then supply sad distribution. Separata drey and Vary depots aft no longer required. ■ TOHL rijoloa#!, MO 438 THUS COPT S ~xtACT FBOM A1& EVALUATION BOARD SWPA H3P0HT Ho. 36. MEDICAL SUPPOHT OF Ain AsAI'ANl lu TKS i»0uTh A S*'fA S'Mv* 7. 1941 to AU&UST 1940. ******* 0. "Sarly methods of medical supply to the Air forces were Inadequate. The assignment of Audi cal Supply Platoons (avn) to the Air forces coupled with Jthe use of transport planes to carry medical supplies to forward areas improved this fisnrka However, the assignment of only three of the Medical Supply Platoons to the Air loress out of the tea assigned to the theater, was not suffic- ient to care for Air force needs. Air evacuation la both, theaters commenced as an emergency measure. Ab- solutely no organisation wee achieved during the early days of the ear until Med- leal Air Evacuation Squadrons specifleal1/ designed for this purpobe were asBinned to thee# theater*. The full potentiallties of the system of evacuation of patient* by air wee not achieved because of inadequate organisation and coordination, The large-scale evacuation of patients by liaison-type planes from battle areas was extremely satisfactory. Uhls system was under the complete control of ihe medical group attached to the Sixth Arey and demonstrated the efficient results that could be obtained froa centralised control of air evacuation. All types of patients were evacuated by air in emergencies in these theaters, however, the evacuation of certain types of patients by this means was found to be undesirable unless it was absolutely necessary. She Medical Air Sracuatlon Squadrons proved to be effectively organised and equipped to meet requirements in most respects, fheater policies did nut permit the full utilisation of air evacuation personnel, par- ticularly nurses. Provisions for the rotation of flying personnel of air evacu- ation squadrons were inadequate throughout the course of the war.*•***•**•*•» t,iT^C>coLomt no 439 THUS hXIiUJT Ovu-I (Ltr Dr. H.S. Hoffman, dtd 1'6 Kay 48) ********* G. "Medical Logistics in military campaigns in the Pacific, in ay opinion, were "deluxe". Occasionally there was some delay in the natter of automatic re-shipments, but the initial supply list was adequate to carry- organizations until further supplies and equipment arrived. Despite sub- stantial losses in medical equipment and supplies Incident to the raid on Hoi and Hnnur on the 12th day ashore, adequate replacement was aie promptly enough to prevent any real suffering, WKTPO&; COLOIOt, MC 440 tTO OOIT TOldOT (Latter fToa It. Col, Grayson a, OftTriioa, D.O., Wif Soott Air fore# 1m«, UUerilla, XU., dttii 96 April IMS) ••••• *SnUl HpipMl and supplias 1m ilia Kiddle last vara vary difficult to obtain from October 1942 la Kay 1943, Practically every group that arrived froa the etatea during that period had no deatal equipment. leak Group Deatal Surgeon had the aaaa story—ho was told at the W1 that hie equipment was awaiting hia at hit destination. fhia raeultad in many groupa feeing without dental service until equipment aad supplies could fee obtained. This was dona through the Britt eh dray aad HAJ who ware vary co-operative aad willing ta share what a eager auppllac aad aquipueat they had aad alee by purchasing on tha open market in Cairo, JJgypt, at exorbitant prices, a number of essential items. Working with this inferior makeshift set-up during tha above period played havoc with tha moral of Group Dental Surgeona until U.S.jl.M.D. Chest 60*s finally arrived.* _H tK.A_;h 2." K» Fefcl, ooi«a«iv mo 441 THUS COPT (Extract Ltr X* C*Stayer, **ajor Genera , U* S, Army, Retired, 19 Aur AS) ***«• *(g) Medical logistics in military campaigns• This has teen one of the outstanding good things of the Medical Service* Is have never heard any criticisms of the supplies furnished by the Medical Department* This eas particularly true in the floe of eats riels to the various Theatres* However, 1 think When it cooes to eateriels for the civilians of occupied territories, it would be better to have the advice of the Theatre Surgeons rather than that of people who bad no idem what they were doing* There is a great deal of difference between writ- ing a directive and «*»* & rCHL ' > 442 EXTRACT FROM INTERVIEW WITH SRIGADIT* GEK’HAL SILAS B, HAYS, MC, OSA ON 11 MAI 19A8 AT 2*35 p#m. GFHFfUl* HATSt These questions are based on your theatres, I assume• l*y answers will be predicated on my experience in that theatre* I am fully cognizant of the fact that other theatres had entirely different problem® which had to be solved in entirely differ- ant ways* The primary difference from a logistical standpoint between the vsritms theatres, as I see it, was on their size, intervening distances between base commands and relative ease or difficulty of communication* The European Theatre was a closely coordinated area with no intervening water mass of ary size, large numbers of troops, good transportation and pood communications• Supply methods used la the Zone of the Interior required little change In that theatre to operate satisfactorily* At the other extreme would be the Pacific area with widely separated buses and large expanses of water, poor communications end water surface transportation in which each base commander had to be self-sufficient and In which each local com- mander had to hare all facilities under hl« complete control* The Mediterranean theatre was probably in between these two extremes* (G) Question 1. What was the prise failure In stodieml logistical fields in yonr theatre? Did lack of supply hsiapcr the medical effort? Did the lack of shipping cause the difficulty? Was it staff or command decisions that proved the obstacle to accomplishing your plans? How can we correct that? GFFPRAL HAYS* We had relatively little difficulty in the European Theater# We bad shortage of a few items, none of which were important enough to affect operations. Our principal difficulty was in split shipments of hospitals arriving in the theatre so that hospital equipment hod to be assembled within the theatre. Another difficulty was what I term the logistical paradox in that the smaller the item is the much more difficult it is to mows sometimes# This, I would think, applies only to theatres utilizing rail transporta- tion in which the G-A and the Chief of Transportation is desirous of moving tonnage rather than necessary items# ADETRAL ANDERSON* Regarding split shipments# Do you haws any suggestion about improvement? GENERAL HAYS* Yes, We have developed a system whereby the Surgeon General or Chief Medical Officer is charged with the responsibility «f assembling all hospital erganimbional equipment 443 EXTRACT FROK IKTKRVIBf KITH SRIGADPH CFKERAL SILAS B. HAYS, BC, USA OS 11 MAT 19A8 AT 2i35 p.m. (Continted) except motor vehicles. Minim essential equipment (SKE) and personnel equipment* This includes the equipment cot only medical but also that ftf other technical services, of peeking and narking this equipment for overseas shipment and preparing complete documentation. This has now been done twice on an experimental basis, once in the European Theatre of Operations following V-E Day in redeployment of troops aid equip- ment to the Pacific and second, very recently in shipment of a few hospitals to Greece. There is now a proposed Department of Army Air Force Circular in process establishing this as accepted procedure. Question 2. Did block ship loading prove adeposte for your needs later in the war? Do you favor the block system of resupply? Did you find it feasible to change the components of the nodical block satis- factorily In your experience? ’'HAL HATSi My experience in the war waa not extensive enough re block loading for ee to sake any intelligent consents* X would 111 e to add something, however, to that and that concerns auto- antic supply. That automatic supply, while necessary and important, la only to be used in the early stages of establishing any base* That «s soon as possible the base should requisition its supplies* Question 3. Did lack of land transportation hamper the medical service during campaigns? Do you consider it essential that all medical field units have sufficient transportation to wove all of its equipment, etc.? Did movement by echelon in units prove satisfactory? GEflnUl. HATS} The lack of land tranuportation Aid not hamper the medical service In my theatre, I think* No, 1 do not foal it la oaeentl&l for all nodical field units to have sufficient trans- portation, It depends on the amount of mobility expected of a unit in relation to the amount of equipment and supplies which it oust carry* In regard to movement hy echelon - yes. Question 4. Should the supply of whole fresh blood be made a responsi- bility of our medical supply services? If not, who should handle it? Laboratory? Do you favor all supply of this item to come from the Zone of the Interior? CENTRAL HATS* It Is my opinion that all supply should not come from the Zone of the Interior, that indigent population should be bled and that, service troops in the rear area should also furnish 444 EXTRACT FROM IHTrRVT’T? WITH BRIG AD FR GHSRRAL SILAS B. HATS, MC, OSA ON 11 MAI 19A8 AT 2*35 p.m. (Continued) blood* I believe that the a ripply of whole fresh blood should be handled by a snail specialized organisation which handles nothing else* As to whose administrative control it is under, I consider it to be of rela- tively little importance. It nay prove advantageous to establish these units handling whole blood at or near medical depots, or if conditions are different, it nay prove advantageous to attach thee to hospitals or laboratories. The collection and processing of blood within the theatre of course is a laboratory procedure, in fact, a rather highly specialized laboratory procedure requiring considerable equipatent* Question 6. What is your general impression of the medical supply effort and system during World War II? Where could it be improved? Did our supply units have sufficient personnel? Were they competent? GENfRAL KAYS: I think that our medical supply effort and system at the beginning of World War II were very bad* I think that we improved'them all during the war and that in the last year or two of the war that they were efficient* Army-wise, the medical supply system in the later stages of the war was second to none, I think. GENERAL MARTIN t Are we in a position at this tine to restate campaigns In theatres of war with the same system and the same efficiency with which we ended World War II? GENERAL HAYS* The answer is that we have still in the service a relatively large number of people who had a lot of experience during World War II. The new people that we have gotten in are being trained intensively In systems developed during World War II. w® have cm hand considerable amounts of supplies and equipment left over fror World War II which has good and bad aspects — bad because they are no longer new — good because we have them. I think that I can feel confident that If we get Into another war that we can make supplies available as rapidly or more rapidly than troops can be made available* The principal raisons for the supply situation being so bad at the beginning of the war Army-wi.se was* (1) We had been living in a peacetime penny-pinching period for twenty years in which the thinking of most people was oriented in the direction of ecoooay above service* (2) We had a very small group of individuals who were trained in anything other than strictly station supply. (3) Wo had no equipment lists except those left from World War I* (A) We didn’t know how to determine requirements, and (5) and least important, to ay way of thinking, was the fact that 44 5 extract nmu nmmnr with brigadier generai shas b. hays, rc, bsa OW n RAT 1948 AT 2x35 p.B. (Continued) whlie a® Industrial mobilisation plan had bean prepared, that the President did net see fit to put it into operation when war cane* CnSNIRAL KAHTINi In your opinion, will atonic warfare. If used against the civilian centers in the United States, impose an overwhelming burden on the only available medical supply agencies that can be used in an emergency? GBIISAL HAYS: Of course, the answer to that Is that one atonic bomb in one city wouldn't overwhelm us from a supply slim* tion. Just how many atonic bombs, and injuring how many people — I don't know* It would require several* I would assume that in that event that arsed forces medical supplies would be made available immediately and that the armed forces would have to proceed to replace needed supplies* There is a very definite connection between civilian defence medically and the armed forces* I am not familiar at ths present time as to how far plans along theme linee have progressed. I do know that some plans are under way* In the event of atomic * warfare affecting the United States all medical supplies and equip- ment both civilian and military would have to be made available* The Army now has nine mpdleal depots in the United States, the Havy has five, the Veterans Administration has four. Public Health Service has one* X have a map shoving location of these depots* In addi- tion to that commercial wholesale stocks do exist throughout the country, generally concentrated In accordance with population. I think it is important that these plans for civilian defense for the medical care of possible civilian casualties processed as rapidly Us is practicable and integrated completely with plans of the armed forces* To ay mind, one of the big dangers is a tendency on the part of local people and by local people I mean everyone from the Major of a town to an Army Commander or a Navy District Commander who has a local area - there is a tendency to want to have a stock- pile of supplies under their own control available for them in the case of emergency. There aren't enough supplies to build a stock- pile for everybody and I think the plan which is evolved must provide for centralised control of stocks which are dispersed through- out the country* QMFRA1 MARTIMx One reason for centralised control is rapid movement by air* 446 EXTRACT FROE IBI'-RVIF* «ITH BRIO ADI'S GTITIUL SILAS B. RAIS, EC, USA OK U KAY 19£8 At 2*35 p.m. (Continued) * GEH’HAL HAYS* Yes. We can get supplies in as fast as they can get the patients out of the contendnated area. Medloal supplies are relatively snail and easily transported fay air. Even a complete hospital can be transported fay air. GEK: KAL BAHTIN * The question is this. Is sufficient con- sideration being given In the development of lighter containers and equipment to the very obvious proven feet that the supply of light netala has always been critical in all previous war efforts end will not be allocated except on priorities to those services whose needs are greatest, for light aetidal croniAL HAYS* lour point is well taken. The Air Univer- sity at Randolph Field is working on the development of an airborne hospital and equipment to go in it. This work le being coordinated with the Army and Kavy who are else working along the earns lines. * *♦»*♦ The danger of eelection of metals which will be required for aircraft production is being and will be given continuing considera- tion. Another pitfall which oust be avoided is extreme ideas of lightening equipment and thereby getting away from eocwcrclally produced articles which are relatively easily procured. If many non-cortffcrcial items are developed, the result in delay of procure- ment will far overbalance any advantage gained. Question 7. Did we waste medical supplies? How could this be prevented? Were any items in constant ever supply? CENTRAL HATS* Yes. Most of the wastage In medical supplies was the result of large supplies being on hand when the war ended or in the ease of individual bap© theatres and bases when the war moved cm to another location and the supplies were left behind. This could haw been prevented by better computation of requirements and by a crystal ball which could have told us when the was was going to be over. Overall in the cost of the war this wastage was so insignificant as to be of no national consequence. Furthermore, many of these supplies have been diverted into civilian channels both in this country and in foreign countries and hence put to use, which, however, did not put money back in the pocket. I don’t think any items were in constant over supply. The meeting adjourned at 3*30 p.m. 447 L. K. Pohjby Colonel, UC BITFIACT OF n?AW$iTS MADS 3Ys flolonel Frederic WCa on 22 April 19U9 at interview Subcasaittoe on' tlve of Military IjocLLcal (F) 8, I can11 mama* that on© from a global standpoint. I think we cam pretty dose to having enough hospital ships in the Pacific from what I know* With a war going on, you can’t always Iiave everythin'' Just where you want it at the right tiao| but I don’t know of any occasion— I am mire Acteiral Anderson knows this better than I do—where our casualties suffered for lack of sufficient hospital ship®* They suffered from lack of all sorts of ether things, but I don’t think a shortage ■*£ hospital ships was the answer* That1® ny personal pinion* "Medical departments should certainly have control of evacuation, air and otlerwlse. I don’t jaean they have to command tliese units, hut they' certainly must have centred over them so they can’t bo sabotaged and taken away Just whsai we need them most* And that includes. In my opinion, returning cases to tlie Zone of Interior. From ny personal ex- perience wq had little if any difficulty, W® found excellent ataff co- opera ti or* and when the going was really tough and when ovacutation was needed, it seemed to mo from the highest coa nnd of "the Pacific on dam we got everything that they could possibly make available at the time, even furnishing fighter cover for our evacuation planes. "As far as No* 9 is 6onceniGd, to assure air evacuation early in any future war, we must have early planning and we must see to it that the command is aware cf the importance, not wait until the plans are all mde up and come in at the last laimrte and toll him we have for- gotten something w© 'nave bo got it in early* And that goes back to cue of my earlier eta laments tnat the medical p eople are part of the armed forces and they have to be not halfTioartodly but wholeheartedly con- sidered a pasrt cf the team at all times. They have to be in on the plan- ning from the beginning. "(F) 10. Communication between medical units are fairly satis- factory, It certainly would be enhanced with radio in all fiejld nodical units and I strongly rocon lend that all medical units dam to and in- cluding collecting companies and divisions have radio communication of their am, so that they will not have to borrow from some signal officer. "(G) 1* I have no specific consent on tide question 1. AH sorts of things happened and wa ran short of things, and so did everybody else| not Just the medical people. In ay opinion it was Just a question of a big Job being don® on a shoestring with everybody the best he could and not having quite enough to do the Job the way we would like to see it done, correction, of course, is either better topside planning cr maybe Jde b better luck." L, K. Poha, 4 48 co r.t’d 1* "XTUCT Of STAT&CTTS ims Iti V MC, D.S.A, on 22April I'M at int.jrvimr with huJcotaaittee on the oyiaent of liLiltery Itooical ourcos “(0) 2* Block ship loading is fine under certain conditions. It*a iterative in sy opinion in the early stages «af a base, A oase that la going to bo set up on captured land should have the advantage of clock loading and automatic resupply far a reasonable length of tine. This length of time, of course, depends upon the distance from the of the Interiori it depends upon the agencies through wliich requisitions have to passj and of course it always depends upon the initiative and the training of the people at the base in knowing what they need and hew to get it* "I think that block supply shipments should be kept to the mini- mum, It is not an economical way to supply* It* a expensive, like everything else In war, of course, and should bo discontinued at the earliest possible moment, Our experience was that wo could gradually shorten the period of automatic supply as we were able to put in trained people to initiate supply on their am sooner than untrained people could have done. "It is not easy to change the coiaponente of the mdical block once you get supply people running down the line and furnishing, block A and block 3 and block C, It is in my opinion or in my experience rather complicated to bust into these blocks and try to change thenj when they have a lot of thinrs made up, they would rather ship them the way they are, and'it*s another slow, complicated process* °(G) 3* My opinion does not reflect a world-wide opinion* were never operating in large land mss as and therefore land trans- portation was relatively much more effective* 3y tliat I xtsaan short hauls, short distances, *ith lack of ecaaa of the severe mountain ter- rain which was experienced in other theaters, our land transportation was relatively ranch mere effective, 1 am sure, thai it was in other theater®. "I think it is advisable, maybe not essential, that all field medical units have sufficient transportation to move their equipment. It would certainly tend to keep the medical department on a mobile basis without recourse to aid from other agencies. "I never saw any unite moved by echelon and I am not qualified to comment on that. "In i*7 personal aatparionea denial of additional transportation was a minor obstacle in planning* 'nit it was never done unless it was absolutely necessary,” r. xrt: r$sr; 'csrswiv m 449 (g) contfd 2» EXTRACT OF life OR BYi Colonel IVocleric WsierveTi* MC> U«S*At 2.2 April 1*?U8 at interview witb 5ul>comiaittee on tlie \V43ioy1aent of i&iitary !tediccl desouroes "(G) I f«f©l that supply of frso'h blood should bo bandied by the supply services* Whereas the laboratory chocks certainly might be indicated, the laboratory people are not a supply service* They are not set up to supply it eras arid to aove then and store them in any bulk* I feel that the isedical supply people should handle the storage of and issue of froete whole blood* "I can’t answer thin part (b), but I favor all supply coming frasa the Zone of tho Interior* I don’t know how it happened In ®t&er t&eotors. In our case it did coae from the hone of Interior* It all came from the sta bes, and even with tho extreme distances involved the supply was cm- ceedin.ly prompt* I don* t believe wo ever received blood more than six dayu from the time the blood was drawn ©van whan we were on Okinawa, and in our particular situation it would have boon entirely impracticable to use local source of supply* M(d) 5* I can’t answer question 5 in any specific detail* Ze were never in sy opinion theater-wide short of anything* I may Imre forgotten sore thing* I can’t offhand think of anything in which we were short* Locally m item might be short and might have to be flown in from another base* This was done repeatedly, of course, in the case of whole blood. And as I remember a Line item in the case of mortar aia.ran.ltion. It doesn’t involve us here* We wore never, to my knowledge, critically short of anything that affected the mortality rat© or the immediate comfort of our wounded* we sometimes wore down to wliere wo had to see the next plane coning in, but we never actually ran out, n(G) p. In answer to tho first part of No, 9—1 will try to answer all these—we noticed a considerable iiaprovaaont in the appearance of lie wards In hospitals after the nurses arrived on trie scene# I think we noticed an improvement in the morale uf tho patients* Cur posts in combat were so overloaded and the patients moved through thorn so fast that the morale factor from the presence of nurses was a relatively insignificant matter} far loss significant than it would have bean in a hospital where the patients remained for a long period of time. *Fop professional reasons, the Navy gets along without wuosn in their forward hospitals and the Navy runs some pretty hospitals* don’t operate the same way. If we did, if wo filled our hospitals around meltj nursing and male toclmicians, then I tMnk you would get along without the woman perfectly well. For psychological reasons — I think they were a vary terrible psychological factor, 'The men are either in a Stateside type of environment or they are at war, and whan you put men in t'oo battlefield, many of them, and tluen nave a few women, or you have convaluacant man, or you have staff people or people of any category in large numbers and a few women, I think the morale factor is very bad," y» MCx U.S.on 22 April 19/>8 at interview with Subcor.i.dtteo on the Medical '^sources nX think that everybody wishes it was his own family there, and I think they would probably 'be better off from a psychological stand- point if the women were kept out of the picture entirely* I am re- ferring new to the combat areas, cf course* "Females very definitely hamper the movement of a unit* In our case their absence was almost crippling—in our cases at Saipan and Okinawa, and places of tint kind, it vts a very serious drawback be- cause we were using units that were designed to operate with female nurses and then wo didn* t take tie nurses in because of the fear of capture, That was the chief reason we didn* t take them in, he didn’t want the nurses to have any reasonable possibility cf being captured by the Japanese* At Saipan the nurses never went in during battle, I believe they got there the day the flag went up, excuse me. At Okinawa we arbitrarily set a 30-day deadline in advance, This was just on guesswork, actually permitted the nurses to come in, as I recall, at the eid of about six weeks, in tho meantime our hospitals, ter- ribly overloaded as they were, were operating short the actual bodies of the nurses. . “If these hospitals had been designed to operate with male per- sonnel, the efficiency would have been considerably greater, im- personal recommendation is fiat wo keep women out of the combat aone*Heit a 451 laaumJMMfiE (!•«•»• *»■ M»1» *. ». u, (*>). n. a. Urr dated 5 May 1948} ***** "#,*•• la fvurtl I boilers that itdiMl department organisations In all tho fanrloot vsrs notably superior la accomplishments as compared vith non-medical branches. 7. Vith a few glaring exceptions, nodical logit ties in the Pacific daring World War XX voro adequate. In this eoanostioa tho felloviag goaoralitios are offered! (a). Aray medical officers who had been trained in staff and logistics duties were much better equipped for their work than comparable S*vy medical officers whose knowledge had been acquired solely from experience. Mary officers should bo similarly trained. (b). It was extremely difficult for the medical department to secure Its required share of the total insufficient ship tonnage in every iaoifio operation up to tho Xwo dim campaign. She allotment, of tonnago for this eanpalgn was secured with relatively little lag. For the invasion of ttkinawa adequate tonnage was available and vs had room to spare for all required nodical stores and equipment. (o). during the summer and early fall of 1944, there was consider- able misconception in BuKcd of our requirements for supplies, based probably on a failure to recognise the vast distances in the Pacific in their relationship to the relatively greater quantity of supplies it took to keep tho ■pipe-linc" filled. In late 1944, Bear Admiral K. 6. Melhorn visited Pearl Harbor and, after evaluating the situation, felt that even more was required than vs had requested. After this there wore no further difficulties vith Mat Div. (d). One of the outstanding devslepsnsnts In logistics vas the sup ly to combatant ships by tankers and storcphlps of previously packaged medical stores in empirical amounts and assortments. There was tome criticism of the composition of those empirically packaged supplies. Zt would be obviously impossible to satisfy all needs In this manner. There is nothing wrong vith the system and with farther refine- ment, amplification and modification it should be employed again. (•). Tilt transportation "by HATS In the Pacific of whole blood and It a ready availability thru strategically located distribution centers and selected ships was an outstanding achievement. The system developed can bo adapted for the rapid distribution of other perishable remedial agents as wall. ****** 4 52 L. K. Pohl, Colonel, MO tmm eon sjucy of ibtshyixw with colonsl rmu coekkll, kc jsa ao aphil X94s •*•••••• ft. sitodit.K. POHL, COLOHSL.MC 457 THUS COPY ~££TiUST (from address of Major General Albert V, leaner, MO, USA, 1? May 1943} QWSBaL KmrsMx "In that connedtIon I was often, during this. past war. Impressed with the desirability of haring an air medical service controlled by the theatre or ehlef surgeon. The air did a won- derful job for ns, but the availability of planee for evacuation depended upon tactical requirements and not upon aedloal requirements. Z believe, therefore, as I said, wo should hare an air aedloal service. That probab- ly may be misunderstood. I mean air facilities controlled by the surged* who has the overall responsibility of taking ears of sick and woumdfd* t believe that had ve had 0-4?e marked with red crosses and available for me other purpose than the carrying ef aedloal personnel and medical supplies and equipment — net available for any tactical purposes — controlled by the ehlef surgeon, vo would have been la a much bettor position, in the evacuation of Army installations and communication tone Installation, than vo vtrt in this past war. BHXGaDXSB miKAt MAHTXBi Do you eoasldar that the airplane is new but another method of evacuating the tick mad wounded end should therefore be placed in the same category as ambulances, hospital trains, hospital ships, and all those prsrvlouely used conveyances? If se, it it net Imperative that this newer method of transportation be similarly controlled by the surgeon of say unit in which there it this need for air svacuatien? MAJOB 61SJBEAI EESBERj Absolutely. The only service that hat net kspt up with the modern air concepts has been the medieal service. Tactically the air service has had nothing set up formally, except tactical and supply missions for tactical unite. It hmui to ao imperative that vo should hare aa ambulance of the air Just ao much ao vo bar* aa ambulance that rollo oa wheels. X think it to Imperative If vo again oarioioa tho aoat van mo departing tactleal- ly froa prevloao concepts, because tho distances Involved la the next vmr will probably ho aoeh greater and year support will ho mach farther away— tho haooo — than it vao la thlo loot war. Boar la wind that la Vortd far II, In the Invaoioa of tho Ceatlaont of Bnropo, vo had oar haoo Jaot a natter of 20 odd alio* across tho channel. In the next war oar haeeo may he thousands of miles froa the United States. They nay not he as eeoaro ao the hates we had in thle pact war, and therefore ve any consider that evacuation Is going to he overextended, dir it the only means that X know of of getting your badly wounded hade to your Installations capable of rendering definitive care within the time that is going to he neeee- eary to save lives or loeo of liab.****** ***** "MAJOR OaiRXAL tmnsm Going on to the a«rt question — aedioal logletlee la nllitary eeapalgae — you are covering a lot of territory on that oao. 458 X Ullire that vi hare not given enough study on our experience tables in establishing a batter balance of nodical supply, particularly in field units. Tine and again you renarked, as Z did, that here would be one itsn way la ezoese, piled 19 with nobody wanting it, as, for instance, cotton. This bird wne carrying around a whole let of stuff that nobody wanted, yet he would be short on an essential itsn that he would hare to hare. X know that we started In Africa an experience table of supply. X don't know whether It has been continued. But certainly sonebody ■net hare aade up experience tables. And If they are not nade up* there arc officers of the nodical serrlce who know what they should be. X don't bellere a field unit should carry one pound more than It has to carry. To stock tip with a whole lot of stuff that cones up antonatloally* or not* Is Inposlng an extra load on nodical personnel, and to no purpose. Vo had satoaatlo supply. Xn so nany days up would cone a bunch of stuff. Veil* a lot of It wo didn't need. Tot cone of the rital Item were not coning up la such amber. And In that connection, too. X an rsnladed that la some Instances the ooantmlcation soae had no nodical depots within the ooanualcatlon sone. And up until December of 1944 there was no nodical depot between Paris and the Any. That Is a long line of connunleatlon. As you know, a division requires 800 tons of supply dally. The Trench railroad train carried 600 tons. Bow nodical supplies very often would be included in a particular ahipnent. When the train arrived at a distributing point, nobody knew where the nodical supplies were. The line wont Into their cars for their rations and Class ▼ stuff* and the engineers went In for theirs; and It would emetines be a week before the nodical people would get In their stqpplleo. 80 X think that our supply system In forward areas, in connunleatlon sones particularly, could be improved. X nay eay those were Just administrative faults. They probably were, but they shouldn't be repeated. How on coordination of st$ply requirements and standardisation of medical Items as between the Army. levy and Air force, with overall control exercised at the Defense lewd, brings us to previous rmaiks. It seme to me that common user items oould bo employed by tho levy ae well as by the Amy; and instead of having a special kind of forceps* we oould all formalist or standardise our equipment and have Interchangeable perts. 459 He made a mistake 1b this past war la oar transportation. Here we had ambulances sad* toy ford, ambulances mad* toy tenoral Motors, aatoulaac** mad* toy oth*r automobile concern#. Th* am* were confronted toy th* earn* situation, lad Instead of carrying spares for on* make, and lacking Interehaagaatolllty of parts, you had to carry a whole lot of extra equipment around. It sesms to a* that w* should adopt standard aatoul&noe* for th* Service* with lnt*rohaag*atolllty of parts. Also, B*dlo al supply should to* th* eoaaaad responsibility of th* area or major unit commander for all elsaents of any of th* d*f*ns* fore**. REAR ADMIRAL AJKDXaSOHt Tou have referred to aatoaatle supply la th* fl*ld. That Is n*o*ssary early la th* operation. MAJOR GENERAL XSHSXSi T*«, tout I think th*r* should to* son* control over It, so that an agency that 1* shoring up too much stuff on automatic supply will to* acquainted with that fact. I agree that v* need automatic supply until such tin*, certainly, ae we may establish the proper medical supply distribution. BRIGADIER GENERAL MARTI Hi la your experience, did deficient medical supply result la failure of the medical services, or reduced efficiency of the medical services of the field early In the wart MAJOR 0HB2RAL OHHSRt Ho sir. BRIGADIER GENERAL KARTIHi That Is quite a point MAJOR GENERAL XEHKERj At no time la my experience, either In Africa or later on In Bur ope, was there say deficiency la medical supply that adversely affected the medical service. BRIGADIER GENERAL MAHTIH: Tou have spoken of items that were at lew level*. As the need arose the medical officer* were stole to use other Itsme or substitute or get toy? MAJOR GENERAL KKHNE&i Tee sir. In Afrloa we were la short supply on some Items, critical Itsms, tout wc dldaft get *e short that w* eoulda*t carry out our mission. BRIGADIER GEHXRfL MASTZK: V*re the shortages due to difficulty 1m procurement? 460 MAJOR 03HSHAL KiaotSHi Th, Vat alto to Increased denand for thooo particular items. V« m Into a lot of dysentery and dlarrhoa. Bisauth and eulphaguanadlno wort orltleal Items la Africa.11 ••••• L. I. Fowl, Coloa«lt MO 461 IKUi. HOSPITALIZATION AMP EVACUATION POLICIES WITHIN THE COMBAT ZONE AND EVACUATION TO THE COMMnNXCATIQNS ZONE AMD TO THE ZONE OF THE INTERIOR. I. GENERAL World War II presented s wide variance of situations to thor- oughly test the doctrines of the Medical Departments regarding the evac- uation and hospitalisation of the sick and wounded in theaters of war* They proved sound. In the isolated instances where the process was not too satisfactory the lade of adequate facilities was responsible in most cases* Other failures were the result of lade of appreciation of the problem by new and often untrained medical staffs and command echelons* During the latter phases of the war much improvement was apparent in all echelons • This developed as the result of actual experience in the theaters of war which cannot he gained by individuals in the classroom during peace or war* Future war poses some possibilities that should be considered by our planners* While it is conceived that the atomic bomb will only be used on industrial and key targets in our homeland it is pertinent to consider the importance of our World War II Theater of Operation babes as targets for the bomb* tJhless we can devise some other method of supplying ground forces engaged in a theater of war it is inevitable that large bases, containing hundreds of thousands of troops, aunt again be established at large ports of entry* Accept- ing the soundness of this premise, we can assume that the enemy will use the bomb early and often if necessary to destroy our vital over- seas bases* Planning for this eventuality must take into considera- tion two important factors if an adequate medical service is to be furnished* The first of these is the location of hospitals* Hence- forward it will court disaster to place base hospitalisation facilities inside the effective tone of the atomic bomb* This means dispersion of medical facilities well out in the periphery of the port facilities* In turn, this concept will require the building of fixed hospitals where previously existing buildings in cities were used to the maximum* The second factor is the requirement for a large increase in the number of reserve beds authorised theaters of operation. If the medical service is to adequately cope with the casualties resulting from the atomic bombing of its overseas bases it is apparent that this need for addi- tional beds is imperative* The argument that service troops serving a base will be dispersed to afford safety from atomic attack does not belle the fact that service troops must operate the bases from shipside and cannot do so without working in the danger sone* There is no escape from this fact if the base is to be operated* Japanese experience figures are the only ones available for planning. If followed, pro- visions must be made for hospital authorisations for overseas bases to care for one-half of the troop strength of any base* The urgency for 462 Radical service facilities immediately following atonic attack cannot wholly or adequately be net by inporting field type hoepitalixatlon unite from other areas. The tine elenent involved precludes any planning which waits until the event has happened before action en- sues to neet its implications* Our previous experience in render- ing battlefield medical care is insignificant and in no way compar- able to the problems involved in oaring for the number of casualties bound to result from a single atomic attack on masses of our troops. This possibility requires the immediate revision upward of our for- mer figures used for calculating beds for Theaters of Operation. It inevitably must result in a greatly increased troop basis strength for the Medical Departments of the Services. It is the concensus of all that the Wavy and Air Force of- ficers must be given staff status in command echelons in the future independent and distinct from the administrative and/or logistics sections of those staffs. This obtains in the Army as a rule and has proven sound. It has produced the desired freedom of action to discharge their responsibilities with dispatch and without interfer- ence. There is a need for clarification of the rules of the Genera Convention in the concepts of combat, staff and medical of- ficers • Extreme difficulty mas encountered during World War II in getting the armed forces transportation services to interpret the laws to enable the best use of protected transportation for the medical services* In view of our actions in using the atomic bomb against helpless civilians there is question as to our national at- titude concerning international rules and agreements of the past for the protection of the helpless including the sick and wounded. This most important matter oust be brought to a decision to permit of logical planning for the medical services in future wars. Action is indicated at once to force this decision. If the decision is that we are to continue to operate under current rules, stops should be taken at once to educate through proper means of publica- tion all personnel of the armed forces on just what the laws permit us to do and not to do. Because of the intensive attention being given to research and development by all the armed forces in the field of Arctic war- fare this possibility has not been given detailed consideration in this report. It is believed that the current projects are compre- hensive enough to indicate what special equipment and facilities will be needed to conduct military operations in the Arctic Zone. 463 n. «LananBBL-or-.iHE problem 1* BwpUftHiatlOB a. Combat Zona Medical service In this area Is wholly dspondont on tho typo of conflict and tho area Involved. Field hospitalisation as developed and used by the Arny proved adequate in these areas when sufficient units were available to meet the needs. When they were not available for any reason, poor service resulted in the needless loss of lives and longer periods of morbidity and convalescence. Errors of the past should be corrected where possible in planning for the future. The basis for hospitalisation well forward in this sons is sound. Its mission is to complete minor easts and to rapidly prepare long term eases for evacuation to facilities in ths rear. The greatest medical failure in World War II occurred in this aone in that sufficient fac- ilities were not made available for the definitive care of short term oases. The entire service was geared to efficiently handle the peak loads of wounded at the expense of the more important work of sal- vaging manpower well up forward. As a result, thousands and thousands of short term medical type eases were evacuated to communication son# installations where they remained for weeks and months in comfort and resisted efforts to return to the front. This unsound practice calls for a complete revamping of our estimates and requirements for mobile beds in forward areas based on the knowledge that in any campaign ap- proximately 80$ of all admissions have been medical in nature and that 90$ of these have been salvagable in a fifteen day period. The system used for the care of the so-called "exhaustion* type of case in this area proved adequate and needs only minor refinement for the future. The recent development of the mobile surgical hospital of 60 bed capacity to replace the makeshift arrangement of World War II wherein platoons of field hospitals were utilised as surgical hos- pitals for selected major cases will solve one of the major problems in this sons. In general, there was too much emphasis on evacuation in this zone rather than on sound medical and surgical care* The amphi- bious operations in the Pacific presented far different problems in this field than on the land mass of Europe* Often it was consider- ed impossible or inadvisable for some reason to follow up the invad- ing troops with adequate mobile field hospitalisation unite* The Okinawa campaign in the Pacific proved the essentiality of this 464 sound procedure which bad been adopted as standard in the amphibious operation* in the Mediterranean early in the war and later in the landings in Noraandy. The permanent use of hospital ships and con* verted troop carriers or cargo vessels has been reeoooMnded by some as the ideal method of oaring for the side and woundad in amphi- bious operations. These floating medical vessels, unless greatly improved in number and special facilities for modie&I use are not considered Idee! by many others. They do have their use in plans for small campaigns of expected short duration and they do provide extreme flexibility of medical means which is a very deslrabls fac- tor in any situation* Major opinion prefers the use of field hos- pitalisation ashore as soon as it is humanly possible to get it in. There la unanimity of opinion that most fisld hospital units should bo similar in organisation and equipment in the armed forces. There ere some who favor the univerMl manning and provision of field hospitals by Army personnel for all land operations regard- loss of the identity or composition of the ground force. It has many advantages and should bo given full consideration in future planning by the joint staff. Mobile comrades cent hospitals are a necessity in the type field Any medical service* The recent development of the 1500 bed type will improve the use of these Important facilities in future land operations. Large air force groups operating from fields in the com- bat some should be provided with sufficient field hospitalisation units If based at any great distance from ground force installa- tions* The type field hoapital was designed prior to World War II for use in these situations and proved wholly adequate in practice during World War II* b* 29M Our medical doctrines governing hospitalisation in tbs Communications Zone proved sound In World War II practice* Devia- tions from the Ideal system which is always planned were often caused by unexpected tactical successes, especially in France* These fortunes of war will continue as in the past to test the flexibility of our plans in the future* Because of the fixed nature of the hospital facilities in this sons, flexibility to meet the unexpected can only be obtained by keeping units in reserve* This is often impossible without sacrificing needed beds and thereby 465 creating serious Manpower losses by increased evacuation of short tern eases to the Zone of Interior* The increased bed needs over World War II experience for this zone is covered under general discussion in Paragraph 1. There has been general criticise of the practice of pass- ing the sick and wounded through a series of hospitals in the Coanuai- cations Zone before definitive care is reached* This is never desir- able* It was forced by conditions beyond the- control of the Medical Department in most instances* It can be obviated somewhat by better use of air evacuation, earlier triage and specialisation of hospitals for type eases* However, until there Is more certainty in the con- tinuous availability of air evacuation, there will be need for ad- vancing large hospitals in the Communication Zone as it advances be- hind the combat troops* Overlong periods In transit on vehicles or trains is not conducive to the best treatment of recent battle casualties* We nust continue to move hospitals to the cases until our transport develops far beyond that of World War II efficiency* It is generally agreed that station hospitals in this sons should not do surgery beyond their capabilities but that they cam be used to relieve general hospitals of less serious cases* It is general knowledge that in war many hospitalised individuals develop •hoepltalltlc* which makes it exceedingly hard to return them to duty* Hospital commanders and their staffs often were not indoc- trinated sufficiently on the importance of returning cases to duty at the earliest possible date* There Is universal agreement that convalescent centers are best established as part of each general hospital* This system allows a complete follow-up on each case by the same personnel which saves tine and effort* From convalescent, centers patients should be cent to reconditioning centers operated by the line. These centers require adequate medical staffs to advise on the physical condition Of each individual to the end that harm is avoided as well as to Insure speed In the reconditioning process* There is need for a SOP in this zone which can be rigidly carried out which specifies a uniform standard for transfer of cases to convalescent and re- conditioning facilities* Too much leeway was given hospital com- manders in this field during World War XI and resulted in a needless less of manpower* 466 War experience proved that the Communications Zone medical facilities were swamped with hordes of individuals who were passed on to them through medical channels but who were not side physically and had proved useless as soldiers in combat areas. Obviously these in* dividuals should have never been accepted for military service or at least for combat duty. There is need for specific administrative dir* eetlves which will relieve the Medical Departments from the care of this type of Individual promptly. It is a sheer wastage of medical personnel to permit their occupation of hospital beds. There has always been much wastage of time and facilities with confusion in the process of returning "duty* cases from hospitals to the place- ment depots in the Communications Zone. The responsibility in the Army for this process has been placed on the Personnel Section of the Area Commander’s staff. The system has failed to work repeated- ly, mostly because of lade of transportation and it has been recom- mended that S change be made in regulations and doctrine which will place the responsibility for the procedure on the commanding officers of Replacement Depots. This appears sound. Detached Air Force commands in the Communications Zone must be given adequate hospital coverage. There is much demand by the Air Force for the assignment of general hospitals to then for the care of their ride and injured. The basis for this request rests in the assertion that aero medical trained officers can more efficiently supervise medical care to air crews and that administrative control of side and injured air crew personnel is facilitated when they are concentrated in one.hospital. Further, that there was s great loss of air crew personnel, especially in the Pacific, where the sick and wounded were hospitalised in many facilities. Later, this condi- tion was improved by assigning an Air Force liaison group to each of the hospitals. It is believed by the Subcommittee that no harm would ensue if general hospitals, when actually demanded by the specific situation in a combat some, were attached to Air Force com- mands for operational use only. The construction of hospitals in the Communications Zone presented many trying problems, especially in the Pacific Theaters. For the most part the construction was accomplished by medical per- sonnel which caused much wastage of specialised skills, but it was necessary if any hospitals were ever to be established. The Corps of Engineers in the Army who were responsible for this work failed to provide the means for the task. Mary construction of hospitals 467 ashore lagged even more than in the Army, indicating the same diffi- culties were encountered in the construction field; Because of neoes sity the construction in the Pacific was mostly of 'the Australian cow shed type* This type could be prefabricated and readily supplied* Later in the war stateside constructed prefabricated buildings were available and proved to be moderately valuable in the tropics* Had the campaigns extended to the temperate sone they would have been ideal* Continuing study must be made in this field toward the developing of prefabricated structures that can be made available in ample numbers for Communications Zone needs* The locating of hospitals well outside the danger sone of large bases in future wars will surely demand the use of this type of construction for most fixed hospitalisation* The intricate maze of hospitals in ETC through which pat- ients were passed from Germany to the United Kingdom is a good ex- ample of what the lade of facilities for rapidly building temporary hospital structures forward as the troops advance can produce* Many are of the opinion that by creating a Hospital Construction Division in the Corps of Engineers a forward step will be taken to eliminate the glaring deficiencies of World War II practice in the hospital construction field. Holding hospitals are necessary in the Combat Zone* The Army has developed since World War II a now unit for this function so essential in operating an air evacuation system* There is di- vergence of opinion as to who should control these units - the Army Surgeon or the Surgeon of the Communication Zone. It appears logi- cal to have the Comirronications Zone responsible for them on the basis that they are responsible for evacuation from Army service areas* Efforts made by the Amy ground forces to push develop- ment of ambulance means since World War H have been unsuccessful to date. On the sound premise that the medical services must operate ambulances on land, on the sea, and in the air, it is reason- able to demand that development in their physical features and use be accelerated by direction from top level authority. The Committee agrees unanimously that this is an essential need and must be done at once* 468 2. EracuaUgB PttllfiieB a. General The basis for the establishment of an evacuation policy In days within & Theater of Operations Is sound. Planning for beds and evacuation needs In each medical echelon cannot be done without soae basis for computation. Experience factors of Vorld Wars I and II are reliable as guides for determining requirements for modi- cal facilities In each of the successive medical echelons from front to rear. Vorld War II proved our doctrines and methods sound In this field and there Is no need for change except to readjust ex* perlenoe tables as necessary to the data accumulated during World War II. The Army and Wavy had different policies of evacuation In the Pacific. All agree that both services should have identical policies in the future, especially where joint use of medical facili- ties is to be generally adopted. The purpose of establishing evacuation policies Is to effect salvage of manpower as far forward as possible and to free forward units of long tern eases as rapidly as possible to provide more beds for nlnor oases* The policy will always be dependent on the number of beds available, the number of sick and wounded admitted and the amount of transport available for the movement of cases and the tactical situation in any given echelon of the medical service. Early In amphibious operations there can be no set evacuation policy. b. In the Combat Zone Practice has proven the advisability of establishing a ten to fourteen day policy for the combat tone. It can rarely be adhered to except in very static situations but does serve its pur- pose as a guide for planning medieal facilities and the indoctrina- tion of medical personnel in the process cf sorting eases for evac- uation. It must be subject to change on a minutes1 notice to cope with tactical requirements• During quiet periods it was often In- creased to thirty days. The proper use and availability in the combat son# of sufficient convalescent hospitals will permit of a longer policy. 469 c. In the Communications Zone The policy In these senes was established by the Surgeon Generals of the Services during World War II. It varied depending upon the Medical facilities available in any theater and was from ninety to one hundred and eighty days in the various theaters. This system proved sound and requires no change in future plans of operation. Sqm auggest that the establishment of the policy be left to the Theater Surgeon rather than the Surgeon Generals. That is illogical as the Zone of Interior facilities most be geared on sore definite and detailed plana which can only be made on reason- ably certain estimates of the number of casualties to be returned from the theaters. It would seen feasible to compromise on an intermediate solution wherein the Theater Surgeon would recommend to the Surgaon Generals any changes in set policies as local condi- tions justified. 3. tewtipa Efrm Developments in the use of air naans during the recent war indicate consideration of fuller use of tills Beans for the transportation of the sick and wounded. Tests in the suitability of the helicopter and various types of light aircraft are proving encouraging in this field. In certain areas the L-5 type of plana proved excellent for evacuation of elngle cases while in others It could not be used because of the rough terrain and weather conditions There has been recently proposed by the Amy Medical Department Board an air nodical evacuating company equipped with twelve light plancc for use in the Army Service area. It is proposed to keep these planes as a separate medical unit under direct medical con- trol and to have them suitably marked with Red Cross insignia. This addition to the medical means available in the combat area should be considered a bonus and no reduction allowed in the recent- ly authorised full complement of surface means of transport. Until terrain, weather, and enemy interference can be eliminated the use of air means in any combat seme must be viewed with extreme caution* The standard system of evacuation contained in Army medi- cal doctrine proved wind In war and needs no change for the future. In one theater the Army Corps ras changed with the evacuation of division and corps medical installations to field Army units and they were given the necessary means to accomplish the task. This scheme proved to be excellent during a period of twenty months in combat and aided materially in the training of corps surgeons for higher medical command. 470 In amphibious operations especially in the Pacific It appears that every type of craft was used at one tine or another In the evacuation process from share to ship* Evidence, however. Indicates that as experience was gained a better system for the orderly transport of patients to designated hospital ships devel- oped. There Is still much to be done in this field before the Medical Departments can approach the effectiveness developed for evacuation of ground forces engaged on land* Complaints of shore and sea nodical officers were universal in condemning the lack of control net only of snail craft ferrying casualties fro* beaches to ships but also the typos of ships allotted then for the transport of cases to bases in th# roar* The LSTH, although utilised In all theaters at one tine or another seems to have boon best used in the Kornandy landings. Tbs short haul Invol- ved In Its operations made Its use reasonable* For longer hauls It needs mneh Improvement In Its facilities* One of the major failures was the lade of control over the LSTHs by medical of- ficers afloat on D-Day. In some eases the ships were directed by the line command on diversion missions and this resulted in the complete breakdown of the planned evacuation system on D-Day. Such employment defeated the planned use of those ships apd must bo corrected ly stringent demands of the Medical Department of the lavy for control of the ships allotted to It In any task assigned* It is possible that the Msdleal Service of the Navy should design and demand a special type water ambulance for off* shore evacuation of casualties. The British hospital carriers used in the Mediterranean were equipped with then and demonstrated their effectiveness on many occasions* Full control of these small craft by medical men with positive destinations was assured to the end that the useless ferrying and begging of larger craft to accept casualties did net happen. tittle criticism was elicited regarding the facilities of specially designed hospital ships* However, there were toe few early in the war* This can be corrected by keeping those now in being in reserve during peace with provisions for early recondi- tioning in an emergency* It will always toe late if action to build or convert shipe for this purpose id delayed until war comes. Several witnesses expressed the meed fo* some type of fast ambul- anee shipe for long water hauls of casualties* This should be considered in the survey of the whole problem of amphibious operations 471 The further development in the use of air evacuation means to permit its early use in campaigns may veil eliminate the need for faster long distance eater transportation. Universal condemnation of the use of troop carriers for the reception and transport of casualties mas forcibly brought out. Although the use of these ships was for- ced by necessity that fact constitutes a failure in implementing the medical planning for carrying out of ite mission. This failure can only be corrected by stringent action on the proper level NOS? to prevent the same error in future ware. It is unthinkable that the Medical Department of the Navy cannot secure the necessary per- sonnel and equipment and full control ever its use to carry out its responsibilities for the evacuation and care of casualties ones afloat* The Navy has lagged far behind its sister services in this important field* There is definite evidence accumulated to shoe that naval line commanders and staffs have not bean sufficiently indoctrinated in Medical Department functions and responsibilities, especially in amphibious operations* This can partially be cor- rected by proper presentation of its problems at the highest level and more training of selected medical officers for staff and com- mand assignments in war at naval line and service schools* The problem of amphibious medical service demands immed- iate survey by competent war experienced Army and Navy medical of fleers* Some workable system that will avoid the serious break- downs in past efforts must be evolved* Considerable theoretical work mi the eelution of this problem has been started at the ser- vice schools of the Army and Navy* This experience should be util- ised by the survey team in ite task in reaching the answer to one of the poorest links in our medical services* Evidence wae elicited which indicated the need for better triage of eases ashore early in amphibious operations when air evac- uation became available* It was largely because of lack of suffic- ient field hospitalisation and qualified medical officer personnel ashore that the serious errors occurred. This brings out the im- portance of bringing sufficient and capable medical facilities in to shore immediately following the assault phases of an attack. No system of evacuation no matter hor ideal offshore can obviate this oft-demonstrated and primary essential to good medical services 4. inOTftUqiL.ih» Pswomlfiatlw. 2dm Medical doctrine in the Army places responsibility for evacuation from the Combat Zone to the Communications Zone on the Communications Zone* This is sound and should be continued. In 472 many Instances the Coamunlcations Zone did not hare the transport facilities at its disposal for accomplishing the task and of neces- sity it fell to the let of the Cowbat Zone Medical Sendee to do the job* As long as distances were short no hardship resulted* As distances increased the use of air neons became imperative for good medical service* It vas the breakdown in this for* of evac- uation which brought such criticise free the Cowbat Zone because of the dawning bade of its casualties which ensued* Although tac- tical needs for air transport naans will always take precedence over its use for aedieal evacuation we cannot help but emphasise the dependence present concept* in the evacuation field play on this naans of transport* If it is to be dependable and we believe it can be nade reasonably so, there is need for developnent of a system to definitely provide the needs of ths aedieal service, la one concept it is suggested that sir transport by a process of evolution In developnent ie replacing the slower means of the past,' just the sane as ths motor sabttlancs replaced the horse- drawn in World War II* If such is accepted it ie logical that tho sane control ever air means as surface means should be vested in the Medical Departments of the armed forces• It may cone wham our aircraft building facilities are developed to the point where the air ambulance can be put into production without delaying er sacrificing combat type aircraft production* Until that tine ar- rives and weather conditions are beaten to insure reasonable de- pendability, the reliance on ground means for transportation of the sick and wounded will have to continue* Extreme caution is demanded therefore in planning for the future to Insure sufficient ground transport means for the movement of expected casualties • Any system devised by the Communications Zone to effect its responsibilities should include means for rapid and constant eomnmioatlon between the medical echelons involved. Medical evac- uation liaison personnel of the Communications Zone should form part of ths staff of the Chief Surgeons la the Combat Zone area. By this means the requirements for the lift of patients in the Combat Zone can be readily translated into action directly and efficiently* There is much discussion as to who should furnish air means and how the operation of this means should be handled. Experience indicated that the presence of a suitably qualified Medical Depart- ment officer from the Medical Air Evacuation Squadron or from the Troop Carrier Command was essential on the staff of the Combat Zone Surgeons* Through fcla Air Force channels he was able to seeurs in- formation as to the availability of lift in a reasonable manner. 473 The decision as to who Is to furnish air lift tar evacuation must be made for the Air Force under present limitations of air means* This decision should be demanded by the Surgeon Generals of the services if we are to devise a workable system using air maaxis between the Combat and Communications Zona* The use of hospital ships and air means tor the evacuation ef the sick and wounded from amphibious landing areas to intra-theater bases is comparable to the land phases in the evacuation process used between Combat and Communications Zone* In many instaneee tamperary medical facilities afloat la the Pacific word overrated In capacity and insufficiently staffed to do major surgery* The results were ob- vious* It needs such study regarding its method of operation and the control of facilities* Because of the joint nature of most amphibious operations both the Army and Navy are Involved in this phase of medi- cal evacuation* Only joint service planning will solve the problems of the future to the satisfaction of all* The survey previously sug- gested should include this important phase of the medical service in its study and recommendations, 5* „tg„Mat. ZgaBjtf.Xatari-fflir Medical doctrine places the responsibility on the Zone of Interior for this phase of medical operation. Experience indicated the soundness of this doctrine and it needs no change for future ware. More autonomy by the Surgeon Generals in controlling the sys- tem of evacuation is indicated. World War II developed the use of air transport for this phase of medical service to the point where it must be adopted as a major means In the operation of the evacua- tion system. Eeeent developments In the carrying capacity of cargo aircraft presage more economical use of this means. It proved extreme- ly dependable within the Unite to which it was made available for medical nsc. Caution, however, ie indicated In planning for the future in depending wholly on air means for this phase of medical service, especially early in war. Hospital ships must remain the backbone of the systoa until sufficient air means are provided for our needs. Aircraft production is the key to availability and until ve arc represented in production schedules for our needs it is impera- tive that we face reality if we are to accomplish our task. There is meed for mere study in the use and control of hospital ships used for Theater to Zone of Interior evacuation. The uncertainty of ar- rivals in Theaters proved a most distressing experience. Breakdowns which delayed their schedules were a major factor in their use. There has been enough experience accumulated in breakdowns te deter- mine a definite mathematical factor for use in the overall scheduling 474 of trips* Time sad tins again ths demands of theaters for medical evacuation could not be net and because of the local lack of beds this necessitated the use of scarce category cargo aircraft which had to be diverted from its primary purpose* The study indicated should determine not only the factors which led to the constant mechanical breakdowns of the ships but also the sufficiency of the ships we had to do the job* Methods of control by a central trans- portation agency of all hospital ships to guarantee the essential flexibility.Is demanded* the advisability of continuing past practice in assignment of some ships to levy and some to Army con- trol, more adequate communications including liaison systems, and the methods by which theater requirements ean be processed ere fac- tor* which must bo considered. in. gog&Dgjosg. the Committee concludesi 1. That medical doctrines and principles were sound In florid flar XI experience. That where sound planning was dono and sufficient medical means were available, superior results were achieved. That the reverse was true In certain instances* 2. That possibilities of future atomic war affecting the medical services in large overseas bases are pertinent fields for further study and planning* That failure to appreciate these possibilities by provisions for adequate medical means may veil wreck the reputation of our medi- cal services. 3m That there is urgent need for indoctrination and training of naval officers to the end that their medical service Is given the Importance it demands in war planning especially in the field of amphibious warfare. Lm. That clarification of our future status concerning the rules of the Geneva Convention aid other International agreements for the protection of the helpless is necessary. That field hospitalization in the Combat Zone as used by the Army was eminently successful* 475 That there was need for improvement in the technique of reader- lag nodical aerrioo in amphibious operation!. That because of tholr joint nature in many inatanoaa nor# coor- dinated planning ia indicated by the various nodical services. 6a. That the big failure of the aedieal service occurred in the Com- bat Zone because of insufficient attention and the lade of sufficient medical facilities for the definitive care of nodical type eases* That large wastage of critically needed combat troops resulted from this failure of the aedieal services. 7-*- That the provision of a nqw mobile surgical hospital by the Army for use in caring for non-transportables in forward eonbat areas will eliatinate the need for World War II practice of Improvisation in that field. That this new unit will prove ideal for early use in future an- phiblous operations. 8. That in most instances the aedieal service in amphibious opera- tions especially in the Pacific was not satisfactory. That sufficient importance was not given this complex problem by line or aedieal staffs. That intensive further study by experienced medical and line per- sonnel is needed to iron out the difficulties encountered before any- thing specific can bo accomplished to improve the character of medi- cal service In this field. That the supply of standard hospital ships was insufficient early during the war. That the temporary use of troop carriers and cargo ships for medical purposes is unsound, dangerous and not tip to the standard for medical service demanded by the American people for its combat soldiers• 9. That more convalescent facilities are needed in all echelons of the medical service. That each general hospital should have its own convalescent section. 476 IQ. That the aoundnaee of the doctrine which place* the responai- bilitj for evacuation of the next forward medical echelon on the next rearward echelon proved sound and demands no change. That seana to acoonplish their respective alesions Bust be an* thorlaed all nodical echelons and be actually present In war. 11- That there was too much passing of the sick and wounded t>irough successive hospitals In transit to definitive care In all theaters• That better nodical planning and npre adequate and reliable direct evacuation means can prove the answer to avoiding this un- desirable and wasteful practice in the future. That this la a Batter for local action rather than top level policy. 12- That there was universal wastage of nodical means and combat manpower because of the lack of forceful medical leadership in every echelon in demanding the earlier return of patients in hospital to a duty status. That proper Indoctrination in this field for all medical of- ficers was lacking. That because of it* extras* importance disciplinary aeasure* should be considered as a means to enforce implementation of dir- ectives in that field* 13. That anxiety type eases proved a terrific burden on all hospi- tals in theaters of operations. That more careful and scientific selection of Individuals for combat duty offers some hope for alleviation of this medical wastage factor* That administrative action Is indicated to effect the prompt release from medical facilities of this type of individual. 1Z. That more and better consideration for hospitalisation needs of Mr Force troops In Isolated regions is indicated. That local arrangements between the involved surgeons may beet serve the needs of each particular situation. 477 That this is usually a problsa for local determination rather than one of top level control. 15* That tho construction of hospitals by the Corps of Engineers of tho Any during World War II in Theaters of Operation was entire* ly inadequate and that this contributed to serious wastage of nodi- cal nanpower. That definite action by tho Surgeon General to correct this glaring deficiency must be taken before any future ear if the nodi- cal serrices are not to suffer from the sane lack of assistance* That the suggestion that a special section in the Corps of Engineers be est&blishnent for the development of this specialised field has nerits and would prows no worse than the results exper- ienced during the war* That continuing research is indicated in developing acne better type of prefabricated buildings for use in hospital facilities of Theaters of Operation. That types developed so far are not suitable for universal use in the tropics, arctic and tenperate zones• 16. That the recently developed holding hospitals are an inport&nt inprevenent in the process of evacuation. That control of these facilities in the Combat Zone should rest with the Communications Zone which is charged with the responsibility for evacuation* 17. That the evacuation policies used in all areas during World War II proved sound and do not require any further study for reimplements tion in the future* 16. That there is insufficient centralised effort being given to produce more efficient types of ambulances for land, sea and air use in evacuation. That this must be sponsored as a medical problem at once if we are to improve the medical services of the future* 19. That the Any medical doctrine of the past proved sound in ap- plication in the Combat Zones during World War II and requires no change at present* 478 That air evacuation facilities in the Coabat Zone should be provided by the assignment to Xedieal Departaent control of the Field Aray Surgeon ae a nodical unit of not lees than twelve hell* copters or similar type light aircraft. That the proposed air evacuation company should be adopted and be given a field trial. 2Q. That insufficient importance and attention was given fay laval lino and aedloal personnel to the medical requirements of amphibious operations with the result that serious err ore occurred in many In- stances. That a wall developed plan for the indoctrination of all Navy officers in nodical logistics is a prims responsibility of the Surgeon General of the Navy, 21. That Army medical doctrine governing evacuation and hospitalisa- tion in the Communication Zone proved sound in practice. That until more dependable air naans arc at hand adequate pro- visions for transporting the sick and wounded from the Coabat Zones to the Communications Zens fay surface means must continue to bo provided in planning. That when and If air naans do become available to provide separate end primary nee by the ledloal Department that control over then must be vested solely In the Chief Surgeon involved. 22. That recent developments In the carrying capacity of cargo typo aircraft Indicate more economical means for Theater of Operation to Zone of Interior evacuation than during World War II. 23. That the system used for controlling hospital ships during World War II did not Insure sufficient dependability to Theaters of Operation. That this suggestion requires intensive study to elicit the direct causes for failure and recommendations for improvements In the future. 479 XT. mecumniynaB The Committee reecssendst 1. That farther immediate and detailed studies by competent joint arsed serrioe sedieal personnel are mandatory is the folleelag fleldai (a) The implications of atesle attacks on large overseas bases as it involved the sedieal services. (b) The determination of ear future status regarding the pro* visions of the Geneva Convention and allied International agrees ants for the protection of the helpless* This study to include a scans for the indoctrination of all Arsed Forces personnel as to that determined status* (e) The development of sound doctrine end sethode of procedure to cope with all of the sedieal aspects of asphibious warfare* This study to include covering the entire field of floating sedieal evac- uation transportation* (d) The' development of an administrative policy which will sore promptly relievo service hospitals In all rear areas of the masses of anxiety eases during war* (o) The Aevelopsent of a better system tor the control and use of hospital ships during war* 2* That motion bo taken by the Surgeon General of the Navy to enable the desired Indoctrination of all Naval officers In the importance of the medical services in asphibious warfare* 3* That action bo taken by the Surgeon Generals te sufficiently in- crease the number of medical facilities in the Combat Zone to permit of the salvage of sedieal typo cases in thceoearoae* A* That staff action be taken by the Surgeon Generals to Insure the improvement of hospital construction procedures by the Corps of En- gineers In Theaters of Operation over World War IX practice* • 5* That nooessary staff action be taken tc set up a Joint Army, Wavy and Air Force project for the development of better types of unbalances for land, sea and air sedieal use* 6* That sore and better consideration far hospitalisation needs of Air Force troops in isolated regions is indicated and should be pro- vided. 480 TUBE COPT EXTRACT (Utter, Colon.1 0. Mcllmy, KC, Air rare, dated 20 April 1%6) ***** "h. Hospitalisation and evacuation policies within the eowbat son* and evacuation to tho communication son# and to tbo sono of interior are exceed 1 ugly dependent upon the type and loco* tione of the ailitary conflict. However, it is believed that a general policy of woch greater utilisation of airplane ambulances is desired* Medical facilities located anywhere near the front lines should be United to eaergency and first aid procedure, except in regard to the care of military personnel wfaoae condition is such that their return to their organisation within a short period of tine is anticipated* The major portion of definitive surgery should be accomplished well beyond the front lines in the communication sone, thus enabling the establishment of larger and acre permanent medical centers* By this, it is not implied that dispersing within such medical centers is not desirable. The general idea of longer range evacuation of eoloetod casualties to tho Zone of Interior at the earliest practicable date, should be carried further* In other words, the emphasis so far as possible should be placed upon carrying the patients by rapid means of transportation over longer distances to well organised and properly staffed hospitals rather than attempting to carry tho hospital to the wounded *N ***** » ■ ’ i 481 L. K. PohlVColon.1, «C xm .gflEXJffflAOT (Letter fro* Dr. W». c. Hennings-. Topeka, Kansas, dated 23 April 1948} *(h) Hospitalisation and evacuation pollclee in the firet part of the war were totally inadequate for neuropsyohiatrio patients. There were, in spite of lessons from the last war, no plans for the ear* and treatment of one out of every four casualties, namely, the psyehiatrie patient. With makeshift efforts we developed such pro- vision hut these were far from what we should have tyad and should plan for in the event of another war. The Neuropsychiatry Consultants Division of the Surgeon General• e Office has drawn up extensive plans for the treatment of combat psyehiatrie casualties and this plan should he quickly written into the regulations and implamented to the extent of setting up SD's, training programs and appropriat# installations, **♦•••• r—>1—wa:: , L. X. Poki, Oolon«l, MC 482 T8DS COPT (Extract itr K* C. St*ywr, Major Generalt U* S, Arsqr, Betired,19 Apr AS) **** * (h) Hospitalisation and evacuation policies within the combat son#, and evacuation to the comini nation sons and to the sons of the interior* It has bean my experience that this mas dona extrenely vail and I have no consent, except that I feel the hospitalisation and evacuation sere handled with expedi- tion and good results* Mr evacuation should ha used to the utooet**«ft*ft Colonel, Mb" THM MBUOt 00?T (Ur trig tu »ny 3. teal*. , 4td 18 *4>r 48) ••*«* •a. Hospitalisation aa4 miwlloft pel tolas fltM» the Matet com* Mi •▼acnatioa to tho eomunloation mm and to the mi of the 1st tori or - Boro again It ic essential to aaiirrtiad aad npprooiate vfeat Iff# of mlat toa* vo are to kora* The linos of nsMoaloatlons eo*#oiloA la the laropoan Sboatro consisted of praparl/ ooaotrootoi rondo* railroads and air fields at coaro*» loot locations. Ttaa linos of opaamai nation la the fisifte theatre vore or or oast expanses of ocean* the policies, tootles, and tutaifos of the aodleal sorrioo oust to so floodtie as to to rapid!/ readjusted to mot changing com dltions, to the/ aoraal conditions, arotio conditions, or Jungle conditions! transportation and linos of ooaanaication hy load, sea or als»* uk m Colon#!, m im MhASI 0QfY ill* Lionel Robert F, Vllllase, MO, did l« Apr 4«) ***** H. 'Hospitalisation «ai mMillM p«U«ii9 rltlis Uu teabal font, tad tratattion tt tbt cwawltatlM font tad tt tfctttat tf la tartar* flan ptUtitt should la a part tf twiy tar pita tad tit ratal! tf aalfltd staff tattoo* Bo t*t 1st poll tits Wtvaa* aossmaiottlon tad aomtat stat units aotU W latladtd.******* e*i*a*x, ns 485 mm COPY (Lettor from 8oI«mel Bobort K« Sinpson, USA (Hat.) dated X May 1948) ••••• *(h) Homsi tall ration and evacuation policies within the combat »m«, and evacuation to the communication sons and to the aone of the interior, within the conbat tone, evacuation by aircraft certainly is most satisfactory, and it Is ay desire to place special emphasis on the liason type of aircraft and the helicopter. In the coaacrunloatloa tone and to the tone of the Interior, tho use of the larger cargo typo of airplane altogether will depend open the part of the world whore the conflict nay be. X an of the opinion that hoepital ships can bo utilised to an advantage ae floating evacuation hospitals rather than as a Deane of transportation of sick and wounded. This was certainly true la the Southwest Faoifie, and particularly in tho Leyte oanpaign where general hospitals had to be hewn out of tho jungle end nod. The policies adopted during World War II ae to typos of oases evacuated to tho sono of tho intexior, etc,, wore sound and to tho best of my knowledge and belief satisfactory. Psychoses should bo evacuated to the sene of tho interior as soon as possible, Extremely mobile surgical hospitals, with carefully selected trained personnel, should function ae far forward as possible, Tho idea of employing trailers should bo considered rather than tentage altogether. The uee of tentage, in my opinion, should be abandoned; there it no eenparlsoa with the Qoonsot hut and pro~fabricated type of housing,"•••os » L, X. Pohl, Colonel, MO 484 amMma vmi (utter fro® capt. wwi* t. ao, « da tod 20 April 1943) ****** “h, Hospitalisation and evacuation policies within the eoobat zone, end evacuation to the communication son© and to the sane of the Interior, Based on experience In amphibious operations la the Pacific Area during V.orld T*ar II. many of the hospitalisation and evacuation problems in this type of warfare would have been solved if core hospital ships had been available. The utiliza- tion of troop-carrying transports os hospital ships after they had discharged their troops was never entirely satisfactory. These ships were usually overloaded with casualties far beyond the capabilities of the medical staff and facilities aboard. Their primary purpose was transportation of troops , not the care of the wounded. Their utilization as hospital ships wop com- plicated by the many factors related to the combat alto ation. Hospital ships on the other hand provide better facilities for the oars of the sick end wounded* Sene could remain in the area to care for the slightly wounded and thus return them to duty and prevent the enormous loss of manpower occasioned by the departure of, the transports with wen who could return to their organizations''In a few days# During the war In the Pacific In shore to ship evacuation L5T*s designated as “Evacuation Control IST»s" were used as a link between the shore and the ships. The 1ST fs that were used in this capacity were also utilised to boring vehicles to the operation, Aftsr they had discharged their vehicles they were hastily cleaned up and utilized as 1ST (H), the "H* meaning hospital. They were the weakest links In the evacuation chain# If these ships can he assigned entirely to the Medical Deportment on a permanent basis, completely converted, and equipped as small Hospital Ships, they can be utilized suc- cessfully In amphibious warfare # They should be altered to provide clean, readily accessible operating, shock rooms and wards. They should have a medical staff adequate to cere for the large number of oasulaties handled so that they say provide a standard of medical cere comparable to that maintained in other sea and shore- based medical installations# There is need for better control of ambulance boats and amphibious vehicles which are utilised in shore to ship evacuation of casualties. There were, many instances in the Pacific war when these oammlty-carrying vehicles received the "hruehoff* fro® transports and the case wains of these ambulance boats were required to peddle their wounded as they did at Gallipoli in Horld War I# This needless confusion was due to a dual responsi- bility in the operation of these boats. The assignment and operation of boats, amphibious vehicles, and ships for tbs seaward evacuation of casualties is a coaaand and line responsibility. The medical care all along the chain of evacuation is a Medical Corps responsibility# 485 ******* *H (ContM*) The two are closely related* Sob© casualties can be safely novodj others mat be retained where they ore for necessary treatment* When and where casualties are to be Moved mat be decided by the Medical Officer* The duel responsibility com- plicated the. task* It ia believed this problem could be solved by having a line command group operating these boats under orders of the Commander of the operation* This task would also be greatly simplified by having more hospital' ships to handle thu seaboard casualty lift and by having a sufficient number stand in m 0 Day* ** _____ Colonel, U* 8* Amy 486 TRUE COPX (Extract Ltr Albert T* Walker, Captain EC, USN, 26 April 19AS) «**» "The natter of medical logistics in military campaigns, hospitalisation «nd evacuation policies within the combat sone and within the sons of the interior, are all so intimately combined that they must be considered together* I feel that, to a large extent during the last war, too much emphasis was placed on eas- ualty evacuation and not enough on adequate early, definitive surgical oars in the combat sons* In the first place, our so-called mobile hospitals ware not vesy mobile and during a rapidly advancing campaign, such as that in the Southwest Pacific and the Central Pacific, thee# Bass Hospitals were left so far in the rear that much valuable shipping and aircraft ware required to gat the casualties to hospitals from the far beach* Long-tern casualties wars trans- ported at too frequent intervals from one Base Hospital to another in succeeding steps away from the combat sone with no possibility of continuing care, and usually to the detriment of the patient* Long-term casualties should be evacuated directly to the mainland in high-speed ambulance ships or aircraft to minlmiss logistic support of Base Hospitals which are themselves too far behind the lines* The nearest thing to adequate casualty care we wars able to provide in the Southwest Pacific Area was by the use of properly staffed and equipped surgical teams on landing ships, such as converted 1ST*a, Which were set up to receive casualties within a few minutes of the original landing and to operate upon them whan first received* These ships should be staffed not only with general surgeons but specialists in various surgical specialties and with blood banks with complete facilities for transfusions* In addition to these specially staffed and equipped landing craft for the lurodiat© receipt of the casualties, there should be a number of high-speed evacuation ships, such as specially designed APA9s, to augment aircraft on which casualties destined for long recovery periods or whose dfclnate return to duty is not probable, can be evacuated directly to the sons of the interior* These chips must be constructed so that casualty spaces will be readily accessible* Our A PH’s during the last war were very poorly designed inasmuch as much of the troop space which should have been available for casualties was inaccessible to stretcher cases or ambulatory cripples* The sequence of events for casualty ears will then be as follows t fresh casualties are brought aboard specially equipped and staffed LST'S or similar craft, are given early definitive surgical care including transfusions, short- term casualties whose return to duty is definite are kept aboard, long-term casualties are placed aboard the above mentioned ambulance ships (AEMs) to bs taken directly back to the sons of tbs interior or an interaadiatc sons In which logistic problems can be solved locally* The short-term casualties will then bs transferred upon the return of the casualty 1ST from the far beach to 1ST type hospital ships which hare been specially designed as hospital ships (LSHvs) and treated for ultimate return to duty* In this connection, we then have tee types of landing ships performing entirely different functions* the converted I3f*s Which take troops in on a landing which are fitted to carry surgical teems will receive and process casualties directly from the beach* When filled to capacity they retire, transfer their casualties to LSH*s (the specially con- structed hospital landing craft) and the long-term casualties directly to the ships designed as smbalanos ships for transportation back directly to the sons of the interior* These ambulance ships must be properly staffed end provide 487 continuing care for the casualties daring the trip hoses when such early, definitive surgery can be accomplished at the optimum tine* It will be noted that no mention has been nade of the Geneva protected hospital ships (AH)* It is ay feeling that the day of that ship has about vanished and that much better employ- ment can be made of the converted 1ST and the LSH in the combat aone with ambulance ships for the long haul back to permanent hospital facilities* This plan will provide a completely integrated casualty program coordinated at Cabinet level, embracing Military, Naval and civilian cooperation* As such as possible of Medical Department organisations and facilities should be kept afloat* This applies to medical storehouses as well as hospital facilities* Landing craft of the LSI type are readily adaptable to both hospital ships and medical supply ships and inasmuch a s they are afloat, they can be tainted wherever the need is greatest for them* They can move forward with task forces or remain in a reas of fleet concentrations to be used as hospital ships and medical supply ships for the care of the normally sick and injured* There should be no Navy Base Hospitals overseas—all Mavy De- partment facilities should be kept afloat with plenty of ISH's and 1ST type medical supply ships to handling all casualties and casualty care in the for- ward areas* In line with coordinated Military and Naval medical activities, it is felt that all shore based medical establishments should be under the cognisance of the Amy and aj.1 such facilities afloat including all hospital ships be under BikilwIttMmnihmrtrkirtritsp under the control of the Navy. In this connec- tion, it is of the utmost importance that the Fleet Staff be so organised that the Fleet Surgeon is placed on tbs same echelon as the other Department Heads such as the Operations, Intelligence, and Flans Officers and not la a subordinate position under a so-called Logistic Officer as most Fleet Staffs are now organised* En- closure (A) is the organisational chart of the Seventh Fleet Staff showing the proper position fen: the Fleet Surgeon* Plans for hospital LST*e (LSfl) sere drawn and submitted to Nasal Opera- tions from Comaander, Seventh Fleet in 1944* They sere approved by the Bureau of Medicine and Surgery but were slop ed at Naval Operations because of failure to realise that deep draft hospital ships did not provide the facilities for ianediate casualty care which were inherent in the LST plan* (Refer to Commander, Seventh Amphibious Force Secret letter. Serial 00*501, File FI 25/P6/L9-3 to Ccctsandds In Chief, U, S, Fleet, dated 9 Kay 1944•)“ ***** L. K. POHL Colonel, MB 488 TRUK COPT EXTRACT (Utter, Colonel C. J. Beker, KC, Air Fore# dated 22 April 1948) *♦♦* "h, Hospitalization within the combat zone should be of aa short duration aa possible, only enough surgery and Redicine pfactieed to prepare patients requiring definitive treatment for transfer to the communication zone and the zone of the interior, with a policy of short tine illness and injuries being returned to combat without evacuation, where possible* Evacuation should be principally by air; other methods being used only where that mean is not possible. The use of helicopters for short hauls should be thoroughly developed.* **** rang con EXTRACT (Letter, Rear Adrlral C. L. Andnw, («C) TOR dated 27 April 19A*) •*•** * (h) It is believed that the hospital and dispensary units as developed during Jforld War II, in the form of *G* components, provide excellent and adequate facilities for the general hospitalisation of patients within the combat zone* Special medical outfits such ae those furnished for the marines in amphibious operations and in forward posi- tions were greatly improved during Eorld Kar II and are considered to be entirely adequate* However, these outfits should be kept under constant revision and any new developments incorporated as indicated* In time of war it is believed that all hospital ships should be opera- ted by the Kavy but beyond this opinion it is felt that evacuation policies can best be commented on by someone more familiar with eva- cuation problems*• ***** \ L. I« Pohl, Colonel, MC 489 IMJSElJKlMgl (hotter from Captain M. J. Aston (MO), 081 Portsmouth, Virginia, da tod 23 April 1948) ooooo lospitalisntioa and evacuation policies within tho ooabat ■oat, and evacuation to the eomunioation seao and to the soaa of tho interior. Eero again X thlxflt that thooo policies as X obs erred then to bo carried out voro sound. Tho vouadod in aoeordaaso vith thoir needs wore brought to proper disposition in tho shortest tins practicable and possible. The use of aircraft in those proceedings vas also nest efficiently employed. Those personnel oho required eraeuation to eeamni* cation aonesor to the sens of the interior were sent ‘Seek as soon as proper facilities were available. Therefore, discrepancies la this regard vers bound to occur, the lightly vouadod were in nan? instances soon to return to ooabat. The eaae ie true of a&ay of our sick. The physical means available to carry out thee# evacuations were several in typo and la all probability would be those to be employed in n future conflict. They all served well! With on adequate amber of evacuating aircraft, hospital ships, and hospital transports many of ths sarly diffi- cult iss vs in ths Solaes saeouatsrsd could net occur. In ths beginning of ths war it seemed to ns that vs wars evacuating a greater amber of ever combat personnel then was neoesaary fron a strictly military viewpoint. Later on a tightening-up policy was employed, which in no instances accord- ing to ay knowledge resulted in unfair or unjust treatment or neglect of the individual.* ••••• L. K. MO 490 TRUE COPT (Extract from Ltr Alfred ff* iyort Captain (WU), USN, 17 April *48) (h) Hospitalisation and evacuation policies within the combat zone and evacuation to the coorrunication sone and to the one of the Interior* It is believed that hospitalisation and evacuation policies for Naval personnel in the corabattant and communication sones wore adequate • < However, In future warfare, it is that due consideration should be given to more extensive evacuation from the sone of communication to the sone of the interior* This infers the provision of minimal required hospitalisation facilities in the comrfamicat'on sone and rapid evacuation of casualties, preferably by air* Treatment in the combat sone should be limited to strictly emergency work* Good definitive care should bo given in the coBuranicailons sone* It is not believed that retention of casualty non-effectives in the sone of communication for more than thirty days is practicable or feasible* Further, consideration should be given the medical establishments in the commnications sons based on probable types of warfare to be encountered* in possible total war, small well dispersed establisfccients are considered more practical* ... ih L. K, Colonel, JC TRUE COPY EXTRACT (Letter,vDr. Russel V* Lee, dated 18 April 1948) ***** * Hospitalization and evacuation policies within the eonbat sons and evacuation to the communication zone and to the sone of the interior. *Again, the utilisation of air transportation would change everything for the better—small planes and helicopters close up in the combat area, larger transports further back, casualties cared for with 2 bases 500 miles to the rear in really definitively equipped and staffed hospitals. Air evaluation also makes possible the immediate removal of most casualties to tee sons of Interior to be cared for in hospitals nearest their homes," ***** L. K, Pohl,\Colonel, «C 500 TROT COPT EXTRACT (Letter, Captain Robert H. Clllett (IK) OSS dated 15 4rll 1940) ***** "Hospitalisation and evacuation policies should remain •fluid* and be left to Task Force and Area Commanders insofar as practicable.1* ***** L, K, Pohl, v jpF TRPK COPY KXTRACT (letter. Colonel John A. Roger*, «C, B3i (Ret.) dated 19 April 1948) ***** "H. Hospitalization and evacuation policies within the fisstiat-iflnfl-ana. evacuation to the eoganmicatioo zone and to the zone of the interior, "It is believed that, in general, with the medical service well established, a ten day period of evacuation is suitable within the Army area. The 3000 bed Convalescent Hospital, or two 1500 bed Con- valescent Hospitals, will provide the necessary facilities for the care of such cases. Any patient needing more than ten days* hospi- talisation should be evacuated to the contaunlcation sone." ••*** I.. K. Pohi; Colonel, MC 501 TRUE COPT (Extract from Ltr. Col* Harry G. Armstrong, MC, 16 April 1946) «*** ***• Hospitalisation and Evacuation Policies Within the Combat Zona and Evacuation io the £om:lunicationIona and to the tone of interior* (1) Defectsi (a) Complete control over hospitals by Ground Forces. (b) Arbitrary standards of svacuation. (c) Failure to appreciate and use air evacuation of patients* (2) Remedies i (a) Air Force have its proportionate share of hospital beds* (b) Air evacuation from confcat sone of all possible patients* (c) Evacuation to the sone of the interior rather than establishment of advanced hospitals *• L* K. Colonel, 1C 502 TBUE COPT CSxtrmct fro* Ltr W* H* Michael, Hear A&iral (MC), USN, Retired) «««* *Hosp itallaatixm la the combat none in the 7th fleet sas and should be predicated on Inability to do duty* The extent or distance of evacuation should be determined on the estimated length of the period of disability and the strategic situation* That is. It nay he advisable to keep a pat#lent at an advanced hospital who has a prospective disability of as long as 2 seeks, while operational prospects way dictate air or other foxms of evacuation from advanced hospitals for patients who have a prospective disability of only 3 days* The same principle should obtain all along the lints of cnmawiri cation returning to duty those able to do duty and keeping or passing the others along depending on the prospective periods of disability and as directed by the staff nodical officer based on his estimate of the situation* In overseas duty acme criterion as to length of estimated period of disability should be established and all vith a longer period should be sent to the United States* "Definitive evacuation to the United States fro® the 7th Fleet was being abused when 1 reported, so that the fighting services sere losing uselessly several thousand sen a month - many entirely rrorweedical problems* That is, cosaanding officers used and misused the medical department to rid their units of all men who did not measure up to their standards of discipline and ability* Many of these men sere finally demobilised with a psychiatric diagnoses* "Another item I consider important* ®e found a most valuable means of evacuation in the Southwest Pacific was the L*S*T* equipped as an evacua- tion ship* About one out of six of the LST’a used in an assault saa converted Into an evacuation ship aa soon as it had sent Its troops and transportation ashore* The details of the setup should be available in the archives of the 7th Fleet* This idea to put hospitalisation at the shore with the assault group should still have it utility* ' "I hm had no exporieno* oa evacuation la tho mom of the interior except vneoatlOQ to anecialixod hoaoltaXa tram Lena Beach* that 898tea 888Md eati«f*ctory>» 2* U PCHt \ 503 TgOB SOFT EXTRACT ). Probably the greatest single factor which contributed cost to the aorale of the wounded nan was the realisa- tion ti-.it he would be evacuated to the ooaaunloatlon sons as speedily as possible. This evacuation policy may have la soae instances resulted in the evacuation of soae wounded that night hare recovered equally as well within the oonbat tone. It is believed, however, that such were rare instances, and our hospital ships, hospital ship auxiliaries and personnel transports were aost effective in reducing the aorbidlty rate through early evacuation and supportive aedioal and surgical ears enrauts. The eone of coavunieatioa was well prepared to take over the care and treat- ment of the evacuees and prepare then for further evacuation to the cone of interior. The general polioy of evacuating all wounded dorian the early days of an assault was a most small sat one and relieved the flald and evaoua- tloa hospitals of a heavy burden. With the successful progress of the campaign, it was feasible to held battle easualties for a longer period of tine, and a fair percentage of such eases were successfully treated and returned to combat duties as hospital facilities became better established. ... /P /7S- / 513 L. K. Pohl, Colonel, KC XM QQPT KI1UCI (Utt.r fro. CteptaU 0. Jr., (KO). OBI dated 19 April 1948) ***** *2he maintenance la read/ rmm of am adequate somber of Hospital Ships that oaa he put lato commission tooa after the outbreak of hostilities. Hospital ship* hare ae other mission than the care of oasualtlsa. They oaa receive casualties directly from the beachhead. This eliminates one stags * in the seaward evacuation chain along with the dangerous shook Incident to repeated casualty handling and the delay in treatment which often results from the uncertainties of destination and reception of the ambulance boats.**•••• TRITE,'COPY EXTRACT (Letter, Brig. Qen. Robert C. McDonald, MC, USA, (Ret.) dated 15 April 1948) ***** "(h) Hospitalisation and Evacuation Policloe within the Combat Zone, and evacuation to the Communications Zone and to tbs Zona of the Interior. *(1) Comment and Hospitalisation in the Combat Zone should be in mobile medical unite and should be of short duration. Patients requiring over 3 days' hospital cars should be evacuated from divisional and corps unite to Army milts. Those requiring more than 2 weeks' care should ordinarily be evacuated to Communications Zone hospitals. Seriously ill and wounded patients should be transferred from the Combat Zone as soon as transportable. Except in theaters remote from the ZI all patients requiring 90 days or more of hospitalisation should be evacuated to the Zone of the Interior." ***** L. X. Fahl. CHoma, MO 514 TRU1 COPT EXTRACT FROM Aik KTALUAf 10.1 BOARD SKPA HSPOftT 10. S£. THA MAGICAL SUPPORT OF AIM WARFARE U TH3 rOUTH A£D SVj?A FROM DAG 7, 1941 TO AUGUST 1945. •••••**«•« S» "The medical care rendered by Air Force Medical Officers In unit dis- pensaries v&e of high quality throughout the war* Group Aid Stations were not used to any greet extent because of the limitations placed upon the type of case that could he treated lu these installations* Portable Surgical Hospitals proved to ho extremely useful in the care ef Air Force troops whea they were under the operational control of the Air Forces. However* the Air Forces did mot have administrative control of these units. All Air Force troops wore hospitalised in Service of Supply hospitals, this procedure was unsatisfactory to the Air Forces because of the administrative problems which resulted, though the prof- essional care rendered was excellent. The Air Forces wore unable to obtain in- formation on these patients concerning their location* the probable period ef hospitalisation, their eventual disposition, and the diagnosis and typo of treat- ment given. As a result efficient forecasts of future replacement requirements were not possible. The assignment of hospitals of all categories to the Airforces was, therefore, requested but not approved. The designation of certain General Hospitals for the reception of Airforce troops did much to relieve some of the administrative problems confronting the Airforces lu the hospitalisation of their personnel. An Air Force Convalescent Trai ning Program was developed and used in conjunction with the General Hospital* designated for reception of Air Force patients. This program proved to be an efficient method of conserving manpower by rapidly reconditioning Air Force patients. Without this program it would have boon necessary to evacuate many of these patients to the Zone of Interior. **••••♦• . kc 515 tmm ixmef of judical of ths osaaf is ths sosqpsab t-oRtm or GFIRATIOiS. HISTORICAL SBGfXOV - AFTAJ5 ********** 8* *The hospitalisation of «u«i it ftritlih liUUiy aad elriliat hos- pltals, mad* MMisaiy «t first because of the widely dispersed a&i Iiait«A number of American hospitals, was discontinued as a general policy whoa American hospitals became established within roach of Righth Mr Foroo airdromes. The coordination aad service {im our foreos V British Institutions was oa tho average satisfactory. Xt was also doelAod by ths Commanding General, BT0TJ3A, that the evacuation of cas- ualties by sir im the Xaropoaa fheator would ho the responsibility of the Mr Foreos. furthermore, aad finally, hospitals of the harries aad Ground Forces aad the Salted Ilugdem vers established without record to troop cone saturation or tho allitary aodloal problems of the Mr Forces within the theater. For exampls, at Burtonwood, Foci and, where spproxlmately 30,000 Mr Fore# troops wore stati mod > only a dispensary wee arsilahla for nodical ssrriee. it Frestwlck, Scotland, which was the serial port of ombarfcaliom for patleats oareute to the Zone of Xntorlcr, tho nearest hospital was 50 alios distant. As a result of such poor distribution and the Halted number of OS Any hospitals, a lores part ef the hospital I* ation of Eighth Air Force patleats was accomplished la Royal Mr Force fSAF) aad British Civilian Emergency Medical Serwice Hospitals. Many of these hospitals wore def- initely substandard according to Marl eon standards. During the reminder ef the war la the Barepeaa Cheater of Operations, The Surgeon General jealously guarded the right to control theater hospitalisation. At the mm tine, however, The Mr Surgeon ms quite anxious for the Air Forces to control its own hospitalisation la tho theater. This situation Between tho two offices stast he taken into consideration la evaluating tho various reports of theater hospitalisation. Hospital Facilities for AAF Lag far behind Schedule. Inasmuch as Services of Supply was responsible for all hospitalisation in tho European, Theater of Operations, this section is concerned principally with tho efficiency of the boo* pitalisatlon service furnished to the Mr Forces, and, ineldoatly, to tho efforts of the Mr Forces to secure control of its hospital i sail on. That hospital facilities aad supplies, like ether equally important war Measures, should be far behind schedule was not unexpected. As rescans for thin situation, however, were apparent* ly not fully appreciated by all the officials involved. Ool. W.S. Wool ford, in an laepectlcn report of 7 May 1943, stated that the development of the hospital program for the American Foreos la the Baited Magda* ms * besot with many difficulties, and in an aaasing story compounded of effielal British inertia, evasions, inability to qppireeiato or unwillingness to accept the American hospitalisation plan, aad of labor and material shortages." Maj. Gen. Ira 6. Baker, Commanding General, Eighth Mr Fores, complained about the moatlsfaetozy situation of hospitalisation for tho Sigfeth Mr Force on Id February 1943. The chief difficulty seemed to be tho delay in opening Amor* lean hospitals. So stated that it was necessary to hospitalise approximately 30 percent of Eighth Mr Force personnel in British hospitals. This was unsatlsfaetoiy because the British hospitals were often understaffed and, hence, not able to give tho detailed care desirable. Another unsatisfactory situation ms the location of Anri can hospitals in areas distant from Mr Force stations resulting In long linos of evacuation. Throe charts wore attached to show that American hospitals were chiefly located In the southern part of Ragland where there were practically no Mr Force units. There were 5,600 Mr Corps troops la ths Burtonwood area and 516 THUS EXTRACT COPT OF MBOICaL SUPPORT OF THIS USAAF IR Tli£ BUHQPBAM TRaATSK OP OPERA- TIONS, HISTORICAL SSCTXOH - AFTAS, COKTIRUSOi tha nearest American hospital was 75 miles by road. Bsither vas there a hospital functioning in the London area where there were 5,600 Sighth Air Force troops. It vas noted that a hospital vas proposed for the St. Albans area north of London; however, this site would be 22 miles from Vide Vlag and 20 miles from High Wycombe. That the hospital situation was unsatisfactory is evident. But the reasons for this unsatisfactory condition, however, were not due to tha lack of efforts on the part of the Chief Surgeon, European Theater of Operations. Upon receipt of the letter from General Baker, Brig. Gan, Paul R. Hawley Chief Surgeon, European Theater of Operations, answered with a complete statement detailing Ms efforts to secure ho spl tall cation, and pointing out the difficulties which he had encountered. General Bavley was of tha opinion, after having receiv- ed General Baker*s letter, and after a recent conversation with him, that tha Com- manding General, Eighth Air Force, did not have all the facts in the situation. This opinion was responsible for the detailed history of the hospital program which was sent to General Baker. A part of the difficulty was attributed to the British system of committee planning which vac adopted by the theater. It seems that the theater general staff abdicated in favor of the London Bolero C&rusittee as soon as it was formed. The committee which was responsible for hospitalization was the Provision of Medical Services Subcommittee, which was a sub-subcommittee reporting to the Accommodations Subcommittee which, in turn, was responsible to the London Bolero Committee. There- fore, the committee which was responsible for hospital service was far down In the organisational scheme. Then General Howley found, to his surprise, that "none of these committees, not even the London BOLERO Committee Itself, had the slightest authority to order anything to be done, or anybody to do if. Taking cognizance of this situation and the fact that the hospital program was felling far benind. General Bavley began a vigorous campaign to get action. Eventually a visit with General J.C.H. Lee to see Lord Portal, the Minister of Works and Planning, did get results. General Hawley regretted the "Inaccurate picture” of the hospital plan as shown by General taker's enclosed maps. Attention was called to the fact that general hospitals served the theater as a whole and that their location was more dependent on rail and road communications and success to ports than on the location of troops. Inasmuch as Great Britain included such a snail area, practically any hospital existing in the country could be used. That four of five of the hospitals obtainable were in Southern Command is due to the fact that they were absolutely all that were sellable, and they were not chosen because ground force troops were located here. As for the station hospitals they had to be built, for no existing plants were obtainable. These station hospitals were built in the area where the Sighth Air Force, with a strength of 17 percent of the theater, was allotted 25 percent. This was based on the promise that the Sighth Air Force would be suffer- ing casualties while the ground forces stationed in Britain would not. Although the whole hospital program had bean delayed, there was less delay in the hospital construction for the Eighth Air Force than for other units. General Hawley put it in this language: "You have 25 percent of your new station hospitals; the rest of ETC has exactly none! 1 know that this is fl little solace when you need all your hospitals, but 1 hope you do accept it as evidence thrt we TEOE EXTHACT COPT OF MEDICAL SUPPOET Of THS USAAF IS THE ZUHOPKaM THEATER OF QFEB* ▲flOSS* MISTOfilCAL &SCTIOS - AFSAS, CofiTlSPEat have tried harder to get you your hospitals — only because you seeded then more — than w hare tried in the program as a whole* It would appear from this corresp- eadeaoe that the delays In hospital construction could act he attributed to the lack of effort* on the part of the Chief Surgeon* European Theater of Operations. Colonel Wool ford, referring to 8 considerable controversy between the Surgeon, Eighth Air Force, and the Theater Surgeon* over lack of American hospitals for the Eighth ▲ir Force, cane to the seise conclusion. After a Study of the correspondence rela- tive to the hospital program, he was convinced "that the theater Surgeon was a Victim of circumstance« beyond hie control, and is blameless*. lo Withstanding a lack of a full appreciation of the true hospital sit- uation, as evidenced by the letter of General Baker, the fact remains that lines ef evacuation to general hospitals were long, and that the progress ia construct- ing station hospitals was very slow. The complaint ef the Air forces, then, waa a means ef initiating action to correct this unfortunate situation. The Air Surgeon, however* continued hie efforts to secure the authority for the Air forces to control hospitalisation la the theaters, To provide a just- ification for this cause. The Air Surgeon east out a detailed questionnaire, in Kerch 1944, to the surgeons of all air faces asking specific information on hos- pitalisation furnished V Services of Supply* In a letter to Col. Harry &, Arms- trong. Surgeon, Eighth Air Force, She Air Surgeon stated: “The possible saving of nan-days which would accrue to the AAF if AAF theater hospitalisation were author- ised, continues to be a natter of great concern to this office. The answers to this question in the questionnaire sent out March 1944 froa this office reveal that an important saving could bo effected.* It appears, however, that by August 1944 General Grow no longer agreed with the Air Surgeon in his contention that man-days would to saved if AAF theater hospitalisation were authorised, that is, ia the JcTO. In a letter to the Air Sur- geon, which was approved by General Grow, it vac stated that "no appreciable sav- ing of aan-daya would result la AAF theater hospitalisation were established. Ex- cellent cooperation in this regard has been secured from SOS hospital units serv- ing the Eighth Air Force.* On the question cf policy concerning hospitalisation, the board con- cluded: "In view ef the long established system of hospitalisation in the 1T0 aad contemplated new operations, it is felt that any change in the general prin- ciple of hospitalisation in the ETC at this time should not to recommended. These field hospitals seemed to satisfy the peculiar demands of a tactical air force. When the fighter groups wore operating from fixed bases in Britain, where hospital b wore plentiful, SOS hospitals could be used; how- ever, on the Continent, the tactical air force was either operating from forward fighter fields or from behind airfields being constructed In the Army area aad ahead of Communications gone installations. Hospitalisation for Air Force per- sonnel then would have to to either in the Army hospitals of the forward areas cr to the rear In Communications Eons hospitals. The field hospital units proved to be extremely desirable because they w«re located from the standpoint of the air field. The rapid movement ef tactical air force dements made planned hos- pitalisation dependent upon it being a function of the air force* 518 TKDB BXTIteCT uOPY Of MSDICAL SUPPOBT OfTHTtfSAAF IS THE SUB0PKA8 TiTSATKE Of OP 1ft- AXIOMS, HISTORICAL SECTKW - AfTAS, CCEfYIMKIh Evacuation in the United Ilngdoa. Wounded or sick Air force personnel received initial treatment in Air force dispensaries* Patients whose condition required farther treatment were cent by ambulance to SOS station hospitals and general hospitals. If patients were hospitalised 30 days or lest they were re- turned direct to their unites however* if they were hospitalised for a longer period than 90 days they were returned toAir force Replacement Centers. Evacuation from the Continent. Battle casualties and sick and noifc- hattle Injure#, were sowed from advance airdromes In Army areas to evacuation hoe- pitals after treatment In aviation dispensaries* from Air force Installations In the Communications Zone, patients were tent from aviation dispensaries to the nearest station or general hospital* Personnel from the field hospitals or plat~ oone of field hospitals likewise were sent to the nearest station er general hoe- pital,•♦••♦••see L,£. FOM& Colonel, MO EXTRACTS wf elements made by Brig. O-ea, Robert O. fcoDonald, MG Sa (hetired) 81 April 10*«, before tho Subcommittee on Military Medical Resource*. "Hospitalisation and Evacuation Policies within tho combat Zone, and evacuation to tho Communications Son# and to tho Zona of tho Interior. Hospital- isation la tho Combat Zone should bo In mobile nodical units and should bo of short duration. Ve started into Australia and into the Southwest Pacific with the Idea we were going to have to put up lot# of prefabricated buildings, and It would bars been a grand thing If wo had had those ready* but I think that part of the war was about ever by the tine wo did get thea over* I didn't go over to the theater very each* but I suspect they weren't ready* I do think we should have prefabricated buildings ready in tine tho next time, because they are of very great advantage in tho tropics. I think tho levy, froa reports I received, wore ahead of us in that respect. They did have better provision for their mobile hospitals, snail onss, than the combat area. X think that the Division area, for exasple, up near the front, really shouldn't try to hold patient* mors than two or three days. In maneuvers and la combat in the first world war, X found that was impracticable if you are getting very many wounded and sick. You would have to clear those units because they have to be kept mobile and bade in the Aray area In time of active combat two weakt would certainly be a maxlama, or in the ease of a badly wounded nan who had no prospect of returning to the front lines soon, or a seriously ill man, return him to the rear as soon as he was physically able to stand the transportation. Regarding the polley of evacuating to the £X, 1 think that depends so mush upon the situation, that ic, the else of tho war, the nature of it, the strength of the enemy, the lines of communication, and the distance froa the hone territory, and bo on, its very difficult to determine that.. I think that we first started out in the world war to go on a 90 day policy, and I think some of our patients froa India got to San Francisco about the end of the 90 days and wsre ready to turn right around and go back, and they did get well, and that was too short, of course, a time for a theater like that. On the other hand* I believe It was G-eaend iiawley *s policy in England to rotain hie people six maths. that war, he for# the active combat started* however, during th# assembly and mobilisation of the force for the attack on Europe, and It apoareatly worked ell right* It did enable hla to build up hospitalization which would he ready for the peak load when It did coae, which 1 think was a very fortunate thing; hut eosaowfaera fro® 90 daye to six months is probably the tone for retaining patients in the coaasunlcations sone or In the theater of operations* 'zfkJ&D L*K. P0KL.C8WJSXI,, HC TfilTE EXTRACT COPYi (Extract of ctete wants node by Colonel Thomas J« Hartford, UC, CM on 23 April 48 at interview with Suboonmittee on the Employment of Military Medical Resources) ***** «h* X an speakln*.; of medical cases, tonsillitis, Httla fevers* It hae teen known generally that hundreds of thousands of these Individuals, doe to lock of facilities in forward are«% found theneelven In rear medical installations developing •hoopitalltiB1’ to major extents and thereby preventing their return to a full-duty status inordinately* That's true, but part of that then was lade of Interest on the pert of the asdloal personnel to retain those oases* They weren't interesting, and with our present emphasis on professional nodical oare only X think it will be worse ninct tine* X don't think it would make any difference bow aaany Installations you put out there* I still think the people will find a way beck) but I think this convalescent hospital, especially as it's being reconstituted, Is a good idea* tie kept a lot of patients in there* I don't mean to say we were the only A nay that took care of these people, because we didn't take oare of them either* tie went aerose the Rhine* For 26 days every patient we had was hauled out by air* It wen nighty easy to take then down there and get rid of then in a hell of a hurry* The Air Corps hauled out about five or elx hundred a day for us for about a Month straight without a day's gap, and they want) but if wa would have had a general hospital or sows thing in the front line, I still think we would have lost a lot of then we shouldn't loos, that should be kept in the forward area* I don't know bow you are going to obviate that* X naan, I think there is nose to it than lack of facilities* Salatlve to air evacuation, in the theater X was in certainly they did wonderful things, things we didn’t believe they could do# They ears hauling patients oat regardless of what the history says on Omaha Beach about 0-2 or 3» doa to their shill and daring; but It was always, insofar as we were concerned, a bonus, and whan the Air Any became tactical quite frequently we depend on it das to the necessary secrecy in planning, and so forth* tis at times had oar holding units filled with patients only to find oat at a very lata data that ws didn’t have any plants costing in to pick up the patients, and thosa holding units wars mot staffed to keep these people very long* The system amd the liaison I don't tMie be improved upon very mush, but the vheXe fact wae that it was a bonus, and daring the latter stages we couldn't depend on it ae much ae wo would like* 521 CC«T>D **** " R* How, whether we coaid have pianoe for evacuation only, I an sot prepared to defend, because it would hove to be defended upon an absolute wd and the fact that It couldn't be worked out any other way* Perhaps if a certain umber of planes could be set aside for administration* supply sad evacuation, that that could be worked out, but X think it's something that la important, and X think there has to be some compromise between the people who say, “Well but you have ambulances, there is no reason why yoa shouldn’t have your own airplanes," end to people that eay it has to be strictly on the basis of a bonus* "Hospitalisation and evacuation policies «* Well, X think you have to have a hospital evacuation policy if you arc going to do any planning* even if it has to be changed occasionally and it can’t bo followed absolutely* In other words, if you have a 120-day evacuation policy and a man was going to be in the theater for twice that long, you went to rend him home, of course you have to wait until his condition permits his being transferred to tbs sons of interior* Z think that perhaps we should be thinking—and someone may be—about utilising air transportation} that we may be able to cut down our over-all requirements of fined beds in theaters by trans- ferring more people to the sons of interior ae our lift in planes becomes greater, development, which 1 suppose they will* «**«**«« L, K, Pohl HQ XXTSACT OF STAfSHSBTS MASS BY CAPT. S.H. KSHIN8, JR. . (MC) USB OB 22 APRIL 1948 Af 1HTBKTIBW WITH SOBCOMMITTKS ON TiiS BKPLOYHSXT OF MILITARY RADICAL RESOURCES. •*»••*«** «abother thing at Saipan in our planning for oar hospitalisation ashore, at tho last adnuto we wore assigned a corps nodical Battalion which had never had a day’s training. They had nor or cron tarn thair equips out or sat it up. And vo had oaa field hospital from the Any. plus two surgical teaas to Beak up three divisions. At that tine I didn’t realise hov inadequate that support was. until X went to Okinawa and mw the way the Anqr Back up thair divisions. I think thay had 14 fiald hospitals oa Okinawa Backing up a front of throe fighting divisions. Tha Is a traaandous diffarenas. Vs didn’t at that tin#, let ne say. realise the auoua$ ef hospitalisation that was necessary on the target. My division hospital had a deslgnatad capacity of 800 Bads. At oaa tins wo had 1.543 patients. I have no further consent. But I would like to reiterate that Z think the Amy should accept responsibility, and the levy should actually gat out of temporary and ssulpemaaent hospitalisation for tho reason that wo do aot have tha personnel. and we never will, with the Background to sake oaa of those things function wall enough. **••••••• TRPB B3CTSAC* COPT (Lir Brig. (ten. a.ft. Xsnn shook, Bontal Corpst did 7 Msjr 48} ********* E> *AU aaxlllo fas 1*1 UJuriii which will roqnlro long hospital lint Ion should bo oraeuatod as soon as transportable to ihs Zona of ths laiorior. Vo ireataont othor than th«t of an oaorgoncgr natvrs should bs cirsa for ihoso oasos In ihs ooabat or eoaswnloatloa *oa*s» •••♦♦•♦•*• ©sirT m c 523 THUS KXTHAGT COPT Of RADICAL SUPPORT Of THIS USkkf Iff THIS KSDITEfiHAMSAS TfiSAT H HISTOJBIGAT, S20TIOI - KTTAS ********* H. ’Originally no hospitals wr« attached to the Air Forces la the Mediterranean Theater. Hospitalization was the responsibility solely of the Ground Forces. For several months after the invasion of lorth Africa the British were responsible for hospitalization in the area of and east of Al- giers, and the United States was responsible for hospltfdization west of that city la the areas of Oran and Casablanca. During the first month of the Invasion several United States Air Force* unite vere established in Tunisia# The nearest American hospitals were in Oran# some Biles distant, and British hospitals In the Tunisian area ware few la number and overcrowded and were frequently moved to keep contact with ground forces. Moreover, unfamiliar routines and the rather formal atmosphere of British hos- pitals lowered the morale of American patients, and there was considerable danger of their becoming lost to their units in the British evacuation chain. In these circumstances great reliance was placed upon evacuation by air from improvised group dispensaries and holding stations* la March 1943 American hospitals hocame available la the area of Constantine and in Tunisia, relieving to a great extent the critical situation. Some difficulties, however, persisted. The rapidity with which Airforce units frequently moved from airdrome to airdrome and the invariably wide dispersal of airdromes over long lines of cos&iamications made adequate hospital coverage extremely difficult. Xruaany areas hospitals were separated from large airdromes by from 30 to 90 miles of almost impassable roads. Moreover, during the final phase of tae Tunisian Campaign brief crises occurred when movements of the Ground forces left the Air fore® units In a relatively Isolated position with reopect to hdapitale. The occupation of Paatellerla In June 1943 presented a problem unen- countered previously, since no Ground Forces were employed in that mission. In order to provide hospitalization on the island the 34th Station Hospital was attached to the Twelfth Air Force for the three months' period of occupation by Air Force units and mis placed under the supervision of the surgeon of a pro- vision?:! Air Force organization designed to administer the whole island. During the campaign in Sicily in July and August 1943 a large portion of the casualties were evacuated to American hospitals iaKorth Africa. American hospitals in Sicily wer~ first located in the vicinity of Palermo# while sev- eral British hospitals were established in Catania. Owing to the difficulties experienced with British hospitals, American units stationed in the vicinity of Palermo were earoloylng air evacuation as late as Kay 1944, The end of the Sicilian Campaign found several Fighter Groups sad a Fighter Wing in the Milazzo area# other Fighter Groups sad a Fighter Ving la Palermo and Troop Carrier unite in Catania. A platoon of an American field hos- pital was stationed in Kilazzo during a part of August. After its departure the units in that area had to evacuate patients westward along the northern coast to an American evacuation hospital near San Stefaao. The situation in Kilazzo became increasingly difficult as troops poured into that area in prep- aration for the Invasion of Italy. 524 THJJK EXTRACT COPT OF MEDICAL SUPPORT OF THE USAAF IS THS MBDIT;3U&K&AK THSATLE HISTORICAL SECTION - AFTAS, COLTpU^ Oaring the remainder of the /ear. as tactical Air Force units became relatively more stable. Many of the difficulties that existed previously disap- peared. The elements of the Twifth Air Force that participated in the in- vasion of southern France, W be sure, experienced temporary hardships with respect to hospitalisation. Evacuation hospitals accompanying the rapidly ad- vancing troops unavoidably left Air Force units with ho hospitals nearer than 40 or 60 miles. However, the arrival of fixed hospital installations in the rear, corrected this unsatisfactory situation, Elsewhere — In Sardinia, Corsica, and western and southeastern Italy — ample hospitalization facilities were at all times available to unit of the Twelfth Air Force. For the Fifteenth Air Force in eastern Italy hospitalization facilities were excellent — a cir- cumstance attributed in part to the fact that hospitals in that area were attach ed to the Air Forces. Many of the difficulties in hospitalization experienced by Medical Department officers responsible for medical services in the Air Forces were attributed to the fact that so hospitals were assigned to the Air Forces in the theater. Although assighment was considered preferable, to attachment, it was generally agreed that the attachment of several hospitals to the Air Forces in eastern Italy greatly improved the situation in that area with respect to hospitalisation of Air Force personnel. Although the attachment of hospitals to the Air forces proved to be. on the whole, a satisfactory* arrangement, there remained problems that arose from the lack of training and experience on the part of hospital medical off- icers la aero-medicine. However, as hospital personnel became conditioned to the hospital requirements peculiar to aircrews — a situation that developed in attached hospitals end in mazy instances in ether American hospitals in areas occupied almost exclusively by Air Force troops — excellent services were rendered. vO Z*nC TOHL*\OoIoa«I, MO EXTRACT OF STATEMENTS MADE BY COLONEL OSCAR S. REEDER, 16, OS A, OK 15 APRIL 1948 AT INTERVIEW WITH SUBCOMMITTEE ON THE EMPLOYMENT OF MILITARY MEDICAL RESOURCES• *•**♦ "(H) 1. The sain factors demanding changes vers changes in the tactical situation, I do consider it necessary that a goal to establish evacuation poll elds be made knowing for certain that changes will hare to be made. I think they were toe rapidly followed, that good judgment was not always used In selec- tion of cases for evacuation and professional decisions were not always good for reasons that were not professional. In nary instances professional officers did not sake the decisions. An evacuation officer aade the decisions and he did it by rule of thumb to the great detriment of the Amy from the standpoint of Manpower. I believe Chiefs of Service in the hospital should decide who would be evacuated and these decisions should be carefully checked by the commanding officer to see that these policies are carried out. *2. Tea. There were too many Medical cases evacuated In the forward areas. - Increase bed capacity for nodical cases. Doctors don't have to be specialised but units could be specialised. I believe the basic organisation of the evacuation hospital as now established is sound because the evacuation hospital as near organised has sufficient personnel to carry on in ccnbat for a sustained period. In tines of stress, however, they do need the addition of surgical teens to augment thee. *3. I believe there are some bad points to it. Verf often the rear echelon does not feel the pressure up forward or the rear echelon doesn't have sufficient transportation to evacuate the casualties. I really believe the Army should be allowed to evacuate its own casualties to the rear If it has to hut should be provided with sufficient transportation to do so. I believe the CZ should have the responsibility. I believe the theater com- mander should be cognisant of his responsibilities in this matter. Re re- covered cases - yes. There was considerable loss of manpower by overstaying la hospitals and by patients being evacuated further to the rear than neces- sary because the Medical Department had no place to put tfcen. A definite directive from the highest echelon of command In regard to these responsi- bilities la my recommendation. The key obstacle of removal of casualties to ZI was lack of transportation both in number and time of arrival. There was no even flow of transportation towards the theater to remove casualties. A more efficient system could be developed by having staff control of hos- pital ships or staff representation with the Transportation Corps to notify the theater sturgeon in advance of the arrival of personnel ships giving the casualty carrying capacities of each ship and by having representation In the highest echelon of the Air Force to be assured that maximum use co?ild be made of planes returning from the theaters of operation, The Surgeon Generals should be cognisant of their responsibilities in evacuation theaters of casualties and should have the proper staff machinery set up to discharge them. L; K, Pohl, Colonel, MC EXTRACT CF STATEMENTS MADE BI COLONEL OSCAR S. REEDER, MC, USA, OR 15 APRIL I9A« AT INTERVIEW WITH SUBCOMOTTEE ON THE EMPLOYMENT CF MILITARY MEDICAL RESOURCES. (Continued) •I think the hospital ships should be under the staff control of the Surgeon General. The sane with the air evacuation system. This plan ap- plies particularly nov in rise of the large casualty carrying capacity of the new planes. "6. The only solution I see to this problen is to have sufficient hospital beds in the proper areas to obviate the necessity for passing than fro* one hospital to another. I believe the solution to this practice could be solved by grouping traffic!ent hospitals of certain typos In the forward areas to prselttd* the necessity of transferring the* on bade, re- ferring particularly to convalescent installations. I believe observation is acre applicable to the communication sons, but should bs attempted only If there is an adequate grouping of hospitals. •7. I think tiis nsln factors interfering in the control of evacuation was lade of facilities, such as trains, planes. Staff Interference cans in in the natter of priorities of nevsnsnt. The lack of eenuBdcatlcn plays a vary important part, in ths operation of the air evacuation schene, particularly. Mo great difficulty was experienced in the movement of trains or ambulances. •8. So. 0-1 replacement pools would have a tendency to waste manpower In view of the necessity for transfer of all patients leaving hospitals through ths replacement depot ays tea. •9. I believe convalescent hospitals are absolutely essential in both the combat sons and eoaaxmieation acne. I believe the hbspitals la the eoMRonication sene should have convalescent sections. It is acre economical to attach to hospitals themselves. Rs 1,000 bad - yes. I believe It will.”***** •**«• •! do not bailor* that tho Engineering Corpo fulfilled ita responsibilities 1b regard to tho construction and aaintenance of aedieal faellltlos during tho oar. In tho first plaeo, they wore not cognisant of their responsibilities• In tho second place, they did net bar* tho necessary omnipotent to take car* of the hospitals. I would say that I do boiler* that there should bo a separata section of the Engineering Corps in peace and war for hospital construction."***"♦ L, K. Pohl, 'Belonel, WC TRUE COPY EXTRACT (Utter, Colonel Arthur B* Welsh, MC, USA dated 19 April 1948) ***** "h, Huim wsra enwnd decisions, Consideration in World War II should hart boon given to s sixty day oversea evacuation policy to tha sons of interior, utilising air evacuation to tha taxira and anploying favor fixad hospitals within tha coanualeatien senes, Thara wars sany eontinganoios that had to be considered in establishing an evacuation policy for the eoaibat seme. In general an arey couldn't plan to inplenent an evacuation policy of nore than fifteen days duration. This was not always possible. The evacuation policy was principally an aid in planning. The nfaas one bad dot endued what one could do and farmed the policy. In brief the evacuation policy was only a pre-deternined course of action to be taken during an operation in regard to casualty evacuation and hospitalisation •* ***** L, K, ?ohl, Colonel, SC TRDB COPT EXTRACT (Letter, Colonel Richard T, Amest, KC, OB A, (Rat.) da tad 19 April 19*8) ***** "In tha amy araa a two week policy or longer should ba estab- lished for return to duty casualties. For this purpose large evacuation hospitals and convalescent hospitals should ba utilised. Casualties requiring a period greater than one eonth for recovery should be sent to fixed hospitals in the Cosntmi cation Zone. A 90 to ISO day policy for evacuation fron the ConssBBioatlon Zone to the Zone of the Interior should be established depending on the facilities for evacuation and holding facilities In the Cnesnwdcation Zone. It mat always be borne In sdnd that the longer the holding policy the greater will be the bed requirenent in the theater. Air evacuation should be utilised to the naxlsne and definitely planned for. AabUlance convoy and hospital trains will be used when practical. In the Coenunieation Zone exist- ing buildings should always be utilised for hospital purposes when available| seal-permanent construction, second, and tent hospitals as a last result." ***** L* K. Pohl, Colonel, tfC TRDS COPT KSTRAGT (Latter. Colonel Robert £• Peyton, HC, USA dated 19 April 1948) •eeeexn the European Theater where Z served, the Amy provided fixed hospitalisation for the Air Force* As I see it, radar the conditions which existed separate hospitalisation for the Any sad for the Air Fores oould hare been to the advantage of neither. The levy did occupy for a while a large hospital plant at Southasptea, The plant was procured originally by the Amy and it was understood that the facilities were for joint use. This could bo regarded as helpful assistance rather than as duplication. There is no doubt that the presence of Amy, Vary, and Air Force personnel in a hospital ef another amad service increases adninistrative diffi- culties r Zf we are to oross-hospltalise in any large somber it will require representatives fro* the respective forces for admin- istrative and disciplinary control of their own personnel,***** I*. K« Fohlj MC 530 TSKJE COPT SITEACT (letter, Itear C.3# Caterer (SS), dated 21 April 1^8) Probably the greatest advance la the transporting of casuals to the roar from combat areas was their evacuation by aeans of air craft* This was found by trial to bo feasible and expedient, saving many lives and vastly raising morale* This service should be amplified and de- finitely provided for In all active coi±>at areas* The general measures adopted and found of proved efficiency as employed in World War II should be scrutinised and improved along the general lines of existing policy* It is mandatory that os many casuals be cleared out of front areas as . rapidly as possible and the combination of first line core, evacuation to "bock areas ” and thence to son go cf the interior in order to afford better medical care and at the sane time relieve active combatants of their pre- sence, with attendant logistic prohlesB, etc#, appears** «**♦ EX 1mz tecnai; MB 531 TRUE COPY EXTRACT (Letter, Captain F. R. Urban (MC) USB dated 28 April 1948) ***** * ;h) Hospitalisation and evacuation policies within the coobat sone, and evacuation to the commnl cation soae and to the sane of the interior* "(1) In the Amy in certain instances many base and general hospitals were placed in poor locations with reference to lines of oosoRmleation*” ***** . _ L. K* Pohl, Colonel, MC COPI EXTlUCT (Letter, Captain D. Hightower (U^)# U* *», Havy 1 1 ' dated 21 April 19U8) ***** w(h) It would seen logical to continue the policy adopted In the last war of evacuating from the coabat sons* all casualties which obviously would not be restored to full duty within 3© to 6© days* Further screening in the cooieuni.catitn sens would detorwlne the policy of evacuation to the sons of the interior*" ***** X, K, Pohl, Colonel, IK 533 EXTRACT COPT OF PERTIIPIff MATERIAL COST AIMS) II AIR FORCK MEDICAL DEPARTUBST HISTORICAL RECORDS OP WORLD WAR II. (Ltr. toi Ihosmr It Hay Concam did 6 Fab. 1943 unaignad (aubnittad by Col. Robinaon, but probably praparad by Maj• Bargeman) ***** ■Rarlsion of the T/M and Controlled I teats Baking prorl alone for portable X Raj equipment, ai ero scope v and laboratory eqnipBent in order that sore definitive care can bo given to eoabat crews, Baking the unite, nor* or lose, independent rather than dependent on a arthlcal chain of eracoat Ion. t. K« Pohl, Colonel, KC EXTRACT OF mDK Vt Colonel Frederic % 'V'et-beWeltj l&a U.S,A. on 22 April 19)-t8 at interview wlUi 3u )coWaitte<; on ti& t o/ ’LbcUcal ■tesc-grc^oa ***** "(H) 1* An evacuation policy properly belongs in a medical plan for any operation. In the type of operation we experienced in the Pacific, an immediate evacuation policy was of necessity the only one which could be adopted* The planning virtually contained a provision that the policy would be increased whan it could. That was the only type of policy tJmt we could set up and therefore I can’t answer the question. "We maintained the immediate evacuation policy as planned and we extended the policy as soon as we possibly could. The main factors that demanded change, of coarse, wore enemy actions which necessitated the supporting ships to leave the area momentarily, typhoons, other unforeseen things which seemed to always come up during an operation. "(H) 2. I think ltfs true of any case that entirely too many purely medical cases and entirely too many minor surgical eases are evacuated out of forward areas, There la only cue may you can possibly stop this and that's to have additional facilities so that you can hold these people ia the forward areas. Until those facilities are avail- able* the surgeon and the personnel officer for the commander must mutually decide or present to the commander for decision whether he wants to sacrifice potential replacements in the form of sick U8 at Interviar wlih hubco. iaittoQ cn t!ho c£ 'IfeTiTtaL*y Ijbdical *»*»*» (H) 8, In any unit in which X had any control, policies were sufficiently general so that the local unit commander could taka ad- vantage of his own initiative and knowledge within reasonable limits. Via tried never to hamstring either an administrative or professional individual, I believe that if you did hamstring people to that ox- tent that you certainly would create a waste of manpower as far as salvage of groups of certain cases were concerned. ”(H) 10, I do not favor a separate evacuation and treatment chain of facilities for NP cases for very practical reasons, I cm see some of tli© arguments that are presented from the morale standpoint* but it's just in my opinion entirely too involved to segregate these people all the way along the line into a little private evacuation system of your sen. "I do recognise the value of concentrating them as far forward as possible, and the scheme of trying to hold them within the division areas certainly salvages a great many of these people, but that Isn’t a separate evacuation system. “(H) 11, If you are lucky enough to be able to keep minor cases in forward medical units until their recovery, you certainly should keep then busy. "(H) 12, Uy answer to 12 1st yes, siri it’s acre theoretical and personal knowledge, but I certainly do think you have to have continuous contact, and tho rear echelon being responsible for the evacuation cer- tainly should have a representative In the forward echelon so your con- tact can be- immediate and continuous,*#'*’*** ’ ■ fsm Go?! muot wt isrsaam nvu coLom viboil cokhsu*. mo usa, so apmx. 1948. H. *lospi talisatioa and evacuation policies within the eenbat im«, end nimUon to the comma 1 cations »m and to the 21* - Jhe need It recognised for a basis policy which will retain sick and wounded as far forward as possible eosbissd with rapid evacuation of pat!eats of over 90-120 da/ elate to the 21. I as sure you hara discussed that before* Convalescent hospitals ware excellent a? used late la the lest war with active rehabilitation. Mala tala the pattest a salt identity far so rale. Rapid return free 02 hospitals to Ars/ convalescent hospitals. If there la aagr doubt, let the decision be sade iniha Are/ loses that la, at the eesvaleeeest hospital. Avoid rami a* those aea through replacement pools where they lose emit Identltj, and It also saves tine* .7 L.K. POSL, VJQiOm.MO 538 TBUa COt'I mac? OF IKTKRTIKv tflTR R 1AH AiAlkAL MORTON Di, VXLLC0TT3 («C) DSN 4 May 1948. •*••••*« H. *Vhat Is your idea of the methods of hospitalization and eradiation policies within the combat eon# and evacuation to the communication cone and to the eons of interior? REAR ADMIRAL VILLCUTTS: Eradiation In Okinawa was carried out largely by serrice hospital ships and by the air service. It was excellent, *1he patients were evacuated promptly bade to base hospitals where they were screened; and then, depending upon the planning of the n»xt engagement, the next project, dates were set up accordingly so that sick boys of ISO days would be evacuated back, or 90 days, or 60 days. On Ok 1 nova X saw any number of boys go abound our hospital ships and by the time they got back to Guam they left the ship on their own and in pretty good condition. They were exhausted, mental casualties at Okinova, and four days later they were recovered. It seemed odd that because of the so-called Genera Convention they had to be put in a hospital and processed, which took a long time and perhaps many men hours and such manpower was lost. These boys, many of them, wanted to go back, but because of toe Genera Convention rules they were taken ashore end the hospital ship came up e^pty. Again, the next war will be total war; and I feel that we can save, and should save, everything that we can to step up efficiency- I think that should bo considered. 1 see no reason why a hospital ship shouldn't transport convalescent p patients that will be discharged at the war beach as well as a thousand idles hack. 1 might stress one point. In the Services we have, of course, what you might tens total medicine — preventive, curative, and so on. And there Is a.great loss of man hours when we make an error in screening who 3h>uld come back. Weeks, and months are lost. That certainly should be given very careful study -- what you are going to do with these boye that can be utilised other than in combat. BEAR ADMIRAL ANDERSONj There is one difficulty in handling large numbers of casualties that probably contributes to tho thing, and that is the lack of fao» llitlca to take care of such large numbers speedily. Tou have got to make room for additional casualties. That happened In the JPaelfle at del nova, and tho same thing was true of Guam. The hospitals were foil, and we had to do something about It. And undoubtedly we sent back many that should have been retained. ******** u L7<7 POKL, GOLOSjSL, mc tOT POET JKTlAOt (froa addrtss of Major doaoral Alhort V. Inur, MG, USA, 13 May 1948) KUOX OXnntAL immm •«•»•«» next (oostioa hat to do with hotpltali- satioa and oraeu%tioa polleltt within tho eoahat soao, mad orae—tioa to tho tho on—nnloatlon so at aad to tho seat of tho lat trior, that it doptadoat upon tho oitoatioa at tho thoatro of oporatloao aad toat othor factors. Oat rtwurtc Z would liko to aakd is that Z holism that tho eo—lea. tloa soao thoald support tho araiot do tor thaa thtgr did ia tho last war. fht ooaamaioatioa soao should ho aooordod, ia soao situations, tho pririltgo of go lac iato aa aray aroa. Most any ooaaaadtrs don’t want tho 808 ia say part of thoir aray aroa. Zt is a ooahat arta that thty —at to rotorro for tho—alms, for ohrlout purposes. Hovoror, ia oortaia situations, particular- ly ia a fast aoriag tltuatioa, I holioro tho aodioal load oa araiot oould ho —torially roduood hy permitting tho ooaanaioatioa soao ol—oats to ostahlioh thoasolTos within aa arsgr aroa. Wo ran into,' sororal tints, aotahly ia Ooaoral Patton* t third dray, whoa thty had a front of so— 400 allot aad a depth that *as al— st at —oh. Aad short traouatioa hospitals had hooa ostahlishod thty did shat ia offset tho goaoni hospitals did. thty sort do lag all tho —tit of general hospitals aad sort tiod up. Za those lastaaoos Z holioro it —aid hart hooa to. tho adraatogo of tho any to haro ponittod a o—I—tioa soao outfit to haro hooa ostahlishod ia tho any aroa. ■••••• L. X. Pohl, Ooloaol, MO D-li. Hospitalisation and evacuation policies within the sons of tho Interior with special referonoo to countruction, distribution, and staffing of alii tor/ hospitals* X* MgaglM 1* the recommendations as to else, favor an average of 750 to 1000 bod normal operating capacity for General Hospital typo installations* It vat felt thoir else should not exceed 1500 bed capacity, although soao did favor extreme capacities of 3000 to 2500 hods* S, Lack of modern architectural design, delay In and lack of suit- able type construction with unnecessary rigidity in details of such oonstr- notion in spite of an on-the-spot medical recommendation for minor ohaagoe to Improve adaptation for moo, are mentioned* 9* Criticism of looatlons with opinions for and against location in more congested population centers, report of Insufficient numbers of special treatment centers In ell parts of tho country, belief that patients should and should not by particular effort ho hospitalised near their home, end opinion for end against special treatment centers are oppressed* 4* Mention is made of poor distribution of patients so as to overcrowd seme installations with nearby hospitals net utilised to even reasonably full eapaeity) alee to lack of thought for fonsiblo joint staff- ing and free joint use of facilities by ell agencies of the Armed forest* In the latter regard, the need for uniformity of records, hospitalisation and evacuation policies, uniform construction end coordinated staffing is stressed* Overstaffing of General Hospitals was reported frequently* ft* Che lads of professions! opportunity for Medical Officers assigned to small dispensary end station typo hospitals is eeasidarcd by some as very detrimental to accomplishing obviously desirable rotation of field and hospital assignments* 6* Inadequacy of debarkation medical centers with meed for Im- proved evacuation therefrom to proper General Hospitals to receive full final treatment is spoken of. 7* Convalescent hospitals operated in conjunction with large General type hospital* are fevered by seme and ethers emphasise the need for such to be located In favorable climatic areas,to be aceeeelble It city recreational features* ft* Adjacency tc adequate air landing stripe with adequate rail facilities and nom»de»lrability in many respects cf utilising modified hotel* etc crc ether features considered* ft* Opinions vaiy as to hospital centre! but consensu* seems to be for technical operation throtgh the medical echelon with military command vested in the Army area or force command representation* 10. A reasonable utilisation of the physical1/ haadioapped provided they are mentally capable and of technical value le favored for ZZ installations* full utilisation of female components with in- creased WAG assignments to hospitals Is favored. 11. Zt was felt that excessive niceties and prolonged hospital- isation as praetiesd( oven though able to do partial duty, contrlbutsd toward non-desire to return to duty status by patients and was a source of loss of potential national manpower. 12* Care of dependents is considered Met desirable from morale and educational viewpoints if facilities and personnel are adequate. 13. Planning for location of ZX hospitals in evsnt of another national Emergency was considered a must end nospolitieel considerations with thought toward maximum additional use for civilian populations In event of catastrophe* are believed most urgent. 14, Complete Medical control of General Hospitals as separate pests is almost universally advocated. Line command Is considered a proper station hospital level policy. IS. Beportlng and control of patient census procedures were be- lieved defleient in many respects with prolonged unnecessary hoepitalisdtica and unnecessary bed occupancy resulting from personnel management break- down , It was accepted almcet universally that disposition ef patients to units should be a hospital function and the wherewithal to do se be pro- vided. zz* wmama 1. Military hospital planning for a possible World War III should benefit Immeasurably from the experiences of World War ZZ. 2, Modem architectural design with uniform construction, practical site of installations, proper planning for location practicalarly In regard to accessibility to an adequate Air field, and consideration of joint util- isation of expanded adequate existing structures with and for possible add- itional civilian use, are considered essential. 3. Za the event of War in the United States strategical concepts should be provided to allow adequate Medical planning for required hospital- isation. When and if such occurs. Joint military and civilian hospitalisation policies will need to be established and ready for maximum coordination and direction of effort. Zt ie believed that In such event national control of most hospitalisation by the national Military Xatablishaent will ensue end planning for such contingency should be dene new. 4. In the event of war in Foreign Sheaters of Operation, the Zone of Interior hospitalisation should he exploited to the maximum utilising air evacuation, adequate and properly located debarkation centers land fullest adaptation of returning cargo planes or special medical planes to large pay loads of patients. Staffing of General Hospitals, plus their operation and control In event of a World War III should he initiated cn the tael* that the distinction between the military and civilian United States cifciiea will probably no longer obtain to the former degree, in modern total war it it eeees to our choree. 5, The designation of umbered Armed force Hospitals for all inch pretest and future institutions with aortal capacity of 1000 or over is believed indicated. All such installations should be capable of pro* riding the complete and varied special treatment presently tarried eut by Army General and Kav&l hospitals* In addition, these hospitals might veil be earmarked and channelised individually for maximum emphasis to oontlnue the special treatment tenter idea initiated during World War XX if deemed necessary. Thus an installation’s designation might mall hot Armed foroes Hospital Bo. 1, 2, 3, 4, otc. with opor&tioaal oentrol con- tinuing in the vast majority of instances with the parent fcreci c.g. Aimed force Hospital Bo. 1, Bet has da, Kd., Bavy. "Special Canter for treat- ment of Malignant Diseases11. Another example might well bet Armed Vereee Hospital Bo. 2, Hot Springs, Arkansas, Army, "Special Center for Physical Medicine". C. To supplement numbered Armed force hospitals, that medical care to be rendered within a somewhat flexible but general SO day evacu- ation policy, should be provided each Major force. To achieve this the designation night well be Armed force Hagionel or Station Hospitals and continuing with numb or designations to be utilised, regional for those installations ranging from 200 bod normal capacity tc 1000 bed* end station for hospitals below 200 normal in capacity. Xn this manner regional or area coverage would be provided with the force of major troop concentration providing Medical operational control. 7. % the above designations, the psychological concepts end ad- vantages toward unified and coordinated effort but without actual merger arc very apparent. She tame number would net be utilised for designating an Armed force Hospital and alee an Armed force Begional Hospital or an Armed foree Station Hospital. Assignment of blocks of ambers would allow for and provide ready identification as to location, else# etc. fhc terms Begional and Station might well be dropped in usage for designation because of the implication that good medical care Is obtainable only in General and Saval Hospitals. i* Oentimulng the Armed force cumber designation of Wnrwftnc Hos- pitals, fixed and mobile, within assigned number blocks would go far toward simplification of designation end allow for appropriate Identification. m. Mmmamm 1. Shat a study be made to Investigate the feasibility of changing designation of Armed force Hospital a* practiced la Mend War ||. That a mumerleal designation with standardised Policy for type cad location, ic indicated* 2# Initiating nodical military hospitalisation planning cm Xailoaal Military Defease level, required tc coordinate military and civilian defies# In the event of Intel war 1 wolfing the Whited States* j, Frerlde for military nodical Arnod for coo (Arajr-H&ry-Air) hospital planning In conjunction with Joint Chiefs of Staff tar Plana and Strotogloal Oonoopta. 4. Joint Anted fbreca planning ho inatltutod for ataadardliatlon of anmrra fined and aohilo hospital nnlt requirement*. 5, fhat foil inToatlgfttlon ho node of the praotioahlllty of Joint Staffing of Solootod loapitala. TRUE COFI EXTRACT (Letter, Rear Admiral C, L* Andrus, (MC) US* dated 27 April 1948) ***** •»(!) Hospitalisation within the son# of tha interior presents ■any problems, some of which are not neoeeaarilj to the advantage of the individual or to the services* For example, it is net always best for all concerned to have a patient taken to the hospital nearest his ham at the first opportunity* Patients requiring special fens of treatnent should be sent to hospitals equipped and Banned to care for their par* ticular type of disability. Receiving hospitals should be located at ports of entry into the acne of the interior for the ready reception and screening of patients upon arrival in the United States* Transfer should then be node to the indicated hospital (imputation Center, Tuberculous Hospital, General Hospital, etc*)* "For the best administration and medical care it is believed that in general, hospitals should be limited in else to 2000*2500 beds capacity* •In general, hospitals should not be located in congested areas* They should be on main lines of rail transportation and should be in reasonable proximity to cities and towns large enough to provide proper recreation for both patients and staff* "For the most pert war time hospitals should bo of temporary con- struction designed to render the best of nodical care for the duration of the war but not to >e continued In operation after the war ie over and demobilisation Is completed. Their cost is a part of the coot of war. The aoquleition of hctels and other civilian installations are often costly and conversion changes are seldom as satisfactory as are temporary hospitals built for the purpose. So-called eomralesoent hoe* pitala are a disappointment unless properly located in reference to ac- cessibility and liberty outlets for ambulatory patients* •Military hospitals should be staffed by military personnel with heads of departments carefully selected to meet the requirements ef specialty services and special centers as mentioned la (e) above* The equivalent ef •laves1 and 'face* ean be utilised to advantage in military hospitals*" ***** L* K* Pohl, Colonel, K YHDI COPT XXTRkOT (Letter fro* Colonel Bofcert X. 8lapeon, USA (Bet.) dated 1 Hay 1948) ••*•• "(i) Hospitalisation and evacuation policies within the tone of the Interior with special reference to conetruction, distribution and staffing of nilitary hospitals. This has been aentioned under suhpar(f), More attention should hare been paid to temporary hospital design and oonstruo- tion daring World War ZZ. As to distribution of hospitals, (general hospitals) there is no consent other than to the effect that a specialised general hospital could and should serre all hranchfs of the Araed forces. Tor exsaple, an orthopedic center for Amy, Mary and Air force. Psychiatric Center, Tuberculous Center, etc. There appears to hare been none unneces- sary duplication in this respect. Such specialised hospitals should he staffed by the hotter trained and nor* talented personnel of course. Ivory effort should he aade to fit "square pegs in square holes". There certain- ly were far too many instances of *al-assignaent in the theatres and in the sene of the interior of World war ZZ, and such aal-assignaents contributed a great deal toward lowered norale and discontent. There should he none systea of rotating Junior nodical officers froa duty with troops to hospital assignaents and rice versa. Month after nonth of no nodical activity other than attending sick call and inspecting latrines and nesses pronotes stagnation and is an alnost universal ooaplaint aade by Junior officers Z have cone in contact with. ****** L. X. PohlVColeael, SO imjmjsmui (Uttor, Colonel Arthur B. Walsh, HC, «i dated 19 April 1948) ***** #1, Dispensary beds for short tor* oases staffed by salt Mediae! personnel could bare profitably been used In the sane of Interior to a great* er extent In World War IX, if snch dispensary beds bad been supported by snail, carefully staffed station hospitals* This oould hare Materially re- duced the total number of station hospital beds in the sone of Interior and would haws sawed personnel. "Hospitalisation wasn't on an area basis In the sene of Interior* It should haws boon ouch like it was done overseas* "Personnel of the arnod services were not admitted to hospitals regard* less of, ooMwand Jurisdiction* It should have boon so directed for the sons of interior as It was overseas* "Insufficient thought was given to permanency location and post-war use when building hospitals—a ling range plan, area though we had the fed* oral Beard of Hospitalisation, was not apparent* Tee few beds were provided to aorvo population area densities. "Insufficient thought was given to expansion oapabllltlas whan construct- ing hospitals, particularly la critical areas* "Badsrground hospital structure# were newer planned* fortunately wo didn't need than for World War II since wo woo the stools race* Had wo built a few wa would have than now for World War HI—but probably positioned in the wrong placet "Agreement among services wasn't reached on hospital design* It appears that the Army Engineers ware permitted to ran rampant* Hospitals should have bean built fifty years ahead la design rather then bade twenty, as was dona in World War II* Too few hospital architects ware aoployed* The levy with their Soabooo did a batter hospital construction Job overseas* They had bettor plans sad aero talent* The Army could haws learned a lesson free the Wavy eenpoaant sywtaa in oversea hospital construction. "Thought wasn't given to Joint staffing and Joint use of facilities* The fact that each service bad to have medical autoncay within its own struc- ture apparently prohibited this desirable feature* laterally each service has to ecntrol its own nodical naans* Even so wo oould have bad nor# Joint nodioil operation and Joint service* The planners fulled* "frofesslenal consultants could not out across command channels and servo the Army, Havy and Air* On# group could have dona the Job*" ***** f.k.PM) L. I. fohl. Colonel, HC THP3 COPY gffllAffiE (Letter froa Sear Admiral A, H. Searing (MC), U3V da tad 36 April 1946) *•«»*»(i) Botpitaliiatioa and evacuation policies within ths coat of the laterior with tpeclal reference to construction, distribution, and staff- ing of military hospital*. In the early years of the war there appeared to he no firm policy regarding the transfer of patients between hospitals vithia the United States. Later a policy was enunciated of transfoneng patients, who vers able, to a hospital near their heme, this was desirable from the stead, point of morale of the patient and his dependents but, in many oases, there were no specialised hospitals for the treatment of certain injuries or diseases that vers near the patient1! home. As a result patients who vers sent to these special hospitals wore extremely unhappy because others who vore injured with then left the debarkation hospital* to go to their home while they, themselves, were transferred to some remote point. It is suggested that In cate of future var such special hospitals be designated throughout the country to eliminate this difficulty. At the Port of Embarkation in San Pranoieeo, the large hospital at Oakland was forced Is act both as a receiving hospital and a general hospital until early in 1945. I believe that the same situation held at Seattle end Sea Diego. If possible, future planning should envision the utilisation of buildings or the erection of temporary buildings ether than the established hospitals at the Port of Debarkation for the receiving, classification and further transfer of all sick and wounded received from overseas. Although, there is always pressure fkom the recognised specialists to have a special hospital established fbr certain injuries and diseases such as; orthopedics, neuro-surgery, plastic surgery, neuro-psyohiatrie, psychiatry, etc. I believe that the policy held te by the levy of designating each hospital as a general hospital for the. oars of all diseases but, with certain hospitals having emphasis placed on certain conditions, was vise, this policy should bs adhered to in the future, *♦•••• 1. K. r*U,'e»l«Ml, KO 548 TRUK CO I EXTRACT (Letter, Dr, A. R. Shands, Jr. dated 20 April 1948) ***** nThe hospitalisation and evacuation policies in the 7.1 at times showed rather poor planning for the distribution of patients, «a many of the hospitals were overcrowded while others had few patients with too much personnel•" ***** L. K, Pohl, Colonel, MC TRUK COPY EXTRACT (Letter, Brig. Gen. Robert C. McDonald, KC, USA, (Ret.) dated 15 April 1948) ***** "(i) Hospitalization and Evacuation Policies within the ZI with special reference to construction, distribution, and staffing of military hospitals. "(1) Comment and Suggestions! Construction of station and area (regional) hospitals will be reculred to serve ZI posts, camps, and stations. Construction of general hospitals should be kept to minimum through use of existing Federal hospitals, arid existing buildings, such as resort and other hotels, and public buildings. The distribution of station and regional hospitals is governed by the location of troops which they serve. General hospitals should be located in accessible areas, generally near population centers, so the wounded may be hospitalized near their homes. Convales- cent hospitals should bo established in resort areas where climatic condi- tions favor recovery. The staffing of hospitals, particularly with specialists, will always present a difficult problem. Each hospital should be staffed so as to be able to carry out its mission. Regional hospitals and large station hospitals should be staffed for definitive general medical and surgical treatment. In addition, general hospitals should be staffed to care for specialized cases. The designation of certain general hospitals as special centers will conserve specialists. The location of general hospitals near large population centers will enable them to have specialists and consultants from civil life assist in special work," ***** L, K, PohJj Colonel, MC TRUE COPT EXTRACT (Utter, Colonel F. A. Blesse, MC, USA, dated 19 April 1948) •♦***9. Hospitalisation .and Evacuation policies within the Zona of lateglcr.-ffltfr mwM raftraacg to ,g9Mtarartifta» dUtrtfraUgn uA g.ttfnnt of aUitor bwlfrlg* "a* Duplication of hospital facilities Is frequently heard mentioned as an example of the need for unification. Joint hospitalisation should be possible and was actually accomplished in overseas areas share separate hos- pitals could not be provided. The difference in medical records caused coma difficulty and required the assignment of Mavy personnel to Aray hos- pitals. It is believed that Medical records should be standardized so as to provide one type of forms and requirements common to all. •b, Tha staffing of such hospitals should bo in accordance with a directive indicating primary interest. Certain hospitals would be predomi- nantly Kavy, Aray or Air Corps and tables of allowances of personnel would have to be based on this factor. The service with major interest should logically command and furnish the large portion of the personnel. "e. Hospitalisation and evacuation pollelaa within tha zona of the interior, particularly construction standards or scale of accooodations and staffing of military hospitals, should be unifora between the sendees* Tha lack of a uniform set of construction standards in the past war resulted in considerable variations in the types of nodical facilities built by the services end unnecessary expenditures of public funds* With respect to staffing of ailitary hospitals with commissioned, enlisted personnel and civilian MD employees in the sons of the interior, I can see no reeeon why there should be any difference between the services, As for distribution of the sons of the interior nodical facilities, there is no valid reason why, when troops of both services are in a particular area, there should be any necessity for separate medical facilities* To insure efficiency, however, close cooperation and coordination is essential,*eeec J. K« Pohl, Colon*1, WC THUS COPY EXTRACT (Letter, Dr. Howard A, Ruak to Secretary for Air dated 27 January 19&8) ***** "A nodical aerrice is only as good as the doctors who comprise it; and in order for a doctor to work to his fullest capacity, ho oust hare security, opportunities for professional advancement and research, hospital facilities and laboratories in which he can provide for his patients the last word in medical ware, and, last but not least, the pride of belonging. "It scans to ns in general, the eownon problems in the service aedieal departments are supply (X understand a eeanon supply program has been developed in the Any and levy at the present tine and has been functioning exceptionally well for over a year), conn on procurement and eawen hospitalisation* The latter, which I knew has been a such debated subject, it seens to ne could be solved on the basis that the branch of the service with major responsibility in a given area would assume the responsibility for high-level hospitalisation In that given area, and an arrangeaent should be made for an inter-service exchange of specialists* "I understand at the present time that it is impossible for the Air Force to assume a major responsibility in the hospitalisa- tion field, but X also fool very deeply that if the Air Feres expects to got and retain first-claea doctors they suet he per- mitted to practice medicine as they have been taught and this ■net include service at the highest hospital level. Good doctors, except in rare instances, will net be content to narrow their activities to aviation nedlelne and the dispensary levs! of practice* Specific problems of aviation medicine are wall under* stood) high altitude flying, diet as It relates to flying, air evacuation, and a multitude of problems in aviation physiology, selection, retirement, etc** ***** L. X. Pohl, MC TRUE COPY (Extract from Ltr Col Harry Q 1C, 16 April 1948) *1# Hospital Nation and Evacuation Policies Within the Zone of the Interior tilth- Special ftsfaronce to Uonsiructiona ’kdbirtbutlona and Staffing of Military Hoapltala» 1 1''' (1) Defectst (a) Failure to use air svaosstion to ite utnoet* (b) Hospitals located for political reasons rather than military necessity* (e) Central hospitals over staffed, especially by Dental Officers* (d) Modem planning and construction not used) i*a«f air conditioning* (2) Remedies9 (a) Exploitation of air srsenatioa< (b) General hospitalisation based on geogxsphicai needs* 03% military population from See York area and leas than 1£ general hospital beds in same area*) (c) Hospitals located near air transportation facilities* (d) Use modem hospital designs and sqplpsffnt** ltil u k« pchl\ Colonel, 1C TRUK COPT (Extract from Ltr Alfred V* Eyer, Captain (UC), OSH, 1? April I94S) ***•*(!) Hoepitall nation and evacuation policies within the sone of the Interior with fecial reference to construction, distribution, and Staffing ef Military hospitals* Hospitalisation and evacuation policies within the sons of the interior should envisage possible or probable attack on continental United States* Refer to paragraph 1 (a)* In general, it la believed that all future construction should be restricted in siss (2000 to 4000 beds) and should be well dispersed with access to good lints of communication and supply in oast aid west central United States* Further, planning should envisage total utilisation by both military and civilian of existing area Medical facilities* There is no particular requirement seen for Joint staffing of continental activities* However, units situated in the sons of ecsmiunieatlon should be Jointly staffed to enable Maxim efficient collaboration between the services* The development of underground facilities for regular wartime hospitalisation is not believed feasible from the standpoint of patient care, or practical from the standpoint of expense****** C« K* PCHIX Colonel, MC\ TRCT COPI EXTRACT (Latter, Dr. Ruwel T. Lee. dated 1# April 1948) sees# •(!) Hospitalisation and evacuation poll dee within the sene of the Interior with special reforoneo to construction, distribution, and staffing of Military hospitals* •A few groat Mtdieal centers should be established in favorable cliaatlc areas to which Moat of tho patients should be brought by air* A regular jitney rm of air ovaeeatlen touts ovary earning could gather the patients froM outlying stations and deliver than to tho nodical cantors and take back convalescents on tho outgoing trips* These centers should have a consultant staff ef olds* dis- tinguished civilian experts on a part-tine basis plus recognised military special- ists* The oenters could bo used for the training for board qualifications of -younger doctors sod service there would bo made as attractive as that in any civilian hospital* These centers would bo centers of research and could actually ba the site of governmental nodical schools relieving the tremendous pressure free prospective ntdieal students which exists at present******* t, K. Pohl* SC raw COPT KMUOT (UtUr froa Dr, tfia, 0, Menninger, Topeka, Kansas, dated 22 April 1948) ***** *(i) Hospitalization and evacuation policies within the tone of the interior,-—The plans for the psychiatric wards in our army general hospitals were antique, constructed in great excess of the needs and the hospitals were unequipped to give the modern psychiatric care to the patients, Towards the end of the war we did get "social therapy" buildings added which provided for occupational therapy and United recreational facilities. Specific recommendations have been made by the neuropsychi&trio consultants to the Surgeon General of thp Army with regard to the staffing of hospitals with this group of specialists. Many of tho tables of organi- sation should be radically revised. Perhaps under this head certain other points should be nade. The promotion policy was grossly inadequate, Medical officers and enlisted aen were often "penalised" in relation to other branches of the Service, This nay have been related to the fact that very often they served under line officers who were limited in their ability to sake pronotlons be- cause of rigid table of organizations. Par too often promotion was based upon the table of organization plus the llcngth of service and personal relationships to the commanding officer (politics). Barely were they based upon the quality of professional work or the ability of the individual. Hany regulations and their frequent change, along with command rigidity of attitude, worked in the direction of interferring with the use of good medical .Judgment, One of the results frequently was a con- siderable reduction in medical initiative. Ve can’t fall to recognise that frequently there wae discrimina- tion against medical personnel on the basis of race or religion. If we expect Negroes and Jews to come Into the aray and navy then we have to treat then on the i&m basis of anybody else we accept in the any or navy. Assignments to tactical units and undesirable posts vers often bassd on personal feslings of the commanding officer with a total dis- regard for the requirements of the job or the ekille of the individual. Certainly the any, and I am not familiar with the navy, has to revise its system of disposal of inefficient and non-effective officers. Within the medical corps it wae always a tatter of trying to find the place where a man could do tits least harm beoaust ws had no system of getting rid of him. ****** L, X. Pohl jNJolontl, NC EXTRACT FROM INTERVIEW KITH COLONEL W. D, GRAHAM, UC, USA, OR 11 MAI 19A« AT 2i00 p.m. 1. Was the regional hospital effective for 21 origin eases in World War II? A. On the regional hospitals I think for planning purposes It is essen- tial that general hospital care as we define it, in the Army, had to be statistically — the flow of patients had to be statistically evaluated on 21 and overseas. ***** 2. Is specialization of general hospitals effective? A. The regional hospital was supposed to render general hospital type care to general nodical and general surgical eases. In the event that there were in the 21 any specialized eases arising they would not go to a regional hospital. They would go to a specialty center in the general hospital. Q. In any future emergency when should this specialisation become effective? A. Specialisation is still in existence in our general hospitals. , As I conceive It, the specialties that centers will operate for free now until the next emergency will gradually be reduced in number until we have only Medicine, surgery, etc. T.B. will continue and probably we will have an arned forces T.B. center. We will lower the amber of specialties for which Wo reserve beds until the thing begins to bo an emergency again and when it does we will begin to delegate certain beds as vascular, etc., and they won’t be returned to full specialisation until the load becomes heavy enough. 3. The policy of locating general hospitals is open to crlticlsa. Dose the factor of patient being cloee to hone outbalance the desirability of the advantages of climatic considerations which night enhance conval- escence and promote economy? A. - In all instances of which I know that climatic conditions might be better fen* the patient the centers have been pased in these climatic conditions. From a medical standpoint they should be put where the hospital has the best climatic conditions for rehabilitation. EXTRACT FROM IHTEOTIEW WITH fOLOBEL W, D. GRAHAM, MC, BSA, OK 11 MAI 1948 AT 2|00 p.a. (Continued) A* What Is the maxima else you recommend for tha 21? A. - I don't think It nkea any difference. To elaborate on that, I don't think it remain* one hospital beyond, fron my on experience — 1500 beds* The general feeling is from 750 to 1000 if yon could control it yourself* Admiral Anderson: Do you hare the sane opinion about hospitals during peacetime? A* - Ho, they should be limited to around 1200 to 1500 - would be the maximum* The reason for the difference is that you don't haw* the morale during peace that yon have during ear, therefore you bare to look into details mire closely than yon would during a war* 5* Should convalescent facilities be separate or parts of each general hospital? A* - Convalescent facilities should be inherent in every hospital* The convalescent facilities should probably remain under the control of the medical authorities by being established in hospital centers rather than as a part of a general hospital* 6* Should long-term oases be discharged to civilian institutions for final care at Government expense? Veterans Bureau hospitals? A* - Provided adequate facilities and personnel are available In the Veterans Administration or in any other institutions to give then acceptable cere and meet the high standards It is esssntial long term patients should be offloaded from the military medical set-up as soon as possible* 7* Should civilian consultants replace military medical specialists in localities where the former are available? A* - If in the future the civilian consultant, whether la uniform or out, is dearly responsible to a medical officer of the services for implmantlng his reeanmondatloBS the snsser to the question Is yss* t* Is the spredlilg type of construction for general hospitals advisable? XT net. Shat is the solution in the faoo of critical material shortages? Does the design sow used used modification? Vhat are its weeVuasees and objectionable features? extract frob nrrroiEB with colcto s. d. gram*, bc, vsi, on 11 k« 194* /T 2tOO p*m* Continued) A* • I think Barton or Tyres on construction and design should answer that. 9* Who should control general hospitals In the ZT? Should area control under line officers car under deputies of the Surgeon General be set up geographically? A. • The Surgeon General should hare technical control Is a Banner similar to that established in the general order of the Mary where there are four types of oosmand. Military command should be In the area corn* mended and not under the Surgeon General and should be a senior medical officer representing the Surgeon General of whatever force is concerned and he should be consulted in matters involving the medical service* Re is attached to the staff as the Surgeon General ie attached to the staff* ***** This should be done* X have urged the adoption by the Army of a general order clearly defining the concept of command and Its division into four major portions as outlined in Ravy General Order Ho* 245 of 1946* 10* To what extent can the partially physically handicapped, both officers and enlisted mm, be used to staff hospitals in the ZI? Can greater use of female doctors be made in ZI installations? Can WACe replace enlisted males to a greater extent? Co you favor the Nurses Aid program as established during World War II? A* • As long as the handicap is not above the ears we can use them and we can use then overseas also* Regarding the use of female doctors — I happen to knew quite a bit about them because I had an orientation group at Urweon General Hospital* Greater us# could bo made of them, that is to say, they could be used in greater numbers, but because of limiting factors they have to be integrated Into the service with definite reference to the percentage of female personnel who might be patients* Re 1AC - yes, we can use more VAC's* I don't know much about nurses aid* 12* Are debarkation hospitals necessary? In atomic bomb target areas what Is the solution to the location of such installations? A* • I think debarkation hospitals are necessary* I think that the mere elaborate the facility is made and the better It le staffed the less likely it le to serve its function properly* EXTRACT FROM IHTERVIKW WITH COLOHFL W. D. GRAHAM, MC, USA, OB 11 MAT V&S at 2*00 p.a. (Continued) 12. • A. - I think the mum precautionary measures on these installations hare to be taken as they bate on debarkation. If an atomic bomb is going to drop on that port, yon better move the pert before it drops. 13. Were there too marry frills and luxuries in our hospitals vhieh ad* Tersely affected the desire of soldiers to return to a duty status? It so, what can be eUalnated? Was the policy criteria for return to duty status tee high la view of manpower shortages? A, • Iti, it affected the desire of tho soldier to return to duty, nothing can be ellainated without a aajor change in national policy. From a allltary standpoint it is probable that nany patients could haws been returned to gainful occupation as distinguished from military My, Whether the line eonaaader would accept then when they were sent beck to duty la questionable* L. K« BC 558 Extract of Statement* mad* by Brig Oen Hobart C* McDonald, IT 9 USA (Retired), 21 April 19AB, before the Subcommittee on the Employment of Military Medical Heeourcae- **HH**»0n the subject of "Hospitalization end Evacuation Policies within the ZI with special reference to construction, distribution, and staffing of military hospitals* "Construction of station and area"—* that is regional— "hospitals will be reqdred to serve 21 posts, camps and stations," where they are* We have simply got to follow the combat troops or the line of the anted forces and establish hospitaliza- tion wherever required for the less seriously ill and slightly wounded* How, the ’'Construction of general hospitals should be kpfrt to minimum through use of existing Federal hospitals, and existing buildings, such as resort and other hotels, and public buildings# The distribution of station and regional hospitals is governed by the location of troops which they serve* General hospitals should be located in accessible areas, generally near population centers, sc the wounded may be hospitalised near their homes* Convalescent hospitals should be estab- lished in resort areas where oilaatic conditions favor recovery* The staffing of hospitals, particularly with specialists, will always present a difficult problem* Each hospital should be staffed so as to be able to carry out Its mission* Regions! hospitals and large station hospitals should be staffed for definitive general medical and surgical treatment* In addition, general hospitals should be staffed to ears for specialised cases* The designation of certain general hospitals as specialised eases* The deeignation of certain general hospitals as special centers will conserve specialists* The location of general hospitals near large population centers will enable them to have specialists and consultants from civil lift assist in special work*" X think the growth of our convalescent hospital system in the last war was largely due to the lack of beds in our general hospitals* Therefore* we sought to expand theca by establishing convalescent hospitals in favorable locations wherever we could find them end without much reference to where the general hospitals were located* The-ideal situation would be for each general hospital to take care of Its own convalescents, have them at their hospitals there they have bean under treatment so that the asms doctors could supervise their rehabilitation* Too often they were separated from a special staff* for example, I bad a large convalescent hospital at Daytona Beach, Florida* *bers was no general hospital around there anywhere* The nearest one. X guess, was Tbomasrille, Georgia, seme 250 alias sway* It was difficult to give the wounded that were convalescing-proper supervision* Be had to put additional staff down there in order to do that, and we had to build up the local hospital mors than would have been neeessaxy otherwise • The establishment of a luge separate installation for the treatment of convalescents should be, 1 thlnfr* the exception rather than the rale* There an instances where we can go into a health resort like Atlantis City or Daytona or Miami end do that thing to advantage# Vat X believe that that should be the excep- tion rather then the role* X believe we should take ware of pur wounded at the hospital where they pet their definitive treatment* •Was the regional hospital effective for 21 origin cases in World War lit* X think that the regional hospital urns very successful* •The policy of locating general hospitals is open to critic! 3a* Does the factor of patient being close to hose outbalance the desirability of the ad- vantages of dies tic considerations shich eight enhance eonralescenoe and pro- mote economy?* Generally speaking, 1 believe that general hospitals should be located so that the patients dll be near their homes* I think it does outweigh* •Is specialisation of general hospitals affective? In any future energeney shaa should this specialisation bacons effective?* X think specialisation of general hospitals naa effective* it eas in ay service acnaand* As to when it should begin, it should begin from the beginning, but be on a email scale* In other cords, instead of having A or 5 specialists of one kind in, ee dll say, a service oomand, you would only have one, or per- haps one in each section of the United States* fiat they should be increased when the demand for then cones* They should not be sat up and have the personnel wasted froa the beginning* •What is the Barbras alas you reeomaend f*r_the 2X7 • ky largest one was about 5*000* That was down in Memphis* I don't think they should be over 2,000 beds* •Should long-tern oases be discharged to civilian institutions for final cars at Qcvement expense? Veterans Bureau hospitals?* X think they should be to the Veterans Bureau hospitals, but not to civilian institutions* . •Should civilian consultants r”n2*es military specialists la where the former are available?* Tee, eirt * think they can be used* •Is the spreading type of construction for general hospitals advisable? If not, id»t is the solution in the face of critical material shortages? Decs the dssign now used need modification? What arc its weaknesses and objectionable features?* I don't think the sprawling type of construction for general hospital* is sdviekble? General hospitals should be established la exist!:* buildings, in se far as practical* I have answered part of that* •Who should control general hospitals in the 21? Should area control under officer* or under deputies of ths Surgeon General be set up geographically?* I don't think ef any reason for setting up deputies separate from the service command, we will s ay# I think the service coramand surgeon general will carry out any policies and plans of the surgeon general, just as well as a separate person would# I don't think there would be any difficulty co- ordinating that with a service command surgeon general# “Should the Surgeon Generals control evacuation transportation in the ZI? Did the adopted system prove efficient? If not, what changes aro indicated?* Tes, I agree that the surgeon general should control evacuation transporta- tion in the ZI# I think it worked very well# "lxw debarkation hospitals necessary? In atomic bomb areas What is the solution to the location of such installations?" Tee, I don't see what we could have done at Charleston without Stark# We couldn't get them out fast enough on the trains, and ws had to have a place to put them# Some of them had to be redressed and put in shape# I agree that debarkation hospitals are necessary# I don't see why it shouldn't be located near the port# Vie do have to take chances on atomic bombings* "Were there too many frills and luxuries in our hospitals which adversely affected the desire of soldiers to return to a duty status? If so, what can be eliminated? Was the policy criteria for return to duty status too high in view of manpower shortages?" . I don't think that the soldiers were provided too many luxuries and conveniences in our hospitals# I don't think they were made to t tay away from their work because of the kindly care they were receiving# I do think that medical officers in charge of cases should be very diligent, in estimating the condition of patients, and should give enough attention to know he is ready for duly and getting back# •Should care of dependents cease during war?" I don't think that care of dependents should be stopped entirely during the war# There are many Instances where the civil medical services axe inadequate They went without care unless it was furnished by the Amy* I don't think we* Should have special provision made for providing adequate care for dependents# but £ think when medical service is available and dependents need it, it Should be given# Brig Qen Martini In the face of criticism that that was a wastage of doctors during the war? " # Brig Qen McDonald! Tea, that's right, I doubt if very many doctors were engaged entirely An that work# In some large dispensaries, yes) in Washington, ef course# •Should IIP eases be given an opportunity to dot one tret* whether he can accept Military status before he is eliminated? (figures shoe 600,000 eT Inina ted on initial exaril nation?* Obviously disabled should be, of course, eliminated Iwertl ately* Bat a borderline case should be given a trial* Too Manor were eliminated in World War ZZ* •9s you favor a reasonable rotation policy for specialists between the ZZ end theatres of operation? For other e las see?* Z believe In rotation on a periodic basis* •What was the greatest cause of delay in construction of hospitals in the ZZ? What recoBMsndatioDS do you have as a remedy for this deficiency?* Z think It was the scarcity of building material* Brig Oen Bartini It wuaen’t plaining? Brig Oen McDonald! Ho, Z don’t think it was planning* Of oouiee the plans were probably changed quite often* But I would think the main daisy la hospitals was the shortage of vital materials * •Should peacetime planning provide for personnel on a reserve states to Men ZZ hospitals? Should they be affiliated unite?* lee, I think they should be provided a reserve status) and I agree they Should be affiliated unite* There may be some difficulty in getting the unite built up, an this baste, since, generally speaking, theywant to ge overseas the first thing* but certainly it would be valuable as a reserve* •Can we at this tine plan for locations of ZI hospitals, leaving their else for later decision?* Z think that suitable locations for ZZ hospitals should be selected in time of peace, but, that a great many more than are required should be selected se that we will have sene elasticity in locating them *wm the necessity comes* •Should general hospitals be separate poets with complete control over all Maintenance, poet housekeeping,etc*? If not, do you favor a line command for those services?* I*d like to have them at separate poets to keep control over maintenance* Tea get along better that way* •Were doctors used too Much on administrative positions in ZZ hospitals? If yes, ea what Jobe? Could U8C personnel relieve them7* lM| IWs lawwd that* •Wi tilt Corps fulfill its rooponolbllltot la tho ooio traction tad Mtintononoo of nodical facilities during tho wt If not* short dfcCthtgr fttilT Its It tht rooult of ottitado or ihortog— Of engineering portoanol tad materials? Do you agree that there should be a separate section in tho Engineering Corps in peace and war for hospital construction?" So far as I know they did a very good job In construction of hospitals# But i didnft have definite knowledge of that until practically all the hospitals were completed# "Do you consider the administrative difficulties of operating joint service hospital facilities the paramount objection for combined use? If non-medical, widely differing administrative requirements of the Amy. the Navy and Air Force were rectified by adoption of an identical administrative system (same forms, jlaws, etc#) would joint use of facilities be feasible?" % answer to the last part of that auostion is "yes# X think they ought to get to ether and have the same list#"**** U K* POUT'— Colonel, in THUS EXTRACT COPIi (Extract of statements made by Colonel Thooas J« Hartford, ££, Ul*k an 23 April IS at interview with Subooociittoe on the Eoployaent of Military Med4iml Resources) ****** *i» I igm that tbm should be a separata section in corps in peace sad car for hospital ocostruction* The soot valuable group that Z can think of in the theater—-and I blessed then sway tines—«ae a hospital design teaaj a group of generally soldiers who had bad experience in hospital construc- tion, and the engineers as they sent along, especially in the coBDtmieetioas sens, got better end better in constructing and doing over concerned and miring them into hospitals, and 1 became an engineer convert* X thought they sere pretty good* And each tine they built a hospital it was better, end when they vers able to go into the Genas® prisoner ear camps and pick out really skilled artisans, shy it get still better* But when the war was over and I found wye© If in the knag with some fins fighting engineers of tbs Third Any, X found out that even I was a better carpenter than nost of then* They couldn't build anything* They didn't have tbs slightest Ideal and they tinkered around for waeka in ay area trying to reconvert cone concerns to hospitals, and until we got two or three kindred prisoners in each one of those* places why you couldn't even tell what they had '&£****«*** - ----- L. K# Pohl Colonel, m THUS SX3SACT COPT OF imWIW WITH COL JUKI C. PHILLIPS, AKC, 27 Apr 48, I. "The physical of our installations has much to do with tho amount of personnel that It seeded. Although bod-pat loot load might ho reduced oao month or for a period of months, that doesn't moan wards and ellnlet close, and wo still hare the same amount of area to cover. Ton can't do proper nurs- ing work If you. are going to spend your tins walking hack and forth Just to cover an area to see what it going on* |*d also like to see authorization for eBploynent* In hospitals* of personal for housekeeping duties* probably vith civilian housekeeper in charge* which would result la hotter housekeeping maintenance and would r el lore weird personnel who should he available la assisting ia the carsjaf a patient.******* r.c» wIvmi* kc THUS EXTRACT COPT (Ltr Brig, Son. ft.R. fonnobeck. Dental Corps, dtd 7 May 48) **♦•**♦* X. aIn the Zone of the Interior buildings designed for the purpose should he'eonstrusted In a central location and each military installation and all available dental personnel concentrated therein* Such an arrangement results in more efficient operation. It will be necessary for a few dental officers to be on duty at each station hospital for the treatment of patiente. However* mo t dental treatment is given on an out~pattont status and therefore the larger dental installations need not be operated in conjunction with station hotpitals.******** Cohqael.MO EXTRACT CP STATEMENTS MADE BY COLONEL OSCAR S. REEDER, 1C, USA, 01 15 APRIL 1948 AT XITSR7IEI WITH SUBCOHflTTEE OR THE EMPLOYMENT OP MILITARY MEDICAL RESOURCES* ***** *&• Sprawling typo of hospital is not advisable* *9* Area, control* X don't believe so* General hospitals should bo under the control of the Surgeon General* •K). To a considerable extent. Greater use of ft—It doctors could bo —do. I ACS could replace malts around the hospital to a great extent and they sake better nursing assistants. Nurses Aid • yes. Z am eery such in favor of the flC hospital eonpany,•*♦*** r-> L. I. Pohlf Colonel, 1C 1MB EXTRACT CQPIi (Letter from Colonel Richard T, Amest, Ret, dated 19 Ajxril 1948) **♦* "i. In the zone of the interior insofar as is practical, construction should be‘of a permanent nature. Such hospitals should not be released from federal control but released to •veterans or tp states on a loan basis to be available in case of future need. Distribution of hospitals - they should be adjacent to or on cantonments - In the near vicinity of ports but removed ffom large cities. Hotels are not readily adaptable to hospital use. Cantonment type hospitals should only be utilized as a last resort and abandoned as early as practical. Staffing of Zone of Interior hospitals oast always be in accordance with needs. . The surgeon on the spot should best know his needs but must be watched or be will overstaff. Specialized Hospitals should be continued and staffed accordingly. 77sM^‘ L. K. Pohl v Colonel, U. 3* Army TRUE EXTRACT COPT (Ltr fr N, C* Mashbum, Col,, fe®, 19 April 1948) *****Large hospitals serving areas is most efficient and economical* However, medical personnel oaring for individual units must not bo com- pletely separated from the sick* Some cpesproigise plan is rccoiBinended*M«i IT. ‘K* PCKL 1 Colonel, 1C THUS COPY EXTRACT (letter from Captain H, J. Anton (KO), USI Portsmouth, Virginia, dated 27 April 1948) ***** «(i) Hospitalisation and evacuation policies within the zone of the interior with special reference to construction, distribution, and staffing of military hospitals. My comment here must he limited in «s.ocordanoe vita the extent of my first-hand knowledge and experience. I served in two such hospitals which ware voll-*coastmcted, veil-located and veil-staffed and which wore employs! to full capacity yet met all demands that vere made upon thoa. «*•••• L. X, Pohl, Colonel, MG "(I) Hospitalisation aad Evacuation Policies Within the Spaa of the Interior with Special Reference to Instruction, Distribution aaA Staff pf Military Hospitals. Shs paly comment la Ship epaapptioa ip am follows* Xt It bslisvsd that aaay military hospitals la thp Zens pf thp latprlor parly during World War XX wars otaffpd vith Aootprp who vprp never ■ado available for overseas duty, There wap doubtless a hiding aadpr thp galop of llaltod duty of aaay who had relatively insignificant phytloaX dofootp pad wprp kept at hoap oaly hpoaapp tholr respective Commanding Offldorp orlod load and long whoa aorpaoat pf such personnel wap anticipated. A pyptoa waioh poraitp thip la defective pad eorrpotloa anal eoap froa thp higher XptpIp.•••••• frRUv EXTRACT COPT (Ltr Colonel Robert f, William*, HO, fiurgeou, did 16 Apr 4S) X, and evacuation policies within the soae of the Interior with special reference to construction, distribution, and staffing of military hospitalr. Hospitalisation within the Sons of the Interior should he on basis of the service (Army, lavy, Air) as fax asstation hos- pitals and di-penvarles are concerned. Xach hospital to C‘«rs for aeabere of other services as at present. All general hospitals should he based on the unified policy. Concurrence of the Surgeons ©eneral or failing that, decision of the Secretary of Defence should determine which service has Paramount Interest in a given locality. That service should then furnish general hospitalisation for all services. The commander of the hospital should b« from the service having paramount Interest, his executive from the opposite service. The hopsital should be staffed by Medical hep art- meat officers of the several services in apr>roxi»ftt«iv the nronoetiun that the patients come from from the various services &• aV/iCHt. Col, KO mm EXTRACT COPY (Ltr Brig, ft on. ftuy B. Dealt, MC, Surgeon, dtd IB Apr 4ft) ••••♦ 2# * Hospitalise tlon and evacuation policies within the sone of the interior with special reference to construction, dietrihutiou, and staffing of military hoopItale - We should never again go hack to Civil War construetion. ►Boepltale should he located with a view of that*#eeAwa» jntiljleaiien.eoeeaeee* I. X, Xohl, OftM, HO IE® CQPI BXX8ACT (Letter, dear Adalral C#3#Caner«r (llC)a 0*S*S*a - -ie tired dated 21 April 19kB) ***** “(i) The outstanding point in this connection appears to be la the provision Ter evacuation froa deceiving Activities end Hospitals. •tc», on the coasts concerned - or other points of entry to the hoaaland • to points further inland as rapidly as possible* far in the £msm of heavy oasualtiee, the receiving points quickly bacons —— end proper am of patleite disdnishes in cOrectVatS. oonttnuoas transportation veil into the interior to previously proposed thus taking the load off the deceiving centers is of vital importance and its neglect invites disaster*” *•** U &• Pyji%9 COtL*meI,^ir TRUE COPI EXTRACT (Letter, Colonel C. J. Baker, MC, Air Force dated 22 April 194?) **** *1. It ehould be the policy to hospitalize any patient from any Branch in any hospital. The procedure and forma for re- porting should be uniform in all hospitals of all Branches. It should be a general policy to evacuate patients to hospitals of their Branch, although this should be very elastic, depending upon the nature of the individual case, i;e. cases definitely due for long periods of hospitalisation or disability discharge should be sent to hospitals near their hones. Cases needing specialised treatment to specialised hospitals, etc. "Hospitals should be of uniform construction for all Branches. General hospitals should be distributed according to civilian popu- lation centers, with only evacuation and station hospitals in the communication sons. All evacuation and general hospitals should be located near the airport. Hospital commanders should be medical officers with free use of Medical Service Corps officers as executives end administrators. Professional Staffs should never be placed under the direct administration of other than a medical officer." **** L« K» Pohl, Colons, MC THUS COPT KXTHACT (Latter, Colonel O. F. Mcllnaj, XC, Air Force dated 20 April 1948) ****** *i« Hospitalisation and evacuation policies within the Zone of Interior were not observed by the undersigned. However, it is understood that there was each wastage of professional personnel due to their being assigned to duty at Hospitals when their services were not yet required* Reorganisation of the Medical Department or* ganizations suggested in paragraph f above would make it umeeessaiy to order such individuals to these hospitals until such ties as their services were actually required. Construction and distribution of hospitals in the Zone of the Interior as elsewhere will be depen* dent upon the type of warfare, but it appears that they must be properly dispersed and that they should not be located in the near vicinity of large cities, ports, industrial areas, or other military functions*” ***** KcUJrtuc L. K. Pohl, Colonel, K TRUE COPT (Extract Ltr M* C# Stayer, Major General, U* S* Army, Ha tired, 18 Apr 48) ***♦ «(i) Hospitalization and evacuation policies within the zone of the interior with special reference to construction, distribution, and staffing of military hospitals* It is my belief that the Theatre Surgeon should hare more to say in the construction, distribution and staffing of military hospitals than was given him in the past* Hospitals mere forced on me that mere expensive, and, in my opinion, mere not properly designed# Hospitals mere built In the Canal Zone by the Amy as permanent installations with little regard to the needs# The medical personnel in the Canal Zone were asked to give little advice and when given, the advice for the most port was ignored# The Army, Navy, and civil authorities built hospitals near each other, and the Air Corps mould have also built, if possible, in tbs Canal Zone# ?his was, and is, a marked picture of the lack of coordinated effort and caused great duplication of construction, personnel and material****** Colonal. MC ugmgf of WA'mt irrs um bti flolorwl lCa U«8.A, op 22 April 1&8 at intwnrlww wife Maeoigaitta# on Va* kgpVoyrwnt of Military Medical »*»«»* "(1) 6# I thick ye«* I think that tho mission of the swdicel department of tho Aruy or tho M«yy cr tho Air is to tsks cars of thoas Major foroos and not tako ears of peopls who area* t not or expected Is bs in tho naar ftzturs active laanbers of those foveas, therefora* 1 think they should Is put In tho Veterans* Bureau hospitals# *1 think that it is feasible and desirable to utilise civilian apodal ia to in Zodo of tho Interior hospitals in consulting oepacltioe, in professional capacities# and teaching capacities# I fool that that Is the place they should bo used# •(I) 9• I can toll you who is going to control# Tho Surgscn General should c ontrol all hospitals in tbs ZI# •(I) 10# X think that physleally-handinappod officars and enlisted am can aid should be used In staff positions in ZI Hospitals, and Z think that certainly in wartlaa greater use can be oade of female doctors in ZZ Installations. That is entirely coops tibl* with ny statement a acosnt age that I don’t think the woosh should bs in tho ccohat Bonos# I don’t knew about BACe replacing enlisted miss# •Definitely in Z I hospitals# In ZI hospitals, yes# Z think if you am keep your worsen in the ZI and 1st /our son go to war, you are going to have better results# •**••* •(I) 11# I do think that tho surgeons general should control ovaona* tlon transportation In the ZI# I am not familiar with the system adopted and can* t answer tho root of the q ueation. •«**** •(I) l$m I saw thouaande of oaaoo of suspected psychosis, or at least psychoneurosea, who war® oondaonod without trial and thereby made vonaj particularly in tba Marinas* Tha minute a man ixa the Marina® was suspected of a neurotic or psycho, or hfta ecraaandar or platoon said, "Tou are not fit to bo a Marina any more,* and that Mda nor® MPa and the thing just snowballed. X think trm a personal stand-point this is not an expert opinion—that they should be given a X. I. raj., Colcod., V 574 Extracts of Statements made by Brig Oen Robert G* McDonald, MC, 084 (Retired), 81 April XMS, before the Subcommittee on Military Medical Bemouroes. «e«s*8ospitalisatlon and Evacuation Poll das within the Combat Zone, and evacuation to the CoBnunications gone and to the Zone of the Interior#* •Hospitalisation in the Combat Sane should bo la mobile medical units and should be of short duration** is started into Australia and into the Southeast Pacific with the idea ws wars going to here to put up lots of prefabricated buildings, and It would hare been a grand thing f ws had had those readmit bat* think that part of the war was about over by the time we did get them over# Z didn’t go over to the theater vary much, but I auspeot they weren't ready# X do think we should hare prefabricated buildings ready In time the next time, because they a re of very great advantage in the tropics* I think the Maty, from reporta X received, were ahead of us in that respect* They did have better provision for their mobile hospitals, Small ones, than the combat area* X think that the Division area, for example, up near the front, really shouldn’t try to hold patients more than two or three days* In maneuvers and in combat In the first world war, I found that was i pmotioable if you are getting very many wounded and sick* lou would have to clear those units because they have to be kept mobile and back in the Any area In time of mo- tive combat two weeks would certainly be a maximum, or in the case of a badly wounded man who had no prospect of returning to the front lines soon, or A seriously ill man, return him to the rear as soon as he was physically able to stand the transportation* Regarding the policy of evacuating t\ the lone of the Interior, I think that depends so much upon the that is, the else of the war, tbs nature of it, the etrength of the enemy, the lines of coa«mlcstiaa, and the distance from the homo territory, and so on, it’s very difficult to determine that* I think that we first started out la the world war to go on a 90-day policy, and I think acne of our patient# from India got to San Francisco about the end of "£he 90 days and were ready to turn right around and go back, and they did get wall, and that was too short, of course, a Urns for a theater like that* On the other hand, X believe It was General *%wley*s policy in England to retain his people six months* That was before the active combat started, however, during the assembly and mobilisation of the force for the attack m Europe, and it apparently worked all right* It did enable him to build'qp hospitalisation which would be ready for tie peak load when It did corns, which X think was a very fortunate thiagf but somewhere from 90 days to six months is probably the some for retaining patients in the communications sons or in the theater of operation *”***« lactraets ef SUtnfili udi 1ty Bri|. Sen, iiotert 0* XsStatU, NO* U3A (ItUfid) 31 April 1948* lifer* the Subcommittee on the Jmployaent of Military Medimal Umitmi. •••••••I* aX think tho general hospital of a thousand hods vo had something Ilka 43 oodieal offleer>, plus* a large sanhor of oodiool administrative effiooro and dontal off loort and others, asking n total of perhaps ever 80* Vo found out lator that wasn't necessary, that perhaps half of that number of medical officer* could do the essential professional work, turning over to nonoedical porscnaol as oaeh of the administrative and routine work of operatise a hospital as was practicable. •the specially qualified personnel available had to bo spread thin enough to oaa all organisations* in the later stages of the war, •Hedle&l equipment was adequate in aost organisations. The development of special oquipaont for Jangle warfare was oat standing. The dovolopaont in peacetime of special oquipaont needed la Arctic climates is aost valuable and tiasly. The training of Medical Department Personnel was well organised* and generally well done. The tactical caployaont of Modloal Organisations was well planned aad carried ontj* as far as X know, X did M| oorvo in a combat sene. The handling of the sick and wounded brought back from Xorcpc in the later stages cf the war was well handled, In the fourth Service Coamend we brought moot Of the badly wounded and seriously ill patients - that is* litter patlento - in to Charleston, and froa there in the hospital unit trains operated by the Office of the Surgeon General they wora very expeditiously distributed te various hospitals. There did develop a great diffieclty because of the dietributioa ef cur general hospitalnamely badly wounded patients who were later te be discharged frem the service ceuld not be hospitalised near their homes. *here was a policy early in the war* when we were afraid the germane* er somebody would be bombing over here* established by the war Department cf met building general hospitals dess to the Coast, X was Surgeon ef the Third Service Command ever here at Baltimore in 1943* mad I lound X was terribly crippled by that, Ve had lets cf population* but very few general hospitals, X made strong recommendations that they abandon that pel lay aad build hospitals along the Comet where they were needed* the moot* aad thay did do that la my own Service Command, They established one out hero in the Shenandoah Valley aad in Xiohmend and at Philadelphia aad Pittsburgh* Vo did finally get a chain ef hospitals. X don’t believe that ve can base our distribution of hospitals cm may such basis as that, it may rsadily be seen that thay perhaps should not bo in the kiddie of groat centers of population* but oertaialy they shouldn't eon eider the Comet me so vulnerable that we ean*t put any he spit ale anywhere near it. The medical unite for the eoamunloatlone sene* particularly for the combat sons, should have supplies aad equipment te enable them to Carry on for a reasonable period. That depends* ef sour so* upon the least ion ef the theater* upon the nature of the warfare* upon the strength of the enemy* end various ether fno torsi but certainly ms a general role X think something like 30 days ef on* peadmble supplies for a combat unit would be reasonable tin going into the thdmtmt* •nd another 30 days* perhaps ia the Amy area* and them into oeamnleations suydhcf from 60 days to four months or oven six months, depending upon the security of the lime of comsunic*tlons and the combat situation. •In general, did medical department unite and organizations hare suffic- ient personnel? If not, hov was the deficiency corrected by you? Hare you any specific recommend-1ions for particularly inddecuately staffed unite or facilities? Were your observations based on peak loads or emergencies or on so-called normal loads?* It applied to my units down there. I had a gre-*t shortage of personnel, enlisted personnel in general hospitals, in large station hospitals. It vat not by assigning prisoners of var on duty; and they did splendid work. In fact, we couldn't have gotten along tbrought the early stages of the demobilisation without then, because we did not have enough personnel to carry on* •Bo we need any new medical units? If so, for what specifically? What is the basis of your recommendation? I can't comment on that. We may need units, but I don't know Just what they are and what they should do. We certainly are developing new ways of warfare, and it is probably going to call for now types of unite. But I don't know what they are. •Odd our planning figures allow for medical department units in any given task? Should we revise our planning date for medical cases in forward areas? Atomic warfare? •Didn’t have knowledge of that situation, I think, generally speaking, that when ve organised a task force or tried to set up equipment for a war plan, that enough stuff was rent over there probably to cover It, But in its distri- bution over there, I don't know what the situation was, or what the situation was after the expansion. My consents wouldn't be worthwhile. •Sid the presence of females la nodical field units prove worthwhile? Accessary for professional reason? For psychological reasons? Should be in- crease the female component in our field and fixed units wherever possible? Bid females hamper the movement of units ? Did they reduce the mobility of unite because of their necessary separate accommodations!B* X don't know about that. Brig, General Martin: 1*4 like you to rawer the last part. Brig. General McDonald: fhe Vacs did excellent eerrlc* in my terries eomaand. Brig, General Martini The question 1« • should we Increase the use of feaalesl Brig. General McDonald: Sot in the combat tone. Brig. General Martint Ton bar* had eaqperlence in a fixed zone? Brig. General McDonald: Toe, re can me* nore females*.•*•♦••••• L. K, MO THUS COPY EXT2UCT OF WITH HiAE ASKlJUa HOMOS 0. WlLLCUTtS («C) MSS 4 ?ta/ 1S40. •••*•*** |# "HT.AR ACNUiAL AH3$iiS0«j How &s to that waae subject in regard to the Continental United States, would you discus?. It with particular reference to tas construction of hospitals and the distribution of hospitals and tiiolr staffing? One question that has come up is who should control the evacuation and distribution of pat'ents Inside the Continental United Sthtes? In our Service it was the Bureau of “edicine and Surgery that controlled it. I mean, who should control it between districts* KCAk AQKIHaL VlhhCUTTSt there again, with total war and with key points destroyed or exposed, I believe that this distribution will have to be de- centralised. I believe you cannot depend upon one bureau to direct an overall hospitalisation. Somebody should hare a blearing record, a clearing sene, so we any know where there are empty beds. But our country is so large that I believe, if possible, we should sake a distribution canter, say, at least 3 or 4 zones - say, west of the Bookies, and the bid best* Against that, of course, cones the senti- ment that the/ want the boy near the hospital where he lives, that was the basin of Abed and Surgery, not so much &■> to getting them into bade as It was to get this kid near his grandmother or his mother. It became the lav that ah/ bo/ could go to a hospital near his hows. That was a luxury of the first order. JtSA& AIBSRSOi5s Bo you think the advantages of transferring a patient to a hospital near his home outweigh other consider at I one like climate* particularly climate? JBKAE AlbtlBAL ‘rflUUJVTTS* So. I think that has vex/ great disadvant- ages - this sending of a bo/ to his hose. Hs has to break apron strings; hs is not the fighter he was for weeks; he softens up when he goes hose. A fight you have to be brutal; /on hare got to be rough. And when you pat this hey hone, he sees his fasti/, his preacher and all the nice things - shiny cookies - and the/ soften him up. If you could keep hia away until the war is over, youwould have a better soldier, a better fighter, and a better sailor* That was pure sentiment that brought those boys to their hones, not efficiency. It was a great morale builder* BaAB AOCIKAL AHBSESOSj that do you suggest as to ideal else of a general hospital or itaral hospital? KSJkB AMIIUL WLLCUfTSt Ain /tm go above 600 to 1000 beds, /on are getting Into n vex/, Ax/ b&g operation. X think n 1,000 bed hospital ecu hs con* sidered a ail liar/ hospital* 8XAR ASM ISA! ABSSBSOli Bo you feel that specialised hospitals* hospitals for the treatment of similar types ef eases - is justified? BHAJt ABRZBAL WILLCWfSx Am /ou tn«pu< tha training pro- |Iib* Aim people a«st Vi train*!, You Viri get young doctors, and the/ shooed have general training* It is difficult to put all /our orthopedic eases la on* hospital ead heart caeca la another* I tdak a general hoepital should ho still a general hoepital with a varlstj of eases* As ollaical Material should hs kept these far training as veil as fer the general nereis building ef the staff* X da hsdieve in the lete stages fer deeffcess and blindness, and these high!/ specialised eases* ths/ certaial/ should he ssersdated* Ae smutees. X think, war# handled all rl^tt* Times COPY H'JX. Of XST3ii?ISW :1TH &rA* ADM?HAL MORTON 24. WILLOW (WC) USS 4 May 4ft B23AH ACHIRAL ARDSHSOHi Co you think convalescents should be cared for in general hospitals or is sonvalescents hospitals? RSAb ADMIRAL W'lbLGUTf 3; There again. X think yaur convalescent patients should holp out in tbs hospital. I can't think of any tin** oc uss 4 HAT 1948, LfigyimBfr SEAS ADM nUL AEDSBSOE* Do you think the S(m«> Aid* Program worked out nil *fnctorlly T ERAS ASRIBSL ¥ILW30TTSj Tot. I think Eurses Aides wore helpful when property eapervlecd, They had to he supervl sed, The ladies did a grnad Jot, a grand thing, The Bed Crons did a gremd Job, as did these various other categories that cam© along, But there again you get a lot ef sentiment, and you hare got to know how to handle then based upon a lot of patience and tolercace. BM AMI SAL AIXKR90!?t Do you feel that the WAVES were successful assist* ants in the Eaval hospitals - and would you increase the neater of WAVES la the stafft S7A& ASK I HAL WILLCtTPTS: 1 think the KATES did a magnificent Job in the ear, SSi tore WAVES aeons Vbnen'e Auxiliary Voluntary and Asergency Service, They did that, They filled that hill splendidly. X do not think, however, they should he a permanent component of the Regular Service, I think they should he kept in the Seterres, I do know in the hospital they worked like a brother and sister to eur nale eorpsaenj and it was a very wonderful performance. They did a great job. At Sen Diego I had at one tine 1,100 WAVES at ay hospital. REAR ADMIRAL AHUBBTOIi What are the objections to the WAVES as a pen* assent part of the medical service? RFAR ADMIRAL WILLOBTTSx In the Havy we have rotation of billets, of Jobe as you knew — sea duty end shore duty, to have rotation of favored billets, by favored billets X mmm staff billets - yoemon billots, clerical billots, la addition to the professional billets such ns the technicians. The WAVS technicians tore ex* cel lent. The female oa that side is better than the nale, that is, at the bedside, but we have got to hare nale attendants at sea end overseas, in the rough places. And if you deprive this hospital eorpsnan of these technical billets and these fate* erite billets, such as clerical and seer tarial petitions, they nust learn admin* 1 strati on and they nust lean to do staff work * that Interferes and t an fearful ef a reversal of sentlnent towards the/ WAVES by our enlisted nen in peeeetlne. REAR ADMIRAL AIDERSOIx ire there any further questions on this?* (lone) eeeeeeeeee* luX. POHL, CQLOHUt, MO ABS i HAOTKD TKOk FhJiSOlUl LXffMB ¥0 COL. L. K. FOHL, MC FliOM COL, X, MC, DAT5ID 19 May 1948. I. "Another policy which should be changed in. the General Hospital Plan. Is the one witch requires patients to reoala in hosoital* for periods long beyond the time required in civilian life. The resulting increase in hospital bid requirements, wakes this a very expensive policy, requires ouch supervls'on on the part of trained Medical por-onael causes a breakdown in morale of the patients, dus to the fooling that they are still hospitalised awaiting Board actions, and makes Medical officers annoyed at looking at the sane faces long periods of time. A system of transferring patients la command control, tmaedlately they ere well, should be set up in all hospitals. The old-fashioned idea, originating ia the Infantry and Cavalry, of keeping la the hospital until he can ride a horse, is ebsolete, There is no reason why, la a technical Amy or Air force, a man in a cast eanft sit at a desk or machine and perform certain functions. Another big error was the over-cons traction of The A$ figure ie excessive and expensive* Modern chemotherapy, early ambulation, and a system of quick return to command control, should save billions of dollars in hospital eon a true tion* eeeeeeeee X.C post., OOLOStt. MS mpmimm sum commits bt au fom* medical oapAanoaT omesas, aaomvs nxu*» TO COL. L.A. jTOiflE., HO. A3 PBOfXBKD ISJGKM1L1T MAT 30, 1943. i„ *Ha«pitsXisatlan and evacuation pal Idas within the zone of the iiv- with special reference to construction, distribution end staffing of ail- it ary hospitals. 0 obstruct Ion - Tbs ja&Jority of our hospitals at present are the eon tenement type built during World War II and reflect the necessity of estab- lishing and alnlsus standards for ecah and every department. It Is believed that the minimum standards established should reflect the functional layout plans and floor space utilimotion proposed In *Sle»ests of the &*ner*sl Hospital* prepared by Division of Hospital facilities, USPHS. This publication reprinted fro:s th* •architectural accord* is based on civilian requirements* There is no doubt that the military hospital with Its ever present emergency role la modern warfare, must bo prepared for aU casualties, military and civil- lea, ns must the civilian hospital be prepared for civilian and military cas- us*! ties. Outstanding inadequacies are* 1) 0H*s, clinics without adequate record rooms, dressing rooms, waiting or lounge rooms. 3) 01*s with expensive ex- plosion proof switches and spark proof electrical outlets, yet the floor Is noa- eondaetive and a potential OH hazard. Efforts to install floor grids or conductive type linoleum are met with the comment that a t U funds have been depleted. 3) X-ray clinics - consist cf the office space, exposure rooms, dark room and waiting bench*? usually in the hospital corridor, fo provision made for the inclusion of toilet facilities, required when barium enemas are used for floureecopyi dressing rooms, a must with the m-ray examinations of female patients. Again efforts to make these chaagee result in the comment that funds ere not available. (Hepair and Utilities). SSPBOmJCSD mm COItftBBTS BT Aid roses MSDIO&L fiSPAfifKSgT 07FlCl3tS, AHDBSVS FI£UJ, 20 OJL, L.K. POHL, MO, AS PSD7ZM9 IIFOfiMALLX MAI 20, 1948, I CQITClgimm 4} OB Clinics, dslivsxy imu, nurseries, «le. are with a Inlaw •> pMdlkre of funds and la nany instances do not provide fort a) Srplosioa proof Delivery Boob. B) Air conditioning la the clinic. «) Cubical techniques la Bnrsery, d) formula rooa revolt log la the preparation of foanla la the ward diet kitchen* Eegardless of construction, the present standard* of aaiateimnoo end the procedures of aaiateaanee are entirely inadequate. She shortage of funds, {MSS) the Methods of classifying proposed changes, Installations, etc. do not load toward efficient aadatoosaoe. There la ao doubt that with the present set* up, the oust of processing the paper work oa a wall work project at a station hospital would and does exceed the oust of the project which, la a civilian ho** pi tad, would ho dependant upon the decision of the adaluistrHtor and accomplished hr Hospital Utility personas! that seas day. This condition of outright dependency of the nodical service oa other nativities or services which are controlled hy noanaedical Interests naturally Manifests itself la every departaent of the hospital, a) She Medical service has available funds for technical }>ersoxmeI which are not available through ■illtazy sources But art availaBla free local civilian sources. Personas! csll- Iftgo in effect, da sot allow hiring of additional civilians so the hospital goto along without the technician* B) The following is an extract free "On Ho spit ah? In the Biographical not# of tbs author, S.S. Uoldv&ter, K.S. * forser ©o*als»ioaer of Ileal th of the City of law fork sod ccwolsaiouor of Hospitals of the City of Sow fork* *fo carry out his policies in a systeaa inextricably Bound up with city government entailed a eons taut struggle not aorely against the e ruder ferae of favoritiw, interference, and partisanship. But against havering legal restrictions on the proiopt nation, delicate decisions, end flexihle Judgments which, to Ms a lad, were essential in hospital work. A central purchasing Bureau should not, he protested, have the power to substitute another bread of sutures for th# one asked for b. the surgeon* "She surgeon carries Both a legal and moral respon- siBility and I think the 01 tf is Bouad to support hla in the exercise of Me judgment*. He strongly fevered the merit system, and the Department made very suBstantlal advances in the civil service classification of its employees. But he maintained that interne should not be selected by cidl service; the aedical staff observes the interns at work and 9for the Judgasa&t that is Bora of this experience there is no substitute*. He contended that hospital planning should not Be assigned to a general Department of Ooattraction, for it was a logical function of the Hospital Department, which had a central end immediate interest in the construction of hospitals and had access to the advice of qualified special- ist o in every nodical field.* It i» apparent that* at present, the conditions expressed shore hy Dr* OelAvater oleselj parrallel the present ailitary aedlcaX set~cp at the arerege station hospital# L,K* tom* O0LOSXL, MC THUS COPT SXTHACT OF IHTERVIBW WITH BBIG. OEH. JOSEPH S. BASTION, MO, USA, (SSTIBEO) 0® 3 MAT 1948, ******** X. "Hospitalisation aad evacuation policies within the son* of interior with special reference to construction, distribution, and staffing of military hospitals.** Well, of course, now to begin with in the last business you know they tried to set up hospitals for areas} that is, take the midwest area, that would hare two; everybody would have to come there because they lived there. But due to the dearth of specialists, and so forth, that, as you knew, didn't work, aad it won't work, and I think that hospitals - you have got to have special hospitals, because you are not going to have enough specialists to go from Texas to the Bread Lakes, Within reason you can separate them. BaiGADXiia SSTM MARTIN; 1 might ask you at this point in the seat of the Interior in time of war would It be feasible to use local specialists la the civilian statue at armed service Institutions rather than call them into service and dissipate their work? M10ABI1H BSR5LEAL BASTION; That could be dose, yes, I wouldn't like it, but I would do it to hepl the over-all role in the medical phase of the whole war, whatever it is. It can be dene. A lot of things depend upon whoever the commanding head medical is la those places. Ho matter who you've got, no matter how good an outfit you've get under you, if the fellow isn't trained at the top to recognise all these things, you aren't going to gat anywhere anyway; but that can be done. BHIBADIHR OEWSBAL BAST!OH; I don't quite get that. C0L01T1L POHL; If a man has a load comparative to that carried by civil* lan physicians that remained out of the service in the past war, the mount of work that he can do Is limited. Therefore, if there is a selection which he must make as to what surgeries, for instances he will do, it is my feeling that he would possibly very humanly prefer the work which would give him the greatest financial return, Would such a factor operate possibly to the detriment of the adequacy of the medical service rendered by that Individual V BHIGADISR 01SSML BASTIOEi Tes, It would, If that happeaad, If you lot it happ«a* COLONEL POBLt What can you do to prevent it If the circumstances existY BRIGADIER BSHBBAL BASTION; Tou would have to go to this pool and get one full time. BRIGADIER CENTRAL MARTIN; How I have a question here. The policy of locating general hospitals is open io criticism. Boos the factor of patient being close to home outbalance the desirability of the advantages of climatic consider- ations which might enhance convalescence aad promote economy! BEZdABIER 8X2T RAJL BASTION; Bo, It certainly dees net. That is what X was trying to bring out. Climate is nice for certain things, but you will never TRUE COPY EXTRACT OP ITORVm WITH BRIO. CM. JOSEPH S. BABTluN, MC.OSA (RETIRED) OB 3 May 1948. , I gOAXIflUIPt be able to put a general hospital, as far as 1 hare been able to see, in a locality and hare all these very high top-grade specialists do the greatest good to the greatest number. Ton haven't got enough of them in the country to fight the war and run these big hospitals. My answer to that would he no. 1R1GADISR GSN33RAL MARTI St What* s the maximum else for « general hos- pital that you would recommend for the Zll BRIGADIER GEEEBAL BASTION* Well, are you talking about what you think one fellow could run? BRIGADIER GSSLHAL MARTIN* Efficiency. BRIGADIER GBSZRAL BASTION* Between 1800 and 2900. BRIGADIER GENERAL MARTIN* Should the oonralesoaat faellltiea be eeparate er parts of each general hospital? BRIGADIER GENERAL BASTI05* Separate. BRIGADIER GM2RAL BA ST I OH t Officer aad enlisted personnel should hare separate oonralesceat facilities! MIOADISS OESTHAL HAiiTIIj Should long-tei* Cases ho die charged fron terries hospital* to civilian Institutions for final case at Govornaont edpensoT BRIGADIER GENERAL BASTION* Well, aow, there art a great many factors. Zt would depend upon the institution. If that Institution were set up to take care of paraplegic cases, we will say, you can do it; but the thing you hare te be careful there is the patients resent rery much being tent away from the mil- itary during that time, and it should be done as little as possible. In other words, the Armed Forces should take care of their people up to the rery last min- ute, X think. BRIGADIER OETiRAL MARTINj Another question. Is the sprawling type of construction for general hospitals adriaable? If not, what it the solution in the face of critical material shortages? BRIGADIER GENERAL BASTION* I dom’t like it. Tou eaa here a system of reaps of easy rises that would take eare of most of the objections, I think. Go up in the air more aad save people miles ef running around all day and wasting space and taking care of miles ef eerrldere. and everything else. BH1&ADIKE OutKSAL tURTXSt Vho itotd control the general ho «p it alt in the sir BRIGADIER GENERAL BASTION* It should be under part of the Armed Forces, whatever you want to call it. Zt should not be under the Army area Commander. BRIGA3ZSH (HBSSBJJ* KAMI I* What It yonr opinion at to utilising nor* folly the physically haaAioappod or lialtodksorylco typo of porsonn*! in hospitals U tho XXI TEU3 COPT OF I3TJ8RVI3W WITH MIC. CM. JOSEPH 3. BA STICK, HC, USA (KBTIMB) OH 3 MAT 1948, Jj. WMt BRIGADIER GEJKRAL M ST I OK; People have an idea thf,t hospital* can he run V morons and any defectives that somebody alee doaen t want. Their proportionate share should ha allotted to any sons of the Interior installation and not from the standpoint heoan.se they are hospitals. BRIGADIER GM-uRAL MAETIKt Ware there too many frill* and luxuries in our hospital a which adversely affected the desire of soldiers to roturh to a duty status? BRIGADIER GIHSBAL BASflOMi To*. BHI0AD1M GDKEBAL MAHXIMi What can u* eliminated? BRIGADIER G3XHSAL BASTION: Off the record. Tee, they did, hut one of the things that was even j|s bad ae that, if not worse, was the desire of the civilian physicians who dldn t understand the problem to hang onto these people and a hospital commander should at least once a week go out and clean house. I believe that as long as the ma is a patient nothing too much can be done for that person, and he should he treated as a patient; hut the minute professional opinion comes along that ho is hatter, he should go, then there should be - that's another thing, there should be some way you can got them out in 24 hours, or 48. I think that our business of sending than from here to there and other places, what do they call those places whore they send them, where a few of thorn wont - well they didn't go hack right to their units. 3HIGADI3R OMSHAL MAhTIH; Rehabilitation. BRIGADIER GliH'SRAL BASTION: Tes, and several of those. They hung <1 ong the road too long. BHIGAD1SH GKHHKAL BAHTIN: What was the greatest cause of delay in the construction of hospitals In the 21? BRIGADIER G3SHJHAL BASTION: X wouldn't know. BRIG ADI HE GMSBAL MARTI!; Would you favor at this time planning for the location of 21 hospitals leaving thoir exact siso for lator determination? BRIGADIER OEhT.RAL BASTION: I would, y*s. BRIGADIM GEHKEA1 MARTIN: Should general hospitals he separate posts with complete control over all maiitonanco, poet housekeeping, and so forth? BRIGADIER GENERAL BASTION: Tos. BRIGADIER GBVEBAL MARTIN: Were doctors used too much in administrative positions in 31 hospitals? BKIOAJ3IBR GMSHAL BASTIOHj Rot la nine, but I >nov of some whore they wore* that’s up to the local commander. the local nan in charge. That’s up to the local commander. Z don't see enj problem Chafe. y/* LiX POBL, OOLOm, KO THUb OOPT KXTHACT (from address of Major General Albert W. tenner, MO, USA 13 Kay 1948) NAJOJBt GMXBAL OHHSHj ••• "As to hospitalisation and evacuation pplieies within the 21 I hare just one comment. I believe that oases tkat are known to hare no military potential, just as soon as that is determined, should be turned over to some agency, VA, or somebody else, because they are of no use to the Army. They hare no military potential, therefore why keep them for a year or a year and a half until attain mart mum hospitalisation. BRIGADISH 0KH2BAL MA3TIH: To what extent can the partially handi- capped, both officers and enlisted men, be used to staff hospitals in the 2X1 KAJOH GJBRXBAL nSHSHj Z believe a board should be set up to review all of the disabilities now currently listed by the TA for the purpose of determining what type of casualty may be considered as available for duty in a limited status. tfe have some cases of residuals from wounds that preclude the individual's assignment back to his basic arm or hie assign- meat to certain military duties, but will permit him to perform a very useful function in sons other capacity. Xn that way we would be able to obtain ths maximum utilisation of our manpower. ••••••• L. K. Pohl, Colontl, KO ygJS COPT KTBAOT (Letter, Captain H. D. Templeton. MC. US* dated 23 April 1948) *e**e «(I) HOSPITALIZATION AHD EVACUATION POLIO I IS WITHIN THE COMBAT 20HJS AND S7ACUATI0S TO T&S COMMUNICATION Z052 AHD TO M 20M 01 INTJffilOH. The short period of time I performed duty In this country during the last war was entirely Inadequate to sake an appraisal of this subject. The Sayal Hospital at San Diego no doubt carried a far greater burden of responsibility than was necessary. The large nuaber of patients con- centrated in one institution created a burden of considerable magnitude for all departments and it is bellowed that had those patients been mere evenly distributed to hospitals in the central areas, much congestion would have been relieved and more beds would have been made available for incoming casualties. kuch thought and consideration has been given the subject of establish- ing hospitals for one type of easts, and to a certain extent this Idea was carried out as related to the oare and treatment of battle fatigue cases and convalescent institutions for the war wounded. I believe that this subject should be reopened and given such consideration, because it ie entirely feasible to staff hospitals with specially trained medical personnel, and no doubt acre successfully treat and rehabilitate such type cases.* sees* \ , L. I. Pohl,\Colonel, MO D-lj GEETSAL KKUTIOKSairS ”'ITH OTiCT BMCHEE OF THE AMSTO SERVICES RELATIVE TO MEDICAL PLAKHIBG AMD REOU1REMHHTS i. mm Bocauea of the broadness of its scope, this subject re- quires consideration of organisation of the Army and Nary during the last ear from top to bottom as it affected the operation of their nodical services. Further, it is logical that the study should point out specifically what organisational measures ere in- dicated to prevent the recurrence of the sane errors that were made and the wastage of resources that thereby occurred* The evidence available for consideration has brought forth sore definite cement concerning the basic need for a nor# adequate organisation for the control of the entire nodical ef- fort in war than in any other subject considered* This is natural as the failures as well as the trials and tribulations of nodical personnel in trying to do their Jobs as they saw than during World War II steamed in most part fro* the apparent general lack of im- portance given the nodical service effort in all echelons of com- mand* The Medical Departments of the Armed Forces have today a directive froa the Secretary of Defense to develop practical methods for the most economical use of all service medical person- nel and facilities, especially in peacetime activities* This Sub- committee has assumed its mission to extend this directive to cover emergency situations of war* There can be no worthwhile results emanate from the current study unless all deliberations and'recom- mendations are based on the sound premiss that the medical service is only one of the many technical and supply services that are neoeeaarily a pert of our war-making machine. There can be no in- dependence of any service in the fighting team* Each service de- pends upon all others for its operation and existence* All arc necessary to gain success* Because of this each service is eon- fronted with many identical problems in staff relationships. Bach must restrain its natural desires to be considered pre-eminently the most important* The very fact of mutual dependence should bo enough to bring forth mutual technical and supply inter-service agreement that each of the services must be equally represented at the top and on eaeh staff echelon* No implication is intended that all of the service functions in the armed forces do not need 588 coordinated control, especially in the logistics field. This control ■oat be supervised by sene staff action cm each level which should be United to coordination only. Full recourse to the Chief of Staff and Coenander in objecting to Uniting staff decisions sost always be possible. It should never have to occur in properly selected staffs. The use of liaison officers to effect staff coordination is sound. However, practice has demonstrated that nodical representatives when so used should retain their status as members of tbs staff of ths surgeon in every case and not be assigned to general etaff sections where they soon lose their Identity and develop a critical control attitude of thing! medical. Caution Is necessary in submitting rec- ommendations that would imply special consideration for the Medical Departments without adding the definite implication at least that all other comparable services receive Identical recognition. It might be sunned up by saying that the attitude should be "what is good for one is good for all". There seems to hare been lest in the cobwebs of time the lessons of history wherein the lade of a proper medical service lost wars* It can happen in the future and will If the Depart- ments do net from time to time retrieve these lessons for the con- sideration of the nation. Its armed force commanders and the civil- ian medical profession as well* These days of uncertain national wavering are moat appropriate ones in which to concentrate our Medi- cal Department efforts In preparing our requirements of the future* To disregard the opportunity is to gamble with fate and worst of all, to fail in our reaponslbilitlss to ourselves and to our Ameri- can people* The armed forces have always been organised and operated from their beginnings without deviation from the fundamental that absolute authority and responsibility has to be and is vested in the Commander regardless of his echelon in the military helrarehy. Medical. Departments in all their history have never questioned the soundness of that basic principle and should not at this time in- timate in any way in action that because of the special conditions facing them at this time for united effort that a supreme medical commander for all things medical In the armed services Is justified. It is a certainly even if the future brings true unification of tha armed forces ths chief medical authority will still sadat only as s staff officer to the supreme commander. Failure* in application and serious wastages of medical resources occurred in Farid War II in the Army within each of the acrviec medical departments because of faulty9 unsound organisation 589 which was directed by the ter Department* This suet newer happen again and action ia indicated to correct it* Terns of the current law loader which the three arsed forces operate deuand that Medical Departments of the Army end Savy naintaist separate identity* It ie pertinent to point out that the Medical Department# of the Any and Mary are only one of the many service* which overlap in function under the current national defense esteb* liabsent end it ia only reasonable to fersee the tine when each of the other services will be eelled upon tir follow the Medical Depart* stents in studies to offset.coordinated effort* Methods by which more than the beat possible coordination between the Any end Navy can be effected in all medical fields and which require the amend- ment of current lame or new legislation for accomplishment are not considered pertinent to the present study* The Command decision now in effect by which the Medical Service for the Air Fores continues for the time being to be furnished by the Army has been accepted as a basis for procedure ia this study* It ia generally admitted as a failure that little end certainly insufficient coordination in the medical fields occurred between the Army end Navy during World far II except on the lower levels when joint Any end Navy medical staff* were operative* This fact that fine coordinated effort was possible and occurred in lower echelons in joint operations indicates clearly the absolute need for some form of e joint medical Army# Navy end Air Force body to operate ia this field on the highest echelon attainable under the laws* This level ie the Joint Staff of the Joint Chiefs of Staff* There is no question but that this joint body most be permanent in nature both ia pease end war end that it ansi be established as a separata section of the joint staffs* There is some divergence of opinion as to the else end composition of this section* Some insist that the Surgeon Generals of the Amy end Navy and the Air Surgeon must in being constitute the section* A sounder military organisation which sets up a subsidiary staff consisting of senior, qualified representatives of the Surgeon Generals concerned with •ole, full tine duty in the section is favored as nor* practical ie affect its purpose and mission* The scope of the mission of this see* tion should encompass every area and aspect of medical activities in the armed forces* Essentially, it should be a strategical planning body whose main mission is to insure essential medical representation on the highest level of planning* This will fill the total void of World War II in which no agency was established to coordinate the efforts of the medical services of the armed forces* lie duties should be expended to devise ea the result of service investigations end studies of suitable methods for the improvement ia all nediaal fields, and procedure to enable each of the Medical Departments of the Arsed Farces to carry out ia full its specific scission In pesos and war with the strictest economy ef medical resources of Mil nature* 590 The membership of tills section suet be thoroughly indoe* trinated with the obvious feet that each of the armed forces medical sections has a particular specialty in its field which during war and oftises in peace is the most important factor in rendering its particular type of service* In furtherance thereof in all of its planning it must insure that adequate provisions are made to sup* pert these specialised service requirements* The fact that the section as planned would be composed of Army, Navy and Air Force personnel insures the equitable and desirable recognition for the different problems of each of the medical services as well as their protection from biased decisions* Only by this concept can the best possible use of all medical military resources be achieved* It is most unsound to proceed further on the insecure basis as has been past practice that the attainment of the moat economical and well coordinated medical effort can be achieved through the casual mooting of extremely busy individuals who have other full time positions. This in itself can bo conceivably cited as a waste of nodical effort* Suggestion has boon made that the Medical Departments maintain closer liaison with the Information and Education Division of the Aray at all echelons because of the importance of proper in* doctrlnation in maintaining mental health of the individual* Ex* perienee overwhelmingly indicates the value of proper indoctrination of all who play a part in war, especially the fighting man* The Committee agrees that special effort In this field is needed to correct those failures in World War It* Various sources have criticised the part the dental staff officer played in World War XX* Soma advocate that the Chief Den* tal Officer in every echelon be given staff autonomy separate from the Surgeon. While not denying that some instances did occur in this field which retarded the dental effort it is believed that most of the trouble arose from personalities and lack of confidence and leadership rather than the staff position traditionally given den* tal officers* To sot up separate staff sections for each of the specialties of medicine is unthinkable and Indicates no change in the position of Dental Surgeons* n* emwms qr m mm* 1* World War XX Medical Organisation (a) Joint Chiefs of Staff level* 591 Mo provision was Bade during World War II at thla level to Include medical support planning and direction for aobillsation or for any of the military operations that later ensued* This lade of information as to what mas contemplated resulted In delay, masts, error, inefficiency and efforts of each of the medleal services to protect its omn interest* This subject is fully discussed in the preceding pages of this report* A solution is offered to prevent recurrence of this glaring deficiency* (b) War Department Level (World War II) The Medical Department of the Array «m relegated by an organisational directive which cane without warning and which specl- fieally prevented objection to a section of a newly created super colossus termed the Array Service Forces* The Surgeon General of the Array by this edict'became in fact the Surgeon General only of the Army Service Forces and aa such was unable to supervise or control the medical services of the ground forces and the Air Force corapon- ents of the Array for which he was charged with responsibility by law The volume of evidence that proved this system of organisation was unworkable and totally unsound is sufficient to demand that never again should the medical-military profession be hamstrung so com- pletely in the discharge of Its legal responsibilities* The defense of that system that in the end the fledical Service of the Army was performed superiorly during the war under Its auspices* dees net justify the means used nor does it portray the constant friction* the many serious mistakes made* and the many actions that were necessarily taken by the Surgeon General in appeal to higher authority of ill-designed decisions of this agency* In the field of mobilisation of its allotted medical personnel resources the Surgeon Generali of the Armed Forces must have complete autonomy to implement their plans if wastage is to be controlled* Staff coordination of effort is essential and should be accomplished on the basis of recognised competency of the involved service forces* Even when incompetence is patent* the control and cure for it does not rest in close supervision* debate* questioning and disagreement over the requests of the involved services* When singled out by the lavs of the nation with eole responsibility for specific duties It ie inconceivable that any service chief such as the Surgeon Gen- eral should be hampered in the discharge of that responsibility by strings of attachment to any other agency which has the authority to make decisions adversely affecting the plans of hie service* Either new legislation to place the responsibility elsewhere ie indicated or cognisance of the provisions of the present laws in regard to medical responsibility should be demanded on the highest military level* (c) Havy Department Level The organisation of the Havy on this level provided the necessary features to insure its Stic;’eon General end the Purest! of Medicine full control over its facilities to accept its wartime mission. The lack of criticism of its stuctur© is amt© testimony that It was soundly conceived. There is much criticism, however. In the lack of liaison permitted by the Bureau of f-edlcine with the fiaval har Plans Section of the Kaval . This appeared to be solely due to the refusal of the Chief of the Plans faction to have a medical officer on his staff. As a result serious mis- takes were made which affected the efficiency of the medical ser- vice in all lower echelons. That this serious error can and should be corrected by proper command directive in the future is imperative* There has been forceful representation made for the es- tablishment of a staff medical section in the U, S, Marine Corps Headquarters. This lo needed to develop and represent the radical needs for war in the operation of the Marine Corps* It Is also recommended that a Department of Amphibious Medicine be set up in the Bureau of Medicine. Both of these suggestions hare a sound basis and the Subcommittee feels that action in these areas is im- perative as a means to overcome the difficulties encountered in the past war. (d) Tha Army Ground Forces This Agency was created during the mobilisation phase of World War II* Its staff was patterned after the wartime general staff organisation. It included a Medical Section whose Chief was designated as the Army Ground Force Surgeon. This Agency was des- igned to permit centralised and specialized control over the or- ganization, mobilisation and training of the Army Field Forces for use la the war. No special provisions were made for the carrying out of the overall responsibility of the Surgeon General of'the Army in this force, it being assumed that the Surgeon of the Ground Forces would effect the necessary liaison with the Surgeon General of the Army to prosecute the necessary nodical requirements. To the everlasting credit of the medical personnel of the staff of tha Army Ground Forcas it may be said that they cooperated In a superior manner with the Staff of the Surgeon Generals Office la promoting effective results in the medical field even though it 593 could have been correctly decided that the Surgeon General had by faulty reorganisation of the Artsy been relegated to the sane level as theirs In the Army Service Forces* The miner clashes of opinion that arose were inconsequential and are not worthy of comment* (e) Service Command and Naval District Level Severe criticism has been elicited of the Method by which the large Radical training facilities of the *"edical Department of the Any were operated under service command control* These facili- ties were at various times under the direct control of the War De- partment and at others under service commands. It is agreed by Medical Department officers concerned that they operated smoothly and efficiently only whan under direct War Department control. When placed under service commands every conceivable difficulty arose* The most important of these were the diversion of authori- sed trainer and administrative personnel to other service commend functions and the interference in training by incompetent non- medical staff agents* The Commanding Generals of these training centers found themselves without the means to acquit their responsi- bilities In every ease* It was argued that the Surgeon of the Ser- vice Command should have represented the medical training centers at Servlet Command Headquarters* That this did not work has been amply demonstrated. All favor the direct control by the Surgeon General in the future of all large medical training facilities to avoid the serious infringements of authority and the constant wrangling that occurred in past practice when they were placed under area commanders who proved themselves unable to supervise medical training in any field* There was little criticism elicited in the field of staff or command interference with the Medical Department of the Wavy in- stallations within the Naval Districts of the United States* It is believed that much less interference occurred and no constructive criticism can be offered to better the organisation in the future* (f) Theater of Operations Level Serious difficulties arose in the Any in several Theaters of Operation because of the practice of relegating the Chief Surgeon to the S*0*S* after the pattern of the War Department in the Zone of Interior* There was much restriction thereby placed on his supervision of Ground and Air Force medical activities* It was partially overcome in tome instances by personal acquaintanceship 594 factors* This tarings out forcibly the fact that any plan or organi- sation which depends for sucesss solely on personalities is unsound and needs correction* The medical sections on any level must be separate entitles on the highest staff in the future if we are to discharge our responsibilities in full* The morale factor and hence efficiency in the lower medical echelons ir directly affected by the position that the medical section occupies with respect to authority on the highest level* The evidence reveals that the cooperation in planning and in Joint utilisation of medical facilities in the various theaters was exceptionally good* The relationships were cordial and mutually effective in producing desirable results* On the Navy side there ie nothing quite comparable to the organisation of the Army for a Theater of Operations in the *edioal Field* Naval medical facilities afloat and ashore were controlled in acceptable fashion from all reports except that severe criticism is given in the priority of construction of medical installations ashore in several instances* The facts show that ice cream factories and officers clubs were constructed in some areas prior to the hospital facilities, which had to function in the tropical mud for long periods because of this practice• It was similar to the experience in the Amy that hospital construction did not receive the priority or importance It desmnded* Evidence shows that it was not until late in the war that Havy line commanders in the large fleets accepted medical staff of flcere and it appears that often severe hostility was encountered even then* Medical planning at the high level suf- fered from this practice and as a result most of the serious medical errors occurred In amphibious operations* There can be no question as to the necessity for changing this attitude, in the future if the earn# errors are to be prevented* Discussion of the need of further indoctrination of Tina Navy officers In all medical fields is contained in another section of this report* Late in the war combined Army and Navy staffs afloat on the highest level produced excellent results* This demonstrates the necessity for close coordination and cooperation in joint operations• It oust be made the practice early in the future* 595 (g) Field Amy and Task Force Level Nothing but the highest praise can be given to the opera- tion of the medical service on the field anay level during the war. The Amy Surgeons were unhampered in the discharge of their duties from beginning to end. This resulted from the confidence placed in them by commanders and staffs with whom most of the surgeons had been trained in Army Service Schools. On the Navy aids it was not until lata in the war that surgeons were accepted by task force commanders. The record la replete with recriminations of the attitude and actions of the commanders and staffs for their hostility to the medical representa- tion* The withholding of information as to plans and the overriding and disregard of medical requirements by task fores commander# forms an ignoble page in tbs history of naval operations in the Pacific. The corrective action is plain. Sufficient training of Naval line and Naval medical officers in Medical Department matters is impera- tive if they are mutually to acquit their responsibilities more fully in the future. nx. tmmxm The Committes concludesi 1. That the organisation of the War Department in World War 71 was seriously faulty in that it relegated the Surgeon General of the Army to an inferior level in the Army Service Forces which prevented him aa the head of the Medlcal Department of the Army from discharging his legal responsibilities in full. That this mistake should never be mads again. That action to lay the groundwork for its prevention in the future is indicated now. 2* That little or no coordination between the *edical Departments of the Armed Forces occurred on the highest level during World War IX. That under the terms of current lews the Medical Departments of the Navy and Army must remain separate. That because of this the fullest cooperation and coordination of their efforts must be accomplished continually in peace end la war. 596 That because of the uncertainty of the future and final status of the nedioal service of the Air Force, it ia necessary to include for the tine being representation of the Air Surgeon in Joint nodi- cal matters* That under the lav this can only effectively accomplish- ed by joint A ray, Navy and Air Force nodical representation on every level la which the problen neede action* That at the top level this can best be accomplished by the creation of a joint nedioal section in the Office of the Joint Staff of the Joint Chiefs of Staff* That the need for action to accomplish this Is imperative at the moment* That the present Joint Committee on Medical and Hospital Servioss of the Arsed Forces now sitting on the Secretary of Defense level should continue in being until some permanent arrangement for its functions is establishsd* 3* That insufficient importance was given in the Navy Department to its nodical effort in planning and in execution of its amphibious operations. That actual hostility of naval commanders to medical representation on their staffs sxhibitsd a gross defect in the Navy system* That to prevent the serious error® of World War H in the future, aggressive action by the Surgeon General of the Navy to stimulate the necessary corrective measures is imperative during these peace years# A* That coordination between the medical services of the Amy, Navy and Air Force in Theater# of Operation, especially in the final days in the Pacific was most noteworthy and deserving ef emulation in the future* 5* That control of all training activities of the Medical Departments in tines of war by the Surgeon Generals concerned is sound and essen- tial to produce the best results* That adoption by the Aray for its Medical activities of Navy meth- ods as presented by Navy General Order 2A5 for control and operation of medical facilities in the Zone of Interior is indicated at once* That such action will prevent the Interference experienced during the war from Service Commands. 6. That in some Theaters of Operation relegation of the Chief Surgeon and his medical section to the staff of the S.O.S. hampered the medical effort and la unsound. That to correct this deficiency action must be taken during peace to establish proper organisational systems in the Amy which will place the Chief Surgeon la his proper place on Theater of Operations st^tffp. That this action must original# and be pressed by the Surgeon General of the Amy of the errore of world War ZZ la this field are to be prevented in the future. 7. That if the Karine Corps medioal service le to be improved ever World War IX standard# which were not too good, it Is impera* live that a medical section be created for tbs headquarters of that force. That to effect the best development of amphibious medical service that a section for that branch is essential in the Bureau of Medicine of the Wavy. zt. mmmmm. The Committee recommendsi 1. That action bo token at cnee to create a joint Amy, Wavy, Air Force medioal section In the Joint Staff of the Joint Chiefs of Staff level. , 2. That the present Committee on Medical and Hospital Services at Secretary of Defease level be continued until the action in (1) above is consummated. 3. That action bo taken by the Surgeon Generals of the Armed Faroes by proper staff methods tot a* Aettxr* thslr position in oars of tho future on tha proper staff 1ml. 598 b. Assure the position of Chief Surgeons la Theater of Operations on the Proper staff level* c. Press the adoption by the Aray and Air Forces of the Navy system of supervision and control for their respective medical installations as prescribed in Navy General Order 2/5, 4* That action be taken by the Surgeon General of the Nary by proper staff methods to: a. Assure the proper indoctrination of the Navy Command on all levels on the importance of the medical effort and the necessity for the use of medical staff repre- sentation on all levels, especially in forces coor- dinating amphibious warfare* b. Assure the creation of an amphibious medical section in tho Bureau of Medicine of the Navy* c. Aspire tho establishment of a medical section in the headquarters TT,S, Karine Corps* 599 8MD1 POET gKTSAQT (Letter from 'Brig, Oensral Boy 0. Reflebower, WUL (let*) datsd Coloa*!, MO TRO» CQPI EXTRACT (Letter, Colonel C. J. Baker, BC, Air Force dated 22 April 1948) t#ff The general relationship with other Branches should be equal and veil coordinated with the appointment of liaison officers where two or acre Branches are operating jointly, regard* less of rank, each Branch representative should hare equal powers*' eeeeeee ITOt COFI mSACT (Utter, Itear Adalnd C. t. Andr«, (K) OW dated 27 April 1%8) ***** *(j) It is essential that close liaison be naintained with other branches of the Armed Forces for planning purposes if proper over-all nodical logistic support is to be provided# Medi- cal Department representation with active participation should be an integral part of all planning offices and agencies, especially those in the higher echelons# Ton can not give the answers unless you know the score#1* ***** L, K. KC ran oopt mma (m*« tna coiowi bwt t. siap.on, m (tot.) 1>M 1 tor 1948) ***** "(j) General relationships vith other branches of tho Arsed Sorriooo relative to medioa! planning and requirement. Vo consent other than I an of the opinion that there vere tOQ mwar .dLHOTWjd fftWirlftf * nodical etaff. and there vere far too nangr nodical effieere on etaft assignment*. Tor example* in the flying Training Ooanand, Amy Airforces* there vere a surgeon and hie aeeietante aaeigaed. Older this eonsend there vere a surgeon and hie aeeietante aeeigned. Older thie ooanand there vere three training centers* each vith a nere than neeeseary staff. Ae a natter of feat* Z see no necessity of haring had each a staff of nodical effieere at all vith the Training Centers. All Medical Department Administration could Just as veil been attended by the Surgeon1 s office* flying Training Command. Ac surgeon of the Central flying Training Ooanand (the lover echelon) X was required to hare an assistant* a Tetomarian* a Dental officer* a venereal Disease Control officer* etc.* etc.* when it appeared to ae at least the whole organisation was an unnecessary cog in the aachine. As Surgeon of the far Vast Air forces Z saw ns necessity of there being a staff surgeon* vith his assistants* for each of the two Air forces (5th A 13th) the coapcasnts of the far Vast Air forces. Hospital installations within the theatre of operations nay be planned to serve all branches* and thus avoid reduplication of effort and energy. The sane is true as regards evacuation. There should be an grtTftU frlit DlM It tfrf Aygy* Im *»d MX ill ae regards hospitalisation and evacuation for each campaign. ****** L. X. fohl> Colonel, MO TBmt gmitCT CCPXi (utter ftt* Capt. Barwlok I. Brow), (HO), OSI dated 20 April 1948) neeease wj. General relationships with other branches of the Anasd Services relative to asdical planning and requirement. In ay experience this was pensraliy harmonious and ■atually satisfactory. ****** L. K. PobK. Colonel* U, Aragr Ifflflt ,CT8AffI QOTI (t%r Brig Sen Q«y ». Dealt. MO, Surgeon, 13 4pr 48) «•••• •0enoral relationships with other branches of tho Areed Servicee rolatiro to sedical planning and requirement - There suet be a Medical Section of the Joint Chiefs of Staff with eoaeoae over this Medical Section that has the authority to sake doeieione and to roeolYo difforeeeoe 4 eosiadttee of three chiefs that depend? solely upon agreements is not sufficient In time of strife. The resources of all the anted services eust be available to each of the araed services in such Measure as may be re- quired during vartiee.•••••• r„*. POHL Colonel, uVjyrsgr TRIE COPT (Extract Ltr Albert T. Walker, Captain, IC9 03N, 26 April 194£) **tw*Any future war ia going to be an "all hands* evolution" as far aa the citizens of the country are concerned and for this reason, I feel that total mobilization of all medical facilities is essential* This could best be ac- complished by a Joint Medical Staff composed qt military and civilian medical leaders coordinated at Cabinet level* This mill require the a pointment of a U, S* Surgeon General to be a Cabinet member* This Joint Medical Staff should bo formed and commence functioning for planning purposes at once* I realise this is a radical suggestion but feel that vigorous methods must be eaployed if me are to spread our medical care sufficiently to include not only the Armed Services but the civilian population as mail* With respect to general relationships of the other branches of the Armed Services relative to medical planning and requirement, my experience may have been unique, but certainly no greater cooperation could have been achieved than that between the medical services of the /nay and Navy in the Southwest Pacific Area* Our supplies mere interchangeable, the %vy assumed complete casualty care in every ope ration *until such tine as the Amy units could be properly set up on the beach and after tost had been accomplished, ms then assumed complete care from the far beach to the Base Hospital* In two instances, A nay and Navy hospitals combined to received patients from either service, thus relieving valuable beds and facilities to be used elsewhere and Brisbane, Australia)* It is absolutely essential of course that complete cooperation between all the branches of the Aimed Services be established and maintained." «*** . '/t/SD l« k* poo# Colonel. mC TRUE CQPI (Extract Ltr Quinton SU Sanger, BUlflBD, USMft 15 April 1948) ***#*Varlou8 critic lama aero made of "Lins* • "Staff" relationships* It was maintained that no Lins officer should be permitted to exercise authority over a medical officer with respect to the health or physical welfare of Navy personnel, regardless of general Navy precedents and traditions• Many war- time reserve officers believed too much attention was given to "spit and polish” and not enough to professional development* Low priorities assigned to eons traction for medical facilities was a cause of trouble* The result in one case (Subic Day, P* I-#) was the carrying oh of " a large volume of medical work in a filthy, practically impassable morass during the rainy season, while at the same time an elaborate officers* club was built and operating"* During the war there was a tendency on the part of sons districts and group ccaanandB to encroach on the Independence of hospitals under their military Jurisdiction.11*#** l»m Kf PGBjL V Colonel, )C fBTTE COPY EXTRACT (Letter, Brig. Gen* Robert C* McDonald, MC,USA, (Ret*) dated 15 April 1948) •**♦» "(j) General Relationships with other branches of the Armed Services relative to medical planning and requirement* "(1) Comment i Medical planning must be coordinated by representatives of all the Armed Services* Requirements in personnel and materiel must be coordinated so as to promote team work," ***** I. K* Pohl, Cplonel, MC EXTRACT COPY OF PFRTIKFKT EATTIIAL CONTAINED IF AIR FORCE MEDICAL DEPARTMENT HISTORICAL RECORDS OF WORLD WAR II. (Ltr. fr Brig. Gen. M&lcon C. Grow, Surgeon OSSTAF, II March 1945 to Brig, Gen. Charles R. Glenn, DAS) ***** "In relation to planning for a postwar Medical service. It would seen to me that you should endeavor to obtain as such control of your per- sonnel from top to bottom as possible. In the HAT setup. Air Marshal Whittinghan has direct control of his personnel at all tines, and can move personnel from one post to another, promote them as he sees fit, and is not Interfered with by intermediate Air Corps commands, as is the ease in our setup. In this Theater, once an officer is turned over to e cowand you have practically lost all Jurisdiction in relation to administrative natters and a considerable amount in relation to professional technical details. This is due to the fact that in certain Air Forces everything has to go through command channels, and technical channels are cut out entirely in some cases and greatly minimised in others. Whether you emll it A 'medical command1 or 'medical service* would appear to be immaterial except that the former implies command prerogatives and If It could be put through the War Department I believe that tarn would be desirable. What with T/Os and other administrative difficulties, the position of the Flight Surgeon in the lower echelons Is most unenviable, and a great many men with a lot of ability are not receiving their just rewards. It le inpossible, when one understands human nature, to expect that the Air Corps will sacrifice chances to promote Air Corps officers In order to promote Medical Corps officers, and when the medical officers are nixed up in a common T/0, Manning Table, or Bulk Allotment, there is nothing that the higher medical Hq can do to help them. In this respect, I believe that there should be an elevation of one rank in squadrons and groups. In other words, the Group Surgeon should be s Lt. Colonel and the Squadron Surgeon should be a Major on the T/O,"***** (Ltr to* Whomever it Kay Concern dtd 6 Feb. 1943 unsigned (submitted by Colonel Robinson but probably prepared by Maj. Rergerwua) ***** "Haring arrived in this theater with complete Ignorance as to the conditions and problem* that would confront us, easy attempts were made, both through medical and command channels, to Improve the health of the command. It is felt that too many high ranking officers la the higher echelons, who are totally lacking in the proper perspective and knowledge of the problems which confront tactical units, occupy the various positions. Much correspondence, channels, and generalised ‘red tape1 succeed very successfully in bogging the matter down completely.* It is recommended that, before being placed in higher echelons, off!cere spend sufficient time in the field picture of conditions as they are. L. I. ?ohl^Colowdt WC EXTRACT COPf OF PERTINENT MATERIAL CONTAINED IK AIR FORCE MEDICAL DEPARTMENT HISTORICAL RECORDS OF WORLD VAR II. (324 Sq. Grp., ObatmUona of Major Jecee F. Merritt, MC) ***** "On September IS, 1913, the dispensary «m combined with the squadron cad aovcd to DJebel Oust, Tunisia, near Tunis* Here at this point medical demotions wore almost nil • ••• Morale ran lev. The old spirit of being a unit of which men were proud had disappeared. Proa a useful nodical dispen- sary which was referred to by all menbere of the Group as *the hospital*, the section had become to be known as *ths medics* • Gradually the sen became sore restless. Transfer requests were many. Two sen became chronic alcoholics. This situation waa brought about by the new eoaeaanding officer, who knew nothing of medical problems, but always took an antagonistic atti- tude and seemed to enjoy belittling the medical profession in general ,*•*•* (Uth Air Dap. Gp.) - Major Samuel Fortig** (Sq. Surgeon) complaint. ***** "Due to the drastic reduction of Squadron T/Os considerable difficulties and Inconvenience a have arisen which are incompatible to the proper performance of Aid Station duties. A typical example Is that of Supply equadron which is complemented with one ambulance driver (private) and two medical technicians (Pfc and Corp.) In addition to their duties as medical technicians It is necessary for these men to take care of all clerical and ehargo-of-quartera duties. This of course overtaxes the wort: of the Surgeon, as wall as the enlisted men. It stay be well to Men- tion also that the withholding by the Squadron of the proper medical T/0 ratings which would pronote the technicians to Corporal and Sergeant respectively, is a norale factor which is neat certainly net conducive to the host interests of the Medical Section. The nen, Pfc. Robert Greece and Corporal Lowell Bromberg are experienced end valuable technicians who, not unnaturally, feel slighted end dispirited because of the Squadron Commander's refusal to comply with the Surgeon's recommendations for promo- tion. Apparently the only reason given for non-cowplisnce is unavailability due to the belief that the vert of the regular squadron personnel is of greater importance. "These instances have arisen quite frequently throughout the entire period of overseas history and have oftines proven very d5 ffieult to combat. It is the opinion of this writer that if Medical Section T/0’« were legally classified as inviolable and distributable solely upon the reeoenendations ef the responsible Surgeons, it would do mart to increase the confidence and pride in the Medical Department which is so nooeaeary to attain the desirable exacting performance of enlisted personnel."***** L. K. »C EXTRACT COPT OF FTOTIKTUT MATERIAL COST AIRED IS AIR FORCE WD1CAL DEPARTMENT HISTORICAL RECORDS Of WORLD WAR II, (19 Sq. Op,) ***** "Under the present Method of adtainistration It uaa fond that the Medical Officer had no control orer aedleal personnel. The head- quarters squadron emnander was responsible for the adniniatratioe of ■sdlcal personnel. Shea aen were needed for outside details It was not at all unusual to all for nodical personnel to perforn their duties.* L. K. Pohl, Colonel, SC THUS COPT SXdUCT (LTfi DR. H. S. HOIFfeAV, 3RD 13 HAT 48) **»*•••» J. "One glaring weak spot In Medical Department operations daring military caimoaif.nB In the Pacific existed throughout the entire period of hostilities. It was probably responsible for more failures of the Medical Corps than any other single factor. It caused increased loss of life and delayed certain operations by producing large (but preventable) man-day losses due to illness. Reference is made to a common practice of Commanding Officers (Line) of refusing to accept recommendations of their medical staff in the planting stage, or, during op-rations to permit prompt execution of plans previously approved. One notable exception is described to emphasize the general rule. During the staging period for the operation lu the Marshalls one prospective Island Commander gave his base surgeon a carte blanche in the matter of preparing for medical operations including sanitation and burial of Jap dead. On arrival on the island, he continued his absolute support of medical operations and would tolerate no Interference from any source. As a result, when Admiral Nlmltt arrived on the island on D7 or 8, he found burial •f the Jap dead prectically complete and the general sanitation of the Island so for advanced that he gave the base surgeon a "well done" on the operation. It is bslioved that more suitable action on his part would have teen the award of a decoration to the Island Commander. that had teen accomplished by the Medical Department was due almost' wholly to hie coaplete cooperation. Apparent- ly some attempt has teen made to Improve this situation, by recent changes in regulations. Obviously the sound principle of unity of command in the field creates difficult problems in this regard. Mere than one medical off! car - especially Reserve - came to grief in the futile attempt to persuade Line Officers to permit the execution of vitally necessary medical operations. 2 believe this situation is well known to the Medical Department. One wonders, therefore, why medical officers in this position have failed to receive sympathetic consideration from medial superiors. If a medical officer refuted to modify his faetuel reports of the obvious medical deficiencies of his operation on direct orders from his Command" lag Officer, he became persona non grata with him. So got a poor fitness re- port and/or a transfer to otter duty. If he complied with hie commanding officer's orders and modified his import, he tacitly as turned the responsibility for failures not properly his own* In sitter event he wound up behind the eight tell with the Medical Department despite the fact that hie medical superiors were cognisant of the circumstances; many of them having been in the seme petit lea - no __ COWffiJSL 1KUE con EXTRACT (latter, Captain 0. B. liorrlaon, Jr., MC, IBM dated 23 April 1948) ******* «J, General with other branches of the arsed services relative to radical planning and requirements • iotoinlatrative officers of all the branches involved should B»et and discuss the planning and requlreaents • Share will be fee problems that cannot be solved when each nember feels that all Involved branches understand shat the prohlen iaj'******** L, K.Pohl, Cyiooal, US TKB COPT BXmOT tbom air rtaluatioi board sw?a wepokt so. 30. thb hbdxqal SUPPORT 07 AIR WAHfARS IV f H3 SOUTH AID SWPA FROM DSC 7. 1941 TO AUGUST 1945. *««•««• j, i|4t infrequently a high morbidity rate, which threatened the opsre- tloaal effieleaay of a unit and the eneeeas ef a plaaaed operation, wosuited from the failure to Implement preventive measures. Zt was apparent that in most Instances the recommendations ef the Unit Surgeon* were act implemented by command personnel ef all echelon*. These commanders failed to appreciate their responsibilities in the maintenance of the health ef personnel la their command. The majority of Air Tore* troops did not maintain a good nutritional state during the course of the war,' The main reason for this situation was the fact that personnel refused to eat n large portion ef the feed served to them. In addition, the nutritive value ef the ration ns issued was frequently Inad- equate. Poor preparation of food by nets personnel was primarily responelble for the nonacceptability ef the ration. Lade of variety la the ration a* issu- ed and ths dislike by personnel for certain types of feed were alee responelble. The poor preparation ef food commonly encountered was n direct result ef the aeeignment of both officer and enlleted personnel to mete duties who were not qualified for the Job. field Instruction ef this personnel was instituted and proved to be an efficient method of increasing the pal stability ef meal* serv- ed te Air foree troop*. The effeetlvenmes Of thl* instruction was limited by ths lack cf authorisation for instructor personnel and equipment.•••*•••••• & L. CQLOML, MO 626 TliOK COPT smiCT (Letter, Rear AdadraX Caterer (MC)t Retired dated 21 April 1$>U3) **** •( j) The doe oat possible cooperation and liaison Boat be established md maintained with Uie of Interchangeable and onifosna equipment throughout* This factor Is considered as most important* rquipmont and supplies far ALL branches of Medical activities should be identical insofar as their respective missions perfidt,****** TXSS COPT 1XTIACT FRO* AIR XTALUATIOH BOARD SWA REPORT 10. 25, THK RADICAL SUPPORT 0? Ad WARfARX IS THK SOUTH AID SWA F80K SIC 7, 1941 to AUSUST 1945. •••**» I. *The fall potentialities of the nodical services were not attained because the majority of eoaaaad poreonael of all echelons dll aot appreciate the extremely Important relationship between preventive aedielne and operat- ional efficiency.»•♦••••• sTC'MgmsarvB TRUE COPT EXTRACT (Utter, Colonel Arthur B, leleh, MC, USA dated 19 April 194*} ***** " j. Each service did its own planning and earns up with its own requirements, Jointly established tables of organisation and wanning tables were noticeably absent* The Wary required wore doctors per over- sea fixed bed than the Any. One agency didn’t exist to review these requirements and reconcile discrepancies* There was too little joint nodical planning. Flexibility in planning so essential to enable step- ups or cut backs or intra-service transfers of facilities, personnel, or equipment was lacking* There wasn't one procurement agency* This sould all have been tied up in an Arsed Service of Supply organisation provided there had been intelligent medical leadership* This would have required an individual who knew military and civilian medicine and to whoa the responsibility for the efficient operation of medical activities had been delegated * Such an Individual would have needed both responsibility and authority and could not have been hamstrung as The Surgeon General of the Army was in ths ASF organisation in World War II*" ***** THUS XXTHaGT COPT (Ltr Cadr Martin f. Maeklln (MO) USS dtd 12 May. 48. *•«•*«• "However* to avert past operational errors the staff Task* Squadron* Division* Group and Unit medical officers mast be considered as integral and essential members of Tha Operating Forces* reg rdless of his rank with full knowledge of the mission to be performed and not be considered merely as an accessory, to "dove tall* in the Operation Plan at the behest, op in accord vith the whims and wishes of the line members of the joint staff or rtaffs* The Medical Annex must be considered in the same strategical light as the other annexes of the Operation Plan. X, K, Pohl, Colonal, NC TUBS XZflUCf FI OF K SOI CAL SUPPORT Of THIS DSAA? IS THE SU2QP2AH JUTSR Of OFIft- AtIOSS, HISTORICAL SSCTIOS - AJTAS. ********* J. "Personnel Problems and Policies. The medical reports froa the Ssrop- ean theater of Operations up until the closing sooths of hostilities almost invar- iably aalea earn# reference to the shortage of medial and dental personnel. Corres- pondence to and froa the Office of the Air Surgeon attest the existence of this problem along with n sense of despair in the efforts baiog put forth to remedy a situation due not only to an Inadequate supply of doctors and dentists hot to the faet that those available ware inadequately trained to eope with the problems intro- duced by aerial warfare. The lack of understanding among highest authorities in the theater and in the bar Department of the medical problems encountered by the Air forces contributed to the difficulties ef those responsible for the health and effic- iency of fliers* The inflexibility of the rales and regulations prevented on nu»» ereus occasions and under various circumstances the full utilisation of the medically trained personnel in the theater* file assignment of aadidal of fleers to routine duties unrelated to their previous training and experience, discriminations against them in natters of rank, poorly defined and executed leave sad disposition policies - ell combined to make the administration of the Mediaal Uaoartment a task envied by no one.••*•***••• /E**, TrOHL, Co1ob«I, AC ffgasanasu. The importance of keeping the office of the Air force surgeon in direct contact cr access to ceaaa&d channels had bscn overlooked. As a result* the channels ef eoaaunication became clogged and the Air feme surgeon last immediate contact with the tactical unite to which a considerable part ef the medical per- sonnel was assigned. la relation to planning for a postwar medical service, It would seem •hat you should endeavor to obtain as much control of your personnel fro* top to hot ton as possible. la the BAT eetlp, dir Karshall Whittingham has direct control of his personnel at all tines, and can more personnel froa eas post to another, presets then as he ssss fit, and is aot interfered with by intermediate Air Corps ooamaads, as Is th*> case in ©nr setup. In this Theater, once an officer is turned ever to a cosnaad you have practically lost all Jurisdiction in relation to admins istrntlre matters and a considerable aaount la relation to professional technics! details. This Is due to the fact that in certain Air forces everything has to go through command channels, and technical channels are cut out entirely in cose easci and greatly minimised in others, tbether you call it a •medical coreand* er med- ical service, would appear to he immaterial except that the former implies eomsemd perogatives aad if it eonld he pat through the War Denartaent I believe that team would he dcnirahlc^weeeeee tvlement that# The idea of a board with representatives fwm the various medical services I should think would be the proper way# I think it's a good idea# Brig Qen McDonalds I am very heartily in favor of providing for medical staff representation throughout all echelons of the aimed forces# I think in the last world war when the medical services of the corps areap or service ouanands were reduced In level so that they became assistants to a supply director, it was bad# Fortunately I had no difficulty with that matter because the Director of Supply of the *hlrd Service Command told m to cany on Just the sane as I bid with his and the Commanding General, but from what Z heapd that did not pertain in all service commands• I don’t think W» should have any plan that's going to depend upon personalities, and I think that that one did depend a good deal on personalities, because if somebody over the surgeon, or the surgeon himself, did not have Just the right slant on it, the medical service of the service command suffered# I am heartily in ffevor of having some sort of a firm policy established on that# I think that's correct* "Sou .d more outonomy of the Surgeon Genrals prevent much of the confusion that now exists in personnel control by 0-1?* Tes, X think it would. I think that the Surgeon General should have considerable control over professional and specially -qualified personnel used by their services# “What is your opini n of the value of using the Surgeon or another medical officer as a member of the (K4 staff? Should he be a liaison officer of the surgeon or a consultant assigned to 0-4-7" I think he should be separatej and he should have the same access to thecocnr,xanding general that 0-4 himself has# "Do you consider it imperative that the surgeon be included from beginning to end in all planning in the armed services/" let. "Should the surgeon keep liaison officers on all sections of the general staff? If not, why? Would they be accepted, in your opinion?" I don’t think I would locate medical officers in the office# of a general staff, as a general policy. There might bo instances in Which it would be valuable. But if there Is the proper relationship and spirit of coordination and cooperation between the general staff and the surgeon general, there is no difficulty In keep- ing track of all that is going on*"****# X* K• PGGL Colonel* M3 TBUE EITKACI COPTi (Extract of a ta tenants aads by Oolootl Thomas J« Hartford, HQ, D3A on 23 April 48 at interview with Suboooaittee on the fiaploynent of Military Medio&l fiesooross) ***** *J* In the theater that X was in m wers afforded fron the eery beginning an opportunity to be in on all the planning» Ve rare given ell the information that axqrooe worn given on the ■Intakes and planning generally* There vere sane staff organise* tiona that node it a little difficult for ns to operate — and I mi speaking then of the theater—but perhaps sonewhat dee to tha personality of General Hawley, mm certainly couldn’t on infornation ne mere given* X would eay liaison, net aatoncay* X etill think there has to be a HA section ayeelf 9 end I think they have to ran it, end X think it would be worse if we had it entirely under oar control* X night go to Siberia for that* X think we do need good coordination, and X think that the nest war idea the Personnel Division—I an speaking of only Any now ennee to the Surgeon General9e office and aays, "How about giving no tone hard-working lad to help advise ns and coordinate with so," that our answer shouldn’t be as I know it was in tbs last war. "Ha can’t spare one nan*" be ought to give kin that sen and then we would have the coordination* ****** Coles* X* VC ' TIPI COPT aXTIACT (Letter from Captain V. D. Snail (HO), TJ. S. Havy dated 8 Najr 1948) ***** *10, The medical eectlon of CinCPae’e staff was composed of portoansl from all the Servldee. Zt operated ae a oloeely cohesive unit with a • ingle eoaaon ala. She most oordial and cooperative * spirit, both official *nd personal, was maintained. Zt is ay opinion that it was the noet effective Joint aedioal etnff in the Pacific. There appears to be ae good reason why fetors planning, requiresent and implementation cannot, under proper leadership, be accomplished la like manner. However, such effectiveness cannot be developed unless Rempire building* by one branch of the Armed Services at the expense of another branch is prevented. The aedioal dep&rtaenta of the Armed Services having as they do a eoaaon profession governed by high ethical principles should do a better Job in this respect than other branches.****** K. Pohl, Colonel, HC TiiU£ JSSffBACT COPY (Ltr it Ool M.J. Keuter, Deatal Corps, dU II Majr 48) «•*«»*«* j# of Dontal Officers, Deficiency - Under the present organisation of the Medical Department dental officers do not hare res- ponsibility of the dental service and make decisions regarding dental matters subject to the approval of the Surgeon, Since the Sturgeon has final responsi- bility, If of necessity follows that final decision, also In dental natters, mutt tost with bln. The Dental Corps has gained ouch in its association with the Medical Corps, Generally it is believed very salable relations exist between surgeon and dontal Furthermore, the Dental Corps without a doubt has benefited again and again by vise decisions of the Surgeon in natters pertaining to the dental service, particularly during the war when there was aue£ untrain- ed personnel, including dental. On the ether hand, it is believed the dental officers generally feel that decisions by surgeons regarding dontal matters are at times contrary to the desires of the dental surgeon and contrary to the interests of the dental service; such decisions being made because of l&ck of know- ledge or understanding of the dental situation, because of personal dislike to too dental surgeon, to make his authority felt, and the like. Practices of this nature certainly are not the rule but the exception. Also dental officers ere not staff members and dental natters are presented and discussed, not by the dental surgeon but by the surgeon. J2- Unfavorable Effects - She chief unfavorable effect is believed to evolve upon the dental officers themselves and upon tha dental service as a whole, and results from the position the dental service occupies within the Medical Department, Serving under a Medical officer creates in the dental officer a feeding of being supervised by a comparatively disinterested individ- ual, Sven if interested intensely, there still arises the qua tioa whether the surgeon will uaerstand since dentistry as a profession Is so highly special- ised th t only a dentist thoroughly understands dentistry. Dental matters to be discussed at staff meetings are presented by the surgeon while the dental surgeon witj detailed knowledge of the situation remain absent, Pertinent military mat- ters may come to his attention second hand or not at all. The surgeon gains In administrative eaqjerlence through hie attendance at staff meetings wnilo the dental surgeon is denied this. Subsequently, he suffers embarrassment because of his lack of administrative experience, Present regulations permit the dontal surgeon a direct approach to the commanding officer of the base in ease of dis- agreement with the surgeon regarding matters of dental policy. However, to take advantage of this privilege Just once could surely terminate ail' amiable relations that may previously have existed. With all this In mind, there evolves a fooling of inferiority upon the dontal officers w ieh breeds insecurity, discontent, lowered morale and an inferior dental service. BSCOKhlSKSOTlOKSb That such changes be mads la the organisation of the'Medical Department as will give the dontal officers responsibility of the dental service, oak# the dontal surgeon a member of the base and/or headquart- ers staff, and give the dental surgeon control of dontal enlisted personnel•****+• %KWlSt, Coiott#!, MO TEUK C0FY roRACT (Letter, Colonel 0. F. Mcllnay, MC, Air Force dated 20 April 1948) ***** "j* The undersigned experienced no difficulties in general relationships with other branches of the Armed Services raletire to medical planning and requirement. It is understood, however, that such difficulties were encountered, end it should be impressed upon the chiefs of ell services that there cannot be any proper medical planning unless those responsible for the medical services are fully informed at all tines*” ***** Tkm: COPY (Ltr Brig. Oen. O.H. Kennebecfc, Dental Coips, dtd 7 Kay 48) **«•««* J. "Training schedules of all branches of the Armed fervtees should h« ro arranged that there are some periods when Individuals could receive dental treatment without falling behind in the instruction being given. In World War II a number of individuals undergoing school courses neglected necessary dental treatment because they feared absence from instruction might jeopardise their chances of graduating with their class. •••••••♦• L, K# Pohl, 'Solonel, MC TRUE XXTRACT COPT 07 MEDICAL SUPPORT 07 TH38 USAAP IS TUB MEDITERRANEAN THEATER HISTORICAL SECTION - A7TAS «**««*•* j, »th» Surge oai it responsible as a staff off tear to the Commanding General, Array Air fore* Service Command. Mediterraaean Theatre of Ops rations, for Nodical activities of all organisations astignod or attached to the command; and ho is responsible to the Surgeon, Any Air Forest, Mediterranean Theater of Operations, for nodical administration of all major echelons personnel. In practice, however, only in regard to malaria control, nodical reports, and nodical supply procedures for depots was directire action takas with respect to all these high echelon organisations; in other natters for the nost part the supervision was advisory In nature* For example, the dental and veterinary activ- ities in the Ninetieth Photographic Wing Reconnaissance and the Army Air Farce Engineer Command were supervised in the sane manner ae those if Any Air Force Service Command units, while the Twelfth and Fifteenth Air Forces remained prac- tically autonomous with respect to these two functions. The Surgeon, Any Air Force Service Command, was made the Air force technical channel to and from the Surgeon, North African Theater of Operations, and the only Air Force supply channel in the Mediterranean Theater, to and from the Sons of Interior. Also normal command channels concerning monthly sanitary and veneral reports were altered. These reports were submitted by all Air Force units in the theater to the surgeon, Army Air Force Service Command, and unless they were deemed to be totally unsatisfactory or for other reasons to require the attention of the Surgeon, Army Air Forces, Mediterranean Theater of Operations, they were returned to the unit of origin for correction or combed end forward- ed to the Comaianding General, North African Theater of Operations, without far- ther reference to the Commanding General, Amy Air Forces, Mediterranean Theater ef Operations, The high Incidence of Intestinal diseases in the Twelfth Air Tore* for 1943 was attributed to two a&in factors: a lack of applies and a lack •f experience and information on field conditions. Wire screening and lumber to build sanitary mess balls* latrines* and other facilities were not available. Bor were Insect spray materiels and sprayers in supply. Whatever improvisations could be made fell far short ef actual need. Meanwhile* directives wert|eeued Containing information an these diseases and outlining the necessary Sanitary measures to be instituted, by April 1944 adequate supplies of screening and spray materials were available. With the screening of ness tents, meet belle* and latrines* and the institution of other sanitary practices* the general level ef sanitation was greatly improved. This improvement in sanitation included many of the small Italian towns near Air force installations. Although the re- sults of the sanitary program could not be evaluated as early as June 1944* it was considered pertinent that no significant increase in intestinal diseases occurred in Kay 1944. A comparison of the annual rate for May 1943 with that of Kay 1944 shows that the former was 102.1 per it was 38.4. -— TTC. POHL, 16} TRCF COPY EXTRACT FROM PREPARED 3TATHCTWT SUBMITTED BT CAPTAIN LOUIS R. RCDDIS, (KC) US« 10 ilAI 19A8. "Professional and Military Emergency Training Programs Within the Armed Forces* "I believe one of the most important things which the Medical Department could do Would be to bring into the teaching program of all line schools free the War College level through the Naval and Military academies, and various special arms schools the great importance of the organization of military medicine in the winning of campaigns and ware. A carefully prepared teach- ing program should be elaborated to train and indoctrinate the line officer with the knowledge that military medicine is ar important in winning & caw- peign of mar as artillery er infantry) in ether words, that military medicine in modern war is a military weapon. ■The evidence of course le deer end convincing. It can be shown fro* ■any viewpoints* Examples are innumerable in military history showing the success or failure of campaigns doe to Isek of military medical resources end organization and disc the proper employment of military medical organiza- tions* World War IT Is full of evidence of the decisive effect on campaigns. "At present there is a lack of this critical knowledge on the pert of military commanders. The importance of net only the sere end evacuation of the sick and wounded, but the effect of preventive medicine or the success or failure of military operations is net well understood by noomedical military mam, and no real program for instructing then has ewer been planned er carried out. Several mew types of warfare that ere now appearing on the horizon sake the meed for s knowledge of the importance of military medicine In the Army, levy, and the Air Forces still greeter. ■Such a task would not be easy. First, it would have to be explained, justified, and sold to the highest authority in order to plan and place such a program la effect. The lade of texts and of competent instructors if per- haps the greatest handicap. Military medical men have net, in the pest. In- doctrinated the combat officer with the value of military and preventive medicine as a necessary arm to secure victory. I believe one of the greatest contributions we could make would be to introduce the proper teaching of military medicine from the strategical and taction! viewpoint in the Military and Naval Academies, the Far College, in every staff school, and in the train- ing courses of all military services and arms s? L. &• Pohl, Colonel, MC 637 EXTRACT OF STATEMENTS MADE BY CCLOKKL OSCAR S. REEDER, BC, USA, OK 15 APRIL 191* AT IMTER7TEW WITH SUBCOMMITTEE OS THE EMPLOYMEHT OF MILITARY MEDICAL RESOURCES. ***** R(J) I believe there should be a Joint Medical Planning Board of all services concerned on the level of the Joint Chiefs of Staff. “1. Mo. In sons instances nodical staff officers aren’t even advised of the oontenplated operations or included in the planning phase. *2. I don't think there should be a surgeon or medical officer as a member of the 0-A staff. *3. I think it is absolutely necessary. H. I don't believe it is a good idea. I don't think they are neces- sary in all G-A staffs.****** ******6, I do not believe that full consideration was given to all aspects of nodical support by Join# Staffs during the planning phase. I think that as a rule, there vas-cooperation between the medical services. I think the overall plans worked ojit in practice. I think that failure, when it did occur, was because of the different administrative set-ups in the nodi- cal services, particularly with regard to logging of sick and wounded. Re difference of importance - there was at first, but after staff officers were Indoctrinated they had a better understanding of our problems. It vas nainly lack of understanding on the part of lino officers ******* ***** »9# Direct cc—onicatlon tetwin Chi«fSwg* Cf&onel 4 afetaryoTta MC« U«S»A» on 22 April 3glt8 at Intarvi^r wiiK b\ioc«ani tt— rdt> iaa of klli'iax*:/ ***** "I feel that whether the Array General Staff System is good or is not good—which of course lt#e not for me to say—nevertheless that la what we have, and as long oa the Array Is set up to operate a certain way, I feel that the Radical Department, as part of the Army, will do a lot better to fern itself into the taaiaj and by learning what tat teem Is and hew the team functions, under what rules it functions, tbs Medi- cal Department can do a lot better than it can by fading that the Army ie merely a hindrance and holding us back in our professional efforts."•***♦ "As far as overcalling of medical officers is concerned, that can be at least reduced considerably by a better knowledge on the part of tbs Surgeon General as to what the over-all strategic plans are* If ha is permitted to know sufficiently in advance, he can then intelligently request medical manpower at the right time and not be Beared into or bribed or bullied into getting a lot of people In long before they are needed* That1* a quest!cm one# more of getting the medical people into the over-ell planning activities at every re helon* ****** "My experience and all ay training has been to the effect that medical people have continually had to drum and pound and emphasise and fight for adequate medical support for an operation* It seem to be in the nature of a fighting man tiat he never seems to want medical service until he v.aate it right now, and then be wants It rifht now without bav- in planned fer it or permitted it to got there* "I further state fro® personal knowledge that the staff officers and ccsaaandsrs who argue moot against cluttering up their ships with medical units and permitting an adequate medical service to go on an ex- pedition usually seemed to be the ones who cry the most when they get hurt and expect the most out of the medical people that are present for duty* v "In answer to (J) 2, ray personal opinion is this* w}«en you can’t liave close contact a liaison officer is a fine thing* Re is definitely next beet to promote contact between staff agencies* The desirable situation is there the medical section and the G~h a action have con- tinuous friendly understanding contact* If you have to take a trained medical officer fro® your section and put him In somebody eloa’s section, you merely weaken your section by that body, or by the number of bodies you have to take out* There certainly are times whan liaison officers are probably advisable, but they shouldn’t be necessary la the head- quarters of a unit*" t. wa:; ''&a5a;'ig - baT-uc? of &t Colonel :Vodoric X uesterveit, UC, U.S.A, on 22 April 19U0 at intanriair "I have already answered Ho. 3* and I will answer it again* Thi surgeon of any command at any level should be in on the first planning re;*ardlos8 of how fragmentary those plans mey be and should be kept in the middle of the planning until the operation la completed. "I have answered No. lu This is entirely baaed on ay opinion. It say be that I have been lucky in having understanding staff officers to deal with, or aaybe I rave been able to sell ayeelf batter than sent nodical officers, but 1 have never seen any indication for taking officers and putting these in general etaff aectloas*"***** "Cooperation between the involved medical aervieea was definitely the rule aa far as ay experiences ware concerned* X oan*t tidnk of any- thing that worked uottop than the cooperation among the several medical aervieea in oar part of the world. "Tnore is definitely a difference in importance or weight given medical eenrloe by the various armed services* I apeak with feeling on this* the Marines in particular have a type of pride which indicates that they don't iieod any particular aodioal service* they are too tou£i to suffer whan they got hurt, and they fed that the medical service be* yond a little patching up is Just a waste of tine and shipping space* And in my opinion the Marines are just like everybody else* "As far as medical or line officers are concerned, I think if yon just take them all, take all the medical or line officers and lump them together, it1 a about even. The noticeable difference, I repeat, was in the Liarines, which vr«3 very interesting to observe the attitude, and it resulted, of course, in a considerable rapid and dangerous lowering of the morale when they found they were getting hurt and weren't yetting the attention that they ultlxaately oarae to relieve tliey would like to have* "(J) 7* As far as No, 7 is concerned, joint use of all medical facilities was encouraged and w<»s a fact la tbs areas in which I partici- pated! had to be* "Practical difficulties in administration were pay, medical records, forms for emergency medical tags, and forms for diepoelticn cf tbs remains. They w«re the ones that you would expect to present difficulties, and for the moot part are preeeaitly on the way to being resolved. Standard forms have '>een prepared and are being tested at several places right now."****# Ti) 3. I do believe thu accepted notion that troops respect and have confidence as a result of association. I also know frea the s tand- point of the staff relations, and also to get back to this important plan- ning angle—you all knew this very well—-that if the doctor ium gone through K. Pchl, Colonel, MO v cont*d 2. Hati-iact of '.wrz £olJaol 3* "Vfosienrali- UC. U*S,A, cn 22 Aorll lV*t_3 at interview Wrbli on the of Miliary UaSical 'kmourcec tilings with tiies© line officers, gone through the schools with them and associated with tnoa, that tlsoy have a reeling for theta tlat they never have for a mn who i-jzs professional ability iy reputation. If it has been doiaoostrsted with then, they will respect him, but just because a man is a good doctor eloosn11 got him the cooperatlosi* It doesn* t got him the look-in cn the staff planning unless he lias associated with those people, unless he knows them, eats with them and is friendly with tieei and shows thorn tiiat -be is one of then and is part of the game. WI knew freo is? personal experience tiiet I have more, and I think ©very doctor las gotten more, cut of his combined scbotla, the lino schools, far iaat& than the tactics ho lias learned. I'm iao made the association, he has made the friendship of the raeho'.rc of Ills classes, and that association paye big dividends all the way tirough tise rest of his service. "Ton lose the t>ilag that you nood in combat, Tne doctors actually have to be with tlm troops, The doctors that operate tbs battalion aid stations, the doctors tliat see these wounded first should b© with the troops long enough to know tlwaa and bo accepted by the© as being on© of than, I do think the msabors shcula be held to a reasonable lainiiam,”**-*** "I do favor the immediate formation of a permanent joint board. General Martin* "At tls© C ief of Staff level?” Colonel Heetcrvelts **Yes, ©ir, I sm not in position to rocaamond what powers and authority should be given that board, but I would cer- tainly think they should bo pretty wide. And I dc think the planning for future operations in all fields, including procurement, should be a function of this board at the chief-of-staff level, L. K. >dl$ Colonel, m tasm COPT BXTBACT Of XHXSEfI3Slf WITH BBAK JL&HUU& KOETOS ». IflLLCOm (KO) OSS 4 Kay 1948. . j, « Aft Mxt ilfti it Ihft general vcUttouhip with otter branches of Vte Anted Sorviooo relative to nodical planning and reqoiroaamt* There vos & fool log that thi nodical Miriest is various echelons voro At a disadvantage teia| tte vor 1a mot having sufficient Information eone«nia| future plans. It led to uncertainty and confusion and a vast* of personnel and Materiel. It roform to otter branches of tte Xaval Service sad to otter bronchos of tte £i*od force-s. It cover* tte whole subject. S3AH 4SRXIU& WILLCOTTSi An of floor oast know tte oooro if te Is gtiag to dollvor hit test service. Kay Z rolato aa IsAldoot Z ted out At te Diego. Soso of tte finest doctor* X ter• ovor known osao from Texas as a omit. They dropped everything asd osao la as good qportc. Gao doctor, a rsiy oneoXlent cardiologist fros Eon*ton stayed At tte hospital for two year*. Xtea te oaso 1m to too ao and said * l,ro got to get to sea; I eaa*t spend tte war at Saa Diego. 1 said* *Tour»ra do lac a grand Jots I can’t spare you*. So saidi *X can’t fi hoao if Z don’t go to •oat*. That vary sane day a roqosft ease is and Z got Ida traaoforrod te a hos- pital ship. So was delighted. fear aoatte later transportation was arranged on this hospital ship fros teas and of all poople there was this cardiologist aboard. Bo grooted ao sordini ly, of source, being aa old ohlpaato, and yet I eonld detect aa unhappiness and disoontontseat. Z caidi •that’s tte natter * don’t you Uk* tte gklppor»* ted te said, "Oh, the skipper is fiaa*. had I said) •tell, tew about this new nodical officer. Is te ridding yon a little bit I*, ted te said, •So, te’o fine8. X said) •! Saov ptm’re unhappy, and 1'a sure you’re not scared.* dad X saids •tell, don’t yea know tears ws’ro going?•- Shat was it* Vo doctors on this staff are good non; vo are sot kids, te are sutured. Vs know ws ars going to go te a roadcvouo but we don’t know whore. We hear rmors fros hare e&& there that sojaothing Is going os. te don’t know teat it is. They wore lot daws. They were just fed up. Sere X muse aboard thinking I’d get tte news, and they didn’t know. Sons of then had no idea that they were going to Okinawa. They were In the advance sobs sad yet tars dented tte strategy of tte caapslgn. 1 took that up vith Spruanca and te was aaasad and said te dida t realize it, that te had oarer thought of that* Our staff and our doctor* oust know tte score, te should bo in on all planning: sad ns doctors end officers wo certainly are capable of Maintaining ao tight lips ns any other of floor* S3AB ADKIBAL ABffiStSQHs The Sdhcoaaltteo has discussed coma organisation which would la an authoritative way coordinate nodical activities of tte throe ate leal services. Wo have discussed a Joint nedio'il board on a high level, say the Joint Chiefs of Staff level, which would be in a position to obtain or to receive plans of future operations and, with duo regard to the secrecy of tte plane, would transnit than to tte headquarters of tte three nodical services, ftey would bo in a position to, for one detail, regulate tte distribution of hospitals to tte teo- pital services would act te needlessly duplicated. TfiSS COPT SXTKaCT 0? nflftHTIBU WITH JLSAH ADMlKAL HOBSON D. W2UUCCTTS (HC) U35 4 May 1943. jjgfflgMTOl. Du have any suggestions to of far a tout who should compose neb a board and what their additional function* say bat BZA& AH4IBAL VILLCUTTSi Medical planning, to *y mind, goes and etnas frost the top ech-lone. Ve should ho la on all present strategical and tactical planning* Shove that I think, keeping in Bind civil defense, medicine should have representation r*t the highest level, and th&i would he the Rational \f Council. I hare heard they have recommended th t we should have medical repre- sentation oa the Shtional Security He sources Board. Hut what or rather why vo should he denied the ether, whlch.ls the right hand part* 2 think we should have rspreeentaticr), certainly, with Central intelligence* If we are* going to war, good nediclne Bust he developed and Bust definitely he the first thought this tine, 3o not only for military hat for civil defease we should have pluming. tao forces should he represented, ia ay Kind, oa the Mat!anal Security Council sad also as a component of the National Security Bosources Board, and thoa on down through to the 0 defs of Staff, the Munitions Board, and so on. They should hare medical components, and they should alto he out ia the field* In fast, I think the Marines do that better. 2 recall in World tier X we knew what was going on. That was closer. I think you people in the Any hare better knowledge then we in the levy. TOu arc a closer organisation, perhaps. He la the Bavy at times are Isolated on ships and we don't know where we are going or where we crone from or what the score is. Definitely medical planning should stem from the top and bo at the top. 3U*. co&om, mo Tsaix copy sxthact or xmmxw with colossi na&iL coksthj*, mo. usa, so apszl 194a ******** y, «G«a«rsJL rdatlonship* with oilier branches of %he Armed Sendees relative to *edlc.*l plannleg and r«t•“ r.L. Conklin, (MO) DBS, dtd 27 Apr 48 ) ********* X. "Overlapping of aedloal function* of tho Armed force* could be prevented by a Joint Armed forces Board in Washington.*•♦•****«♦ L,K, POHL, Colon*!, MO fm COPY EXTRACT (LTB Oapt, M, S.Mathis (MC)DSI, dtd « May 48) ******** X. *fha in/ and Nat7 both opt rated Medical Supply Depot e la Hawaii, This duplication la function operated to adraatace of both ter* ▼loot. It was a f request occur aace for oat eerriee to f oral ah supplies and equipment to the other whoa either was short or outoofHnaterlale.**** ' L.K.POHD. OolontI, MC TH01 COPT EXTRACT (Letter from Dr. Mm. C. Kennlnger, Topeka. Kansas, dated 22 April 1948) ••••• H(k) factors contributing to alleged overlapping of medical func- tions among the Armed forces.—From ay point of view there was no alleged overlapping. There van overlapping. Again and again there were instances where there was a naval supply depot and an aray supply depot in the same area. Again and again there were hospitals run by the Air force, by the Service Force and by the Navy in the same area with no correlation between the three. I think any of us in civilian aedicine who had any extensive service in the aray could cite aaay examples of this overlapping and, there- fore. it would appear in your aeaorandua where it ie parked a« "alleged" overlapping ie dodging the leeuc. ****** I*. t, Pohl, Colonel, MC TRPB qqpt EXTRACT (Letter Capt. S.P, Kunkel (MO) USI, dtd 21 Apr 48) •••••I* ■! believe that Are/, lavy end Amy Air force eedlcal officer* should at all times maintain their present Identity. However, there certainly ehould be no overlapping of hospital care for the armed forces. Hospitals should be staffed. If Havy, with naval medical officers, and Aray hospitals with Army medical officers.' levertheless, all armed forces personnel. Including dependents of same, should be admitted In like manner, whether Amy or Havy, and at the tame per diem, fhle would necessitate a uniform system of personnel accounting, administration, nomenclature, etc. Hospitals of the armed forces could bs designated as Armed forces Hortltal Mo. X, etc., vice Army* *orc#*g ♦**•••• L.K. fohl, Colonel, MC THUS COPT (Extract tram. Ltr Alfred ¥. £yor, Obtain (Me), USH, 17 April 19A8) ***•*•(k) Factors contributing to alleged overlapping of medical functions among the Aimed Forces* Factors contributing to overlapping of nodical functioro arise from the following t 1. Lack of joint planning. 2. Differing service field and aone of interior ad?;iaistratlve procedures. 3# Maintalnance of different types of records (patient-personnel) and type reports required. 4. Utilisation of socialist pers nnel in the aone of communication where each service attempts to meet its own requirements. 5# Maintainance of duplicate supply ays teas in both sons of the interior and the communication sons.**** * r"-* j U K* POHL Colonel, MC' TRUE COPT EXTRACT (Letter, Dr. Russel V. Lee, dated 1* April 19A8) ***•• »(k) Factors contributing to alleged overlapping of medical functions among the Armed Forces. •Principal factor Is that there are three services Instead of one as there should be. Rules against interchangeability of personnel, of patients and equipment all contribute but would be eliminated If the basic intention of Congress — unification — were achieved." **•*♦ ;;v£4^{£_ L. K, KC TRUE COPT (Extract Ltr wames E# Hix, Lt Col#, MC (Resigned) XI *pril 1948) reaction is probably prejudiced* Obviously, from the poinV-cf-view of the tax-payor* On© medical service taking car© of the Navy* Army and Air Force is all that can be Justified* but it would be difficult to convince certain people of that* or that because of the role of the Air in future protec- tion of this country* that Oen Grow should be the policy maker* and not the ground or water*"***** —r'Cl • Colonel* 1C TRUE COPY EXTRACT (Letter, Brig. Gen. Robert C. McDonald, MC, USA (Ret#) dated 15 April 1948) ***** "(k) Factors contributing to alleged overlapping of medical functions• "(1) Comment! Overlapping occurs in procurement of medical personnel and equipment, lade of standardization in supplies, and failure to coor- dinate the requirements and operation of medical facilities, in areas occupied by more than one of the Armed Forces#" ***** q /tf U L, K, Pohl, Splonel3* FC *PHITM EXTRACT CO Y {htr Brig &en OuyB. Dealt. MC.Surgeon, dtd 13 Apr 48) ***** “In part var there vas m one in authority to say to anyone of the three services that eo and a© would bo done****»**♦»•♦ /fa n fy. K. P0‘5L\Col, mc WH Wfl KgRACT (Utter, Captain F. R. Wrban («C) USX dated 28 April 1948) ***** *(k) Factors oontrlbatiiig to alleged overlapping of nodical functions anong the Arnod Forces* I*ack of eloco relationship with other services Or cctaaBdl contributed to overlapping*■ L* K* KC THU! CQFI EXTRACT (Utter, Itoar Adrti.1 C. I. Audit* (IK) 09 dated 27 AprU 19A8) ***** *(k) It would be ny feeling that in general, alleged over- lapping of nodical function* among the Aimed Force* during World War IX were wore imaginary than real* Each service had Ita respective mission to carry out and in so doing, functioned to full capacity without undue duplication of effort. There were muSmoubtedly specific instances of overlapping of some medical functions but through joint cooperation and get-together, the Medical Departments of the two services ctftttfgfcesisted each other In precluding duplication of facilities or function. An example of eliminating overlapping of function can be referred to in connection with material procurement* To begin with the services were in competition with each other in the procurement of certain material items but it is believed that this situation no longer exists since the joint Procurement Agency was established,* see#* yl>* K* PohlyColonel, UC THUS COPT ETPEtACT (Letter, Hear Admiral C* B*Caterer (MCI), U*5*h*, Retired dated 21 April 19U8) **** »(k) Generally s under *( j)B, Personally no great asacnmt of cs2>arpasaiaer.t frtaa this source, aside free diverse squipissnt, etc,, was observed. Laboratory work could well be better correlated and slsplifiod aaong toe different branches of the Services by closer cooperation, and the application of the same ftoneral prlncicples as submitted under *(j)* TRUE COPY EXTRACT (Latter, T. T, Cooper, VSSi, dated 19 April 1%S) *we« »The Aray Savy Joint catalog and the Joint purchasing agency is a great stride forward insofar as nodical material is concerned, and should do each to conserve manpower and achieve the optima utilisation of available manufacturing facilities. Further, the possibility of tying up certain faci- lities for use by a single service to the exclusion of all others is precluded. Standardisation of specifications and interchangeability of liens Is invaluable. Those charged with aaterial requirements planning should have access to high level information In order to plan wisely. During the last war insufficient information was available to responsible individuals, who were forced to rely too much on the •crystal ball*, tinder the present administrative set-up, relationship with other branches of the armed services will be improved with respect to medical planning and requirements, While inter-service relations during the war were always cordial, they were not always effective. There was, however, a considerable degree of cooperation between Army and Wavy medical aaterial logistics agencies in Sew York and Brooklyn, each helping the other when the need arose. In the field of personnel and aaterial planning, much can be accomplished by close coordination, but It is ay firm opinion that naval and military hospitals should not as a rule be combined. When a small unit of one service is in the vicinity of s hospital of another service, medical ser- vice should be rendered to the smaller group as required. This, of course, is presently done and has bean dene for many years* Overlapping of medical functions is not nearly as great as would appear on casual examination** ***** 0 "tar- WU1 COPY KXCTAQf (Ietter, Captain H. D. Templeton, NO, OUT dated 23 April 1948) ♦•••• "(I) FAOTOBS COETEIBUTIHO JO ALLEGED OTEBLAPPIEO 07 MEDICAL ramm mm the 4W».otct8. Thera were no oeoasions that oaae to ay attention in which there was overlapping of ae&ioal function* aaong the armed forces.N ••••• TRUE COPY KXTRACT (Letter, Colonel John A. Rogers, MC, USA (Ret.) dated 19 April 1948) ***** **• Eac&gre cqnfclkufr,.mrl&vlne of mtesal functions among the Armed Forces. It is believed that medical units could be developed which are suitable for the care of Infantry soldiers, sailors and air corps personnel. They are all human beings and much duplication could be saved by recognition of this fact. The desire of the Air Forces to have special hospitals is a notable example of this duplication. — - — L. X. Colonel, MC TRUE COPY EXTRACT (Letter, Captain Robert M. Glllett (HC) USN dated 15 April 19/P) ***** ”The over-lapping of medical functions among Armed Forces la an advantage under combat conditions If Task Force or Area Com- manders are permitted free utilization of manpower and equipment.” ***** , , L. K, Pohl, Colonel, MC TRUF COPT EXTRACT (Letter, Dr. A. R. Shands, Jr., dated 20 April 19/S) ***** "There was a great deal of over-lapping of medical func- tions in the arsed forces. The duplication of facilities and per- sonnel in many communities was very evident. Coordination of the armed forces medical service will certainly prevent the recurrence of this. The chief circumstance which Asad to disaffection of medical personnel was the lack of proper assignment and the failure to obtain promotions when the personnel thought they were due. I personally believe that all rank should be abolished in the military medical services. A doctor’s prestige on a post even though he might be an excellent physician was not what it should be if he did not have comparative rank to non-medical personnel. This had a tendency to lead to lack of respect on the part of the layman for the doctor•* ***** 7?Q^ L. K, Pobl, KC TRUE C0P1 (Extract from Ltr W. H« Michael, Rear Adairal (MC), USM Retired) ***# "My personal relations with the Amy relative to planning and requirements while in the southwest pacific were excellent* The Amy Medical Department kept me posted as to their moves so that work could be coordinated* "As a result of this cooperation described in (J) above, I do not recall a serious case of overlapping of medical functions In my service in the Southwest Pacific* On the contrary, the Amy Medical Department frequently was able to and willingly did help out the 7th Fleet when for any reason there were descrepenciea in Navy Medical Supply or personnel* The Navy was frequently able to help the Army in the same way*" ***** 'L* E. Colonel, UC TRUE COPT EXTRACT (Letter, Captain J. H. Robbins, (MC) DSN dated 26 April 19&8) mm* "Reduplication of Medical Department Activities« At practi- cally every Base in the South Pacific area there was reduplication of all medical facilities, hospitals, supply, depots, etc., and there was only a few tinea during their existence that any one of the hospitals were filled to capacity. It is recommended that in th* Mart om hospital of sufficient capacity be erected and that it be staffed by both members of tho Army and lavy Nodical Corps and It a designation be made as a D. S. Hospital and it»s commander be designated by the area Comander from available personnel. It la further that only one Supply Depot serving all forces be set up in an area*, L. K, Pohl>Colon«l, KC TRUE COPT (Extract froa Ltr Col Harry 0 Armstrong, HDf 16 April 1948) eea* "k. Factors contributing to Alleged Overlapping of Medical Functions Among, the Tuned ForofrV (1) Defects« (a) amdlllngnssi of service personnel to accept hospital!- action ftroo another branch* (b) UndJULingness of branches to provide hospitalisation for other services# (c) &aptro bonding* (d) Adherence to tradition# (2) Remedies* (a) Mixed staffs at all hospitals share various services are represented in sufficient strength to aarrant this| organisation naserlcaliy strongest in area should operate sain hospital facility#* !»♦ K* rUnlk Colonel, MC TRW COPY EXTRACT (Letter, Dr. Howard A. Rusk to Secretary for Air dated 27 January 1948) ***** *Thare are at present in the Air Force, 190 regular Radical officers and approximately 50 category I reserves. The remainder of the complement of doctors is made up of ASTP students who will finish their tour of duty within the next few months. The minimum require* ment of doctors in the Air Force is approximately 800. Although I do not have the figures, I understand that the other tranches of ser- vice are in a more or less similar position. The procurement problem is critical. "To illustrate how important is the pride of belonging, a recent survey in class A medical schools was circulated to former Air Force pilots now in medical schools. 67.3$ were interested in a service career and 72.5$ of those would prefer service with the Air Force pro- vided a medical career in the Air Force could be assured. If such an appeal were made to all former members of the Air Force in medical school, it seems logical that a considerable number of excellent car- eer physicians could be obtained. *1 feel as you do that the over-all problen should be our first consideration. I am not convinced that a single medical service with its attendant overhead in housekeeping, administration, communication, supply, etc., would provide an economy in personnel. I feel in light of the foregoing discussion that a nodical service coordinated under an armed forces medical council, responsible to the Secretary of Defense, is the most logical solution. "It would seen appropriate to request the Secretary of Defense to issue a direct Ire establishing under the command of the Chief of Staff of the Air Force a nodical, health and sanitary service capable of supporting the Air Force In all phases and situations of its as* signed mission* Furthermore, that the commanding officer of the Air Force medical, health and sanitary service be the medical advisor to the Secretary of the Department of the Air Force and the Chief of Staff of the Air Force. This would assure the Air Force of command responsibility over selection, medical evaluation and separation of its personnel** ***** L. K. Pohl,Colonel, MC THUS COPT SXTHAOT (Latter fro* Rear Admiral A. H. Bearing (KC), USI dated 26 April 1948) factors contributing to alleged overlapping of nodical fane- tione among the Arned forces. The first factor vhich contributed to actual overlap log of nodical functions vas the supply of nodical Materiel. Because of the differences in requirements of Amy and Navy; the fact that there vers different supply catalogs and the difference la the organisation of the logistic services vithin the Medical Departments, it vac necessary to establish both Amy and Navy Medical Supply Depots and storehouses. To the laymen this appeared inexcusable but to have attenpted unification of nodical supply systens within the eonbat and coanonioation sene at the tine when all efforts were directed towards pressing an offensive against the enemy night have been disastrous. The erection of Havy and Army hospitals within several miles of each other on the same island bass has been criticized both by medical personnel and'the laity In the scientific and public press. The number of hospital beds required at each island base were allocated to the two services by the Commander of the Area (medical officer) in accordance with the anticipated needs. The allocation was divided between the two services in accordance with the number of personnel of each service who were engaged or expected to be engaged in combat operations. It must be bora in mind that these Island bases were not large and that the area in which hospitals might be established was necessarily restricted. It is agreed that a hospital of over 1600 beds Is unwieldy and undesirable, and for this reason it was considered better to have two hospitals of 1600 to 2000 beds each than to have one hospital with three or four thousand beds. It hat ‘been alleged In the press that the Army a&d Vary both established large hospitals la the Hew Hebrides—Solomons arose which stood partially emptied for many months of the year. It Is snbsilttcd that time Is required la the planning, ordering and establishment of hospitals and this vast be done prior to the beginning of an offensive which may tend to these hospitals large numbers of wounded. The writer le aware of the Act that probably all of the hospital beds sstabllshed in the Hew Hebrides and Solomon areas were not used but, at the time that they were erected, the plant of the Commander of the area called for a major all-out attack on well fortifisd and strongly manned Japanese bases. These plans wars changed after the hospitals had been erected but, had the plan;? been carried out as first projected, every hospital bed which had been placed in this area would have been required. The same individuals who now criticise the fact that these hospitals wsrs not und would have been the loudest in their denunciation of the services had there been large numbers of wounded with no hospitals to receive them,"***** L. K. Pohl, Lionel, MC Extract of Statements made by Brig Qen Robert C. McDonald, MC, USA (Retired), 21 April 1948, before the Subcommittee on the Employment of Military Medical Resources# **-**«7he next object* "Factor* contributing to alleged overlapping of medical functions*** ** Overlapping occurs in procurement of medical personnel and equipment, lack of standardization in supplies, and failure to coordinate the requirements and operation of medical facilities. In areas occupied by more than one of the Aimed Forces•" I am sure that wo can and will cooperate and coordinate our nodical services in the future® I think that the merger shich has been brought about certainly is in the interest of efficiency of the medical service, and that there will be economy in it and perhaps a higher standard of care and t rcatroent#’’**** PCKL Colonel, yc 1BBE EXTRACT CQPli (Extract of statemonta wade by Cclonal Thotsas J, Hartford, MC, USA cm 23 April A3 at interview with Subcowiittoe on the Enploymcnt of Military Medical Resources) ***** *k* In the ETO the Array made up the ouch larger comrleraontj and X donft think that there was a great deal of overlapping of medical functions among the emod forces* We were criticised, for example* and have been since tho wrr* in one case because the Havy hod one fixed hospital In England* Said cur planning was poor* Fell, actually* that was a hospital that m took from the British* It would hove been staffed in any event, and Navy were perfectly hocest In stating that they wanted that hospital because it would be a naval hospital and show the flap* and that was all there was to it* and I think it was perfectly justified* Vo hor-lta lined each others eases* We kept the sane records on them end took care of them end generally worked very well* I don’t think there was ranch overlapping* We didn’t have the sane problem perhaps they had in the Pacific In that respect* Relative to ell field hoe pit a 11 ration organisation and equ.irtrnt being Identical for all services* 1 think that would be desirable, end our services ape together, fee have had some meetings down at Gasp Lejeune In Horth Caroline In wliich they ere trying to work cut just that tiling, 1 see no reason why a Morins field hospital or surgical hospital should be any different than an Army hospital* X think they should be the ear** wAs a ground activity would you reeaanend in the interest of economy that all field hospitalization In tiie arsed forced be furnished by the ground force a Vtt If they had started out planning on that initially, that perhaps would have worked* but under tho clpourantenoes if they hid a field hospital ten- their support and didn’t mean taking the patients past soao Amy installation, it’s all right with 1, K, kohl Colonel* MC THUD BXTBaCx OOPT 0F MjDICAL SUPPORT OF TiiS OSAAF IS THS KBDlTSHtokaSAH TKSATSE HISTORICAL 339CT10K - AJTA3 •*•«****« X. "In spite of atteepts to slaplify channels, however, anach duplication of effort remained. A directive prepared for the Surgeon, Army Air Forces, Med- iterranean Theater of Operations, had to be coordinated with Headquarters, Any Air Forces Service Command, as well as With Headquarters, Any Air Forces, Med- iterranean Theater of Operations, and in some instances with Headquarters, forth African Theater of Operations. Upon its return, if approved, an appropriate directive was prepared for major echelon Air Force commands, one of which was the Amy Air Forces Service Command itself, and for subordinate units attached or assigned to the Arsgr Air Forces Service Conmand.•**•♦•••• *7. ¥o X, Holonal, MO EXTRACT Or STAIBEUfTS HADE BY COLONEL OSCAR S. RXSDIB, HCf USAf Oi 15 APRIL 1948 AT HTfRnE* WITH SWCOMCTTBE OR THE OffLOOBBT Of EUJTART HEDICAL RESOURCES. —— ■ (K) I think «M gmt possibility of overlapping ef aedieal functions would earn 1m the qkw of hoepltallsailoe. *1* Z belifVB i beginning has boon nede 1ft elininating oitrlappiai functions by the joint supply. In tho field of hospitalisation and evacuation, la objections to joint wc. lo objections bat overall plans should be aada before any stub scheae is set la action. *2* I believe they should. Z thick It aeold be am ecomart cal free the standpoint of precmrsneat. Z believe it could. X believe that each should keep its own basic installations for sonde of patiests. *3. Z believe it is. The attain!stratlve dtflieultiee are the sain factors. Against combined use. Tee. *4. X believe that a truly unified eedieal service ia not exactly the proper thing because the Any, Xavy and Air Force have different prnhlees and aisslons. There has to be eeae difference between the services because Z don’t believe it would be possible to organise all units to satisfy the needs of all three. •6, Z believe a single list could be used for all the services as an economy ecasure but I do not see any need for a constant —— of civilian consultants because in due course of tine I believe the services will have their own specialists. *7. Tee. I think it could be coordinated. The probleas of the two services are alncet identical. *8. Z believe that a Procurement Board on the Defease level would be thecnly solution to that problea. •9. Z don’t believe it would. I believe you should have a Surgeon General of each even in a unified service. •♦•*** *; - ? » a L. K* Pohl, Colonel, WC MS COT SSTflACT (Utter, Captain 0. B. Morrison, Jr,, K, CSV dated S3 April 1948) «KK«MMft "k, Factors contributing to alleged overlapping; of nodical function* aaong the araed forces. There sould be cleaMwt, concise directives frm higher authority as to the duties of each component, Meetings of the representatives of each branch will engender confidence and Mutual respect, end will do each to prevent overlapping of functions,*' ****** I« X* Pohlf Colowlf MS TUBE CQPI m ACT(Utur, ColMMl Arthur B. IB, BBA diM 19 April 194#) ***** "k. There was definite overlapping in the procarturt of Medical Department personnel as well as in the field ef supply* "There was overlapping in the hospitalisation of the sene ef interior as well as in certain oversea theaters where joint operations occurred on a large scale* •There was overlapping in nodical laboratories and in research* •There was Ism overlapping in evacuation than in any ether field* *The major factor responsible for overlapping and not alleged overlapping was so-called departmental allegiance aonetimea bordering on Jealousy, The other major factor waa the existing command structure within the Army and perhaps within the lavyj of the latter 1 have no knowledge** *♦*♦* vt. K, Pohl, Colonel, MC TRUE COPY EXTRACT (letter. Colonel C. J. Baker, *C, Air Force dated 22 April 1948) *•**# »k. The principal reason for overlapping of nodical functions among the Amed Forces was lack of Mutual recognition, resulting in poor coordination and cooperation, also the lade of authority to direct procedures#" **** * L. K. Pohl, Colwwl, MC 679 TRUE COPY EXTRACT (Utter, Colonel F. A, Blesse, «C, USA dated 19 April 19A8) ***** *u. ITistarp mtriteBttag.te alkgtd grwlftrolM qf,. ggdical functions among the Armed For cm. Discussion* The factors contributing to alleged overlapping of medical functions among the Armed Forces are really inevitable lx. view of the existing organisation for national defense. With two separate medical services serving the Armed Forces it goes without saying that overlapping of medical functions in many inf- stances are the natural result of dual organisations each working towards its own goal. The lack of unified control and supervision at the high- est level causes such overlapping* Closer cooperation at all echelons of command would prevent a considerable amount of overlapping but until such time as a system of overall control and supervision is insti- tuted overlapping is to be expected a fid will be the rule rather than the exception•* **** A. K. Pohl, Coiohel, 1C THUS COPT (Extract Ltr X* C* Stayer, Major General, U* S* Any, Retired, 11 Apr AS) Factors contributing to alleged overlapping of nodical functions among the Aimed Forces* 1« The desire to build up an empire and obtain credit for the service to which they belonged* 2* Lack of coordinated planning with the various groups as to tbs requirements in the areas shera either fight- ing or near»fightlng was to take place* 3* Inability of companding officers to coordinate their • ideas* 4* Hen in gMttr places with poor personally no imagination, no training in organisation, and little ability to get things done* 5# The Theatre Sturgeons had UttXe or no contact with toe policyHaaklrjg group of the aedical c R# FQnt Colonel, IC TIPI OQPT ItCUOT (Idlir trm Ooloaol ItWrl I, llapm, P*A (III.) iotod I Umj X948) ••••• "(k) MttoltalUi to tho ollocod mrlappUi of ■oilcot fmtiou of tko Amod forooo. This hat kooa ■oatioaod to oo«o oxtoat alroady* Ao Am toon sold, it to tolltrod tkat foaoral koopitalo of opooiallood aotvo wltkla tho soao of tko latorlor could oorro OH eeopomta of tho Araod forooo, «ad tko um ke tno of fiaonl koopitalo wltkla tko oeakat ooao. Howowor, oook eoapoaoat of tko Araod forooo okoold koro ito aodloal Dopt. oad could «apply porooaaol to otoff oook koop&tals.•••••• L. X. Fold, Colonel, NO TRUE COPT (Extract Ltr Bascom L. Wilson, Colonel, ISC, Air Forces, 21 April 19AS) ***#*H»ferenco par 3(k) "Factors contributing to alleged overlapping of medical functions among the Armed Forces,11 many instances of overlapping of medical functions were noted, moat noted of which was the duplication of Ground Force and Air Force Hospitals in the same area, often contiguous areas, a good example of which was El Paso, Texas, where there existed the Air Force Station Hospital at Biggs *leld| it certainly couldn't have been in the interest of economy either from a momitaxy point of view or that of economy of medical personnel, and it would seem both logical and economical, financially and otherwise, for one hospital, be it Away, Air Force or Navy, to serve any given area where geogrcohl* cally suitably located****** , c ' L\ IU PAUL Colonel, i'C EXTRACT OF STATEMENTS IftBB 3Y» GoXonel MD» U.S»A« on 22 April X9U9 at Interviar with tKe kilitary Ifedlcal dmoarom »*hhh* "(A) 1, In jay opinion, yes, I am not qualified to pass final judgment on it, I think that the joint sujjply program is certainly a definite step in tbs right direction. In administrative procedures, particularly in the care of patients, in handling their records, it<» definitely indicated) also in standardisation of forms for physical eat* aainatAon and others of that nature. “Objections to Joint use cf hospital facilities in 2if in my opinion, are minor, X think, they involve an understanding of joint adodnistra* tion and staffing, which can only be worked out with experience, I think that we are getting into the field of the Hawley Committee's setup, I aa not competent to pass judgment on that. "Whether hospital facilities are used jointly or operated jointly is something which In ay opinion represents two different things* A hospital run and staffed, for example, by Navy personnel can and has handled personnel from all over the services* I have never seen a hospital which was run by a representative of one service and staffed by members of all the military serfices* I guess it can be done all right* With our Amy, Navy, and Air systems aa we have them now set upf I should certainly think it would be easier for the moment at least to operate our hospitals under one lead and then permit patients of other services to come in, rather than try to try joint staffing, although 1 think we are going to come to that before we get through* “Standardisation in field-type hospitalisation would certainly tend to efficiency, to economy la procurement, and to ready Interchang- ing of tha unit from one force or service to another. This in my opinion represents a distinct advantage. “I feel that any ground activity should be furnished by and part of the ground forces. The ground forces are naturally interested in their own medical service, and I think that they should be the prime factor at least In developing the tables and equipment lists for these hospitals# "I can* t answer this cm standardisation and fixed hcepitala in the ZI* In the ZI peace and war* I an not la position to answer whether we can standardise hcapita 1b, or not* Z would say partly so froaa a standpoint of expanse and planning the layout which, Z understand, is very expansive in planning the hospital buildings and what not, and If we could have a more or lees standard layout subject to local modification* I certainly think It would be acre eoomfs^qal XT &T Pohl# 1C E3T3ACT OF ,MA3B WTi Colonel Frederic jL 1C. U.3,A, on 22 Aprdl IffUS at interview with Subcciarai t te e ontho hiapl orient of Military Medical fWources ' ’ "As far as staffing and equit pin;, these .1 capitals, I think that would depend u]>on to wnat extant the surgeon general wanted to specialist activities in tiia several hoepttale* "(K) 3# TMa is personal, too, but I am going to answer it* I don11 think that the adminis trativa difficulties of operating joint service noepltal facilities represent the paramount objection for combined use* I think the chief objection is habit) maybe the selfish interest of the individual who wants to work with the people that h© Is accustomed to working with, or who feels for some reason or ether that Ids particular service does things more to Ms liking than the other service* In short, I think it’s a Iiumn feeling tliat requires education before we cm com® to successful joint staffing and operating of a uospital facility* "I think the idea is so new to service personnel who ever since they have come into the services have felt that their service was just something apart, and what wo need is a realization that we have much acre in con.,on than many are willing to admit, and that tnore is no practical or serious objection to joint staffing and operation. I don11 think any of those objections are sufficiently serious to discourage trial, and I am very optimistic about the results if they are given a fair trial. "The answer to the latter part of question 3, certainly a unified system of administration, including forms and laws, would very definitely facilitate the joint staffing and operating of medical units* As a matter of fact, it would almost make then so simple that they wouldn’t bo joint any more. "(K) U* As far as U is concerned, mandatory coordination is, I think, the only way that a real coordination of these medical servicee can be initiated* It will require mandatory coordination to eat up a system which will eliminate many of those overlapping or alleged over- lapping functions. A direction by a medical liead in the form of a medical section or staff agency on the level of a Secretary of i>ofonse would certainly break the ice in starting the coordination of those service® and bringing about what in my opinion is a true merger of the medical means of the armed forces* *(K) 6* Anawar to No, 6, I should think that a single list of consultants dhould be established as an econaiy measure* I an not familiar with how these consultants are being handled now, but I do know there are several lists, and I assume the list that the Navy has is entirely separate from the Array* I knew that the Surgeon General has a separate list frosa tho Array so I suppose it goes further than that, and I think we should bays j* single list** "XHCTda; Colonel, M ~ extract oy ham si: ffoloneXWocieric *K MG, U.S.A« on 22 April at intervicrg witfc on ci Military lfed£cal~ ”(&) 7* I also feel that crjx residency training programs should be mere closely coordin • tsd| in line with the general idea of eliminat- ing competition among tins services, I think we should coordinate our procurement efforts, our inducements, baits and everything else that we are using to got people to come in# And that is on© more thing that I think 1 could imvc added in a previous question when talking about things that could be coordinated like toe supply effort* I think we could co- ordinate our irocuremant effort as well to avoid outbidding one another in our effort to get people to com® into the regular service, and I kind of touched on Ho* 8 when I talked about bidding for procurement* HTh© spirit of coropetitlcn is a very basic American thing# It’s cm 'thing that makos America strong, but I think that competition can be carried to the point where it becomes just frank rivalry* *1 think in case of medical officers, which are if not in critical supply, they certainly arc not abundant, that it would be better for the welfare of all the armed forces—and particularly in their relation with civilian population—if the armed forces could standardise their ap- proach to the civilian doctors* In other words, offer them the same opportunities for professional training if they wanted it,- offer them the same amount of income, offer them the same grade if coming in direct from civilian life, and things of that nature which at the present time are not in actual fact* There is ccnsiderabX© competition* "(K) 9* I don’t visualise uniformity of all medical services on a defense level* I think that on a defense level w© should !iav© complete uniformity- of medical thinking and possibly—and only possibly—of high level hospital service* I don‘t see how wo can have common medical ser- vice at the tropp and ship level in the services* The roquireiaants are too specialised# A knowledge of the tactics and the operation of the fight- ing units is necessary to give prepor and intelligent medical service# I don’t believe that you can standardise the requirements at that level# “la other wards, I fael that each major fores needs a medical ser- vice at the level of the people that are doing the fighting* I think that this would entail a certain amount of individual research and de- velopment concerning items and what not at those levels* I do think tiiat an upper level as indicated hero, the defense level—I suppose that means Mr* ?orrestal*s level—I think at that level a great deal of the high level medical research problems could .be coraoletalv unified under one head** TTT. 7otg;'goTohei; 'MB KMAOI 0? StAiaOBTS MADS SYl SgloaglJtoa«ri.o J*. w«»t«rr«lt. KC. P.S.A. on 22 April 1948 at latwrlw vi%h 3ubcoflmitt»q on the 3BapXoyg«nt of Military M»dlial Begotircea. I therefore feel that at the top lere! there should he a medical director or medical man for the armed forces as an advisor to the director of the armed forces, to the Seoret&xy of Defease, aad X think that he should have an advisory staff to include research and development at that top levdl. As far as So. 12 Is concerned, X think that the aore combined planning vs do on all nedleal natters, the better ve will be, and X think we nust consider the Teterans' Administration, Public Health Service, and all the civilian organisations together. I think ve must all work together on this problem.«••#•••••• (? L/K. POHL, COLONEL, MC TRUE COPT EXTRACT OP INTERVIEW WITH COLONEL VIRGIL CORNELL, UC, USA, SO APRIL 1948 ********* «x win go to (k) because some of these remarks refer to that* "Factors contributing to alleged overlapping of medical functions among the Armed Forces*" * In small areas, duplication is apt to occur. For example, in Puerto Rico, *41 to *43, there were Army, Navy, Air Corps, Public Health, insular, and Engineer Hospitals, an island 30 by 100 miles. Construction engineers civilians sick, could not be hospitalized in the Army Hospital, so an engineer hospital was built securing materials through high priority which were needed in the other places. Medical personnel in the Air Corps Hospital were not available as re- placements in the Army hospitals. At least two large hospitals in such an area could handle all the work with dispensaries or small station hospitals at the other post to screen oases for hospitalisation in the larger units, which would certainly save personnel and equipment, and I think in time improve treatment. Specialty services could be grouped such as X-ray, laboratory, dental and so forth. Overseas four to six medical officers were assigned to various units held at air fields where only dispensary service was given. They never went on missions except for something to do, but had to be present with that unit be- cause it was an A TO requirement • One of the majors from over at one of the fields on the other side of Italy who was being transferred had been trying hard to get into a hospital where he could get baek and do some medioine partioularly gave me a story at to what they did at this air field. There always had to be three of them present on the field. There were five there; but if there was a orash and injured were brought baek, they gave them dispensary service and immed- iately threw them into a general hospital. I recall at one time early in the war when there was an Air Corps ex- pansion, a small area — 1 forgot whether it was Puerto &ieo or Panama — immed- iately 300 medical officers because there were that many officers oalled for in the organisation of that many groups. With modern air evacuation the number of medical officers can be qulokly increased almost at any point, and if oases needing specialised treatment can be flown back to a base unit where they can get definitive treatment, I feel we shouldn't scatter medical personnel at stand-by points where thsy are not oooupied. As I said a while ago, I believe unification basically is sound and can ultimately be completely accomplished, but that its always hard to bring various groups together who have had Instilled In them for many years a pride in service, and perhaps you might say a little friendly oonfliet. HEAR ADMIRAL AKDESSOW* You mentioned the overlapping of function so far as hospitalisation was concerned in Puerto Hioo* Do you have any suggest- ions as to what agency should o oar dim to hospitalisation, say, in the sons of the interior, in locations like Puerto Eioo, Hawaii, in other words, in areas other than theaters of operation? Vov, 1 night suggest that the Subcommittee have discussed the establish- ment of a joint medical board on a high level, say, the joint-chiof*-of-staff level, which would have the authority to establish coordination not only in regard to hospitalisation, but in all other functions of medical services* Can you give us some ideas of yours along that lin**— mm coir mifcSf or ihtxhyisw with col cohbsll, «c» usa, so pamil ms, OS8MSS* COLOSSI* COSKSLLt Z think you MM right in establishing the Assigna- tion ae to who shall be responsible la a given area at a high level* All of tic services have- had Inculcated in them the idea that If It comes down from above it's carried eat* If It's made locally, there ie always a feeling that there Lee been some - perhaps we sight say • friendly iatriqae; eo that If it cones down from shove that this sons, which is in command of so and so* {tech and each a service, will be in charge of general hospitalisation* Other enits will establish only minor medical waits and will refer their cases that need hospital! sat lea m such and such a general hospital* Have it known as a general hospital, not an Army or Savy or dir Corps hospital; bat the general hospital of each end each m area, which could be staffed by personnel from at present ell of the services, bat later from the medical service* I think one has bean planned for at Boosevelt Seeds and the large navel establishment at the east and of the lolaed might have called far a large hospital there, end cae In the region ef San Juan, amd now I understand - X may be mielafermed, bat X think there is another hospital going up down there, a TA hospital* I think we cam save a let on medical personnel, medical supplies, large medical equipment b, having them neutralised in these areas* Sow, at Salat Thomas, where we lust had a few dray treops and occasion ally same careteklng elements, I believe these men were taken cere ef la a die* pessary, they called it - it was a lovely hospital, in ay way of thinking, and there v e didn't have ea Army hospital. We dlda t need eael X think that's the thing that could be carried on, and X believe the decision should bo made from a high level** J mm cort isxsm&f o? memnmt with ma Ammo* mma a. vxjulcutts (ms) ear 4 May 1948 oeeeeee K. • jt£4g ABMISAl, VlLLCOTTSi X think that is wall established, X think that is a going concern. SSAE AMima* A&msmmi AM. do yon feel also that in procurement them should he sene plan which would ceroid competition among the services * procurement of personnel I an referring to? KM& AW1BAL WIUuCUTfS: 1 wouldn't say ©ospetlUon. X think eon- petition is to he encouraged always* Ho wouldn't do away with football until the Envy had slaughtered yen fellows at Host Feint for previous defeats of the past century* I think competition t« ell right* 1 do think we can safeguard against overlapping, if in a sene he have «n out standing neuro-surgeon or an outstanding eardlologist* or aoashedy which the other sister services have desire of* I don't see nay reason why there shouldn't he exchange of these specialists and consultants and common mate exchange of staff. As to procurement, however* I an fixed upon the point that your doctors are net going to he drafted. ¥hat word •draft** is a peculiar word. As X said a minute ago* the draft will stake then enlisted mas. the only way they ean draft a nan is ah an enlietad parson* an appren- tice ssaa&a. When we register these doctors frost age 48 down* then the doctors know- ing that eertalii quotas are going to he called upon will get busy and sea that mi ««t then. Otherwise, they will he caught in the draft. So we are different on procure- ment* the Amy has their story and we have ours. X don't knew how you axe going to absorb our 3aval Be serves. m ASRIKAL AXBBKSOfft The subcommittee has felt that the deserve organisation should certainly bo maintained. WUJt A2MIBAL We lure a leaerve now that will neat all ear needs, unless we get to a 4,00,000 nan levy, Mira are 14,000 doctors and they are classified, fhere are professional cards on then separated hy divisions. HSAR ADHIB&Xt ASmSRSOIT: Of course If the present draft hill beooaea law the Havy will benefit ty doctors who are brought into the Service ns a resalt of that law. 81AB AJMJRKL WILLCiPHB* But aa will gat oars fro* our W13 pool, and tba Amy will got theirs froa their ASS9 eehoola. Mayka fron the anna steal we will gat brothers, am Amy and ana Maty. Oar aaarea of supply will ho atnHar9 hat they won't ho tho sane procurement. Ift carrying it a Ml farther* 1 don't sae hov i» IM tell jw ou do Joint procurement on your enlisted ana. Mgr any that should M dona, if IMgr ware recruiting. »«gr, la Kofcono, Indiana, whietaay have a quota far 10 Bavy, SO AM# and aa aaay Air three, it la going to ha a tread aindad Marina aha la going ta lat Amy gait a good hay that looks Ilka he'll aaka a good Marina, That la Ja*t cearnn aanaa. Tjtya copt extract of mssnsw with e ae actual kqwob d. viuxwm (mc)usk 4 jiagr 1543, lev ar to physical standards, that profile system Is fine* X think; *e should judge them alike* But I think wo can hero a havy doctor and an Array doctor on recruiting to sell a bill of goods to sack one* I think 11*0 fine to keep a little esprit d© corps* OcLOiaQj FOBLi Tou would recomend a eosplete medical service identified for each* 8M AUWIRAIi VflLLCUTTSi Tea. I would, but sisterly and brotherly end with coupon sense, and vith a wide open door for all typos of pot louts, sesseso n trfc, mc tmm OOPT maun {from »idr«ii of Major Omni Mhort W. Xosmor, KC, USA 13 May 1948) MAJOH GJWBRAX JTiSBNRflj *As to the next question —. factor* contributing to alleged overlapping of nodioal function* anong tho Araod forces — ho «pl tall cation, nodical supply, personnel and research, and elallar factors, it eeeae to no, could ho controlled hy a proper authoritative and integrating or coordinating agency. This overlapping has existed and vs have soon it. Vs had an Army hospital hero, with an Mr hospital there and a lavy hospital there 40 ailes away. The Amy hospital nay have keen sapty, with each taking only its own patients, the other one alnoet empty, end the other one fall to overloving. There again you come right hack to this one central coordinating agency. I think feat is tho only euro for it.* L. X. PoU. Colonel, MO THUS COPY SXmST 0? XKC3RTI ;V WITfi BRIGADIER 0MBKHAL JOSEPH 3, BASTIOK, MC, USA., (BBTIUJU)) 0? 3 1948. ********** K« ■ Factors contributing to alleged overlapping of medical functions among the Armed Forces. BRIGADIER MART IE j Off the record* BRIOADIM QMSML BASTIONi Bight now yon can do a few things Ilka your supply, research, and than 1 think you can do something about the definitive treatment of patients, hospitalisation, general hospitalisation. How, you still will have to have, I think, men trained for duty on ships, and with the Air people for their bases and with the Army for tactical combat troops, but I do think that right now for those things that Z mentioned something could be done.****** O' twi idTHB CHIEF POINTS OR CIRCDMSTANCES WITHIN THE MILITARY STRUCTURE CONTRI- BUTITO MOST TO THE APPARENT DISAFFECTION OF MEDICAL PERSONNEL* I. DISCU5SI0H 1* Any discussion or consideration in regard to apparent dis- affection of medical personnel as a result of their service in World War II should begin with full realization and appreciation that during the last World War the record of the Medical Departments* as a whole* in the saving of lives and in the medical care of the sick and wounded. mm the highest praise from all sources* 2. Review of the comments made by various still active and some inactive Medical Department officers who served during World War II* emphasizes the fact that this problem of disaffection was* and still ir, a most Important necessity for future corrective action by all echelons* Line and Medical Department* from the Secretary of Defense level on down* The comments are too universal and familiar to be ac- cepted lightly' and passed over without their prevention, insofar as is humanly possible* in any future war* It is believed that the pre- sentations already made in this report in regard to previous subjects considered (l*e** personnel procurement methods* assignment policies* etc*} will autmatically do a great deal to effect the desired end* The diversity of action required in attempting to remedy the multi- plicity of complaints encountered* should be provided for in all planning during the coming months and years* 3* It is believed desirable for the purpose of brevity* that the following essential summary of the reported causes of disaffection should be presented s a. Much dissatisfaction with policies and methods in per- sonnel management is reported* In particular, these include procure- ment methods, duty assignments, rank upon being comissioned and otter matters such as difficulties in promotion, prolonged overseas and sea duly for some, as compared with others, plus inconsistency in redeploy- ment and demobilization procedures. There were evidently many irres- ponsible promises made by certain Medical Staff personnel to incoming officers as to rank and duty assignments which were never kept* The permitting of private practice to be continued by some "mobilized personnel" is mentioned* The family and housing conditions exaggera- ted by a lack of human understanding and reasonable consideration of each doctor and dentists* personal problems were believed most impor- tant* Mention is made of a cheapening of the higher medical ranks due to comparative relative ease of promotion, whon position vacan- cies occurred, and which obtained for some of the younger, recently civilian MC officers. Also mentioned are class distinction created by designation of affiliated units, as it existed between regular and nonregular components and as stimulated by the recently required board specialty qualifications and the instances where military duties prevented mary of tho younger officers from furtherance of their pure- ly professional education along the specialty lines desired* b* A Medical Department officer, having been professional- ly trained, has come through a developmental period in preparation for future public service and as an individual capable of indepen- dent thought and action in accordance with the deductions of his own mind as to the proper means for the accomplishment of a desired end* His dislike for regimentation could not always be alleviated by tactful Medical Department Regular Officers. Too often the disaf- fected former Medical Department officers were not aware of the part Lino personnel management played in the picture. Ckwiflicts with non-medical officer personnel were reported of frequent occurrence, and often due to an a base of command authority from which MC officers had little or no possible recourse. It can never be assumed, how- ever, that tough bodied and tough minded laymen in Command positions will have a fill appreciation of the proper functions of doctors and hospitals* c. It was stated and it is believed true that "when medical personnel were actively engaged their morale was high", that varying periods of inactivity, an Inadequacy of preparatory medical indoctrination and training, an excessive and unnecessary or unsuit- able, often most arduous military training, primarily intended for nonmedical personnel, and finally, a frequent failure of recommenda- tion for outstanding services occurred all too frequently* General hospitals were reported as being too large to allow for proper and adequate personnel administration* Conflict between various medical echelons extending to the Surgeon Generals was exposed to full view of many of the civilian Medical officers and they often were allow- ed to participate therein enthusiastically* The concepts of civil- ian medical officers of military service in peacetime, is consider- ed to be predicated upon their wartime experiences* Dissatisfac- tion because of an excessive predominance of the psychiatric element In much of their clinical material evolved, because of the military stresses and other Influences in war time on all patients* The necessity for rendition of medical care to civilians and which was -2- 695 thought could Just as well be done with the doctor again a civilian, caused such discontent for seme medical officers and particularly dentists. This factor, added to a relatively disproportionate income for the military medical officer has prevailed and still exists# There is the concept held by many lay persons and existent in some of the highest positions in our Governmental structure, a nonnnder- standing belief that the medical service, and particularly that for the military, is a commodity which can be bought and sold, in the sane manner as done in other arts and most trades# This is based evidently upon the apparent misunderstanding that the Hippocratic oath atad higasr motivated ideals of the doctor make it mandatory and binding for him to accept ary imposition as may be deemed ex- pedient, in his having to render adequate care of each and every patient, for twenty—four hours a day, seven days a week, etc#, and that therefore he will accept complete exploitation by the so-called business man commodity minded executive and/or commander concerned# 4* Individual opinions varied considerably in regard to primary causes for tbs disaffection and suggested remedies# Fre- quently the suggested remedy, such as some recommended changes in promotion criteria and status of Uedical officers might well favor a certain few Individuals and also If employed and fallowed through in a future conflict result in a deterioration of the quality of medical care rendered. Interference with carrying out of the pri- mary mission of the force concerned would result eventually in a greater dissatisfaction than existed prior to the institution of the supposedly corrective measure# It is believed particular significance should be given to the American Uedical Association Analysis of Post War Questionnaire Report, pertinent extracts from which are reproduced, see page 40 of supporting data# It la here considered in view of the 5 points stated as to* "What These Doctors Wont” — In briefs (a) Avoid- ance of Uedical overlapping; (b) Professional duty assignment; (e) Avoidance of anv needless excessive number of doctors from civilian service; (d) Professional ability rotation and (e) Military hospital construction with adequate consideration of possible civil- ian wartime requirements; that the Force Uedical Department Staffs concerned must give adequate continued attention to appropriate phases of these points in their future planning and operational activities# II.* C0NGLD5I0B5 1# A disaffection of the civilian medical professional groups for the Armed Services after their service in World War II, although partly concurrent with and resultant from the general 696 antagonistic reaction during demobilization, nevertheless, was and most be Considered as persisting, to a most significant degree and parti- cularly among civilian doctors and dentists. 2# The causes of disaffection, although most multiple and individual in degree as applicable to each former medical member of the Armed Forces, are deemed susceptible to marked lessening and cor- rection if analysed and followed through with such intent. Command realisation plus their full cooperation, and the avoidance in Medical echelons, of all possible duplication of similar errors in regard to medical personnel management as reportedly occurred in World War II and as can be humanly accomplished is demanded In preparation for and during future Rational Emergency# 3* It is believed that there has not been adequate mention made of the good and favorable accomplishments and extreme considera- tion given to many former medical officers serving in World War II upon their entry, during their service and to allow for their separa- tion, as was accomplished by the Regular Military Medical Establish- ment# In the minds of most of these so favored former officers are many memories of assistance, guidance and all possible favors as could have been given them so as to render their tasks easier, in their adaptation to the multiple, unusual, vigorous demands of mili- tary life in war* # The lack of revised promotion policies, especially for members of the inactive reserve, is deemed an important requirement for most careful analysis and action# The relative success of the old Regular Ansy promotion system, based upon length of service pro- vided accord, minimum jealousy and a security unparalleled by civilian medicine during the thirties# The "running mate" system of the Navy, insures opportunity for promotion to the MC officer in sequence with the non-medical officer component# III# BECOME EMI&TIONS 1# Policy definition to allow for maxiiana administrative and operational control of medical department activities and particu- larly medical personnel management by the Medical Department of the Armed Forces concerned* 2. Continuing Armed Forces Medical Department analyses and corrective action indicated against those conditions which caused disaffection as are reported and available in detail ty perusal of the supporting data* 3* Coordinated planning directed toward possible revision# of current provisions for rank and pay of Medical Department Officer components of the Armed Forces during Rational ftaergency# TRUE COPY EXTRACT (Letter - Colonel John A, Rogers, MC, USA, Retired dated 19 April 1948.) * The chief points or circumstances within the military structure contributing most to the apparent disaffection of medical, personnel* Perhaps the most serious complaint in this category was the assign- ment of medical officers to combat divisions for periods of several years, A serious effort was made in the European Theater to provide some rotation which was difficult to accomplish at best. The average doctor likes to practice hie profession and this is very difficult during the long training periods with combat troops. It is believed that many good men who were qualified but had not had the opportunity to obtain specialist's rating were utilized in spots not commensurate with their abilities* This undoubtedly created much dissatisfaction. On the other hand, it is appreciated that in mobilization of this magnitude that individual injustices are inevitable. Every effort should be made, however, to have the speed of mobilization of medical personnel keep pace with the actual training and tactical requirements,* TRUE COPY EXTRACT (Letter - Colonel Arthur B. Welsh, MC, USA, - dated 19 April 1948) 4 f 4 The position of The Surgeon General in the Army Service Force* and his inability to advise concerning and Influence the medical service armywide cause the greatest disaffection because of Its rami- fications . There was too much lost motion in effecting coordination* High command did not always avail Itself of medical counsel* * The Surgeon General In World War II had definite responsibilities by law but he didn't have the authority to discharge his responsibili- ties because of his position in the Army Service Forces. " There wasn’t a ’Medical Monitor* who could issue orders In the name of the commander and make the medical service function efficient! and insure the conservation of medical means. * Too much shopping around for Jobs was permitted* The medical o' fleer who came in early often got in a T/0 spot and was permanently stymied while the less capable doctor waited until higher initial r missions were offered either by the Navy, Air Forces, or Army, then came in to a better position than that occupied by his better qualified confrere of longer service who was frozen by the T/0 of his unit* ” Implementation of rotation between tactical and service units both in the zone of interior and overseas was planned but not enforced and cost heavily in morale and post-war doctor good will* L. K. Pohl, Colonel, UC TRUE COn EXTRACT - Continued - Col* A. B. Walsh, MC, OSA "Failure of rotation between overseaa and zone of Interior poaitiona wade doctors faal they ware being discriminated against* "Affiliated units created class distinction. Board certification may do this in the future if permitted to be the principal criterion of assignment* "The emergency medical officer thought there was too much control over his activities by non-professional officers* There is wisdom in medical command* "Theater army and communication some surgeon positions wars not always filled by the same individual* •There was no single power at any level that could move outstanding medical personnel without line concurrence# There should be, provided a numerical replacement Is furnished*" mm COPY EXTRACT (Letter - Colonel F. A. Blesee, MC, USA - dated 19 April 1948} * The chief points or circumstances within the military structure contributing most to the apparent disaffection of medical personnel* * a, Poor training. Many of our war-time officer* bated their jobs because they did not know what to do. As a result there wae Inefficiency, idleness and brooding, and now, in peace time, there ie antipathy. Ex- perienced military men know that battalion and regimental surgeons, clearing company commanders and the like are the ’shock troops* of the medical service. What they do, and how they do it. Influences the operation of the entire system of medical evacuation and treatment* let these men were not, as a rule, adequately trained for their work or properly indoctrinated) if they had been, they would not have felt degraded by serving with the combat troops and would have realised Its importance to $he combat affort. " b. lack of consideration for personal feelings. X believe it can be truthfully said that medical officers are more callous in deal- ing with each ether than are officers of other branches. There are numerous examples of unnecessarily stringent regulations, harsh efficiency reports, failure to make dispensary service attractive by permitting minor surgery to be done, unwillingness to rotate doctors between hospitals and dispensaries, frank discrimination because of professional jealousy, etc. Every medical officer should be made to appreciate his unselfish responsibility for the development and career management of his junior officers* • e. Stagnation in grade. This ie a fundamental defect in our pro- motion system* The British Army system, whereby an officer is given the grade authorised by his position, is worthy of serious consideration* This system prevents an accumulation of excess officers in the higher grades, makes it'possible to reduce an inefficient officer without complex administrative procedure, and rewards the capable officers by giving them rank commensurate with duties* It also emphasises the basic concept that rank is a symbol of responsibility! not a ; j»_ / _ v's /a * A * L.K. Pohl, Colonel, «C TRUE COPT EXTRACT - Continued - Col. F. A. Biases, 1C, USA compensation for time served. ” d. Patriotism does not pay*. Those doctors who stayed at home worked strenuously, bat made their fortunes, On the other hand, the longer a doctor stayed in the military service, the more he and his family sacrificed economically. Some means of equalising end minimizing the inconveniences should be devised. The most satisfactory solution that comes to mind is federalization of medicine during an emergency. This, however, would evoke loud protestations from the entire medical profession and all their prospective patients, even though several millions of people in the Armed Forces would live under federalized medicine. It is probable that this problem could beat be approached from the civilian angle, by one of the committees of the American Medical Association. • e. Among the younger generation, including doctors, thsre appears to be a need for some old fashioned patriotism and an understanding of the importance of unselfish service to the country in time of emergency. Sacrifice and hardship must be expected in time of war and It hits acme harder than others. Medical officers sometimes failed to eee how much more many others aaerifled • Those who did not have the advantage of a commission and whose families suffered financially while they endured real hardships. Many of these were professional men, merchants, etc., who served as enlisted men and lost everything because of the war. Lees was heard from these than from many who had lass reason to complain. * f• Reference could be made to complaint* heard regarding promotion, assignments, rotation, waste of their talents, prolonged periods of field duty compared to ethers, discipline, regimentation, periods of inactivity, etc., but they should serve only as a guide to our studies for possible corrective action. In my opinion, most of the criticism comes from a few disgruntled and poorly informed reserve officers who obtain more publicity than the actual majority whose Ideas differ. I am convinced that this is not the opinion or attitude of the majority of reserve officers who saw service in the last war. A post-war anta- gonise to everything military seems to be a normal reaction which gradually diminishes. Good constructive criticism should always be welcomed and carefully analysed to determine corrective action required. TRUE COPT EXTRACT (Utter, Colonel Richard T. Arnest, MC, USA - Retired dated 19 April 1948) •There were ■toy point* contributing to tho disaffection of nodical officers • Among these were pronition, inequities - tine in grade and position vacancies was fareieial, long periods of inactivity - doctors are accost owed to being bogy* wm L. K. Pohl, Colon#!, HC 700 TRIfrS COPY EXTRACT - Continued • Col. R. T. Aromat, MC, USA "Those officer* brought in during 19140 and 1941 should hare been promoted at the end of their first year. They saw in 1942 their classmates cone in as Majors and Lieutenant Colonels while they still regained 1st Lieutenants and Captains. Of course they griped and it was passed on to other aeabers of the aedieal profession. "Medical Officers by the dozens were placed in replacement pools and left there for months. I knew serer&l cases where they were there sore than a year. These officers should hare been utilized by putting then on duty at a hospital, promoting then if they were worthy and not keeping then waiting and hoping to get into a position that carried a higher grade. "After the war years in the United States the chief concern of officers seees to be a place to lire where they could here their families with then. They still eoeplained bitterly of all of tbesa ether things that ware wide spread throughout the Arny. There are others that I don't haws tint to Bastion*" MS ,C9fI MIBftCI -(Latter, Brig. General Guy »* .Denit, MC, USA datad 13 April 1948) •The chief points or circumstances within ths military structure contributing Boat to ths apparent disaffection of nodical personnel - One of the chief points was that the staff could net be impressed with the fact that it was an is essential that the Medical Department hare more autonomy in running and administering its own affairs* It is believed essential that there be a branch allotment on a per* eentage basis for Medical Department personnel, officers and enlisted men and women; that there be a percentage of grades from general officers on down allotted to the Medical Department; that Medical Department T/0 units be prepared in advance and approved by the Department for all eventualities and that these Medical Department unite be placed under the command of the Sr* Medical Officar on each staff; that the Medical Department be excepted from personnel policies and procedures which establish balk allotments for camps, stations, tactical organisations and theatres of operations.* L. K. Pohl, Colon*!, HC 701 TRUK COPY EXTRACT (Utter, Colonel Robert P. William, MC, USA dated 16 April 1948) •The chief points or circumstances within the Military etmcture contributing mat to the apparent disaffection of Medical personnel* "This subject nay be discussed interminably, The universal draft, with assignment of every individual to Military or civil pests in accordance with the requirements, would cure nest of these Ills. Also It Is believed that this draft would increase the feel- ing that everyone la serving, decrease the present selfish attitude. TRUE CQFT EXTRACT (Utter, Major General M. C. Stayer, MC, USA-Retired dated 19 April 19-48) "The chief points or elrcuastaneea within the Military structure contributing mat to the apparent disaffection ef Medical personnel. ”1* They were not used for professional work and wars used as Members of Boards of Inquiry, Investigation Beards and investigating officers ether than which eeneamad nedlcal or surgical problem* "2. Members of General and Special Courts Martial, which was considered wasting their and the government*a time. *3* Filling administrative positions as executive officers for evacuation hospitals, convalescent hospitals, station hospitals, registrars, and adjutants far hospitals ef the general hospital level* *4* Lade of promotion. •5* Coonanding officers who wore poorly selected and forgot they were still doctors*11 L. K* Pohl, Colonel, MC TRUK COPY EXTRACT (Letter, Brig. Gen. H. C. McDonald, KC, USA, Retired dated 15 April 194S) *The chief points or circumstances within the military structure contributing nost to tha apparent disaffection of nodical personnel. (1) Conaaenti Disaffection of nodical personnel, particularly medical officers, results front a - Kalassignoentsi Too often nodical officers are not assigned according to professional ability - too nueh administrative work is the complaint of nany physicians; b • Too such purely military training, particularly far nodical specialists; « • Lade of, or inequalities in, promotions; d - Idleness enforced by carpalgn conditional s • Delay in demobilisation.* 1. K* Pohl, Colon®!, 1C 703 TUBS COPI EXTRACT (Letter, Dr. Russel 7. Lee - (formerly Air Forco) dated 18 April 1948.) •The chief points or circumstances within the military structure contributing most to the apparent disaffection of medical personnel* •The dissatisfaction is not only apparent but real and often well founded. The principal gripes are lade of professional opportunity, lade of any real duty, subordination to high ranking, but professionally ignorant commanding officers, the inequities of rank (rank should be abolished in the medical service, all should be 'doctor1, pay should vary with position held not with rank), resentment against malassign- ment, sense of futility when confronted with organisational rigidity.• TRUE COPY EXTRACT (Utter, Dr. A. R. Shands -(formerly Air Force) dated 20 April 1948) •The chief circumstance which lead to disaffection of medical personnel was the lack of proper asslgnement and the failure to obtain promotions when the personnel thought they were due. I personally believe that all rack should be abolished in the military medical services. A doctor's prestige on a pest even though he might be an excellent physician was not what it should be if he did not have comparative rank to non-medical personnel. This had a tendency to lead to lade of respect on the piurt of the layman for the doctor *• L. K, Pohl, Colonel, MC TWTR COFT EXTRACT (Captain Lewis T. Dergui, (KC) IBS - no data) tiUsf wlnte ar slrfim»«tea. ’W*3*. <*h«hi*,(1) The indiscriminate end e oessiveXy promotion of various Reserve MC*s* thereby oUespeoing rank and worldUig a great hards dp on Regular personnel is to be depolorad* At the same Uae a lessening of tbs value and regard for rank among the Reserve recipients inevitably occurs* they being in the liervloe for a brief period only* naturally look askance at such tactics and tend to regard it as something toe easily acquired* At the sans tiao the unfortunate wto has coma up the different rungs of promotion the "hard way"* is left far behind and In the eyes of many temporary officers* by the very Banner of their own rapid advunoenwnt* is definitely Inferior to tinea* professionally and otherwise* This* in turn* creates lais-undarv landings, envy* aucpicion* favoritism and general Impaired efficiency* with a corresponding loos sf ros*j>ect and lessened regard for the .tegular lid* as veil as the latter*s resentment and antagonism to the deserve officer* who be can but royard ss unduly ffevored beynd tads tarots«r Regulars* likewise definitely impairing general nodical efficiency,. Personally* X consider this natter to be of great and vital importance in rs morale* radical cooperation - testsrork - and efficient task performance* ***•♦ tfk'.&kQ u z. ic TRUE COPY EXTRACT (Letter, Colonel C. J, Baker, KC, Air Force dated 22 April 191?) **** *l# it is my belief that the following are some of tho factors contributing to the disaffection of medical personnel} "(1) Many medical officers avoided command responsibilities, and many refused or failed to perform proper command functions when by virtue of seniority they were placed in command* This resulted in many command prerogatives being taken away from the medical department* "(2) Medical personnel were commanded by non-professional in- dividuals who demonstrated their Inferiority frequently by rendering decisions affecting professional matters about which they were en- tirely ignorant* Specialists (veil-qualified) were frequently mal-assigned, and specialties were discriminated against, i*e* Hospital Staffs were set up In Tables of Organization that would not permit promotion, i.e* Opthalmologlsts, Oto-rhinolaryngologists, Urologists, Derma- tologists, Obstetricians, Orthopaedists, Cardiologists, Gasto-entero- logists, etc* were classed as subordinates to general surgeons and internists and were never promoted except in instances where they were mal-assigned* ”U) Many medical officers, volunteers, were made promises prior to their volunteering that could not be kept and should never have been made* Many officers who were unfit for field duty were never considered for anything else and vice-versa* General hospitals vers too large to be well administered by one commander• It would be better where wore than one hospital is to be established to have a general hospital limited to 1000 beds and establish a hospital center with one commander in command of as many 1000 bed hospitals as would be required at that center; each hospital to have its own staff, etc* Many officers and enlisted personnel became submerged or lost in the large general hospitals. "(5) Enlisted personnel (Technicians and Medical Specialists) were frequently transferred from Medical Department to Line Branches without apparent reason, disrupting a smooth running service. L. K. Pohl, Colonel, MC 1ME..COTP - Continued - Colon*! C. J. Baker, MC, Air Fore* • (6) During the past war, on* of the greatest eaus*s for dis- affection was the constant wrangling between th* Surgeon General and the Air Surgeon* Being on duty with the Air Tor cm since 1920, I an biased in favor of that Branch; however, the Air Surgeon was not permitted to have under his control a general hospital. The various station hospitals of the Air Force were as a whole wall staffed) by that I seen staffs were carefully selected and wall balanced. Many of than received certificates of approval froa the American College of Surgeons, nevertheless, an order was published prohibiting major surgery, and such procedures as the reducing of a fractured long bone in a station hospital. "(7) Very few hospitals were permitted the Air Force overseas. What few that were placed on detached service were not wanned by personnel having any Air Force indoctrination. This operated to produce disaffection in two ways, i.e. it placed personnel that did not want duty with the Air Force on that duty, and it prevented hospital staffs organised end trained at Air Force stations from proceeding overseas with Air Force units. They had to go oversees with Ground Forces or be broken up and go as tactical personnel with Air Force units or go as individual Air Force medical replace* wants. *(£) Many unpleasant incidents were experienced by medical officers, well qualified professionally and otherwise, at the bands of much younger inexperienced, uneducated and ignorant Line Officers of less service, but with higher rank, merely because of the differ- ences in rank and command prerogative* improperly used. \A.&S) L# K. Pohl, Colonel, MC TRUE COPY EXTRACT (Letter, Colonel H. E. Stone, HC (Res,) Air Force dated 22 April 1948) ***** "The screening of Physicians and Dentists should be ■ore carefully conducted with special attention being given to physical disabilities which disqualified sosm froa active ear* vice. Many were judged physically unfit for active duty due to such ailments as hay fever, gastric ulcers, low bade pain, trick knees, etc. and stayed hone only to build large renanera- tire practices at the expense of those who answered the call of their country* Personally see no reason why nany of these young ■en could not have been inducted on United active duty status for duty in the ZI and thereby release those physically able for overseas duty. Wish to impress on the readers that this statement is net to be nisoonstrusd as ’sour grapes* on the part of the undersigned since it in no way applicable to sy particular circunstanees. Only Mention it because this situa- tion has been a bone of contention to sany doctors discharged froa the service and has led to an unhealthy relationship in the profession in general which I feel reflects directly bade to the Service*" ***** •>: a-: >caP L. K. Pohl, Colonel, MC 717 (*•««. «*»UU ». o. w, TO dtt«4 29 April 1949) “(X.) TEX OHXXT FOISTS OS OIBOUMSfAHOSS WXSHXI TBS MEDICAL srvxtnm oosthbotiso most so ths appahsst sxsaftsotioi — Za the nit mW of instances of di e-satisfnation among nodical personnel, the cause mi usually a personal problem. Zither lack of or inadequate housing for tho individual1« family create* serious problem on amorous occasions. Yrtfuot transfers from one activity to another me the cause of much discontent. Vet infrequently nodical personnel vers nisaesicced, and their cervices could hare "been employed to a hotter advantage in the specialty for which they had been trained. long periods of sea duty were objected to by easy of our personnel. The lack of knowledge of medical department administrative procedures was quite confusing to our reserve medical officers and their distaste for this type of duty was most apparent. The delay in separation of medical personnel resulted in several unpleasant instances and brought about an unwarranted disrespect for those responsible for the policies of the Fevy Department.• sscaerases L. K. Pohl, Colonel, KO 718 TRUB COT (Extract from Col iiarry C Armstrong, :■ C, 16 April i;Ml) t the Medical Department be expected froa persoanel policies and procedures wnleh establish bulk allotments for caia-i*, stations, tactical organisation* and thratrep of operations.****** POHLV Uoloaol* NO 728 TRUE copy EXTRACT (Letter, Colonel Earl Maxwell, MC, Air Force dated 19 April 1948) **♦* "2. In general, the main complaint of the nodical officers seen overseas was that they had been in various training units and re- placement pools for long periods of time without having any duties. On checking their records it was often found that the individual doctor had actually been in the service for a year or more without having seen a patient. It ie believed that this condition was much worse in the Army than in the Navy, In my opinion, the ordinary medi- cal officer who is going to practice medicine or surgery in the military service needs very little training prior to actually going to a func- tioning unit. The Navy would send units overseas with the Commanding Officer and some of his administrative officers and a skeleton crow of enlisted men and the remaining medical officers, nurses and enlisted men would arrive after construction had taken place and the hospital was ready to operate. This seemed a definite saving in medical per- sonnel. **** ***** "9. In the South Pacific one of the main causes of dissatis- faction among the medical officers was the fact that some haul to be as- signed to field units and they did not have an opportunity to practice medicine in a hospital. This was alleviated somewhat by giving post- graduate training courses in which the officers in tactical units would be sent to a hospital for training in their chosen subject for a period of 30 to 60 days and that? the job was covered in the tactical unit by an officer from the hospital when it was necessary. This contributed much to the raising of the morale of officers assigned to tactical units******* \ L. K, Pohl, Colonel. MC 729 TRUE COPT EXTRACT (Letter, Captain F, C. Oreaves («() USH dated 17 April 1948) ***** "I would like to emphasise that such of the criticisn leveled against the medical services in World War II is the result of the wrong type of morale among medical department personnel* It did not affect medioal personnel alone but was common throughout all branches of all services and all levels of civilian life. It was characterised by the wail that went up everhwhere American forces were on duty after 7-J Day, 'I want to go home1* There always seemed to me to be too much catering to the idea that the war effort must be made as painless as possible and not enough to building a hard core of good old fashioned military discipline of the type that forces a man to carry on when the pressure is off in the same manner as when he is under fire* A friend of nine once told me that ha had spent six months training to spend six minutes blasting the enemy in a night battle in the Pacific* The war was of necessity like that* It takes discipline to win battles and wars and that discipline must be built up beforehand• It can just as well be of a nature that will continue after the shooting stops* If that sort of discipline and morale can be built up in the personnel of the Kedical Services it will go a long way toward eliminating the disaffection which eo many former members feel toward the services** L, K • Pohl \C olonel, ISC TRUE COPY EXTRACT (Letter, Rear Admiral C* L* Andrus, (MC) USK dated 27 April 1948) ***** "(1) The Chief Points or circumstances within the military organisetione which caused apparent disaffection among the medical per* normal, especially officers, were disillusionment as to practises made prior to being ordered to active duty, frequent and sudden changes in duty without apparent reason from the individual standpoint, delayed action when ordered to overseas outfits and periods of duty when their services could not be fully utilized. A lack of understanding en the part of the individual that the situations causing his disaffection were perhaps inherently related to operational changes in prosecuting the war and therefore unavoidable when considered from the over-all viewpoint." ***** . L. K, Pohl Scolonel, MC 730 2KB,.Wfl SJSSASS (Letter from Dr, Wn. C. Menninger, fopeka, Kansas, dated 33 April 1948) *****”(1) The chief points or eireuaetaneee within ths military structure contributing most to ths apparent disaffection of nodical personnel. — first, Z think this was because nodical officers were wary often responsible to line officers and not to other nodical officers. Secondly, 1 think so many tines at least in the awy the nodical officers had nothin* to In with the nodical departnent and the nodical departnent in torn had no authority ewer then, thirdly, I think there isa*t any question that nany nodical officers were badly wasted as to their talents and their efforts in the face of a terrific civilian need, fourth, Z think nodical officers were very often used and given training which was entirely unnecessary. Zt never nade sense to have nodical officers run through the infiltration course and obstacle courses.a **eee rare OOP! «iyh¥*l (Ltr Oapt «.P. Kunkel, MO, USI, dtd 31 Apr 48) **•«*« x*. aZt appears that, in general, sons of the factors which are responsible for the dissatisfaction of nodical officers in the levy are: state, of nind of people following a world war; laek of housing; leek of proper sehoollng*fUr children; specialty boards; and last, but not least, reaaneration in the service as compared to civilian positions.seeeeeee riliVlC* POHL t, *. CtolwWl, MO Tam nnpT mmuCT (i\T Cpt. 1 .Ju B.rla, (MO) OS,, DM IT Dm 47) ******** L. »One *f tii* greatest improvement* that would moon* from the adoption of the above recommends11 ona would he a rtlainf of th* ■oral* of officers assigned to Jtf$hlbieus Tore**, •■peelally In peace tin*. Maria* Corps duty has n*r*r been looked upon as ehols* duty, primarily of cours* because of the littlo chance for clinical practice that if offers. If It was generally understood throughout th* Medical Corps that duty with th* Marin* Corps offsrt th* greatest opportunity for life-saving In tie* of war of any branch of th* division which would assure adequate professional training for thooo in the field med- ical service, I an sure that w* would hare wore enthusiastic regard fof this type of duty.••••*****e L.K. 1*0 HL, MO 731 TRUE COPY EXTRACT (Letter, Captain 0. B. Korriacn, Jr*, MC, OSH dated 23 April 1948) ******** «l. The chief points or circumstance a within the military structure contributing meet to the apparent disaffection of medical personnel* After discussing this matter freely with a great number of nodical officers, it is believed that the greatest cause for disaffection of medical personnel is lack of good professional work in the armed services. Admittedly, pay, retirement benefits and other such- considerations, are important, but the desire to practice and become proficient in their profession by far outweighc any and oil other considerations* There is e feeling that only e chosen few are aliened to work in good hospitals, while many are repeatedly assigned billets where little or no professional work is available* Mach careful thought should be given to this matter eo that many of the non-professional billets could be eliminated and in those which can not be eliminated, the medical personnel should be rotated as rapidly as possible* Thus recruiting duty, snail dispensary and isolated station billets could be filled by e rotation of hospital personnel at short intervals* ***** L* K* Pohl^vColonD1, E3 THUS COPT SXTRMff (Ltr Rear Adra ?.t. OonJtlln («C) USW, dtd 2? Apr 48) ******* i,# •Orlpe* of ami/ H««erre Medical Officer* about aot being able to follow their speciality during the war, | believe wore not justified, as they wore la their profession, while other professional »ea were not. Also many of no regular Medical Officers were taken out of our specialty and put la the admlalatrative branch. 1 believe a general pool for the Reserve Medical Officers vould be better than the Medical divisions now being activated. Olromatanoee contributing such to the apparent dis- affection were: l) Inadequate indoctrination. 2) Varied periods of in- activity unavoidable in war, but not understood by the Individual. 3) leaping up expensive Insurance policies and home expenses on a much small- er income. 4) 5ot being assigned to their speci^t/^******* MO 732 TRUE COPT hascom L* Wilson, Colonel, IX, Air forces, 21 April 1948) *****Refcrence par 3(1) "The chief points or circumstances within the military structure contributing most to the apparent disaffection of medical persoanel," it appeared that the ch-ef points or cire instances contributing to the apparent disaffection of medical personnel, (officer personnel) were as follows* (a) Mai* assignment, (b) haphazard methods and inequalities in the promotion system, (c) lack of a planned, definite or fairly flexible system for overseas assignment of ***** medical personnel, and (d) the system of release after cessation of hostilities* ***** In regard to the promotion system for Liedical and Dental Officers as many or probably more complaints were heard onthis subjec t than any other* Among the young officers, those Just out of Medical School, or those with only a few years of experience and without any specialty, the complaints appeared to be un- founded os most of these received Captaincies at least, during their service, which seemed sufficient* However, many of these young Medical Officers found their way into xieadquarters Staff Sections and ultimately, received promotions far beyond that which would normally be expected, while numerous Officers, particularly In the Station and General Hospitals, received very few promotions due to lack of available vacancies* It was quite common to see Medical Officers of outstanding ability and well known in their ccMiirunitios, go tliru their whole service as Captains, while maybe on their own station, they would sec young Air Force Officers, of comparatively' few year service, serving In toe grades of Lt Colonel, and even Colonels* No disparagement is meant to these young Air Fores Officers, however* It is true that later on, after cessation of hostilities, Medical Officers as well as all others, received a one grade promotion on their release from the service if they liad been in-grade for a sufficient ength of time* However* this did not make up for the apparent lack of interest on too part of higher authority and the lack of plans for some sort of equable promotion system for Medical Officers and Dental officers commensurate with their capabilities, experience and standing in civilian life* The promotion of skilled specialists in the Medical and Dental Corps should b© made to grades commensurate with their value to the service regardless of vacancies* Age and experience should be considered*"**** '4. K. PflM Colonel, SiCv 733 THUS canarra*CT (tetter. Captain Bonrtt 0. Hlobtorn (1C). U. 3. Mqr 1 1 " ' . dated fa. April 191*3) aaaaa *(l) A Cm elnnaaitano«a and fboterw white aara noted to contribute to tea apparent diaaffaeticn of aadloal pwweawl* BaaerVU Officers in World »ar ZZf are as follows* "(I) Too frequent changes of dut/* fur axwapla, one Ifedlcal do* serfs Officer Was shifted too ilaaa within a year In the continental United States* "(2) look of utilisation of specialised training* •(3) Look of smoothing to do- doctors in replacoaant pools wars frequently retained for aontha with no opportunity of doing asdics! work vlatiMVOP* *(U) Frequently of floors received taaadlsta datachasot orders only to arrive at thslr saw station and learn that tbs activity would not bo in oowaission for sowars! months, whereas they had boon badly nssdsd in thslr previous asaigsuamt* •(5) Shortage of mediae! officers at ssrtsln activities and an ao*> eoss at nearby actiritiosj l*e., cos hospital was known to hare one Pay* ehiatriat to ear* for over bOO cases while another hospital in the area had four to five Psychiatrists with wary tm patients to oars for* This of course, was the fault of the coomnd whs failed to call the deficiency to the attention of the Detail Office* 9 (6) Irregularities of rank* "(7) ittffioultlaa encountered la repcarting to a now station of duty* Zt was not vseam during the nor to encounter a officer who had bam looking for the ship he was supposed to report to for as long as four aaon^3d«CMHHI MtMl>Aa fbr is X mi sblo to «soortaia# and froo panoul obwmtia>| —diool aorrioso fumlohod Airing World lor II woro cutstanding* Tho bsoXth stand* srde of troops and the aurviwar rats oaoag tho wounded wore unsqualled la tho history of warfOro* Z bsliowo that aoot of tho crltloion dlrootod tcwsrd tho nodical sorvioo ononotad ttm disgruntled Hooorvo Offloscw* This will occur la futeo eoergeaolee, boooaso It is not possible to ploaoo orsiyono la tias of war* Hcworsr, efforts should bo node to Olialaoto doftoionoloo la poroomoBL outgoosi oad luslganont* Th o ehonld apply to tho Offioooo oo noli oo to tho aseerto Offiaws," oosoo w - 734 COrY (Letter, T. F. Cooper, OB* dated 19 April 194 «) ***** "Much criticise has boon leveled at certain aspects of tho policies relating to mobilisation, utilisation and demobilisation of medical resources incident to the last ear* Some of that criticism was bom of individual self-interest and a disregard for basic mili- tary principles. Other mas based on misinformation or misunderstand- ing, Some was and is most certainly justifiable***** ***** “points that have given rise to disaffection among medical personnel are many. War is unpopular and on termination of hmotlll- ties there ie s tendency to separate one's self quickly and complete- ly from any service connection. Differential between service pay and pecuniary rewards In civil practice is too great. Sea duty and duty at small stations, recruiting duty, etc., sre not appealing to the great majority of medical men. Ideas of peacetime service are often based on experience during war service wherein long periods of separation from family and friends, often In rerote areas with only trivial medical duties, obtained. Increase in educational require- ments and coats.of obtaining same are deterrents to service interest. Service interna, If given a regular commission on completion of In- ternship, should be given full credit for longevity and pay purposes for the time spent as an intern,11 *♦**♦ ' I,. T. PohlVColonel, VC f.,: ■ ..XThaCT ddPT (Ltr Sol. Robert P. Vllllaras, MC3, Surgeon, Id tor 48) **♦•• L. “The rjhief or within the military • tructure c ntrliniting ao«t >f the disaffection of medical -on.«l« This sa ject way he discuss©I The universal draft, vit:i asslgn- ■su- ;: t of every iadivtdxtal to ill itarj- or civil posts In accordance with the re',aire...*-atr» vould cure ito--t of th'sn ills* Also it is ’believed that t is dr ft v.-p-ili in areas*- V fr,.^1 ■£ t t *•■*■■■ vyon* is ssrriag, decrease the *r*&*nt eelfish atUtude. y/] Colon®!, MO 735 TRUK COPT (Extract Ltr Quinton M* Sanger,BlilED,USN, 7 April 1948) *HHH**The following preliminary material on subject ia submitted for information# This material is based on criticisms of the Nodical Department voiced by medical officers attached to the Navy during the War, and by Reserve Officers who directed their complaints to Congress# Official comment within BuMed on the various critic Ians made varied considerably all the way from outright disapproval to limited agreement# The complaint was made that after the medical officer’s trained in clinical duties, and la at the height of his abilities as a Captain, he ia diverted to adninistrative duties# In April 1946, 71 out of 112 members of the kedical Corps certified by various specialty boards were in administrative positions. Doctors serving in the wartime Navy complained in letters to Congress that they were unable to practice satisfactorily the nrofession of medicine in the Naval Service* * * a Many billets were deemed undesirable by the doctors because of the professional sterility of nai£r of the wartime (.and peacetime) duties* This opinion was substantiated by the letters to Congress and by a oreliainaxy analysis of the billets filled* It was held that to attract doctors to the they must be assured reasonably absorbing professional responsibilities and duties, professional post graduate training, rotation on necessarily dull duties, and an opportunity to demonstrate and develop individual professional interests* It was suggested that professional promotion procedures were inadequate. It was proposed that there be established a maximum Cumber for each grade in the medical Corps, and that such promotions should bo independent of line percentages. CNO felt this proposal would nullify the beneficial effects of the "Line Staff Equalisation Act of 1926* and wouxd precipitate many of the same inequalities this law was enacted tc correct* Uary reserve medical officers were disgruntled about their assignments or duties during the war* It was pro osed the vagaries of war be explained to the reserves - for example, why casualties were overestimated. Why medical officer distribution was poor in certain areas, etc# CNO asserted that doctors were idle 'at coastal stations or Pacific bases because of temporary postponement of or changes in contemplated operations# ’Moreover, the building of medical facilities and medical personnel in the Pacific during the last few months of the war (which were not used) were (six) necessary in -> reparation for the expected costly assaults on and invasion of the home island#* Cfl6 believed the average intelligent reserve officer already had an understanding of these vagaries of war#"**** L' h POHL \ Colonel, SIT 736 3KUE CGFY EXTRACTS fro® Report to Comal tee on National Smergency Medical Service dated JUKF: 4, 1947, in an Analysis of the Replies to the Post War Questionnaire as prepared hy the American Medical Association, sent and received by 49,457 former medical officers of the Armed Services. ***** "Possibly ths Most important summary statement Is to repeat that 53 per cent, more than 26,000 of the former medical officers contacted re- plied to the lengthy questionnaire. This amazing response cane from 20,001 army doctors, 5>727 former nary doctors and 290 replies fro* United States Public Health Service or Veterans Administration doctors or from combina- tions of the four during World War II." ***** ***** "Comparisons between army and navy doctors revealed that the average army doctor served forty-two months as against thirty-six months fen* the average navy doctor. A smaller percentage of navy doctors, 11, were general practloners before entering military service than army doctors, X7 ***** ***** "The replying navy doctors slightly outranked the replying army doctors, and slightly more of then spent thsir entire or longest period of service in North America. A larger percentage C60) Army than Navy spent more time in hospitals than in dispensaries and other types of service. Navy doctors were more idle than army doctors only because they were busy on 71 per cent of their time, gaged by civilian standard!, of which 51 per cent was in the performance of professional duties and 20 per cent in the performance of nonprofessional duties. These percentages for army doctors were 50 and 30 respectively. Also during noncombat periods navy doctors were more idle than army doctors, with 40 per cent professional plus 16 per cent nonprofessional, whereas army doctors were busy 62 per cent of their tine, 39 per cent professional plus 23 per cent nonprofess- ional, They were asked to estimate the number of doctors actually need- ed In their units; Army replies averaged 72 per cent and Navy replies 70 per cent, reflecting consideration of "peak load" requirements. The general conclusion of the survey is that considerably more doctors were inducted into the armed services than were needed in the opinion of the doctors themselves, although some question may be raised concerning the competence of humble doctors in the ranks to measure military necessity as to both time and nonprofessional duties. Replies from so many doctors give weight to these criticisms - the wastage of medical skills." ***** ***** "Both army and navy doctors agreed that "professional on-the- job" training was the most useful feature of their training, and that an ideal training program should stress sore medical training, both general and in the specialised fields of military medicine. Neither army nor navy doctors were enthusiastic about their assignments, although navy doctors were slightly better satisfied. Forty-eight per cent of the 737 TRUE CQFI EXTRACTS froa Report to Coanittoo on Rational Emergency Medical Sorrier da tod Juno A, 19A7, in on analysis of tho Roplioo to tho Foot lar Questionnaire a* prepared by tho American Modioal Association, ooat mad received by A9, A57 former, medical off!core of tho AraedSorvleoe, continued* nary doctor* roportod that they wort rota tod in assignment, and only 22 per cent 4my doctors.* —ooo ***** ”A question relating to boo medical pereonsol eould hero boon need aero affectively if it van wasted In hi* volt brought replies which strataod better aeoignaente, reduction in tho noefeor of doctors and fooer Donaedical duties, tho latter being stressed acre by any then by nary doctors. Suggestions regarding assignaont of asdlcal off!ears in tho event of another national aaergoney revealed that acre consideration of age end qualifications, assignaont according to actual need, rotation of duties, and rank and proaction according to professional ability wore tbs aoet popular reaadioo. In rating sfforta to utilise their professional Skills, the replies indicate that the doctors thought these efforts only aoder- ataly suoeossfol, oven lass tor Aray than for Mary, tho replies indicated reasonable success in getting medical publications to tho doctors, although, of course, nary doctors had lass trouble with transportation and received the Journals acre regularly. Any doctors reported aore teaching clinic* and acre aadieal meetings in their theaters than navy doctors. Replies froa both indicated that the asst popular suggestions for helping tho doctor in service keep up professionally wore assignments better fitted to professional ekille, prompt receipt of latest literature end hospital assignments.”***** ***** *What These Rosters Went, The Cooaittos has aekod as to state that Z think the 26,000 replying foraor asdloal officers want as well as what the typical civilian praotiener wants in the event of another national emergency. These interpretations are ay own but XAall studiously refrain flroa expressing personal opinions about the issues involved end only tsy to etato clearly what the doctors have been trying to toll us by Beams of the## two surveys, that they want nay not be timely, vise, expedient or feasible•* ***** ***** "What tho doctor® vast is neither neon bor potty nor vindictive nor backward looking, They clearly recognise that on* la boll and war la waste. What they want amt surely be a Told, courageous, forward-looking pr>gran and net quo which looks backward torird the last war* They want a public spirited organisation, representing the profession, established and inplsweated in the hope that it son help to prowwt the ai stakes of Vorld *ar II. They want the United supply of nodical skills earwfully and wisely distributed as to attain the highest standards of Bodies! oars for civilians and sllitary personnel la the crest of another national energwnsy. They doubt that SO par ooat of tho nation's physieisne oould provide effective nodloel card for the oiviUan population in tho event of an stood* war although that properties was (ntraouloualy) evidently sufficient during World War XI. In the eeeead place, tho ferner nodical officer wants the highest officials in Waahingtan to ask the teeretary of War and Searatary of levy to rwvisv their organisational tables and pro- 738 TRUE COPT EXTRACTS fro* Report to Comities cm national Emergency Medical Service dated June 4» 1947, in an analysis of the Replies to the Poet War Questionnaire ae prepared by the American Medical Association, sent and received by 49*457 former medical officers of the Armed Services* continued* eedurae in order to prevent a recurrence of (1) the medical overstaffing of unite, (2) masting of the tine of doctors of medicine in the performance of nonprofeahional duties which could here been performed effectively by nonaedical personnel, (3) removal of a needlessly excessive number of doctors of medicine from civilian hospitals and practices, (4) the rather widespread failure to make assignment and provide for rotation of doetere of medicine on the basic of their professional drills and qualifications, experience and age, (5} a military hospital construction policy which will give dose attention to possible civilian wartime requirements.* ***** RES0I L.K. Pohl, Colonel, MO 739 mm EXTRACT COPT (Ltr Dr. H. S. HOFFMAN. Dtd 13 May 48) ******** I». "In general, officer dissatlsf action was 'biased so at frequently on the following items;!..Inequities in recruitment rank of reserves. 2, Ap- parent inequities in promotions as between regulars and reserves.Apparent inequities in recognition of outstanding services as between regulars and re- serves. 4. Failure of regulars to appreciate training, experience background and ifedlity of reserve officers. £• Apparent unnecessary changes of duty. 6. Hurry-up to s&|nd-by orders. Many reserve officers received orders to report immediately to stations and on arrival found that there was nothing for them to do for weeks. & Assignment to stations distant from homes on return from duty outside continental limits. §, Incompetence of individual senior officers £. Failure of Medical Department to fulfill recruitment promises as to assign- ments. iQ, Failure to receive duty and stations for which preference was re- peatedly expressed in fitness reports. 11.. Difference in official action as between Regular and Reserve in the ratter of separation for disability. 12. Apparent clanishness on the part of the Regular officers and their families toward the families of Reserve officers. 13. Impatience of Reserve officers with the necessity of doing administrative and paper work. Keeping in mind that reference is made to the Xavy Medical Corps only, it was noted that there was little disaffection as between officers and enlisted personnel; that officers were more articulate concerning die- satisfactions than enlisted personnel; that officer "griping" resulted in the main from two factors; (1) Inadequacies of individual superior officers (medical) - net Regular Officer relationships - to be discussed later. Im- proved officer and enlisted personnel relationships was a source of consider- able satisfaction. The improvement as over conditions noted in Vorld War 1 was quite marked. General Comments - Thoughtful review of my entire experience (within the continental limits and in the Pacific Theater) led to the formulation of the following definitive ideas; 1. The medical operations and accosqjllshments of our Armed Forces in World War II is one of the great stories of the war - as yet untold. With huge numbers of troops subjected to difficult weather conditions, unusually perplexing diseases and the devastating effects of high explosives plus exi- tensive burns, the percentage of recoveries was incredibly high. 2. Deficiencies and failures of individual officers - particularly senior off leers of the regular corps - were minimal. There were due In the main to the practice of recalling to active duty previously retired officers at grades substantially higher than their retired ranks. This was adequately offset ty the work of the rest of the corps- pitifully small shortly before the beginning of hostilities. It takes a little thinking to recall examples of poor officers. On the other hand, examples of fine, o&pable officers come to mind very readily. Z. A creat easy - If not the Majority - of the complaints and criticises ooae fro® Junior officers who were consequently not In a position to understand the necessities for certain operations or methods of procedure. Therefore, dissatisfactions from this group vast he heavily discounted. 740 THUS COPT EXTRACT (Ltr Did.. H. S. HOmuS. DTD 13 May 48. COKTIIfUSLOJ Reserve and Regular Officer relationships: There Is much to be sold on both sides. In fact, already too such has been said without constructive suggestions as to possible corrective measures. In the light of the superlative over all accomplishments of the Medical Departments of the Armed forces it is difficult to be too critical. On the other hand, the violence of the negative reaction on the part of the Reserve Officers to the suggestion* that they re- main in the Services after the war. cannot be without some basis in fact. Act- ually. I believe that the chief source of disaffectloas in the medical corps stem directly or indirectly from the inadequacies of this relationship. It would be a rather sterile procedure to discuss at length such items as in- equities in recruiting rank, promotions, recognition of outstanding services, etc., inasmuch as the records of the aepartoent are available for the determin- ation of the actual facts. Other items In the bill of complaints also lend themselves to evaluation by study and analysis of the existing records. Further elaboration, therefore, would serve no useful purposes* /y cm, hc 741 THUS EXTRACT COFT 0? MEDICAL SUPPORT OF THE USAAF IS TUS SOKOFAAH THEATER OF OFKS- ATICRS, HISTORICAL SECTION - AFTAS. ******** "Medical Corps Officers. Passing from morale problems of &irerev and ground force personnel to those involving the nodical personnel* it appears that eoacom on the part of medical of fie- re with duties not customarily within the scope ef their previous training or experience, constant routine, and dissatis- faction with rank produced morale considerations of no small moment to medical administrative authorities, la the first piece, the rank held by any given med- ical officer or group of officers was, in general, below that of line officers whose assigned tasks required no more training or experience and involved no higher degree of responsibility than that required of the former in the exscut ion of their duties. The discrimination levered the morale of medical officers end placed an obstacle In the path of their efficiency. Air Force medical person el see ever changing group# of flying per- sonnel constantly coming and going and rising in rank with a rapid speed. The medical people, who are under-ranked to begin with, soon have removed that in- centive to combined effort which aspiration to higher rank avqoplies. This fact, coupled with the absence of definitive medical activity, continued long absence from home, and the placing of too much stock in unfounded optimistic rumors, ell are responsible for the lowered morale and efficiency. Medical Department Enlisted Men. Just as in the ease of medical officer personnel, the morale of the medical enlisted men was adversely affected by dis- criminations in the matter of rank. It was recognised in February 1943 that the proviei#ns made in the original Table of Organisation, Allotment and Grades for Medical Enlisted Ken, were "grossly inadequate* for the men filling the various responsible positions assigned to them. Mere than a year later the greatest dis- pensary problem in the First Bombardment Division was "that of recognising the good work by some of the enlisted personnel la the Station Complement Squadron.* Despite these admonitions the ratings and ranks of medical enlisted personnel were not altered and remained unsatisfactory after the changes in the T/o in Sept 1944, which allotted the majority of the medical enlisted personnel to the bomber group headquarters and left only five each to the squadrons. Appar- ently no official action was taken to ameliorate or rectify the situation. '£• K, POHL. CbIon«l. MC 7A2 Extract of Statements made by Brig Gen Robert C* McDonald, MCf USA (Retired) , 21 April 19-48, before the Subcommittee on the Employment of Military Medical Resources* *HHHH»The next subject, "The chief points or circumstances within the military structure contributing most to the apparent disaffection of medical personnel*" I saw a considerable lot of dissatisfaction among the medical officers, particularly the reserve, and they were due first to malassignments* "Too often medical officers are not assigned according to professional ability - too much achdnistrative work is the complaint of many physicians*" On the other hand, occasional errors were made in the assigning of men who said they had the qualifications and who actually didn’t have them* All these complaints were not legitimate* Men who are qualified to do high-grade profes- sional work should be put on that* I recall during the first world war, just before the Battle of Saint* tfihlel, 1 was on duty at the medical school over there in France, and the Chief Surgeon sent down and wanted to send everybody up to the front who thought he could take charge of an operating team, or be first assistant* I had about 60 or 70 medical officers, a great many of whoa thought they were qualified until the time came* I announced to them that we would send up to the front all those who w were capable and qualified to do the work and I didn* t'want anybody to volunteer for that work and then go up there and fall down on it, because it certainly would be shoinr up, and I think I got three out of the whole bunch* On© of them would take a team, only one, and the others were assistants* So we do have to check up on the qualifications of medical officers te determine exactly what they shall do in order that they may be properly assigned* The second reason is* "Too much purely military training, particularly for medical specialists*" Take a brain surgeon, or any sort of medical specialist who is not going to do anything except that work* he doesn't want to do anything else* He can't do anything else,and to give him a lot of basic military training I think is un* ' necessary* That shou/d be reduced to a minumm* There probably should be some, but not enough to ruin his morale or take him away from his work very long# "o-Aack of, or inequalities in, promotions I think I heard more kicking about that than any other one thing* Everybody wanted promotions, of course, it's only human nature that they should* le had great difficulty in getting lieutenants promoted up to the grade of captain* In my service command we had hundreds of lieutenants who had * been in the service a considerable time, maybe more than what was req ized, say one year for promotion—oreix months at on© time it was, but we couldn't get them promoted* The policy had been ep proved by the War Department, but It had not 743 been implemented* H was all right* General Somervell said, ”les, give then promotions,” but didn’t tell the Service Commands or anybody else just how it should be done, and you couldn’t get it done* There was a long tine after General Kirk got that policy over before he could ever get those promotions for those lieutenants, and it hurt their morale pretty bqdly* It did finally get worked out all right* I don’t think that anyone in the ’Sar Department was particularly to blame for it* J don’t know why it was held up, I can’t imagine, but It was, and General Kirk didn t seem to bo able to jar it loose and of course we couldn’t do anything down in the next echelon* The next crltician the medical officers particularly have is the ’’Idleness enforced by campaign conditional” In England, when they worowaitlng, getting ready for that attack on Franco, nobody knew when it was coming or whether it was cociing or not| there was a lot of idleness over there that couldn’t be helped* I don't think you can do away with all that, but wo certainly shouind’t have any mors medical officers -than we need, because we have got to have a proper quota in civil life, or at least a reasonable quota, but that was one kick about not having anything to doj not all that was legitimate* either, because scans of them could have found work, I presume, if they tweSpi hard enough! „ The last criticism is the "Delay in demobilisation*” The prominent medical officers who had been carrying on in a splendid way felt that they had carried out their patriotic duty and wanted to get out as soon as the armistice came and they were dissatisfied if they couldn’t get out* And a great many of them did get out and others were held inj but we did have a great many junior consultants and specialists in the later stages of the demobilisation* , Brig Gen McDonald i "Should we promote medical officers in the Reserve based on professional advancement during peace, or should the old system of unit vacancies and military duty in the Reserve be the basic?” Many tines in this last far I know of some instance# where a highly*trained specialist would cone into the Army late, perhaps having been retained in civil life through no fault of his own, and find himself under the supervision of a higher-ranking medical officer who had very little special training* I believe that promotion should be based largely on special qualifications, particularly on professional qualifications* I think that rank in World War 1 and II was given in many instances simply for reimbursement forspectal qualifications* The man got more pay, and in that way I think it was proper* There should be some way of paying a specialist ade- quately for his work* I think it was reasonable, that is, the rank for the dental and veterinary people* •Should American Specialty Board membership be the sole index to the recogni- tion of specialists? If not. would you suggest a basis for decision in this field by the Surgeon General’s Office?* ™ "Will more autonomy of the Surgeon dene rale and consequent release of medical officer control from 0-1 and DuPera provide an opportunity for improve- ment in assignments, etc#?" les« ■Has the commissioning of nurses and other females in WSC and WiC added to the disaffection of medical officers? What is a practical solution to this aspect of the problem ?■ I don't believe that medical officers as a rule were dissatisfied with giving rank to women thatworksd In the hospital* ■Should pay of doctors be increased to comparable civilian levels? In time of mobilisation aren't ail grades denied compensation for their real efforts?■ I don't think we should try to have a doctor earn as much in the service ai he does outside, any more than an engineer should earn more, or anyone else* Obvio sly much idleness of doctors is caused by their call Into service long In advance of professional need for them* What scheme would you advice to re- place that used in World War II? Could the •alert” system as used in World War II be Improved? If no, how?" « I have answered that, saying proper plan ing and timely Glassification* ■Will the present emphasis of replacing medical officers Tydelayment in key administrative positions further increase disaffection in medic ax officers by depriving the® of promotion opportunities?* I don't think so* ■Should the armed service medical departments participate in planning for civil emergency defense? If so, on what level?* Yes, I think they should# It shoold bo on the territorial level, I think# •Would opening of tsainlng facilities In amed service hospitals for selected civilians be advisable to engender better mutual understanding of our problems?* Yes, x think that wo;ild be of advantage* ■What is your opinion as to the advisability of including the Veterans Adalnistration in armed forces planning for procurement of medical personnel, etc#? Public riealth Service?" I think that if you have the registry you would have your whole plan* I believe there saou d be coordination on the needs of all Federal medical services in the procurement of personnel* ■Do you favor the ASTP system of producing medical officers in wart If not. Why? 745 Yes, 1 favor It# x favor making then serve five y»ars instead of tso, after they are through with that training# Two years Ifi too little# They et two ia nths off out of tho 24 so they servo 22 m-nths# lou get tliat man for 22 months, end the Government h e perhaps paid his way for four years# I certainly think five yearn w ild be a better standard* and I believe we could get tlvorn on ti»t basis# "Do you favor subsidising in arv way nodical students during war? IShy?" That’s the AST? system# Brig Qcn bartlni Hot in its entirety# lou could change it to an outright subsidisation# Timt is a moot quest! n now# 6ocso people are not sdivslng only Irwar, but in ponce, a complete subsidisation of a nodical student, even a pro- medical student# ♦ * Brig Qcn icDonaldi believe n It# I do bo ieve in ,ST?# giving medical students a commission as a second l-loutenat in tho BSC Reserve they were exempt from Selective Service calls# Do you favor a return to that system?" I don’t favor are turn to that system# "Did you favor bring in ASTP’s In to the service after tho war .to relieve reserve medical officers earlier frcei the service? If not, what should have been dorse to vevent disaffection in reserve officers?" I believe in bringing them into the service after to war# I believe they should servo at any tine «fter they complete their training# They should give the proscribed length of service to to armed services, whether it is in peace or war# "In your experience,is there a need for an artaed forces medical intelligence agency to establish rid maintain on a currentbaais worldwide nodical information that is so essential*, to planners for global wor? If so, what organisation scons nost practical?" I think it is nocossai7 that m havo armed forces nedlcd iatelligonct a ent»* Brig Cion Martini Co v d that bo /art of to proposed nodical section of tho Joint Chiefs of Staff? Brig Oen IteDonaldi think so# "Should our medical service ppov3.de a section for each of the specialties to prevent disaffection in groups? (Sanitary engineers, biochemists, etc#)" No, too many corps and division# "Do you favor placing a civilian representative of medicine on the staffs of super! r hoadquaiters surgeons during war? If not, why? 7 A6 I do not favor it* I want my consultant caaaiesion In part of my office •«#**** UK. PflHL Colonel, HO 747 TKOE flam (Extract of etateoents node by Colonel Thoaas J« Hartford, k£, USA on 23 April 48 at interview with Subcommittee on tha Qaploynant of Military Medical Hoboutobs) ****** *1# I would like to prafaoe (L) there, by stating that In ay opinion the die satisfaction in the radical service was not any worn than it mm in every other a la sent of the ensod forces} that we ehcaild do everything we can to alnladee the complaints, but that m met realise there will bo complaints regardless of anything we do# 1*# ?ohl Colcnal, MB ?43 TfOlOOPY XtmOf (Letter from Captain V. D. Small (MO), 0. S. Mary dated 6 May 1948) aaaaa *12, (a), Poor leadership. (b). tlaolng of unsuitable, incompetent or disinterested effleere la positions of responsibility. (e). Unwillingness on the part of nasty senior officers to reapset the ability of reserre personnel, to appreciate their diffi- culties and to take the trouble to glre then constructive ail vhen needed. (4). Indecision and vacillation by high command*. (e). Too such control by lint military eoananders over strictly nodical function*. - Xlfetcd pt fnoar.el were authorised a aaxlnuo grade of corporal* Avthor I» *-11 o ue of grsde la olaor Mr Forces wort, tlail&r* & blft Effects - Officer personnel vita highly specialized training wre ril uded In the grrde of Ceptain r&g&rdlee. of «r turity, diligence, attention to duty and technical skill. 3&ti8t£d personnel were stl*vs*lcd la the grde of corporal* la the case of both officers, riid enlisted ecu the Murule end efficiency suffers;; feUtterielly* shli«, the officers hnd no taoeua of escape, enlisted non often were lost to the dental service for this reason alouo after euca tlae had been pent to tr. in the*i for their duty* iiecoa eadc.tlon« - 't'imi gr«d-u W provided deatul officers 1 the &&£.« proportion as officers In oilier e rrice*, *ad th-fc enlisted dental ncd t- ants b* author!*e4 ia th« grade of i#* —* uOX'-‘ZiOi| i-iv# 750 THUS COPT -XMACT (Ltr Gapt. H. S. Mathis (KC) US*, Ltr Did 8 Mgy 48) ***** I. •frequent change* in assignment of duties which appeared to the Individual to be unnecessary, Specialist being required to do prefaeelo&al duties ether than their specialty* Medical Officers la pools la the Pearl Barber area felt that their tine was wasted when unemployed, This was par* ti&lly elewlated by temporarily assigning then to duty In hospitals whore they were able to do eosto professional work* ••* HL, CtoIoWm!”* nf qgg JJtmgf COPT (Ltr Brig. Gen. O.B. KMSXB3CK, Dental Corps, did 7 Key 48) «,,«,** k “The following wore the sola omiti for dissatisfaction by doatol personnel on Air Force daring world War 11, 1) Probably the aott i»> portent single factor woo the dental e&ro given to individuals other than thooo la the alUUqr service, Dental off leers felt that dependents and others act la the service who received dental service was securing It at the expense of service personnel, BegvCUtions author!ted this when practicable hot this had many iaterpretatieao and was usually decided at station lovol by other thru Medical Depcrineat personnel, In the future, those Individual• should either he author!sod treatment definitely and personnel furnished to seeosplith It or it should ho Halted to thesnergoney treatment of pain only, Z) Too frequent transfers to other stations for no apparent reason, 3) Dental officers kept on the routine of inserting amalgam and silicate fill- ings were not given the opportunity for edperience In exodontla, oral surgery* periodontia, prosthesis and crown nod bridge work, 4) The impossibility of finding living quarters in the vicinity of military stations, 5) Serving under officers of the Medical Corps* 6) Poor promotions as coopered to officers of other breaches, 7), Regimentation of Any life and not being their own bos?, 8) So chance to bo proaotod due to Table of Organisation limitation as to rank, 9) Lev pay scale as eoaprred with earnings in civil life* 10) Sons stations caphssle are on a definite production on a Quota system rather than stressing quality of service, IX) Frequent lost by transfer of trained enlisted and civilian assistants, 12) Specialisation training impossible, 13) Army red tape fjrvd class consciousness, 14) Ooctm&tlon of the Dental Corps by the Med- ical Corps, IS) Service polities, 16) Two dental officers per thousand were not enough to do the Job required la World war II, It should at least be three per thousand In the future emergency, 17) prosthetic dental service as supplied by Central Dental Laboratories was attest below the standard of most civilian dental laboratories, IS) Too much record keeping and duplication of dental forms for each individual in the service, COlonel, MO 53a fKD2 mtti COPT Of K1DICA2* SUPrCH'i* OF TKh USAA? IB f HS KSDXTWsAIhAI TESAf.SH historical sKCfio:: - Am.s *•«•*•««* |4> "Another circumstance that caused dissatisfaction in many instances aaoaj hath officers sad enlisted sea of the Medical Department was te neagerness ef opportunities for promotion. The chief obstacles la this respect appear to bare been Table of Organisation restrictions and the policy of sending replace* neats in grade from the Son# of the Interior* ▲ slailar situation with respect to the squadron Medical sections of an Air Depot 0-roup existed over an extended period of tine. Generally speaking, the aorale ef Medical Department officers and en- listed sen was relatively higher daring their first year ef fonign service then afterwards* Although probably the nest universal depressants to aorale were rotation and pronotion policies* mentioned above* other factors contributed in soae instances to dissatisfaction within the nodical section of a particular organisation* Among these causes of a lowering ef norale were insufficient seen* pation. On the whole* nodical offleers found themselves occupied with routine natters in which they had little interest professionally* while dental officers for the Dost part were engaged in work mere nearly in keeping with what they had done la private practice* though* to be sure* they were often overworked and had inadequate equipment* However * the feeling among dental officers and nils ted non that they were being discriminated against with respect to promotion and te rank and ratings fixed by fables ef Organisation probably outweighed the above* mentioned, eontiderations, la the Twelfth Air force it was thought that flight surgeons who were intensely interested in aviation nedieine showed the least loss ef moral eg but that a few medical effieere who had attended the School of Aviation Medicine* apparently against their wishes* tended te lower the morale ef vhe organisation to which they wore assigned. luK. FOSL, Cplon«l, MO 752 THUS EXTRACT COPY 0? I3TSHVISW WITH COL W RT 0. P iILLXPS, ANO, 27 Apr 48. ****** L. *Ths status of our nurses changed three times during the last war, which resulted in changes in promotion policy* It wasn't until officer status was granted that more stable promotion policies were made and position vacancies authorised. Interference la matters of promotion and assignment by personnel, nurse personnel, was made by personnel in higher echelons on the basis of person- alities and personal friendships, rather than on professional requirements and needs. While this was not on a large scale, it happened Ih acre than isolated eases. In general, the housing situation of the voaen in the Medical Depart- ment of the Amy does not compare favorably with the women ef the Havy and nay, unless there Is some equalisation, be a detriment to future procurement. I think every effort should be node to allow woman to have adequate and home-like quarters — I'd say bachelor officers — for both men and women where they any entertain their friends and not feel that they have nothing but a public living room. I think fully-furnished quarters are desirable, and we think that such accommodations would result not only in smoother operation, but In economy of operation and better morale. We had good quarters during peacetime. We were on a different status. We were provided quarters fully maintained and furnished as part of our pay. Many of those quarters are still la good condition. ■ The quarters, of course, that were necessarily constructed during the war were not the type that we had been given prior to the mar, and the furnishings were of a cheeper nature, and of course* didn't stand up. But it has been brought to my attention more forcibly than ever on these trips that we have been taking with the Joint hr: ups ef the dray, Mary, and Air force that the Any and Air force nurses are not as well taken care of in the matters of housing as the Wavy. The levy quarters art fully maintained and fully furnished. X think, maybe, that's about all I have. As I say, there shouldn't be any difference, X don't think. In oper- ational policies for women officers of the armed services — Amy, levy or Air force. BRIGADIER GSKSBAL MASTX& Was there much disaffection a eng nursing personnel during the war because of the care of dependents? COLOSSL PHILLIPS: I don't think so. We had nurses who objected to the care of womeh and children. They said they came into the service to take care ef soldiers. But the number was net great. We still occasionally find some- body who makes such a remark, but I think we are educating thorn to the fact that we want women and children in the hospital; we want to bo able to take care of then because of the types of services. X think the number was not say greater than you would find with any group. You always find eertaln nurses who prefer to take care of male patients rather than female patients. BHI&ADIXE GSM HAL MARTI I; You mentioned the use of nurses in the transport of war brides and so forth. Bo you consider the presence of a nurse necessary to the extent that nurses are or have been used for such Jobs undoubtedly were -present, but I do not believe thle was true to any great extent. ?ome medical officers protested that their special knowledge and capabilities were not being properly employed. I believe that adequate adjustments were made in these cases as soon as was prac- ticable, Certain medical officers considered that their professional standing in civil life should have entitled thorn to higher rank, perhaps some of these individuals were Justified yet I considered that on the whole our reserve medical officers were fairly and very well treated. Apparently few comulalnta of this nature came from medical officers of the regular establishment. The promotions in the army medical corps ’*-ere thought to be more advanced and accelerated then those of the navy medical corps and several instances of this sort were brought to our consideration. Perhaps this is more understandable when one realizes that the Medical Department of the army expanded to a far greater ex- tent that did we of the navy,«•••>* zjz^jL L. X. Pohl, Colonel, KC 764 T8PE COFI mcriUCT (L«U«r, Captain T. R. Urban (WC) DS» dated 28 April 19A8) ***** »(1) The chief points or circumstances within the military structure contributing most to the apparent disaffection of medical personnel* •(1) In the Army there was a lade of opportunity for either professional experience or military promotion for medical officers in tactical units* •(2) A better understanding and more friendly relationship of regular and reserve personnel* "(3) Rank of reserve officers not commensurate with age and experience. *U) Experienced personnel in medical lines receiving admin- istrative positions. Administrative officers in many cases could have taken over medical officers billets *• J?1lQ L. K, Pohl, Colonel, UC 765 TRUE COPY EXTRACT (Letter from Colonel James H. Forsee, MC, USA, dated 20 April 1948) ***** *(L) Tfa« Chief Points of Circumstances Vitkin tko Military Structure Contributing Most to tko Apparent Disinfection of Medical Personnel. Most disaffection vitk the Military structure relative to nodical personnel is I believe related te personnel Management. Suck factors of uncertainty of assignment interfsr vitk future planning on the part of ike individuals and disrupt professional education. The frequency vitk vhiek mores are made in rather a hurry-up aature only to find on arrival that an appropriate assignment is not available is indeed discouraging. Many of those factors are not Medical Department difficulties alone by any means but they do have a very definite influence in discouraging the young officer contemplating a military career in the medical depart a sat. Inadequate housing is one of the most major problems which ve aov face in securing doctors to enter the Service. The present pay levels do not permit Junior officers to be attracted to a military career. The following is quotedfrom a recent article in the Surgery, Gynecology and Obstetrics of April the 17th, 1947 written by Dr. 1. D. Ohurchilli "Pearl Harbor found the civilian medical profeseion in muse of poorly integrated but highly developed specialism in remedial medicine. The prevailing tactical situations in World War XI permitted the useful appli- cation of wide varieties of specialised technique to injury and disease. The range of these techniques had net been anticipated in the plaqs of the Army Medical Department and particularly during the early phases of tko var Medical Officers found difficulty or frustration in their attempts to apply their fall potential. An unenlightened attitude of Command toward the mission and operation of tho Medical Department vas not vholly surprising It can not be assumed that tough-bodled and tough-minded laymen will have a full appreciation of the fuaotlons of doctors and hospitals. Sven a lay Board of Trustees In civilian hospitals required education. Medical staff officers only rarely were vested with the authority that is derived from having the e*r of command. It vae difficult for them to make the vote of Medicine heard above the clamor. The wound surgeon by virtue of his direct clearly understood mission, fared better than his colleagues in so far as it pertainsd to sanitation and hygiene, vae veil carried cuts but warnings and advice regarding baserds that had not been visualised in Army peace time training mad discipline were likely to pass unheeded—. It vae difficult to reach the Command with authoritative advice regarding these hazards and it vas not always followed when reclined. A total health program utilised the knowledge and experience of the medical profession regarding "man and all that concerns him was never envisioned—0. "The role of the doctor in war must always be that of hit role in civilian life—an advisor. There are only two essentials} First, the advice must be sound, *nd second, it must bt heard—*. 766 Those factors mui to no to add up to sinply this, that tho Medical Department! of the Amed Services must pros ant a sound policy and aggressively pursue its acoompllshnsnt. Too long have ve as a grot?) feared or hesitated to strenuously present our demands to the Oeneral Staff and the people. Ve have accepted a budget too snail to oarry on the required pursuits of the Msdlcal Department. Ve have failed to achieve high professional rsoognition within our own nodical societies and organizations. Tho Amed forces should and will he Just at good as the people want. The people net however he properly advised as to Its needs. Ths demands for superior leadership on tho part of tho Amed Torees Including the Nodical Department was prohahly never greater. An adequate Amed Terce is costly. The successful prosecution of tho present objectives of ths Medical Department are likewise costly. Its achievements cannot ho gauged eolely hy material expense. Its veoord during the laet Vorld Var in the saving of lives, and nodical care of tho side and wounded has won tho hlghoot praiso Aron all sources, fills fact nust he oonetantly called to tho attention of tho Oonnond. Tho people ■act ho willing to pay a dear prloo for peace for tho prleo of Var to this nation and to the world will ho greater than death Itself. ****** Ft rLU ' Xu X. P«kl. OolomtX, MO 767 SXIldCT OF SfafiSWBSTS MADS BY; Colonel Frederic B. Westervelt, MC, U. S.A. on 22 April 1948 at interview with Sub- corn it tee on the Employment of Military Medical Besourees: »«»»««« ej think that the common complaint indicated is that 1 can only he covered hy proper planning which goes hack once more to the medical people knowing in advance the high levels of strategic plans insofar as procurement is indicated, and then a proper classification of medical manpower, a calling to duty of tnis manpower only when needed, and a keeping of this manpower busy hy rotating them from one busy spot to another, and then a properly-trained administrative head —■ hy head I mean staff — at the head of the medical department to understand psychology, promotion. Justice, and Just the general over-all make-up of the medical mm to try, insofar as possible, to minimise the causes of this type of complaint. I think it requires a lot of thinking, a let of planting, and a lot of good sound common sense hack of it. I personally believe m far at lo, 2 is concerned that promotions should be hated on ability. Whether that ability is largely professional, or whether it is demonstrated in some other field, X still think it should be on ability rather than on just some particular faculty. By this I mean I don't think that because a man has done a certain thing for so many years or because he is a member of some particular society that $hat la itself aleae should justify promotion. 2 think a promotion is an indication of the man's relative value to the over-all medical service. That value can be equal in a professional field or in an operational field, depending on where he is needed. At least one factor not under the control of the surgeon general which results in disaffection of doctors ie the quarters situation, possibly because a greater proportion of the younger doctors are married and have faailibe than the younger officers. X don't know, but X do know that the chief cause of dissatis- faction that X hear la the fact that officers can he moved from one .lace to another Aon t know where they are going to go and don't knew whether they are going to have their families with than. X know there would be an awful lot of diseatisfaction if they started bringing women in the regular Army. That's what they are talking about right now. Pay of doctors in the Army should be the pay of any other officer in the Army of a comparahla grade. X would like to answer yet to that one, providing it wasn't pushed up above anybody else, but distinctive pay, pay for special efforts, or for special training or for special anything is not appreciated by other branches of the aerfcioe, end when a fellow has to eat with and live with officers of another branch who are Jealous of hia getting extra money, it causes a lot of dissatis- faction. Zt is discriminatory legislation. As much as I like dollars, X rather not have it than have a lot of people feci the way they do about it. X don't know how to answer that question. If you are going to get doctors into the Army for a career, at least one consideration is how much money they make, and they would like to make as much money as they make on the outside. If you can demonstrate that they actually take home as much money in the services when certain advantages are considered and what not, then you have actually increased their pey tc a Comparable civilian level, and I am certainly in favor of professional people getting what they are worth, but I am not in favor of doctors in the Army getting more than ether officers in the Any. 768 sxsmcT or sf . Mrmn mass - Colonel Frederic B. westorrelt, MO, 0.S,A« on 22 April* 1948 at interview with Sub- committee on the JSapl oyeent of Military Medical Eesourcee, Continued* I can*t answer ho, 2* the reason X can't answer it is .that I am forced to feel that there is too such personal selfishness exhibited all over our country today* Everybody is for hiaself today* and I don’t believe you can talk about sacrifice and get any enthusiasm out of anybody* the doctor that gooe into medicine with the motives that he should go in is sacrificing anyway* He is giving hie life to take care of other people* 1 think a true doctor has that spirit of sacrifice in him all the time* rh:nz, POHL,,N20L0CSL» mc 769 THUS COPY EXTRACT 0? jmmStf WITH HKAJS HOitTUS S. HlhbCyfTS (MO) USS '4 May 1948, «»*»***»n,. aSM& ADMIRAL Msmsmt The next subject is the chief points or eircumstone s within the military structure contributing most of the apparent disaffection of medical personnel. R?AK AQMI1UL WILLCUTTSi I have t o or three factors that I think covered all the disaffection I saw. One was, as I said, an absence of military planning and military know- ledge by the doctor . I have referred to that ease, the doctors were dissatis- fied because they didn’t know what the score was. The next one wap doe, I think, to a faulty induction — a faulty con- cept of our type of patients. The inductee would go to the Induction center and then to the training center, and than, instead of being sent base after being screened at the training center he would be sent to our hospital. Out of a 15,000 population of patients, 2000 of then? were on HP ’service? and out of that 2000, I dare say 00 percent were jw t a type of disgruntled boy th-t could hav and would hare fought well had there been a battle on right there In San Diego. Bat they found they wouldn * t teaai up and they sent the® to us at MP cases. I know I had 2000 of thca at San Diego. A proper screening early sight have put most of those boys out of combat duty entirely and kept the® in another productive type of duty. He aight not have been able to do eoabat but he could do something fok the natio.ml economy other than fighting. My doctors got very dissatisfied at tlm« because ward after ward of patients, were not very sick, and that is not good clinical medicine. The doctor became annoyed. He would go in on sick call and see a whole line up of boys not too sick and that could be sent to duty. They had to have a little dental cere; they had to have this and that. And the law says they would rate 30 days leave. The doctor was annoyed by the enormous amount of paper work he . nd to do on a not very sick patient. That made for disaffection and discontentment among the staff nt the hoeoital. To got away from that means very careful selective sorvlcc based upon, I" think, an improved induction system. 1 can’t see why v© can t take an examin- ation at the home base by the local doctor, the selective service doctor, who is a civilian. He will know whether that boy has epilepsy; he snows that ho$, Ha knows the gross disability without screening. She other man can’t know too such about it. So instead of going to the induction center I would like to see them cose right to the training center on probation, no to speak, a probation enlistment, and then after 3 or 4 more studies by a good number of doctors, including a ppychietrist, they would try to screen out those boys who will never make good combat material. It is going to be difficult and it 1b going to ake a lot of careful scrutiny. But, as I say, the ne t war is going to be total war, and certainly these boys can be made fire watchers end robuilders of destroyed houses and firefighters. They can do something. In that way then, in our hospital we would have clinical materiel and proper morale among our doctors. The morale will be higher. That was a serious morale a&oag our doctors. The morale will be higher. That was a serious morale factor, the clinical material we had, Ho thing shot up the morale higher than m to have a new boat load of war wounded boys com in. Yet, they cane in with a bunch of sea-sick kids. They would just groan and say - here are seme mere of those boys, these misfits. Then, of co rse, there is tie third group that wanted to be in bloody surgery all the time. Ton can’t do that, As 1 told the boys on the L8f - what de : 770 fmm COPT EXTRACT of IVsaSfm AJMXRAh MORTOli a. VILLGUTTS (MC) US* ♦ k*t 1948. knaaMPfr they want us to do, explode thee, get a kamlkasie to cripple a third of the ship so they could hare some surgery to do. X told the& If they were not here other doctors would be here, that they are filling a necessary billet. That has been thought out, carefully thought out, that these surgeons checked all these needs and determined we do need on this LST, from our experience in previous near dis- asters we had in other island hopping in the Pacific, extra doctors. Of course there always cooes the loss of comforts known to the doctor at hone. He can’t get housing} he can't bring his family perhaps] perhaps his schooling is upset, and so on. Many of our doctors, as you all know, are in debt. They may look like grand successes outside, bat they have a mortgage on their hone, insurance to aa a tain by high monthly contributions, and to on, and service pay deeen t cover much. I don't think the discontent was toe much. 2 think they wore poor sports. A lot of those people that are disgruntled now say that ws did this and we did that. I have talked to of the# and asked for definite items that would create discontent, and they can t give me a good answer to my satisfaction. I did feel a loss of morals with the poor type of clinical material, doctors also like to hare a little firing, a little gunner , a little action. Many of these doctors were good sports, as yon know, and they want to see action, dud to go homo and see no action - to go back home and be applauded for homo work is not their Idea of good sportsmanship. They like action. I am not too disturbed by the AMA questionnaire that went out. If you analyse the® those questionnaires were well done and those doctors were serious in their replies. But they are not too serious, 1 don't think. As 2 said a minute age, what if you had not had the doctors at the Bulge and that Bulge vent on down to Southern francs? What if we had landed on the China Coast and the mainland of Japan? The civil people would hare had to hare given us more* and when they tell ae they were down to I to 1500, I tell them I have checked the morbidity of the civilian co&anmitlee and It was starting!/ low* They had no great The morbidity sates throughout the country was very favor- able. I can t give civil medicine very meh credit there. I call it poor sport- smanship* When you talk to them over a cockrail, they don't fight such* ****** I*. & * HC 771 Taei cop* of iimamw with oolosjsl vihgiIi coaio&i*, kc. usa, so apkii. 194$ •*«.*«#« b. •The chief points or circumstances within the military structure contributing mast to the apparent disaffection of medical personnel1*. All doctors resent the Ices of individuality. I think thn.t is the basic reason for dissent. They reseat service other than medical duties, and they reseat mediial duties other than those in their own line of practice, and toey resent direct orders. With training and experience, those features are minimized. Consequently we mast start before mobilization by inculcating the idea in the medical fraternity of vhat the Service does and hat to do. I know they don't like to hear a lot of that, but there should be som way that ve could gi e it to them in an interesting manner and by encouraging attendance of medical offleerr at the various civilian meetings. I think personal salesmanship again is most important in letting the civilian doctor know vhat the level of medicine is in the Services, and th t even through ve have t© do some of these administrative tasks, we are getting a lot of good professional training and very good professional work. Only since 1936 have Army medical officers attended medical meetings on a duty status. The Public Health Service has been doing tl for years. The Public Health Service has been doing it for years, when I was curator at the Army hedieal Museum for three years I paid ay own expenses to all of the general meetings, but started a movement to have the curator and some other representatives sent to these meetings, whichis now being done. I think that that should be continued, and should be encouraged. Bov the policy is that you can’t go to a meeting unless you present a paper, Well, I think that some men should he allowed to go as representatives, even If they don’t have a paper, I think their very presence there in uniform is worw a whole lot ft to ail of the services* There is general professional resentment that professional men are not recognized in the higher grades, and that immediately a professional sum Is recognized he generally ceases to be professional. As evidence of that you can t ake the remarks by one of the men from the Surgeon General * s office before & civilian group Just the other day, in which he stressed that one of the recent promotions was of a professional man and that that ban was going to continue in his professional duties, and the very reason it was emphasised is because perhaps its one of tine first times it has happened. I think it is possible and should be, that that cuuld be done ore often. Z think that that is one of the things that the general profession know. The younger men. resent breaking of training periods in order to meet other needs of the hervie, They hare to go to certain Jobs, hut that fits in with what X said a while ago, that as long as we are under-staffed, ve newer are going to he able to let a man continue the period of training without needing hia somewhere. Whether we can meet that, I don’t know, hut that’s one of the things that irks the younger sen as they are sent somewhere to train in some subject and then after a year or year and a half, when they are supposed to he taking a three-year course, they are pulled out and seat somewhere. The rapid changes in policies have instilled a distrust for the future among young men, both la and out of the service. 772 THUS COPT feAt.UC? UP XXtSfifm WITH COL. GOIUOLL* KC, USA, 30 A *L X®48. fc.jgMg.’agK^ ©»e next iUm cosac® fro© lay 01vi«5on Surgeon2 failure to comply with proaisse« of professional rohablllt«tloa for frontline eedlcal office/** upon their return to the 31, fhoee teen are immediately demobilised. The 0,1, Sill of Bight mm not la effeit* to they oouldn11 take advantage of it nr. til some tine after they had returned to their practices, and then they were established and didn’t wo atto. Sat he telle ®a that an«y of the men who had been banking oa that period of re- habilitation to get back late telr aedleal work after a period of combat doty were such disgruntled beeaase that never developed, although it had been premised to then. I can’t personally eey say thing abeut that ether than report that that ie one of the consent a i have heard along that lisa. vtto i*,k. pohu* cta-om*, mo 773 manor* ISTEdOf (from address of Major Omni Albert V. lesser, MO, 084 18 Itagr 1948) K4J0S OMUL ontti ••• "Mai cm then to tlu rat one — the chief points or eirraMtuoM within the military ilmtin Mttvitallii ant to the apparent disaffection of medical ptmutl — I vtU only mtUft * few of them. there vm denial of opportunity to advance professionally. That wms particularly notod in tho attached medical. Tow battalion racoon «M atyaiod on promotion no lone at ho stayed with tho wit to which ho had a oortain amount of loyalty. aalQADZSK 0SHSB4L MASTXBt So you fam a aoro spooifle rotation policy than that uood during World War XX, where it was loft aoro or loco to tho various theatres and lover lord surgeons? NAJOB OSXBAI xm X do. X think tho assignment of medioal officers within a combat unit which precluded thoir relief within a reasonable period of time is one of tho reasons why wo had some disaffec- tion. X noted that area after tho war was over these nodical officers had boon denied any ohancs of professional adranssmont. They were still denied refresher eourses or assignment to major medical imctaUatioac when they could very easily haws bean replaced by ethers who had had these advantages. dotation of assignments were not afforded. Many junior offieora wore kept in general hospitals, in aaay instances when they could here boon very easily spared. They went through the whole war in tome base. Thera should be proper assignments. It is an inpropsr assignment to take an elder medioal off tear who io wall qualified profess tonally and giro him am mssignmant as m battalion surgeon. That io a young man1* gama. Zn aaay iaataaooo X would find battalion surgeons of 45 carrying om a job, but they certainly had physical limitations that tho younger men wouldn't hare had. They were not being used to tho beet advantage of tho oorrico. Hmn vm mtrUlloi on professional Initiative. That la another oomplalat, particularly of tha younger mb, because they had to adhere, 1a application of their professional activities, to eonoopt* laid doom by either the Surgeon General} s Office or by some local chief of the service who was insistent that a hernia operation ho performed hit way rather than lotting the individual perform It in the way he wae accustom- ed and using hie own initiative, with equal good results. They reseated what wo night call this professional regimentation. 774 Another complaint was delayed promotion*. I think we mentioned that before. Our system of promotion, to my mind, left considerable to be desired. So much depended upon where the officer happened to be and whether or not he was particularly in the high esteem of one who was capable of getting him the -promotion. 3n.il/iJI3H G’.SnHAL HA3TIK: In view of the pres ent move to re- place many nodical officers, especially in those kssignments In the hospital where they do administrative work, by MSC personnel, many of whom will hold advanced rank — will this process add to the dis- affection in stymieing the promotion of medical officers within that unit! HaJOH OSHEHAL It shouldn’t. It shouldn’t If we establish for all key positions, for all positions of responsibility, certain grades that the individual officer occupying the key position will get Immediately upon hie assignment to that certain position. Promotion heretofore has depended upon a lot of factors that are not conducive to high morale. Juring the past war an officer was eligible for promotion In the next higher grade after he occupied the grade for a certain period of time. Bat that «lidn*t mean that he got It. It did Been also that some officers go t their promotion mho did not perfom the datlee commensurate with the higher grade. 3o there mere Inconsistencies there which reacted unfavorably. In view of our shortage of medical officers In the Armed Forces we ehouldn’t have a medical officer doing any job that does not require fl medical officer.- BRIGADIER GJOT88AL ItARTIH: In that connection, recent legislation permits the permanent rank of nurses, many of whom are In hloh grades within the hospital structure. In your opinion will that add to the disaffection among the medical officers, especially the junior group who can never attain comparable grades that the nurses hold by matter of assignment? HAJDH (VSFURAJL JWHWSRi I think that le one of the biggest mistakes that ve made. In the first plade, the interne considers a nurse more or less subordinate to him. That Is fundamental In the medical profession. That has been my experience. And to accord nurses actual rank, whatever Interpretation you may apply, conveys a certain oommand responsibility which I believe le certainly detrimental to the morale of the medical officer. 775 (Off the record) Another thing that I think haa created a point of dlMention la the creation of a schism within the medical corps aa between the specialised medical officer, who la being placed In a preferential class, and the administrative medical officer. X think, aa we all know. It waa proposed before Congress to give the special1st a 25 percent increase In base pay because he was a specialist. The fellow who had been denied a chance to be a specialist because of assignment over which he had no control, with field medical unite, felt that he waa being relegated to more or lees an Inferior category within hie own corps. That le another reaeon why I propose this military surgeon specialist MOS. Than ha, within hla own right, become a a specialist and gets mors pay than anybody alae, which will attract a lot of your yeihg medical officers for service with troops. X think that It one way of procuring more medical officers. If this young Interne coming Into the Army goes through a medical service school and the Infantry school, or a combined Army school where he gets knowledge of the tactics of war, and then he goes on to Leavenworth and the War College, and so forth, and he knows that his promotion depends upon hla MOS, as he earns hla MOS and gets assignment to higher echelons and la on the way up, he le willing to stay with the Amy. The other fellow who likes to pursue a specialist course, when he attains everything that he can attain professionally and the recognition that goes with It, le much more prone to resign from the Army and go out into civil practice than this fellow who specialised In military medicine. Vow In general there appears to be considerable difficulty In obtaining doctors for the Armed Services that will eventuate In an In- ability of the Medical Corps of the Armed Services to asst their com- mitments. The appreciation of this situation Is apparent te all. The solution of this problem nay be approached from several angles. a. The reduction of eoanitnents hy: (1) Sot assigning a medical officer to any duty not repairing a medical officer, which le capable of being performed by an officer of tome other branch of the service; ♦ (3) Transferring eases with no military potential to the Teterans Administration, or other facilities as soon as determination of the non-military potential has been made, which should he apparent 776 very early; (3) Withdrawing privilege of medical e«r« to civilians; (4) Training zmrsoa and MSO officers in tho performance of some professional duties now requiring a nodical officer. There are a lot of minor function* of a nodical officer that a nurse of intelligent individual may ho trained to perform. (5) Adopting administrative measures designed to lighten the lead on major medical installations. We should hare an administrative procedure that trill accelerate the return to duty from general hospitals. Ve ell knew that general hospitals in some eases have patients who do met require the facilities of a general hospital in the first place, and that there is administrative delay in returning them to duty that would net eeour if the individual were hospitalised in a station hospital servicing hie unit. (6) Acceptance of patiente from one Armed Service into hospitals of another, that is, the levy having a hospital with plenty of empty feeds would aeespt patients from tho Army or Air, and the ether way around. (T) Assignment of nodical officers of one Armed Service to medical installations of another in a temporary duty statue under certain circumstances. If you hove m balanced staff in a hospital that has few patients and the Havy, for instance, has requirement for an Ml man, end you have a couple in your Army hospital, why may not the Aray medical, of fleer fee brought into the Havy hospital on a temporary duty assignment? (8) Utilisation of civilian medical installations on a per diem feasts with United feed credits. (9) Utilisation of medical reserve off icon for pfaysioal examinations and dispensary oars for small elements by calling them to motive duty In their places of residence, or authorisation to permit tho President to call any medical reserve off leer to motive duty who has had Isss than 8 months continuous active duty. The emergency is still on. Tho reserve cannot resign his commission during the present emer- gency. H# may later when the emergency is declared off. fe. Subsidisation of medical education as a long range project fey commission in the K80 and school assignment of superior graduates of prsmedieal colleges. Whether we nay establish within our structure. 777 notably at Valter 3eed and ritssimons, the Army medical colleges that vlll pert the requirements of the AMA and also meet the, civil r«- ouirementa for medical colleges, and have, as Vest Point has professors with appropriate rank, or some other way, la something I don*t know. It seems to me that is one way of securing medical officers, because the lad who is so educated signs up for five years. If he Is In excess, he is then placed Into the reserve. In that way you will be getting superior young men who thereby would be serving the civilian communities and the Army, Tou are building up a pool of trained men who have had 9 years of military life. Those who do not desire to make the Aray their career after this give years of duty can go Into the reserve pool. There are a lot of young men who would like to study medicine today but who csn*t afford to study medicine. There Is precedent for this In both of our Service Academies, in ths Navy and the U, 3. Army, If the Government can afford to educate line officers for'service In the Armed Forces, it certainly seems to me they ■ay elso afford the education of medical men. That Is a long range policy, and It would take some time to build that up. However, If we had start- ed It two years ago, as 1 once proposed, we would have been two years up on It, &nd in another two years we would have started to get son# results. c. Drafting of doctors upon graduation as an Immediate project before they have established themselves In civilian communities, to include 80 TC medical students. That will probably be acceptable to doctors In that oatsgory if they were assured of Interne and residing training. They get that training usually at their own expense, and here the Government is offering them that training. They would therefore relieve our general hospitals of some of these requirements for Begular officers. 1 think that is all I have gentlemen. X am sorry I have kept you,”**** L. X. Pohl, Colonel, MC 778 RiwPitODUCED JHOM COHkXHTS BY AI8 FOHC1 MSDICAL DBPA&TWifiJIT omC'JS, AMDM&VS FIELD, TO COL. L.JC. POHL, kC, AS PHOT1DXO IH70EMALLT MAY 20, 1948. ******* L. "The above are only a few «f the outstanding inedoqueclos la the ad- ministrative control of the average station hospital and X believe the resultant ic the obvious lack of interest shown V World War XX ASS? Medical Officers and Junior Medical Officers in any military service what-so-ev*r. The small Military hospital, subject te a Multitude of aoa-aedical policies aad regulations Cannot compare with the civilian hospital, when left as a matter of choice, especially to a doctor who has been trained la a& ataoe- phere of professional ethics. The military can aad does break this code ef ethics la the sickle procedure of forwarding clinical records. Clinical records must hare a reports control symbol, as such such be processed through Statistical Control officers and lies sago centers* **•♦♦♦ > L. WJ Tmr? oopt tjxth/ ct or Dmimxv vxti brigades r cunoaui josbph 2. bastion, mo, trad (aSTIRi'D* OH 3 May 1948, Xu ’To air it’s bard to ujr. Actually I bareaH beard of uueh dissatis- faction. They are getting eroryihing under leaven. This is off the record - BEI8ADX2B rSfffSAL BASTION You know it, too, that between the first and second world ware there grew up what sight be called general hospital groups. If the younger wa was not able to get into those groups- and not only was it professionally - why he was on the outer circle and lost out professionally during his whole career* Right now the dissatisfaction - I doa*t know what It Is, Let ■e cay off the record — SHIHASSXU QMSSLAL BASflOSt Dissatisfaction In any medical group - 1 don* t know what you would call It la the Havy or Air force, but that** what I mean - can be greatly eliminated by the attitude of the commander, the medical cosKmnder. Therefore the training of our officers, field officers - yon call them flag officers, don*t you. Admiral! l£Ah &&HML hSQZUBOUi She flag officer is the erase as a general. BEI&ADIKB CrSKKBAli BASTIOHi So, I mean along about majors, or lieut- enant contenders, up in htere - RRAH ADMIRAL AinXBRSGKt I doa*t know that there Is any particular tcra for that grouo* They ere sisply senior officers* Junior officer goes up to lieutenant coianander Inclusive, and senior officer is above that, and the flag officer corresponds to a general. SaiCACtSS Their training, because they are the on^s that are go lag to h&vo these groups when the big emergency coaas, be towards doing away aad seeing that these dlssatlsf ctiens don*t occur, and it’s a ease of leadership. That’s the whole eaever. KSAH ADKtHAL ASBWMRO'Pi Thors is another onestion he e th»t I wauld like to aek. If I nay. Daring the war In the Aray there were promotions of officers who were attached to organisations where the T/0 called for «n officer of higher rank. IrpstsisttS] 779 THUS COPT BJCeUaCT OT IbfEMUJU »ixh BfcZfttam fiUiSKSBAL JOSEPH B» BAStZOli* MO, OSd (aSflSAD) Oli 3 Hay 1943. h O^TIlAI&D: BBX0ADXZ8 SSKHSAL BASSIOH* Tea, sir. kSLAS A.T3MZRAL AH|2SE3£3B{ Aad the officers were proa©ted to fill those vsessfilas. to our organisation we called these proaotiene spot preset ions. With the ftsrey the spot promotion hold only eo long ae the officer held taut position. Wore ho transferred to ecae other doty* he lost hie preootioa. nevertheless* it caused a good deal of diesatlsfaction. Do you kw-.ve f«y suggestion ay to how the ayst«a of promotion can be sodif led to avoid dissatisfaction oaoag the officers that are not furtuaate ia getting prow tloot BEIftADDSE G8SX.'ML BaSflOKt I don’t think you ever can hare It. Toe. ars coins to hare it, sir, no matter what kind ef a ayctcm yea hare, hut yea asm he so fair - thtro again the sea in the higher echelons must he ae fir a& humane ly possible to he in ell these promotion*. Sow, if X were promoted because of your spot promotion,! would rseemi it a great deal to hare to he demoted Just because somebody wanted to store me somewhere an i if I stayed at that place I could held it* On the Cher hand, la some groups where they were promoted because of - what do you call them - «m» eamciee where they had no regular t/o, that was a ease mostly ef selection in putting in the aches, sad you had dissatisfaction there tee* X don’t boor, sir* Ton are going to have it enyvey* lots gets pro- moted ever Smith sad Mrs. Smith reseats it sad she tells somebody else, end se eg down the line, tells the Senator, or somebody, so the only thing you cam ds is msike that promotion business as fair as it can he, the whole group, ssd see DnA it works out according to the regulations, and so forth, with no favoritism. BPX&APISB «BT:rn Kira las the commissi ami ag of nurses, cad other females, in the tiSC and the MAC added to the disaffection of aedldal officers* BSIOADm «33Tm BASflOHt MI* Individuals, 2 would say* to tew do~ grew; tout as a group, X wouldn’t »-ty auciu As far as personal sxperiaace «M «9Bftem4, X saw T*ry little of it. It could happen* and all the other thing*. Banover* with the coealesioning of the female personnel ia tho Medi al Oepart- seat* 1 dd observe that the WAC’s would avsuso responsibility aad take direct ohorg» of whatever duty they wore given, wbera&s the nurse shrank responsibility aad did sot want to take any responsibilities of her oouiasioa wasleee the waa foreod to do eo • except % few older regular mrM«,****W* S2 KSS.t MO 780 THUS c m (Extract Ltr Quinton U. Server, mm>9 USM, 15 April 1948) ***** Toons reserve officers complained that they received Inadequate Internship training# It was held that If such officers were enabled to study natiente after to a hospital that clinical interest wou d be increased and morale b-oroved# Internships In Navy hospitals In 1945 were claimed to be inadequate# Inorovement would Induce more medical officers to main in the Navy# It was oro ooeed that there should be an autooatlc 2$% increase In base pay for nodical officers who have the ability end irdtiatlvje to qualify as diplctnates of Specflaty Boards* This proposal was made in 1945 and also of course in 1X7* It was reccn .ended that a blploaiate be conn' ssionad at a rank no lower than Lfjsuteoaat Carr aador* The "ran inn mate" system which ties the medical officer entering the Havy to the lowest man in the Annapolis class three years previous, was criticised# The medical officer has had nine years education and the comparable lino officer seven years# It was suggested the running sate system be abolished, and that the medical Corps ermi tted a separate listing of ranks based on qualifications and length of service# It v«as claimed morale suffered when an officer was passed over for promotion because of restrictions based on percentages of "the line#* It was contended that the Selection Board system of promotion encouraged favoritism and stifled Initiative# xt was suggested that the plucking system sh uid bo revised to "select outM rather than "select up#" It was suggested that the -rivilego of voluntary retirement on two-thirds pay at the end of twenty years* service be extended to the Medical Corps# A navy medical officer*# orequisites compensate in a considerable degree for the higher oay of civilian doctors# However, his retirement pay ceases at death# It ims recocine tided that consideration be given to the need for an optional Joint survivorship system of retirement nay# In some cases wives of officers who died shortly after retirement are on navy relief# Doctors entering Urn Navy claim they hove no assurance of an orderly rotation of duties, and sometimes are given too large a share of the "SCUVwork# It was suggested that the young nodical officer be given a more 'Specific outline of duties and assignments which he may expect during the first few years of service and that steps be taken to ensure that so far as possible, such assurance# be carried out# U U po&, COLOfSL, MO 781 Mm X. fliaRUSaXta 1* Tnere lea predominant thought and universal desire ex- pressed In the hope for realisation of the fact that conditions of future warfare will be radically different from thoe as prevailed during the past war. A comment that *apparent correction of some de- ficiencies of World War IX may open the door wide to more serious de- ficiencies In the next war* it deemed appropriate for repltition here. 2* . The supporting data reproduced for reference under this project’s title has been limited and it is also in wide variety of sub- ject content* It was fslt that the subjects originally outlined and for which information and comments wsre requested* allowed for ample placement of practically all desired material and would facilitate ultimate breakdown as has been done, for use as supporting data and with the most possible appropriate subject association* As a conse- quence, miscellaneous comments and varied, sometimes repetitious ma- terial, are included under this heading* These include; a* Assignssent suad promotion difficulUss of th# Rurslng Corps of the Kory. b. Difficulties of the Army Fur slag (brpa la regard to uniforms* c. Establishment of Armed Forces bade Medical Schools for peacetime needs and the cost thereof compared with that required to train pilots* d* Appointment of civilians to oeamittees now dealing with various aspects of the Medical Services of the Armed Forces* e* Streamlining of Medical Sectlone of less important commands* f* Seed for adequate planning and readiness to deal with problems of civilian defense which will arise frda new methods of and total war* g. Requirements for adequate intelligence information on medical matters from various countries whore such in- formation is not now available. 3. The development of top offices with, simply stated, the mane of paper work associated therewith as evolved during the year. 1939-1948 has extended its tentacles from varied Government activities into all Medical Department echelons. As a part of the Military Betab- q& lishment, it le final/ believed that an abrupt about face in tha matters of statistical control elements through all levels and a concerted unified reduction of reports, paper work and artificial offices is most urgently indicated. During the war in aany instances it could be truly stated* "the unit accomplished its mission in spite of the existence of interfer- ing and top heavy higher agencies*. Ability to conduct defensive warfare without major hysteria and by decentralised simplified authority based on appropriate standard operating procedures should be a major goal in the education of the Medical Department structures and in fact, it it believed should be considered by the other branches of the Military Establishment. Centralised control with multitudinous reports and complex procedures will result in mass confusion and impoteney as a result of a direct hit by out atomic bomb. Sow is believed to be the time to plan and if possible estab- lish self sufficient medical echelons capable of assuming full operational control for such action demands for which they may be called upon. World War II, medically, was in large part, original holding action followed by multiple objective large scale offensive warfare. The ability to fight another war under such favorable conditions should not be considered certain at this time. The thought "defensive warfare” is repugnant to a victory imbued and educated people and is therefore better contemplated only to insure that as such. It it conducted as an adequate "holding action”. Dis- persion of industry, populations and of military establishments is believed to bo a major requirement in the event of total war. The Medical Depart- ment should make an all out effort to adjust their thinking accordingly. 4. One of the factors which must he considered as falling within this field concerns the utilisation of service medical personnel and faci- lities for the care of civilian populations of occupied countries during and after war. In World War II It was an accepted practice to care for civilian Injured in the Oombat Zone. The Military Government organisation was designed to embrace medical matters in these countries. That it worked under great difficulties is well known. On the Field Army level it was organized with a complete staff including medical and operated as a general staff section. This did not affort the Chief Surgeon of the Army control over civilian medical matters in his zone of responsibility. It in practice led to the necessity of taking over critical situations that could not be handled by the meager personnel of the Military Government Section as each crisis arose. This indicates the need for a thorough study of the system used during the war in an effort to evaluate its soundness on experienced factors. It has been suggested that all medical matters in any specific area should be placed within the realm of responsibility of the Chief Sur- geon of that area and that hie staff should be implemented accordingly to care for civilian needs. Tnis practice would have obviated the instances where conditions forced hie intervention In this field in order to protect the health of the troops as well as provide some merciful attention to the helpless. 5. Certain attributes of Kavy Department General Order Ho. 245 dated 27 November 1946, have been pointed out as being most applicable to the Command and Operational Procedure cost adaptable for the larger medical installations of the three Armed Force®. Paragraph 3 define® Command as the •author!tatire direction exercised over a unit or individual...... in all matters, not specifically excepted by higher authority and is commensurate with the responsibility imposed". It continues and include® 783 the following four componenta of Command, with responsibility in each component commensurate vlth authority end each containing the authority to make appropriate inspections} (a) Military Command,......author!tatire direction, (b) Coordination Control.......to insure adequately Integrated relationships..(c) Management Control.•••••direction exercised, in ether than military matters* ; In routine administration and control of its loonl operating functions; (d) Technical Control....... specialised or professional guidance exercised by an authority in technical matters that hare been assigned to that authority. Continuing, each activity is con- side red subject to the exercise of one or more of these components ae may be designated. In general, the designation for Military Command and Coordina- tion Control are deemed properly to be of the area or local Command. Desig- nation for Nanagemont Control and Technical Control is bsllorod usually bast concentrated to the higher technical echelon. It is beliered that further study in this regard as applied to Army and Air Force Modieel echelons may be of considerable benefit for future definition of respon- sibilities and authority. «. mmsms. 1. That the vide variety of subjects included in this category do not Justify a specific conclusion for each at this tine. Many are matters which can be fully satisfied by independent Armed Forces Medical Department action. 2. That the sources of information regarding things of military medical significance in most areas of the world are very sketchy and not currant. That there should be a Medical Section established which should in peacetime seek out and keep current information as to the true statue of all conditions which pertain to health and medical facilities in all foreign nations. in. msmamnm 1. The establishment of a Medical Section in the Central Intell- igence of the national Security Council composed of suitable experts te secure and hove available la usable form Medical Intelligence of a global nature. 784 TEOB COPT OTHACT Of 10BPQHT Of IITSRTI1W WITH OOL KART 0. PHILLIPS, ASC. 27 Apr 48. ****** M. *Oas of the problems of paramount importance which was probably the aor;t persistent problem during the war mad which has continued throughout the past year is the matter of uniforms. Ho outdoor uniform wa* available ia sufficient quanti- ties at the beginning of the emergency to meet the needs of the rapidly expanding Aray Bure a Corps. Burses were brought into the service and assigned directly to ex- la ting operating hospitals, or wore brought in through the affiliated units and assigned to installations for purposes of training prior to shipment overseas. That period of assignment to those various installations varied from two weeks to over a year. It wasn't until our basic training centers were set up in tue latter part of 1948 that there were established casters from which we could equip nurses. So, up to that tine, tho uniform equipment for nurses, for women of tne Medical Department, was on a mail-order basic. The flint five thousand nurses that wore brought into the service were handled through the Surgeon General's Office, and the eises ef clothing for those people were recorded by the Barsing Division. The list of sisms was submitted to the quartermaster in tho hop# that they would use that as a basis for sotting up their sloe requirements since the grcnq> ef women that were being brought into tho Medical Department wore within a certain age group mad had to moot certain physical requirements as to height and weight. Instead, I understand that the $ftnrtezaaster fieaeral’s office used else tariffs supplied then by the Rational Silk and doit Company, and the result was that they stocked many sines that ws could- n't use and there was a very groat shortage of tho necessary sises and a grsat over- supply of the larger sites. The rapid movement of personnel overseas did not allow time for tho necessary requisiting of clothing from the Quartermaster, then shipment to the post, mad the equipment ef nurses. So, I know from personal experience that maty nurses went overseas with probably a scarf, a pair cf gloves, and a fsw pieces of civilian clothing that they brought with them. It took months for our personnel to got their complete authorised uniform equipment, end many nurses wore doparated from the service after one or two years of service without over having received their full authorised issue. Until a suitable uniform for tropical areas was mads availablo, nurses in tropical areas wore sweltering ia winter uniforms; and, at the seme time, nurses la Europe and Africa were suffering from lack ef adeqiate warn clothing. Oar difficulties, as I soy, have been right with ms through this year, particularly in the supply of our hospital uniform. The sale ef that uniform was net restricted to the personnel authorised and required to wear it. Conse- quently, is overseas areas and ia seme areas at home, civilian personnel could buy It, which would result in depleting the sises our people needed. We found ear nurses in veiy tattered uniform. Be had to appeal to the Quartermaster and the PI to help straighten that situation out, to put in emergency requisitions, but I still find, when I make visits, that they are experiencing trouble. lew, with the authorisation ef a white uniform which will allow the nurses to pur- chase directly from civilian uniform companies as wc did prior to tho war during peacetime. It may take care of that situation. It wasn’t uncommon during the war to experience difficulty in obtaining proper shoes; and, when I was in the office during part of tho morgency, X answer- ed frequent calls from Congressmen and families wanting to know whore they could get coupons to purchase shoes for their daughters overseas and wanted to knew why the Army couldn’t make those items available. 785 TRUE COPT (Extract Ltr Nellie Jane DeWitt, Captain (MC), BSN, 29 April 19-42) «hh»«a senior nurse corps officer should be assigned to e aeh District to act in an advisory capacity to the District Medical Officer in natters pertaining to the nursing service of the District# Bank distribution, and status of reserve nurses on inactive status should be considered carefully and equitably adjusted before an emergency arises# The number of Commanders and Lieutenant Commanders presently allowed Is not ade- quate to cover the top nursing billets in naval hospitals now in operation# It Is recommended that legislation be initiated now to rumove the restrictions in the ranks of commander and lieutenant commander in the II gular Nurse Corps# Unless adjustment is made in the oresont rank structure a detailing and local adnXnistratlve problem will result iq the event of mobilisation of reserves on inactive status# Under the system now prevailing nurses on inactive status In the reserve corps who have been issued permanent appointments in the rank of lieutenant commander, if assigned to active duty, would be senior in rank to regular nurse corps officers senior in service experience who reverted to the rank of lieutenant in accordance with the provisions of Public Laws #36 and #3B1« Another point to be considered is that those officers who reverted to the rank of lieutenant will be required to take a professional examination when they became eligible for promotion, whereas officers in the reserve corps will attain the rank of lieutenant commander without being required to take an examination* it the present time the method of connoting inactive service of members of the Naval Reserve Nurse Corps is at variance with the met od followed by all other branches of the Navy (officer or enlisted personnel), for these nurses do not receive credit for inactive status when computing service for longevity and for pay purposes# A legal advisor should be assigned to the Nurse Corps to advise the Director of the Corps in all matters of a legal or legislative character# Nurses should be assigned to the professional duties for which their education and training have prepared them# In World War II nurses were assigned to duty in linen rooms, and as housekeepers and stenographers# A list of nurses with special training, such as anesthetists, dietitians, operating-room nurses,etc, should be maintained In the Bureau of Medicine and Surgery and ip each District, so that the service of these specialists In the Nurse Corps may be properly and advantageously utilised* Because of the limited facilities available at Receiving, Evacuation and Convalescent Hospitals, it is recommended that such hospital*!* used only for the purpose for which they are established#* ***** . L & FCR1 Colonel, 1C 786 TRUE COPT EXTRACT Of REPORT Of XHTKSriSV WITH COL MART 0. PHILLIPS* ARC, 27 Aft 48. ffiESHL Misinformation at to the seed of aeessstury equipment In overseas areas vat toMtiaes given oat at the port — I don't know through whose fault —- to that sose of oar units tailed after items of uniform, each at raincoats and galoshes, vert taken awgr from thou They would got over seat In the rain tad mod vithout those necessary I tens, and the overseas theaters did mot hart the supply to take taro of thoir needs. failure to restrict Post Exchange sals of women's items in overseas theatres to American women frequently caused depletion of each supplies and ne- cessitated the women of the service requesting thoir families to send other nam- es sary articles. Later on, while the nurses got overseas without being properly equipped* uniforms had to ho shipped overseas to catch up with the nurses; hut* cf course, priority then had to he given to shipment of very necessary war supplies and the clothing very often was held at port waiting for a high enough priority. In our matter of uniforms which was* as I said* one of our biggest problems* I think there are going to have to ha centers of distribution sit pp. BEAR ADMIRAL AIDERSOH: Do you recommend a uniform system of uniforms for all women in a given armed force? COLOUR! PHILLIPS: X surely do. The only difference should he in the professional uniform and the non-professional uniform so that the patlaats in the hospitals will know whether they hare a professional person or one of the non- professional group. The MACS agree with that, too. Rut In other matters of uni- form* the tame* only different insignia. That would do away with our distribution problems. ■•••••••• r~"> i / • >•> ,>*•7;—»- r~« . L,X, POHL, OoIdMl, MO 787 iXTiUCT OF STATISTS tUDL Br CAPT. E*2L HSitIHG, JS., (KC) USS OE 22 APHID 1948 AT IKTSHVISW WITH SUBCOMMITTEE OB THE OF MILITARY MEDICAL ESSOUECSS, •♦••••• ML "This does not refer specifically to A-Bombs, Bat for any catastrophe we should have plans. For instance, in the area la which a/ station is located we have a few local plans. Last /ear ve had two hurricane alerts, and I had say medical companies read/ to go. But it vac Just local. There wasn’t any author- isation for it or any back-up medical supplies other than our combat supplies which ve normally have. la « total vftr ill of us should hare definite plant at to what our utilisation in this country it going to be, rather than Just orer there in the target area,* MMM* A.r. pohl, coioi»i# mb 788 THTO COPY SCTBAOT (Letter from Captain N. J. Aston (MC), OSH Portsmouth, Virginia, dated 23 April 1948) «4, a medical officer of more than thirty-one years service Z desire to state my belief that our nation confers no higher privilege on its citizens than to permit them to serve in its Armed Forces, as a career and most Importantly during a time when the very existence of omr country is at stake. I further consider that the overwhelming majority of the medical personnel of both army and navy served la this late war with complete fidelity and patriotism, and had little cause for discontent vhen the high privilege of such service was fully realised. It is perhaps inevitable that in times of peace our armed forces come in for a varying degree of criticism. Much of this criticism in ay opinion is unwarranted, yet we are exposed to it and in order that it can be held to a minimum, it behooves us to put our house la order and to keep it in order, to the end that we any serve our nation more fully and effectively. ” ••••• L. X. Pohl, Colonel, MO 789 im KEHUCT COPY (Mr Cpt. I.c. tuakel. WC. USB. dtd 21 Apr 48) ******+)(• *fhs peacetime procuremeat of medical officers should he accomplished by the institution of armed forces medical schools, these schools could he located in large cities as Philadelphia, San franc!seo, and etc* this type of school could ho likened to Annapolis* except it would be a medical aeadesgr* so to speak* with the tuition and monthly salary paid hy the gerernment, aad graduating the candidate as a lieut- enant* junior grade* in the medical corps* L*l* ?OHL Coloa«l, MO TOO TRUS COPY EXTRACT (Letter, Rear Admiral C. L. Andrus (MC) U3Ji, 27 April 19A8) ***** *It is also felt that since the Military Medical Resources (Army and Navy) in World Sar II were separately administered in accordance with different long standing regulations, policies, standards and practices of the respective services it is not possible to suggest certain corrective measures unless these basic concepts are reduced to a common demoninator in so far as they can be made applicable to tasks and missions to be per- formed* With this accomplished it is believed that a single Medical Ser- vice mould eliminate the cause of many controversial points and result In fewer reasons for criticism In regard to the Medical Service rendered our Armed Forces•* ***** L. K, Pohl, Colonel, MC mw. BXTBAgl COPT (ttr Brig Oen *uy B. Dealt. 1C. Surgeon. 13 Apr 48) ***** M, *lt la a mistake la my opinion to base our future plans on those plans f.ad policies existing during World War II. That conflict la over and, although we may learn something from the Bistakes of the past, we may be sure that the conditions of future warfare trill be radically different from those pertaining during the past war. Future planning should be based on the visualisation of conditions that yill obtain rather than those that obtained in past conflicts. It has been truly eaid that one thing that we learn from history Is that wo learn nothing. It appeared Impossible to get gone people in the Department of the Army to visualize the type of war* fare fought in the Pacific. Out past and present teachings with reference x to the medical service In theatres of war did not adequately cover the con- dition found in the Pacific campaigns. These campaigns consisted of Island hopping across vast expanses of water with Jungles as the ultimate beachheads. Similar conditions are apt to prevail in the future with a probability of substituting arctic conditions for jungle conditions. At any rate it it that the entire campaign will consist of mass awie's meeting Bass araies In sucji numbers a? have pertained in the European campaigns of iforld Wars 1 and 11.* ***** • a, *'OHL, \5oloneI, HC 791 flgPI COPT KT8AQT (Isttsr from Sr. w», C. Meanlager, Topeka, Kansas, dated 32 April 1948) •*••• "firstv Z vast to to perhaps Impertinent sad strongly recommend to General Hawley through you the sppolataont of several civilians oa your committee of eoerdlaatioa of these aedleal services. I do this with the slaoero belief that some of the elvlllaa aedloal confreres sight have eoatributloas to Bake to your eoastlttee which could act sad will not be brought out, la ay opinion, when the committee Is composed entirely of regular officers of the various Services. General Blseahover repeatedly has Indicated his belief that the Military Services Must Include henceforth the active participation of civilians. To compose a committee of the Medical officers of only the Services and to exclude the potential elvlllaa Bsabers who become so important to you la a time of emergency, seems to as to be a lack of faith la these civilians end their potential contribution to the development of the military Services during "peace time". ***** *•••• "A minor point about court Martials at which psychiatrists were supposed to appear, long since we. have recognised that If we arc going to give testimony about an Individual that this should ba on the bails of a "friend of the court" and not as a partisan witness. This still goes on unchanged."*•*•• L. X. Pohl. Colonel, KC 792 TK® COPT CBrtraet Ur ■>*».S, Hlx, U Col., MC (Kosigned) U April 19«S) 1118 *•**• to ~h"h *U»8«Jof th. part “«*• *• bf.d“». *» a. I TOe It too m lesion of the future riU S cmieremt. Also* it would be unusual to have ail the facte at hand whirh prompted any given policy or decision."***** & L* K. PVSL Colonel, MC ffiUR Juaiaot COjpY (Ltr »ri« Gen duy B. Dealt. MO.Surgeon, did 13 Apr 40) •••*• K. "As stated la the beginning of this letter, these ere random thoughts which occur to as as X dictate this letter* There Is and eanbe ao easy road to success in formulating future policies and plant for the Medical Department. Much research, careful stud/, vivid imagination, and persuasive arguments will he required before any gains can be made* One of the worst mistakes that we can make Is to attest to boletor up an old building with now props* It it essential that we start from the bottom, dig a firm foundation and build upon that a modern structure. X hope, as stated In your letter, that ay remarks will nov be construed as reflecting unfavorably against any individual or group of the military establishment and that they will be kept on a restricted basis. It ie my opinion that the ssdical service*: of the Armed Forces did a superior jcV) during the late war and were far above most of the other services. However, we do not now have and cannot in the very near future formulate plans at excellent for future conditions ao those wi had at the beginning of World Mar II. Tims, experience, and thought will be required to bring our new plane up to the standards of those we had at the beginning: of WorId''Var>II. u X. • V • i-’utlL Colonel, HO 793 TEDS COPY SH3UCT (Letter from Colonel Hobert S. Slmoson, USA (Het.) dated 1 May 1948) ••••• "(3) As to suggestions with the end In view of attempting to remedy the defect* previously noted} Universal military training in high school, premedical training and undergraduate medical education to build up a reserve of medical manpower. This solution depends upon what turn polities may take. Whether or not military training becomes compulsory, some system of obtain- ing trained and proficient physicians and surgeons for the "regular11 or perman- ent Armed Forces must be considered. Medical education nay be subsidised in several ways. Arrangement may be made with a recognised Medical School for the education of Doctors of Medicine to serve the Armed Forces, a kind of Medical Cadet Corps. These applicants may be selected from pre-medical training on t. basis of scholastic record, physical standards, aptitude tests, etc., and sent through medical school at government expense, the course differing in no respect from the routine curriculum during the autumn, winter and spring months, but the summer months devoted entirely to military training and experience. Interneships could be arranged in general hospitals. The trainees would be required to obligate themselves for a number of year* service, certainly, at least, the number of years spent in training, perhaps more. Consider the cost of training an Air Fores pilot la comparison with educating a physician. The expense of one year’s flight training will probably exceed the five years training required for the physician. Pro- fessional and military training in emergency has been mentioned - specialised training at various centers, military or civilian, for the specialists, and special eranhasia on oasm hygiene, preventive medicine, sanitation, etc. for the young general praetleloner, with a minimum of drill and military forma- tions. As to enlisted personnel - train a man (or woman) for a certain Job 'and insofar as possible, while he is in service. Keen him on such a Job. Promotion should be based on length of service and efficiency, primarily the latter, and not governed by rigid, iron bound tables of organisation. In a period of emergency the oMginal rank of the medical officer entering service should be governed by his age and professional experience. The base pay should be increased, to what extent 1 am not qualified to recommend, but at least it should be approximately the same for age groups, if practic- able, of emergency officers. Staff assignments should be more "streamlined* and less professional talent utterly wasted on more or less meaningless desk Jobs. Svery echelon of command does not have to have a staff surgeon with a retinue of lesser lights, to help him "spin hl« wheels". Junior medical officers should be rotated from duty with combat organisations to hospital duty, and every encouragement offered to "keep on their toes" professionally.* ••••• y ■ // L. K, Pohl, Colonel, MG 794 IMS C9FX SITftACT (Letter, Colonel C. J, Beker, MC, Air Force dated 22 April 1948} ***** *3* Ob* other Better which I felled to cement upon previously, but which hea been the cense of ouch disaffection is the Methods of handling physical examination reports and hospital clinical records. It is sy opinion that these reports and records should newer be given to the individual concerned, but should bo ** "Confidential * and forwarded through nodical channels only recoenendations affecting the status of individuals extracted and■ forwarded through military channels or given to the Indldidtnl,' TRPIS COPT EXTRACT (Letter, Brig, Gen, Janes Stevens Simons, USA (Ret,) dated 30 April 1948) *•*•* "However, I am writing to toll you how deeply interested I ii In the planning by your Cocadttee, and how important I feel it le to make adequate'plana for * lilt ary preventive medicine and civilian public health in connection with any total preparations set up by your group. "I hope that such plana an are Bade for military and civilian health in the event of a new emergency will be worked out in such a way as to avoid the confusion due to shortage of specialised health per* sonnel which occurred during the last war* As you know, this resulted in a wasteful competition among the Armed Services and civilian health agencies* "While at the annual meeting of the Association of Schools of Public Health in Toronto on April 16, I was elected President for the coning year and was authorized by thatAssoclatlon to nake contact with you and to tell you that the Association will be glad to cooperate with you and to assist your Committee in any way in which you think they might be useful* The Association is made up of the Deans of the nine accredited sehoole of public health in this country and one in Canada* "I hope that during ay stay in Washington I nay have the pleasure of seeing you and discussing this natter further*” L* K* Pohl, Colonel, K 795 TRUK COPY EXTRACT {Letter, Captain F. C, Gr«am (MC), USM dated 17 April 1948) •The memorandum cm Deficiencies, Operational Errors and Malemployreent of Medical Resources in World War II arrived 15 April. The request for consent and suggestions cm the points mentioned will be difficult to con- ply with in the short tine allowed and also in view of the fact that the validity of the criticism leveled against the Medical Services is question- able or, at least, requires considerable qualification. Certainly no criticism can be made against the results obtained by the Medical Services during World War II, The successful care, treatment and evacuation of casualties narks an all time high In the history of military medicine. The efficiency of preventive medicine practices accomplished by the Medical Services enabled commanders to successfully carry out military campaigns in some of the most disease ridden pest holes of the world,* TRUE COPY EXTRACT (Letter, Dr. Russel ?. Lee, dated 18 April 1948) ***** "While not asked for, seme considerations of civilian defense must be included in military planning. The likelihood of atomic warfare causing hundreds of thousands of civilian casualties is not fantastic. Airborne medical disaster teams should be organised immediately in all cities, prepared to fly with hospital equipment to any area subjected to bombing attack. Dry runs should bo given these teams until they function smoothly. Medical students and pre-medical students must not be drafted. Associated scientific personnel should also be exempt — except in the sense that every active medical nan should be considered as part of the war effort and utilised accordingly.* L. K, Pohl* Colonel, VC 796 TRUE COPY EXTRACT (Letter, Colonel Robert E. Peyton, HC, USA dated 19 April 19A8) General* It is recognized that deficiencies in the employ- ment of military medical resources did exist in World War II, A great mass of the reports of such conditions were undoubtedly in complete error. Only people at the proper range to observe and in possession of complete knowledge to properly evaluate their observations can be regarded as competent to judge many of the reported conditions# Further, it is neither fair nor sensible to confuse hindsight with foresight — particularly when the information on which hindsight la based is pre- judiced, incomplete, or other than that on which foresight is based# "Much of the misunderstanding resulted fro® a failure to appreciate the dynamic situation in an active theater of operations# There is a constant inter-play of such factors as time, distance, dispersion, casualty rates, distribution of units,, shipment of units, evacuation policies and the means used for evacuation, availability and priorities of unit equipment, availability and priorities on ground, surface, and air transportation, the acquisition and development of hospital plant sites, the necessity for the provision of reserves to meet either actual or anticipated needs, and ever changing strategical and tactical situa- tions# Any one of these factors affects the others# The larger the theater and the faster the progress of military operations, the more important will these factors become # Provided the situation becomes static it is possible to approach ideal operating conditions, but even a static condition brings in its train many undesirable features; for example, the complaint that medical means are not being used to their capacity. »**♦* in the theater where I served five American Armies were engaged in a combined operation, which, except for air participation} was initiated by an amphibious operation and progressed into a sustained war of movement on the continent of Europe.' For the record, I think the Medical Department did a superior job. We exercised a degree of medical management never demanded of any men before us. In all sincerity I challenge any men after us to do better. I submit that apparent correc- tion of some deficiencies of World War II may open the door wide to more serious deficiencies in the next war. ...-y L, K* Pohl, Colonel, MC TBITS COPT BXMUsCT fflOH AIR XTaLUaTZOS BOARD 3MPA HI5POHT SO* 36. ?H£ R&DIOAL SUPPORT OS AIR MARmg IH TIP. SOUTH AMO SVh'A :-ROh DSC 7. 1941 fO AUGUST 1946. M. "The various diseases encountered ia these theaters were responsi- ble for the loss of many days of fLying duty* Malaria was erne of the out stand- log health hasarde to efficient air operations* An excellent system of solaria control was developed daring the coarse of the war which Markedly reduced the morbidity rate froa this disease* The airplane spraying of insecticides, es- pecially DDT, was an efficient method of control ling di sease-heari ag mosquitoes and flies. It was the consensus of interested personnel that even sore effect- ive results would have been obtained had a special unit been developed for this purpose. Inadequate nodical intelligence resulted la the failure to take proper precautionary measures in a number of Instances* The high aorbldlty rate froa disease which resulted, seriously threatened planned operations* This was particularly true of malaria during the early days of the war and scrub typhus • during 1944, Water and food borne diseases were extremely common in these theaters and bee use of the lack of training of nil personnel In the basic principle of field manitatlon, the number ef man-days lest from flying was frequently excessive* Materials and supplies necessary to centre! the dis» eases encountered In these theaters were frequently lacking*•&«*»*«» r , m Gomsms Ison asots* SU *Tb® effectiveness ef the Air force medieal cervices in Sloping troops in fighting condition, in contrast to the Japanese, was one ef the most important factors contributing to the defeat of the Japanese Air force. Medical Officers in lower echelons were required to spend a disproportionate share of their time in the preparation ef reports. ******* 798 YBBE £3ffftACT_ CQFXt (&: tract of statements node by Colonel Thomas J* Hartford, HC9 USA on 23 April AS at Interflow with Subcommittee on the Eraployaant of Military Medical Resources) ***** *eu flail, only cos thing* I think that we should emphasise to the rest of the Artsy at ©very opportunity that colds fren purely aiedieal oai« that m sh ****** wT/ L. K, Poll Colonel, ac tars detract copt or midioal support op the uhaat ii mn mopsuor thsatsh op opjs&- ATIOrr* RIST0P.1CA1, S3CTI0E - APTAS, ******** K, "Personally I feel that bo medical efiic«r as each serves any good Purpose on combat mission* and w therefor# risk a erltieal item * the medical effleer - for a very questionable gain, X do not knew your reaction to thie mattor. however, If Plight Sturgeon* wore not eligible for the Air Medal the eombat alaslos problem would be a "dead £«*%•♦♦••••• Colonel, «0 THUK EXTRACT COPT (Ltr Cmdr Martin T. Maeklla («C) USS. dtd 12 May 48) *•*••««« h, »|t would be of advantage to standardise the records of all Armed Service personnel, officers and enlisted, with recommendations for the future considerations of the Veteran's Administration, this standardisation should also include reports, forms, vcqulftltlons, nomenclature, supply catalogs, equip* meat, eto. It would 'bo woII for tho services to establish a working plan for tho Surge Oorps, whereby the Individual * a professional training is utilised for the bedside car® and attention of patients * rather than expending most of their efforts in clerical work and non professional duties that could be perforated by grey ladies or other competent workers. Such a plan would als< aot towards solving the enlisted personnel shortage.«•••••♦••*• POfCTC«\oa*X» KO 800 of 117s ixt (5olono\ j'rodnric 'J. Korstcweli, ISCM U.S.A. an 22April 19h0 at int rview wit3i Suoccr.Lj.ttoc an of :&dical les ounces miibimbi hhiii hi **'11 —* ..1 .*.1 —, ■■ - —■— -■■— .. - - ... — r iw *&><&&' Ag far as atomic warfare is concerned, I can’t answer that I Tjesa any more tl'ian anybody else can* I understand that the general concept of plann ing for disaster relief within the continental limits considers at tills moment ti«at tie major portion of disaster relief will ■« conducted >y civilian agencies* Naturally they will look to and will n od sane typo of military guidance and control, init the ariaad forces cannot bo expected to have medical service for the armed forces and also take care of too civilian population, too* With that in KdLml I don’t believe there will be any or imminent change in our planning* " whhw ”(M) IQ* Ag far an Ho* 10 is concerned, I think the anaod ser- vice medical departments on the very highest level should participate in planning for civil defense because even though civil defense I think properly belongs with the civilians, nevertheless they are >oing to lock to the military for guidance and they are going to have to be given t at giidanco by tiie military* M (M) 19, I agree with 19* I think t lat we definitely need a medical intelligence a,nancy* It was certainly demonstrated in the recent war that wc noodod this information, we needed it badly* I think it should be kept up to data at all times* I don’t knew what or animation in particular would be most practical, but we certainly need soiae or anization* "■a*-*** "Tilhat is your opinion of the advisability of establishing a joint armed forces agency or institution to collect, evaluate, publish, and disseminate the results of past and current research nd develop- ment in the fields of military medicine and surgery and preventive laedicine, including atomic warfare, biological warfare, and psycho- lo ical warfare7%:^ nI think that*a an excellent idea also, I think that the ad- van ta e of training individuals, and further by furnishing trained individuals for future staff use and indoctrination would be tre- mendous, I also think that the very fact tiuit the institution it- self was conducting teaching would keep up their standards and keep then on a inch dgher level by virtue of the fact they not only wore dotn r this work, but ware inserting this infortoation to other people in a student capacity,ft4HfcHsr» SOI TE2S OOP! SHTBlGt 07 ZSTBiVUBW WISH GOLOSH. VISOIL OOKHILL, hC, 03A, 90 APBIL 1948 i| voold like to ask your opinion as to whether the atomic warfare, which scams destined to occur la ware of the future, will Increase ear total medical requirements and if we meed any special units for this possibility? COLOISL COSSSLLj You wean particularly Ar-sy unite la the field or general throughout the Ration? BUGASIM. axsxaAL MMTUt la the field particularly. COLOHSL CO&SSLUt It ha— t occurred to — that it would pay to use tka at— b—k oa forward units to aay groat extent. It night ko used over hugh porta of embarkation, debarkation, supply depots, ordaaaoo depots, largo airports, or —thing of that sort whore a whole group of b—here could ko pat oat over sight, so that only at those points would I thiak that the thiag had to ko considered* It would he of ao value to hero a spodal vait tharo koesmso vo wealds't kero th— after the atoaie ho mb exploded* I thiak that la oao of oar gr—tost daagors. Oar nodical iastallatioas, which will ko greatly aooded aftsr the at— bomb* should aot ta wher- the at— keak aay explode. They should ks at least five, perhsps hotter saw— disc beyond what might ta a center. That's one of Mo reasons I have considered the building of thoeo big now hospitals down town in Washington are rather poorly chosen sites. I don't knew that a special team io needed beeemae after all it In1! Me radiation effeet Mich we are going to bo able to do aatyhiug for immediately on Me pereenc who ere exposed. The greatest need it going to bo in preventing people from coming in oenteet with radiated substances. I tklak oao of ear kiggoot difficulties, especially dtk regard to oar deed progr— * is to ho able to have Ita Intestinal fortitude to coy that this follow skoal da* t got aay blood tanstt it voa*t do hla aay good* Lot’s giro it to ft— My site that —ode it aora» GOLOSH, POHLi The same applies with your ponieillin and these other items, wouldn't it, at to their Heed os met levels I believe Me codecpt io if it goto below e certain stage Mere ie no use in jiving thorn Hood, end if yon hare a Mart supply ef infection preventing aatl~bletiee you are going ta have to Mk» a distinction. Saw, how till theca distinctions be medal Mat teems da we have? COLO&& OQSSBLLt T»a« kl I ioa't kMt how ew supply of ai|hl ko it ttoM tins* X thiak «• cut laintM productloa of thw, tat kloed lo |«ot sonothlag you a— g«t to sash of at * giv—time and will him Just to such «» hand. Of eetfM if jrw stock of oaythiag irltital tas tan dtamnd that9* a—dad to this taolf group of pati—ts, tkaa you tan to decide vhlah group tan ft ohooM* Mi «Uta imp do mot; tail I do taUm fm tta • you sight coll At in itary aspect, broadening tta ntjtet of ntlUtln to radlaaatlv* aotoriolo aov, your voter supplies, evea your building* sad material aod supply dumps, food - I 4os*t thick will ho to a—& affected taint it hoc tan ralata oo by nitaatlivt voter mod la all-aetal ooataiooro - hat those ooa ta cheeked over by trained took* aidaas, sad that could so— to so —aid ta sufficient, Tea wouldn't aood a aedieal efflosr, that ye* aood io a physicist la charge of vaok a ta— r OLoaoa, ms 802 mm con m&ACT of xhtsbtisw with &m adnieal kohtoi & willcutts (mc)U3i OS 4 May 1948 «*•**,« ti. •ter Admiral Andersonj The work of the Subcommittee on Bmploy- ant of Military Kadi cal Hesource# it outlined In this letter you received from the Executive Secretary of the Committee on Medial and Hospital Ser- vice# of the Armed forcee. On the list of subject# given in partigraph 2 are those that we hare asked to review and offer reccaaseadatlon* that might la- pro ve the medical service#. bo are Interested particularly la lapmasBts where experience in the last war indicated that changes la organisation, train- ing, logittie supply, or other parte ef the nodical service might he improved* Do you care first to make a statement following this outline? Os you ears to cement on it without questions, first! BEAK ADMIRAL mifiOTTSt By comment. Admiral Anderson, first, would ho that personally I was very much impree od with the efficiency of the )M- ieal Department ef the Havy. 2 mam no dmflcieaees that could net he explain- ed on the haelt of war, which, as wo all knew, is always wasteful, hasn't It general Forrest who said that victory geos to the one who gets there fastest with the nos tost I Tear subject startled mo — deficiencies, operations! errors and mal employment of military nedldal resources in World gar 12. 2 understand that is a bread subject. 2 am merely earns on ting that personally 2 refute that as a specific charge agftinst the Armed forces, especially with the one I am acquainted with* 2 do net think there are deficiencies. There were errors, there was malemploynent ef military resources* Why? Because ve were at wer* I have no rebut tel er excuses to explain it msey*********** IX FOHLVCOLOHjE., no 803 ccmrms. cm medical amd hospital services OP THE ARMFD FORCES mr, ,qr,„ 3«t«MO Manbers of fiHfoflfflEUtff pfi Kfdlfifll fiftWTCh and Koabers of Snbroiiwl tUo on guplownt of Ullitary Modlool Resoorcog s a»r 1^8 1* This nesting was held at 1A15, Ray 5, 19*3, in accordance with provisions of Latter, Condttee on Medical and Hospital Services of the Areed Forces, Subjects Coordination Anong Subcommittees, and Presentation of Subcommittee Reports, dated April 27, 194*. 2* Officers present were Brigadier General Joseph Martin, MC, Colonel Otis 0* Benson, MC, and Colonel L* JC* Pohl, KC. 3* The precepts and terms of reference being considered by the two Sub- committees were reviewed* 4* The following discussion was recorded* •COLOSFL BEBISORt This is cm research, and it's certainly ay opinion froe attending subcommittee Meetings cm research that there would seen to be rather complete agreement that the directorships and the direction of research in the respective Medical services should renain in their present fonts and status. •Sons of the considerations leading to this apparent conclusion are* "1* That each of the research directors order the respective Surgeons General and Air Surgeon, with their mall staffs, act as day-by-day con- sultants tc their chief and to innumerable Military officers of their de- partment, and act as consultants and inforeants to aany civilians and university agencies* •2, That basic research cannot truly be duplicated, and it would even be desirable if aoxe and more fundamental researches sere duplicated prior to announcement of the result to Insure complete factual!ty and trueness of concept* *3* The Subcommittee would also ease to agree that such closer liaison and coordination mat be effected In the field of nodical developments* *4* A final and very conclusive consideration Is that established by law la the Research and Development Hoard existing at the level of the Secre- tary of Defense. Zta legal teres of reference set this Board up aa the Research and Development Coordinating Agency for the Arsed forces* •In the medical field. In its broadest sense, are two committees, first, the Committee on Medical Sciences, and two, so that this is a contiguous and related field, the Condttee of Hunan Resources. Thus it is 805 apparent that RAD Board la and will ha the Research and Development Coordinating Agency despite an/ contrary opinions expressed by military personnel concerned with research,* • * • OFF THE RECORD * . , 5, The following conclusions and agreenents were readied as a result of this seatingt a. The Subcommittee far Employment of Military Medical Resources has no overlapping findings, conclusions or recommendations which nay be considered in conflict with these being considered and/or planned for recoenendatlon by the Subcommittee on Medical Research, b. Both Subcommittees are in agreement that need exists for a central collection, assembly and disseminating agency for the instruction of mili- tary and civilian (particularly potential nilitary) nodical profsaaional personnel, of research findings end data of cession interest. This is be- lieved particularly desirable so as to lessen preliminary training and in- structional periods required for Medical Department personnel upon mobilisa- tion end to increase their potential efficiency in event of need for their services in either military or civilian status in event of total war on this continent. 806 cohhittfe c® kedical and hospital services cr THF ARISED FORTES max. gi.csmaiigi ct Between Meabere of SflhfflwUttf T« KidlfflUl and Keabara of SttfrfiflMUttfi flfr Of tttlUfllT KttUcti BjMMTBMI S Bar 1^8 807 1* This seeting was held at 1350, May 5 ,1*4 8 in accordance with the provisions of Letter, Coaodttee on Medical and Hospital Services of the Arsed Forces, Subjects Coordination Asong Subcoawittees, and Presenta- tion of Subcoaaittee Reports, dated April 27, 1948* 2* Officers present were Brigadier General Joseph Martin, MC, Colonel Otis 0* Benson, MC, and Colonel L* K* Pohl, MC, 3* The precepts and teres of reference being considered by the tee sub- committees were reviewed* 4. The following discussion was recorded* "COLONEL BESSONt The Subcoaaittee on Intelligence have completed their deliberations and have agreed on reeonendatlons* The final report has not been submitted to the parent coaadttee, but the reeoaaendatione are quoted by virtue of the eubeoanittee agreement concerning then* •RBCOMMEKD ATIdSS s *1. That an Arsed Forcea Cantral Medical Intelligence Organisation he established* •2* a* That this Central Medical Intelligence Organisation be cen- tralised fay a Medical Intelligence Office assigned to and operated under tha Medical Coordinating Board at the level of the Secretary of Defence* •b. Alternate reccaaendaticn* If a Medical Coordinating Board is not established, that the Central Medical Intelligence Organisation be constituted similar to the organisational relationships of the Army-Navy nodical preenrenent office* *3* That the Central Medical Intelligence Organisation be budgeted by the Secretary of Defense or, as an alternate proposal, that the three services contribute to lie financial support* *4. That the Director of the Central Medical Intelligence Organization be a nodical officer from cm© of the services and that he be selected by the Medical Board; thnt the military staffing be on a tri- partite basis* *5* That the cdssion of the Central Radical Intelligence Organiza- tion be as follows i To render such medical intelligence eerrlee aa say be required by each department of the Arsed Forcea and to other accredited agencies* 808 •6. That the Central Medical Intelligence Organisation etimolate and nake greater use of the material currently being collected by mmerovia indivi- duals, missions, and organisations both within and without the Government structure; that the Organisation be given authority to sdnd abroad special observer# or sdseions for the collection of information; that medical at- taches be authorised in sufficient numbers and locations to assure essen- tial coverage; that aedical personnel assigned to special military missions abroad be given an intelligence assignment as part of their over-all duties in the foreign station; that ALL attaches fro* the three departments be briefed by the Central Medical Intelligence Organization prior to assuming duties abroad* *7* That a permanent and enduring relationship between the Central Medical Intelligence Organisation and the Central Intelligence Agency be estab- lished on a formal basis by directive; that the Central Intelligence Agency be requested to perform certain special missions* *8, That the Central Medical Intelligence organization study both the peace and mobilization (war) 'Job1 and training requirements of the medical services for medical Intelligence; that the Organisation assume a dominant role in advising these respective medical services on these considerations* * OFF THE RECORD ■COLONEL POULi Are there any factors in the subjects listed for con- sideration by the Subcommittee on Medical Resources which should be brought to the attention of that Subcommittee as of interest to members of the Sub- committee on Medical Intelligence? ■COLONEL BEKSCKj I believe In our report one place and another that we have covered the difficulties, growing pains, lack of foresight, and all that type of thing, impetus by virtue of else and command position, medical intelligence* I think in the final aid completed document that we will submit that it would tore been covered *■ OFT THE RECORD 5* The following conclusions and agreements were reached as a result of this meeting! a* The Subcommittee for Employment of Military Medical Resources has no overlapping findings, conclusions or recommendations which my be con- sidered in conflict with those being considered and/or planned for recom- mendation by the Subcommittee on Medical Intelligence* b* The Subcoanittee on Employment of Military Medical Resources has decided that the establishment of e medical intelligence agency ae a source of global aedical information is a very necessary and immediate step forward in national defense* Such is re cram ended for action by the Comnittee on Medical and Hospital Services to the Secretary of Defense* 809 OFFICE OF THE SECRTPARI OF DEFUSE StIBCOKK ITTER OR THE. EKPLOYLTJT CF ARI MEDICAL RrGOURCES Tuesday, 11 May 19148 - Room 5)675 - 1*30 p.m. In Attendances Rear Admiral T. C. And arson (ttC) , DS», Chairman Brigadier General Joe* I* Martin, MC, DBA, Member Colonel Louis 1C* Pohl, MC, GSAF, Member Appearings Colonel W. D* Graham, MC, USA Subcommittee on Medical Services for Dependents 810 « • • The Meting convened at 1»30 with Rear Adeirel ▲ndereoki presiding • • • ADMIRAL AMDKRSOBi Our Subcommittee has bean directed to confer with representatives of other Subcommittees of the Hawlqy Board on subjects whose consideration concern both Cosnittees in order that our conclusions and reoosaeendatlons will be in line* lour £nbeonsitteo is on Medical Services for Dependents, I believe. Ve have referred to the cere of dependents in sons of our discussions, particularly In connection with hospitalisation In the Zona of the Interior *** during national ensrgenoy. We would be interested in knowing what conclusions, rseosnendations, or opinions your Subeossdttas has concerning care of dependants during another war. CQLQRKL GRAHAM t Wo had not specifically considered it. although PRO have discussed it. Vo have not sado any reooanendations, nor did wo know wo were suppooad to. Ve thought that would bo your Job. Vo would haws to plaoo tho rootrietions on dependent nedioal care to tho Unit that they wore placed in tho loot war, which woo that no additional facilities could be wads available and dependants would be acre rigidly excluded than they hod been in poaostioo. Sena stations took care of then oil during tho war. Tho dooision should bo a .local ooooandor's decision, probably based on tho rsooonsndation of bio chief asdioal officer. One thing that should be brought book into operation would bo tho prograa known as the Fnergeney Maternal and 811 Infant Cara Program, which would now ba in Federal Security Agency, which provided for obstetrical and care of infante up to one year for soldiers and sailors of the lower four grades. It was presumed that the majority were inducted into the service end therefore their hardship would be greater then hardship of those in a higher pay bracket. Congress passed a law giving funds for that job which was administered out of the Childrens Bureau of the Department of Labor and they used net only civilian medical agencies and hospitals but also military hospitals and there wss e reimbursement made in the ease of federal medical facilities being used. The Childrens Burseu downgraded the authority to the State Health Departments to spend the funds allocated to the states fay them. I don't know if that is specifically tied up with armed forces but certainly the idea should bo pmrsusd. OUfTlAL MART lift Do yon consider In the situation that might arise in the United States in any future wer whether or mot provisions far dependent cere would be more necessary as a result of atomic warfare? COLORS* GRAHAM t I would like to answer that by saying it requires two answers. The first is that the static oars of depend onto should bo downgredsd similar to that in the former wer and hew any dependents wo actually have will depend cm the else of the Any end where the Any Static ears of dependents should 812 be offloaded from the medical resources of the military* In the event of a catastrophe there has to he an overall plan which will use the pool of hospital beds remaining no matter who owns them, supports them, or staffs them* GUJTRAL MARTINi Would you recommend at thia time to ask for additional medical resources in the military services for the care of dependents? COLONEL GRAHAXt le. Sir* ADMIRAL ABDERSCMi It seams tbs problem nos that in the ease of another national emergency that nodical manpower will be wore critical than during the last war* The question of the care of dependents than ' /■ as to whether It shall be done by the allltary services or by civilians goes back to whether there Is enough nedleal talent to leak after thou* It bos a bearing in this way* That there will be a such nore critical scarcity of physicians if they ere called into the service, at laaat as far as lumber la concerned, during the next emergency. It should bo taken into consideration with the Rational Security end Resources \ Beard* They have to have care* If it la to be done by the military a proportional number of physicians and nedleal supplies moat be al- located to the military sarvicas for that purpose. In oar service, at laaat, the ears of dependants was a great morale factor with our personnel* The sen overseas received comfort from the knowledge that im the case of aickmass they would be leaked after* Would that 813 modify your idaa of offloading aa far as possible? COLONEL GRAHAks If wo keep talking about total war, which wa do, wo mat than talk about a practical naans of total mobilization of nodical and other naana. If wa would be able to have a total no- billzation of naana, including nodical, then definitely tha military nodical group ahould not bo loadod with the care of dependants, but tha otherwise mobilised nadioal naans ahould have that job. *•* I don't think it is wall to take oaro of then during wartiao. GENERAL MART IS t Tha Coasdttoa hac taken due cognisance of nany eonplaints by rasanra officers who served during tha war and neat of their tiaa in particular oases, and a groat deal of their tine In other oasaa, was spent ia oar$*& for dependents of atlitary personnel. Can wa batter that condition and prevent disaffection ia tha future? COLONEL GRAHAMt I don't know whether wo can, hot ona way wa can ia to withdraw tha advantages of civilian practice during war tram tha nadiael profession so that they too ara aoblliaad. COLOKRL POHL* Va have considerable eoaplalnt la ragard to thaaa la ragard to diaaffaction • particularly dentists. X think it ia a problaa aa ara going to have to eona up with tea* solution* ADMIRAL AIDERSOBi What is tha mmIwIob of your Suhor—Utaa with ftftfd to tha aara of dependants during peacetime. Should tha aarvloa ha expanded to inelnda dependents? an COLQKKL GH&HAHs Free the standpoint of the Medical Corps as a career it is extreaoly valuable to have dependants aa patients « because then yen get patients free all aga groups with all typas of conditions* Free the standpoint of tha service the care of depen- dents aakes better doctors* Frcn the standpoint of the service the cere of dependents inproves Morale, is an intangible monumont to the low salary of service personnel* Dependent cere is authorised by lav* Dependant care should be extended to the full resources available and that can ba secured* It 1 a iaposslble for ua to Ignore tha fact that everywhere toy of ua in the Conadttee baa ever visited the first conpXaint la - "I need an obstetrician, pediatrician, etc*" If «e bad other than doctors in tuffloient nasber • that would be curses end card attendants * for women and children, I think that the doctors could stretch* *** be could get along with the doctors ee have If tiie budget could get us more saids, etc* • • • The fleeting adjourned at 2*00 a*n* • • • 805 OFFICE OF TOE SECRETARY OF DEFKKS2 SUBCOMMITTEE OH TOE -SMPIXJIMEST CP MILITARY MEDICAL RESOURCES Tuesday, 11 Kay - Room 3D675 - 2*30 p.n* In Attendance* Rear Admiral T, C. Anderson (MC) OSH, Chairman Brigadier General J. I. Martin, KC, USA, Member Colonel Louis K* Pohl, MC, USAF, Member Appearing! Brigadier General Silas B. Hays, MC, USA Major John Luft, MSC, ISA Subcommittee on Medical Supply • • • The faceting convened at 2*30 p.»., with Rear Admiral Anderson presiding • • » ADMIRAL ANDERSON* We have the subject of medical logistics In military campaigns to study and report upon* GENERAL RAYS* The Subcommittee on Medical Supply of the Armed Forces did not consider the logistical support In the Theatre of Opera* lions * Our Committee report did Include a statement that one medical supply service overseas was desirable for wholesale distribution* ADMIRAL ANDERSON * How would the one medical supply service be operated? GENERAL HAYS* Ve recommended .that wholesale distribution of nodical supplies be under the Theatre Commander* ADMIRAL ANDERSON* He would select the particular service that was to operate? GENERAL RAIS* Or could set up a joist one if hs so desired* The meeting adjourned at 2*35 p*m. 616 StJBOO&MlffSa* 035 fHS. WL0TMSV9 Of KILSt&itT ftEfOUMSXS 13 H*r l94St Hoc* 32WS7S • I*30 F«K« la Altond*nooi Roar Adairs! t.C* Andorson («C) U3S» Cfaalraan Ooaoral SrtiaAlir Oonoral Biryjr i. Amotron** **C. BolaMMoai •a Aviation .....tfco bmUbi oowroaod *1 liJSO ?•«.» vita Boar Adair al A&dor*oa providing* AgVHMal rooahod that Um SoBooamittoo on Aviation Modlel&o would aako roproooatatloa rolativo to donrolopaacttft of im* pvorod toeanltnn* la tho aoooapXiohMat of air transport of olote and woundod for tin Amod forooa* furtkor, it vai ogrood that tho SuBooaalttoo or BopXoyaoat of unitary HodiooX Kosourov* would oon» 4d»r taoUeaX oonoopts and roqulrtaont* for air oraouatioa* Sly DLe Vinom mary Establishment OFFICE OF THE SECRETARY OF DEFENSE SUBCOMMITTEE ON THE EMPLOYMENT OF MILITARY MEDICAL RESOURCES 7 May 191*8 - 1:30 p.m. - Room 3D6?5 Appearing: Major General T. L. Smith, DC, USA Rear Admiral C. V. Rault, DC, USN Brigadier General G. R. Kennebeck, DC, USAF Washington, D. (I 818 Conference Reporting Section Reported B.y; R. P . wag. Extension 5167 Room ?C717 NO. _2Q3 (COPY 4) OFFICE OF THE tSCBmSI OF PKFHSKB SUBCCWMimE OR THE EMFLCmET CF imimcr medical mzowc&s 7 May 1$*6 - IjjO pja. - Roaa 5D6T5 In Attendances Seer Adairal T. C. Anderson, HC, UBH, Chairmen Brigadier General J. I. Martin, MC, UBA, Master Colonel L. K. i chi, MC, IBAF, Member Appearings Sukcoggaittoe cm Dental Mattera Major General T. L. ijtxLUx, TC, DBA, Chalruan Bear Adsdxal C. V. Rault, DC, WS, Mentor Brigadier General 0. R. Kcnnebook, DC, WAP, Member 6lp Ihe seating of the STubniwlttee cm the Employment ©f Military Medical Beseuroes convened at 1*30 p*m., 7 May in Boom 3D675, with ter Mmiral T, C. Aaderecn presiding . * « SEAS AnUBAL ASDKROCBi Z think the quickest vay le to take up these subjects where there is overlapping. Than, after ve have discussed those. If there are aene ether subjects on oar agenda that general Snlth night vlah to ocaewnt on, me can accept those. But the first subject that we have listed here ae one la which both of our sub- oeonlttces are interested Is this classification and no~ hUlsation of Medical opjopover for the earned forces. Sow, I Might mgr very briefly that our Suhooondt- tee, la diflcusslng classification, feel that an accurate clAseifioatlCM record In the Burgeon General's office, the Chief of Medicine and Surgery’s office, end the Air Surgeon's office, m actual classification record of each officer of x the Medical department. Is neeeaaaa*y for assigaaent. vr« ansi k&w what Me qualifications are sad verlous details concerning Hie officer before you can aed&i him properly. We feel that this classification should he uniform in the three services. Ve feel that Hie pro oast Any qretaa la a very good cne. It say he subject to acme Modification; 820 but, insofar aa profoGeloml qualifications are concerned, it gives the officer's specialty and grades him In that specialty, whether he Is nationally known, of the A class- ification, h, C, D, etc* In regard to mobilisation, our Subcommittee fed that the oorviooB should continue to maintain their reserve ergandrations and that the reserve officers would probably bo called into service early in case of an emergency, but that, in order to procure medical officers and dental offi- cers in addition to those in the reserve, they should be obtained through a national regia try which would be main- tained through the Selective Service system. There are cone details about the actual mechanics of procurement af- ter we hav** a national registry, but I don't believe those have to enter into it.N What we are Interested la knowing is whether your subcommittee bos discussed these matters and are in agreement with those ideas. MAJOR OSKESAL £H£T3: X certainly an in agreement with everything that has transpired here on that of the national registry and having it conducted by the Selective Service; that is, supervised by the Selective Service. KEfiH AEHEBAL SAULS?* X vouM like to add. If I nagr, that I don't think the Selective Service is the place to beadle it. I think that's a eartlae agwaoy, rad Z 821 think th© Baticnal Security Eeocnipocs Board on the lore! which reports to the 1resident would to totter than Selective Service tocauw Selective Service mgr fiP out of business after any war — after any Certainly, medical saaapcwwr of the country la a national resource* mmmm ammo, msm: z aigxt clear the entire matter UP ty aafctag you if you flavor acne national agency to control this natter. HEAR AEffiML BAWLf i ioal lively. 3SAS ATOHSCB* Best hero la jrofeeoloaal •h* mUtteay snargenoy training jpugcwR within the anted forces. HEAR AXMXBAL BAXUffi my X tusk aneething? Boa are we going to classify people? Do you have a code already la the Axny? We have talked this ever Informally. Z have never aosn It* Z knew IVa Ap B, C# D« Z smb, hew do yea determine vho falls into each o local flection? mmmm ssmmL mans: zj»t»s tase* upon the dowonntrnted aMXity and records of the individual concerned. HEAR ADMIRAL SAULS? t Za there an outline of those requirements la existence? BR3BA13ZIB GSHSBAL MAHUH: Share la. May I ask you this question, which la the one In- volved i do you favor a uniform system of classification of 822 all aedioal resources within the three services? REAR AHCERAL HAXILT: Certainly. BRIGADIER GENERAL MARTIN: That’s the question involved. As tc its typo, we have no definite opinion at the present time as to what it should he. HEAR ADMIRAL MULT: I am In favor of It, to answer your question. REAR AXKXKAL AHDERSGB: To go on to (h), then, taxless there are soate other questions or oosaenta. Our iiuhoonadttee have been conoeraed with train- ing, not as to the particular subjects of training, hut where and how It should he done. We have considered how senior aedioal officers could he qualified for staff duty. One difficulty encountered during the last war, I know from experience In the Pacific, Is the fact that officers were assigned responsible places on the staffs of commanders without suitable previous training. The question cooes up: hew can a sufficient mother of aedioal officers rooeivp the training necessary to qualify them for staff duty? Then, we have discussed what training Is necessary for special- ists, am already qualified in their specialties. The third feature of training 1st what training is accessary for officers who ere to he assigned to units in the field? There was a good deal of complaint frera 823 discharged medical officers about the length of time they spent in oeopa engaged In military training of personnel “4 in reo-trtag tnUHie tw«lr«. Va ba« felt that medical officers should be celled into the service as late as Is practicable in order to receive the necessary train- ing for mark with units in the field in an effort to avoid long duly in camps where they become dissatisfied. X . think those are staff officers, specialists, and staff of* fleers for duly with troops. Are there other things about this training program? ggQAEPSB GESSRAL HAHEESs We are concerned hers particularly with the dental group, and X mould like sens discussion. If you have thought about It or considered It, as to mhat you mould recocntend for military training neces- sary for dental officers called during a mobilisation with- out prior Service In one of the armed services, first, do you believe that it is necessary? BKIGADIZa GEHEEAL KKSEEBBCKs X don't believe It is necessary. MAJOR GLHHSAL EMITHi Ve haven't discussed that at all. Vs have not gome into it. When this committee was called over, ay reaction was that you could get It Indi- vidually, if you like, My reaction mould be that very lit- tle training for the professional men mould be necessary. 82U For mm vho have had no service, the younger group particu- larly, should have non* field training, coordination, or orientation. That, ve haven't discussed up to this tine. But X think they should have acme training. BRIGADIER GEBERAL MABXZH: The next question la: do you consider any professional training necessary to sun vithout prior Military aervloo for military dentistry and naval dentistry. MAJOR GE8ERAL SMITH: If I al£xt qualify that — in certain phases of oral surgery, I vould say, In var In- juries. They haven't had any. SRCQABZXR CEBERAL HABZZB t Hcur long vould you say T MAJOR CSMKBAL SMITH: Three Months. BRIGADIER GENERAL MAiSTffi: Should all he trained in that specially or Just certain selected IndividualsT MAJOR CEHERAL SMITH: Only certain specialties — oertala selected individuals or uhere they vould he deal- ing with that particular specialty. The others I think act. Any disagrsswsntT BKEQAIXECTI CB80BBAL BMHBEHBCK: I don't disagree. Z think that, la the last var, sons of our younger officers felt that the Military training, strictly military, vas not too useful to then; sod, if ve can keep that to the vary Mini asm — DCCtDIPTml 825 BRIGADIER C5GHSRAL MARUK; Has your Ccawittee — BEAR AJHEHAL RAULff: I would like to answer tbe military quo at ion, first* I tellers that our officer* should get soue sill* tary training. In the past war, we in the sedioel depart* sent in the Bavy tried to train then ourselves. 1 an in- clined to haliers they would do hatter if they were trained in line oaqpo. That was done for all the staff officers in the Vary except nodical and dental officers, and I got tils impression that they had hatter basic training than wo wars able to give or were equipped to glee. Z an inclined to believe that those things should he done within each ear* floe because duties aboard ship, sanitation and other wight ha different t1*** they would he la the Ang in the field* - HEAR AmiRAL AHDEBSCIi: Fop ho* long a period ehouid a dental officer lie tralaadt HEAR AMORAL BAQLT: X belief* two weeks. Bear the professional services — that would include m/i sanitation, so forth, has* nothing to do directly with the aHitary. J belief* they should gat sous training. As to the length of it, the General suggested three soothe, and it's probably correct. MAJOR GEHEBAL SMITHt Professional training. 826 HEAH ADMIRAL RAULT: Excuse ms — professional “training for specialists* I think that may be a little long in an emergency, and for certain groups, perhaps, three months vould be desirable and in others lesser time vould be necessary because those people, in addi- tion to getting professional training, vould have to be familiarized vith our forms end clerical procedure vMch is necessary area In var. BRIGADIER GEHERA1 MAROTt I vould libs to ask one acre question. Do you favor the subsidization of dental students during a mobilization or serf MAJOR GEBERAX MTHs If I may answer for the Ccramlttoe on that, that has been discussed, and there has boon no agreement as a Ccnsdttee. JKIGAPTEH CDSHERAL KEKBEBECK* Vhat do you naan Iff subsidyT" They are advised to give a certain amount of service after being deferred vhlls undergoing dental train ingt BKEOADIER GEHERA1 MARTHf: Ccmporable to the AOT invoked during World Var H* MAJOR OESSRAL SKITS: I am in favor of moms snsh program, but not quite as extensive. There Is no full agreement Iff the Comal ttee. It hasn't been in full agree- ment as to vhst it is. They have discussed it at length. 827 but vo have so comaittoe agreement on that. HEAR AUCEBAL HMJLTt Ve haven't brought It up foraaliy, ESIGADIZH m&BtiL KSSSEHSCK: Bov about the train- lag of reserve officers In peacetime, the training of the cffleers v© now have? Vo are ttUdng oo for about Uhen on emwergenoy arioso. Sov about tbo training new of our pree- ont Mwnost REAR AUCCRAL AHOESSOBs Our Suboasaiittoo is Inter - oetod jprlaorlly In training for eswrgooey. BRTQAIglSR OHHKBAL EH2ffiLBSCK: Silo would bo train- ing for emergency of the reserve officers v© new bare. X awaa to keep their interest up and keep the reoerve going. They have to partially train people without «sqt training and sake them reedy when the emergency arisea. Baa that Veen discussed from a oedioal angle? HEAR AUCCRAL ASEERSOHt X don’t believe ve die- cussed at all vhat training should be provided for reaerve orgadtatiema, have ve? COLOSEL KJHLi So. m&aam GEHZBAL KHBEEBCKj Bot particularly the individual reserve, such as fourteen days. COIDKEX IQHLj Bo period of active duty* We have dlsowwi the setting up of a central agency for the 828 collection of Material of caramon interest and sotting it wq? on a training program with the possible thought of expand* ing that further later to having courses which they would attend at such an agenojm miamm OEHEHAL Km&mxt Hae extension work toon discussed other then active duty for the interest of the reserve? REAR AUCEjRAL AEDEHSOS: Vo have bad coswarta for and against* Sons of floor a have felt that ordinarily a correspondence course — that is what you referred to — doesn't get you very far* msamm csahk&l eesukbesk: it didn't help our dental offtoera ft great deal in the post fiem opinion, in the oorreapondetnoa courses, hut the active duty train* tug is another thing* COLOMKL 1CHL* X think the aajorlty of opinion 1« against the extension courses as we have then available* HEAR mmKL AB3D£RG0S! This Buhooaralttee have disoussed the proposal to organise that he a Medical Institute* That would he ft group of competent civilian and nodical officers, preferably, X think, ft Joint undertaking, which would asnenhle Infraction, eld tymA new, iaftXedipg research sad advances concerning adll* tary aedloftl treatment. They would present it in a form 829 that vould bo easy to refer to and be for the benefit of both regular and Inducted raodicai officer a — a reference publication, aa a looseleaf publication that can be modi- fied from tiae to time, to which v© could refer for quick reference, particularly in the field where librorloo, etc., are not available. BRIGADIER GEBERAL KEHHEHBCK* I had in mind expanded oohoola, modified for the re serve. It would be a big Morale booster if dental officers, for instance, in the reserve should get a short course now and then at the Aray Dental School. It vould certainly sell him things that he isn't sold on now. REAR ADMIRAL ARDERSOH: Ve have included such an idea, that such an institute would not only publish con- crete Material, including research advances, in each of the special subjects that concern nodical and dental offi- cers, but also might be expanded to include resident courses for reserve officers. BEAR AEKTBAL RACIff * Ve now conduct such courses for the Saval Reserve at the Baval Dental School la Betheada. Vs give then two-week courses, take shout fifty or sixty in the courses at one tins, and hold the courses quarterly. Each District fills a quota which we assign on the rosiher of dental officers in the reserve la the District. Incidentally, 830 vo hare raoro rotiucste than vc can fill fear the course, shoving that It 1b popular vlth. the people. SEAS mmAL AHDERJ30H! It la vex? encouraging when you think of the reaction to the extension courses. SEAR AHHRAL HAULS1; The correspondence ooursee. aa General Kenoobock points out, have been very unpopular, and X know that the Bavy is engaged at the present time In writing elsdlar courses, X look vlth a good deal of apprehension on their getting Into the field and people trying to resign because I think there ore 200 hours of vork that they have to do on them; end. In the past, X know that these reserve groups got one person to writ© the answers to the course, and the rest of thorn all copied them and sent them in. BBXGAZEHR CEESERAL KJ33SEB5XK: 1 used to ho an In- structor far one of those courses in dentistry. In a 100 hours, there vaa an hour or two of interest to the par- tlcular dentist. It was medical sanitation, problems in evacuation, and mp reading, all rather foreign to vhat the dentist is going to do vhan he cones Into the service. , . . Off the record . . . HEAB AUSTRAL ATORSCB* The next subject is replace- ment pools of medical department personnel. We have In- cluded this as a matter for disouseico with your Subcommittee 831 because of complaints that have boon iaade ty discharged officers of idleness and waste of talent while held la a replacement pool availing asoignraent. Suae eouroe of replacooent of officers In service le asoeeaary, end the problem Is how to have available a reserve supply of officers without having them Idle and dissatisfied in seme replacement pool* BEAR A3KEBAL RAULS': I was not aware of any re- placement pools that the Bevy had la that fashion* Ton way know more about that being out la that forward area in the Pacific, or General Saith In the European Theater* MAJOR GENERAL GKLTH: BeplftO—>Pt pools per ae. as they are coaaonly lateen, are a easts of personnel, and X believe wo can handle It so that there will be no large mother. Heretofore, there has been a replaoeaeat pool in Brook Arsy Medical Center for all nodical department per- sonnel. They ncroly sign their own papers; they never ar- rive there. They have their aseigoiaant. They haws to sake an when they ears accepted. Their orders reach then, and they go to their permanent asalgDaaat. Prior to going to an aaaignaexzt, unless they are waived, they remain in the pool and are put la the pool after that unices their asaigneaent has been node fro® the school prior to their graduation. That’s the only pool X approve of. 832 SEAa A3KCRAL BAXZLT: May X ask you * question? Do you keep thou for soeu period osf tl*»T HAJQe CESKBAL SMXTHt They never go there walesa they are seat there for school — surely a paper trans- acted. DBlCSfiBms C88SEKAL K3E38BE2BCK$ Just keep than on the acmlng report. MAJOR QESESAL SMITH i They are awaiting aselgonont «ud swrtqwd to the pool. Tim# are called directly fra* hcau to the active duly station mleas they are mated there to salt for the hegtwrtng of school. Then 1hey are oatcantloally aeirignea to that pool vheu a aourwe, mleaa they hare already arrived for asal&auat to station. EKAH AXKtBAL ABBSEQOBi Did you have experience with replacement pools of dental officers during the serf MAJOR Cil#teiA.L SKITS i nrplnfrrmnt ay auoh hooawoe we were not allowed a replacement pool la the teopsaa Theater efeere X served. There, say officer easing in would go to a oanp sad wait aastfywwpt at that esap« Sons of then referred to it as a replacement pool, hut they weald all *he to one particular oaup to have a pines for htllst- lag them and for handling paper wort; and. If ws got thir atusa soon why they were lusedlately nianlgaefl to laetallatienai hut, if ws didn’t have the himw papara on 833 them, then they went to this oasp and wore assigned to a pool if you call it that. REAR A3KT3AL AHDEBfCK: That was the oitmtlcn as far ae dented officers were in the Pacific. Ve never had enough dental officers out there to aake a pool. BSIGA3XDE2R CEEHERAL KEHSE3BCE: I havwtt’theard easy erltloiaau froa dental officers about pools as ftron nedi- cal officers. Ve had idaat we called working pools. If ve bad sufficient equipment there and sent a non la, he could go right to work while awaiting aaalgyawot elsewhere. MAJOR esanSRAX JKITHt On return to the United State* when the enargency was over and large nashere were released, they were actually in pool* or redeployawnt caape, they called than, waiting for transportation. We had large sae> bare, too. In that type of pool, bat sot os a pool for oar own benefit other then for transportation. HEAR AIKtRAL BMMSi Those were really discharge coops acre cr 1ms, Ve had 1he eon© thing. I forgot the me that we then. HftJDB SEBEBAL £HOTt In cverMaa stations, it was a eaap, tod we attempted there to have dental officers in the look after the personnel, It was actual3y a work- ing organ! catlaaj hot, when the/ arrived at the port of wtwrkatlcga, they were sorely aval tine trvuiQrtRttca* 83U iliSAB ATMTHAL itfOOSGBs X think that the suggestions you have node are the solution of the replacement pool — nassely, that the officer who is awaiting ascigmeat should be stationed at some unit where he can work in his specialty. It may result in overstaffing of the hospital of the unit, hut that has far fewer disadvantages than placing him in aora© ooaap where he waits indefinitely for his assignment to come along. MAJOR GBJEHAL £KPIH: I am taking a lot of tirao on this. One other thing that no had in the several deploy- ment camps that we bad — we would staff them with two dental officers as permanent staff, hut there would he equipment for ten or twentyj and, as they were passing through while waiting at this comp, they were called Into this clinic and pot to work cm their own personnel not completely staffed. So, as a consensus of the Corned tteo, I would say that we ere against pools as such. BEAK AEKEHAL msmm: Sbs not subject we are concerned vith is redeployment and detaohi 11 ration of per- ©camel. There were mm? coraplainta free aodioal officers dtadag the demobilization period. It ws necessary to re- tain them in the service because the sick were set dis- charged as rapidly as the troops mere demobilised, mad it was necessary to have medical officers to take ears of 835 patients even thought the fcornea were being rapidly deao bill zed. HEAB A3MLHAL RAOIffi Itgr I add that that exists right today? We still haw radical and dental officers fkxai the AS©5 *f>e the Y~\P ppogne tbe ixv bring by*# n» ttl deooblliiation la over — nearly two years* Off the recced • , « HEAS AUCffiAL ASEERSOBs Another complaint concern- ing deaobUleaticn vaa the rather dull type of duty that the nodical officer a were called upon to perform over long periods of time la the demobilization eartan, and a sag* geotod remedy of that situation has been to rotate medieal officers from duty la separation centers to other types of duly. Xa your experience, does this concern the dental officer*? HSAB AEKCRAL BOTfft A*»l«t*Jjrl 0«p MggMt GOtt- plaint vas froa dental officer* who did opeamtiw surgery exclusively, and that applies to pre-aoblllcation days, pcaoetlae, end to postwar days. Recently, 1 put eat a nrnirtnwntfm from the Bureau renneaniidlnc that all of omr people be rotated la one specialty or another so that they get diversified duties, not only for the lack of boredom that goes with that, bat because of the experience they get to operate better shen on Independent duty* 836 BRIGADIER GEHEBAL K£BB£S££K j That applies, however, not only to denobillzation, but right straight through. Be nan in demobilisation dose the sam type of work that he did all through. BEAK ADMIRAL BAUIffi That*a right. Shafo the big- gest oooplalnt we had fron dental officer® — none of the other things you spoke of. Z think that applies for all throe services — the dull routine that they had to aoeoat* plish day In and day out, particularly in the training cen- ters. BRIGADIER GSSS3AL KBflSEBECKt chained to a chair doing naXgaa silicates with a oontlinal turnover of patients, one after another, the sane sort of work day after day. HEAR AXHE3AL BMMSt Bears ver, it la very difficult to vary that routine too anoh because It la the bulk of the work that the patieata need at that age when they oone into the service* X doubt vary aaoh if, la the next war, it will he aaxch easier despite the plana you aake. mza&mm gbusal mmsmt siaoty per cent or your work is rt&% la that area, perhaps. H3EAB A3XQBAL mmsmi Ve return to (c) — ganeral policies relative to aaalgcaBsmt of nodical personas!, la* eluding the use of reeogoised specialists and consultants. 837 HAJQR CS2EIRAL 1KLTB: In that connection, that pol- icy in the planning of the Array of professional personnel, not only professional but all Aray — once a non becomes a specialist, hie career plarmiog le attempted to keep him in that specialty. Whim you transfer him, you try to keep him in the particular line of work that he Is In now. That's pretty fancy, but that's the career planning system through- out the Army for all specialists. mm A3KCBAL AHTERSOH: That's one of the complaints of many discharged medical officers, that they were assigned to billets where they were not employed as specialists. It was not the policy at all, of course, to assign them that way; bet, due to faulty classification records or necessity of the situation, there was a good deal of dissatlafaotion. The medical officers were assigned to billets where they were not employed in the practice of their specialty. HEAJB AIKERAL EAULffj Ve bad that some problem in the Dental Corps, but the necessities are such that we can't em- ploy all the specialists in the fields that they would like to get Into. As X said before, the age group requires a lot of fillings and operative dentistry. Some survey node some- time age of the dental profession indicated that 2?,000 of 70,000 said they were oral surgeons. Ve couldn't employ them in that ratio In the service and then have them left feeling 838 they were expected to do things that wre In the general practitioner*s field, whereas I know all these people didn’t all specialise outside. MAJOR GENERAL SMITH i If you get the rating sys- tem, that will take care of that. BRIGAKOB GSGRAL KESHSBSCKs The rating system on what the man says himself has some things that are not too good. If they could he rated some nay hy their own state society, you would get a tetter rating than a men would put down himself. Ton will get at leaet one-third of them who will say they are oral surgeons if you accept that. HEAR ADMIRAL HMJLTi I think it would he necessary to work out — that’s why I asked that question at first — a classification that will have to he done nationally. 1 wouldn’t went to leave it to the state society. May ha you have something like a procurement assignment service who would collect data that would he sent to the national office, hut to leave it to the society, I think, would he a pretty weak link In the chain. • . . Off the record . • REAR AXMSML ASDERSCK: One other feature about ae- aigarsent of asdlool officers that baa caused scat© complaint Is the requirement that they perform non-profeselonal duties. 839 la a questionnaire which vao addressed tc a large amber of discharged medical officers ly the Bureau of Kocattcsalo Research of the AHA, the discharged Amy medical officer© estimated that 37 per cent of their time vac devoted to rvon-profoeGlonaJ duties. The discharged Bavy radical of- ficer© estiBfited that 28 per cent of their time vas devoted to lidminiatrativo duties. Do you bav© that difficulty to cos tend -with in the assignment of dental officers? MAJOR &mmi. MTH; A very big difficulty In the combat wilts. For instance, vhon they gc In combat, it has boon th® argument of many line, and I might say other, officers that, during combat. It is no time to do dentistry. As a result, the dental officer had other duties entirely In many instances, In the European Theater, actually vhon It van feasible, vo took the officer from the unit and put him in the pool at headqr-artcre If he vented an assignment at headquarters, but they would be detailed where they could dc certain typos of dentistry, They would be running flrot- *> aid stations and every type of work except the work for which they were profecslcnally trained to do, 1 would say 90 per cent of their duties during combat wore other than strictly profess!coal dentistry duties. HEAH A2KERAL AHEERSOSh XSo you think that's a neces- sary feature of the work of the dental officer In the combat 81+0 area? MAJOR GEHERAL SMITH i Bo, sir; cnly In extreme emergency, not routine. HEAH AEKERAL MEEHH3K: Bo you have any auggeo lion about bow it can be avoided? MAJOR GE8KRAL SMITE: Veil, you could have to get into generalities on that. I would prefer to cite a spe- cific case of a division. Vo bad a division in combat % shore the officers were assigned to end aaall units. Vhcn they were actually facing the enemy or In real combat, they were usually put in first-aid stations as admission officers end that type of work. As we have tried to do in the recent attempted table of organisation, we have tried to take those officers out and place the entire group at division head- quarters to be sent out when and if needed to perform re- quested duties. That’s one instance. The ease thing through out the combat mite — fora groups or cells of dental per- sonnel as you now have In the Army, certain auxiliary sur- gical groups, oral surgery teems, etc., have them go to var- ious places and move from the direction of the top level of that particular unit la places wherever they would be needed. That would be a solution, end was a partial solution in the European Theater — not have them assigned as individuals to combat units, but In cells controlled by the headquarters of 8ia that particular division. HEAR AEMIRAL MDERSCBj The dental officer would perform non-profoesionai duties, but under the control of higher echelons. MAJOR GHSERAL SMITE: If his own organization were not in a position to receive professional work, he would be doing It on someone else* REAR AIKTRAL RAULT: In the early days of the war, didn't a lot of dental officers get killed because they war© put in charge of litter bearers cr in front lines, fluid you lost their professional services. MAJOR SPHERAL SMITH? large ma&ar ell during the war were killed* That’s In oca&at* Anybody is liable to get killed, but they were not utilized aa professional nan* CCLQHEL iOELi That’s utter wastage of Manpower, REAR ATMXBAL Wt Tbit’s the critic law 1 beard of the Array dental officers in the field* I don’t knew that this night have happened with our Marines, too, hut I haven’t beard of it so snob* So, if they were sent ashore in Goadaloanal with the first save, they generally took over eooe duties that probably Should have been done lay a line officer; hut, as a whole, X don’t think that charge was leveled at the Bavy because we weren’t in a position to oceeait the offenses* 81*2 MAJOR GENERAL fUTBIi I think that could he cor- rected, as I sold, on the di vial on level, end has, in «gr opinion, been corrected, placing all the dental personnel at the division level at division headquarters to be put out as cells or units whore they can perform professional duties; whom that ceases to be possible or practicable, put then soon place else because only a small percentage of the personnel of a division are In caabat at the same tine* BRIGAdER CEHE8AL KEHHEEBCK* In the Air Faroe, so didn't hate so much of that because they flew from great distances, and our people didn't fly with the planes. Our dental officers stayed back and were able to work rather continuously,' However, I don't think we should have per* naoently assigned, to any snail organizations, dental offi- cers, not to Air Force groups or Air Force wings which would be oonpared to battalions or regimento, but have them on the top level under the staff dental surgeon; let him decide whore they should be utilized. When an Air Force group Is la combat and patients are not available, he can pull the dental officers out and place than in other areas where they can be used • COIOHEL H>HLt You plan to use ©ollulsr teeas tnx& higher level. 8U3 mi&WIER CE3J3iSAL That would be ay idem in the saaattor. MAJOR (113LHAL SMITH: In the parachute regiments, airborne regiiaenfes, dental officers travel rl$it with the men. That* a a waste of professional mm bo cause they can't take their equipcaeat In the first place and can't do dental work without the equipment. They actually with them during the war or wont In on the gliders with their units. That, I think, should be corrected by the cell at head- quarters of the unit and go at such time as they are needed for professional use. HEAR JWMJML AHDERSCIfj Are there «cy other comments about assignment of dental officers? BRIGADIER GENERAL EEHHEEDCKt We didn’t sonticn con- sultanta a uhll© tack. Hew about plans cm consultants, util- imtion of consultants in cs»rg©ncy to check on and super- rise various installations? What la the medical plan on that? HEAR AUCEAL A8B&BC81 Veil, the comments that we home received all recognize the value of consultants la the offices la the areas. They are necessary sad contribute greatly to the quality of professional service that is rendered. There has been some comment about consultants at different levels, I think, with the conclusion that the m consultants should bo attached to high echelons rather than have consultants attached, say, to lover levels where they are not In the position to render service over greater areas, aay, as a consultant at the Any level where he can visit all the units in the area vith- in a consultant's capacity* But the Interviews sod let- ters we have had all indicate that the consultant is in* valuable In the forward area* BKIGAKCnR GENERAL KDEBKEBECKj How rtoafc tbe zone of Interior? HEAR ASHXRAL ASSESSOR t That applies also la the sene of interior. BRK3A3HEB GSE8EHAL KESSEBBCKt With frequent visits to installaticns, etc. 1 think in this last war, as far as dental officers were concerned, we had a few, bat they would cease into the station, probably stay half a day, and attempt to evaluate prosthetic service* They didn't get a tree picture, end local personnel didn't get nosh help* They didn’t stay long enough* Those are the oca-ants X got frem ay people* There weren't enough of then, nor did they coeae around as frequently as they thought they Aowld* HEAR AHCERAL ASESRSOH* Are time* othor oniumta «* tMa? 8U? REAS AOCERAI. KAliLT: I would like to say the finest critical problem facing the dental service & of ail throe outfits is the lack of trained prosthetic dental techni- cians in oar organized reserves. I don't know low we axe going to secure these people or how we should catalog then. At* the present tine, they are training a treaendcua masher of them in the United States, and there will b© a great excess as a whole, hut it is difficult to grade them according to ability as you are trying to do for saadical and dental officers and other personnel. There should be acme naans of classifying those people and cataloging then because they are Just as important to relieve the dental officer of laboratory procedure so hi a services can be utilised at the chair. BRIGADIER GEKERAL gSWBESBBCgt And earaarking thea, too. Alot of those were used for other duties during this last war. MAJOR GESSRAL tlGTEL: Ve had difficulty In spotting * the sen and getting him cataloged as a technician and the like when he was drafted. The difficulty wee In getting him assigned to the medical department. If be had some other qualifications that the line officers liked, they got him first; they got the first shot at him. A recossaondaticn was sade to the effect that passages of that type should be 8U6 sent to the medical department to the capacity they oouM beadle* BRIGAXGDEH CSESEHA1 EEHSEBBCKt Why couldn't a survey of those individuals be code? They are a eubprof ©seioaal group. MAJOR C23TEHAL SMITH* The same thing would apply to your laboratory technician, your bacteriologist, sad your pathologist. REAR AEMERAL BAlffift All those trained technic Ians, Irosthetio technicians are over the age group that fall in- to the category under the draft act that is proposed now — 26 jeers of age. It takes fifteen years, perhaps, for these aen to beoaae ooapeteat in baoteriologloal or pros* thetlc dentistry. Vs have to draw those from the higher age group. that's the reason we can't enlist them In the reserve* They feel that, in time of emergency, they are going to he left out* I don't renenbar the exact figure, but we have about 70,000 reserve dental officers, and I don't think we have more than 90 prosthetic dental tech* aiclans in our reserve. MAJOR GSKERAL SMOtTSs I 1Milk, in the over-all mug, speaking to Admiral Banlt, that possibly there would he. In the entire emergency, an actual draft of all mnpowear* Isn't that what this is considering acre or less? And /on can get 8U7 that type only thing I can see la that, if they are brought la, is that a recoMoenflatlon should be eery strong that they are not to be planed as gunners shea they oan do other work if they oosao la now. You have so say of getting them in. That’s another story. HEAR AIICEBAL RAUUT: Those people trained outside are often specialists in one field, and you have to put all these various parts of technicians together to make a whole. Isn’t that your experience, Generali MAJQB GSSmtAL SKETH; The trouble Is that they wore assigned to line units soawirfaer©. They couldn’t use their Bjechanioal ability In training* They would be as- signed as radio Mechanics and anything with Mechanics* They would catch them, and the Medical depertaesat wouldn’t get them in unless they could go out, spot than, and ar- range for individual transfers* GE5EBAL KE8HEBBCK: Many tines In the Air Force, if ha was handy, if they found a Mechanical Job on the airplanes which would give then a higher rat- ing mapA a better chance for proantion than in the dental laboratory, they would hide their qualifications scan tine* If they ware interviewed, they wouldn’t want to cone to the dental service because their chances were better where they werej their opportunities wears greater. So, if we could 8UB earmark those felloes acme eey — X think there ere enough available technicians if ee could Just esraark than. MAJOR GEHEBAL SCEESi Here than you can seer use will be drafted if you have a real, all-out emergency. HEAR AZMXBAL HABLT: loo. That’* a my difficult group. They axe unlicensed and hard to classify. MAJOR GEKERAL StEOSLi Auto Mechanics — they get plenty of those. Shay &> *nto that channel. She trouble la getting then la the nodical department end get than as- signed to the dental departaont. That** the highest dif- ficulty wo had* X think that about covers all that. Thors is no tus repeating It as X oaa see. HMR AdUBftL mSSSBSCSt fee. X still don’t hare an idea of what the correction is. MWOB GESERAL GKTTSt Merely la the over-all plan- alng, if the bob has a specialty, if he is a laboratory, bacteriological, or dental technician, he should be as- signed, and certainly be gins an opportunity to be as- signed, to that department. That1 a the only suggestion X have. BSAB AUGBAL HAUU5D * Shat would go bade to ay original suggestion that the manpower resomrees board be organised, and X hate seen a written suggestion to this 84P 1 effect — it Is net original with m — that the American Medical Association, the American Dental Association, and the various hospital associations in the Halted States be represented on that board — X don't know what the enact aaao Is — and atadlsr group®. These groups would each look after the awapever situation in that sad rose—waft to the national Resource a Board what should he dene. Bow, there ere bomfldo prosthetic dental labor- atory organ! zatlooe in this country *►- eoe or two, azywey — that ere really recognized ae being dependable, and X know the secretary of one of those yogi le cooing deem to talk to Selective Service within the asst week or so on acne of theproblwai X have Just broogit up, REAH A2KXBIL AHStSOBt Z think Its difficulty job sentl0 consider these max, certainly , in oil age groupe. HEAR AHHKAL AH3DEBS0B* If there is no farther comoent, there is one last subject — the chief points or circumstances within tha military structure contrib- uting snoot to the apparent disaffection of Radical per- sonnel. We have referred to that a number of tines. Do you have aaay additional cosecants on tbatt MAJOR GENERAL SMITH; I think you can boll that down. Vo have discussed that in may instances, and there is no formal coramitteo gecowBeudaticn on that. Living conditions, separation from fatal lies, and the fact that their pay is not comparable to the oca in civil life are three broad subjects which would cover neat of the adverse ooaaneats — particularly the housing and the pay. Hie third one, separation teem fatal lies, you cannot avoid unless they have housing and sufficient pay to keep an establishment. REAS A2KEBAL AKP23&SGB* Any further cowaonts? musmm ammo* msmxxt Aaotiwr caw u special! ration, Of course, we have touched on that — not being able to have specialisation draining profession- ally. Vo cemented on that earlier today. OOLOSEL POHLi X noticed, in easy of the replies we have, that there are many complaints on relative rank 851 with the line, and I fait, in ny observation, that the Dental Corps has bad a rather rough time in rank. MAJOR CEE®3?AL EMtTHt That's one of the big ob- jection# in getting them to cone back on active duty at this tine* BHIGADUE GEHTSAI. KIIEC3CXK: The T/O lladtation on rank, especially overseas, in the Air Force chore a atm can only be a captain regardless of his ability la a big gripe among Air Force people* Men who case In later, classmates, who stayed in the states would go out as lieutenant colonels because they happened to be in the spots where they could be promoted, while the ones who vent overseas oar liar would be captains. MAJOR cmSiKL iKITHi One of the outstanding ex- amples of that la the Amjy is again with your coahat or- ganization. In a division, which Is a larger unit, the highest ranking officer Is a aajor. During the last war, \ there was one. The highest rate the others could attain o was captain unless they were transferred to some other unit. The next promotion In line is that he jumped from raajor to colonel* So the highest rank a nan could he la th combat organization is aajar. We ore attempting to correct the tables of organisa- tion to take care of that, but there is no place to moke that 852 unifora, The result 1st vhen you asked for a twusfer or rotation, you couldn't aSk for a nan by norae in an attempt to rotate hits to the hospital. You bad to send him through Any headquarters, and the ccsdtat wilt could pick out the loss desirable, lot's put It that nay. As a result, the good sen were stock with no opportunity for proaotioo even to the grade of eajor unless the sajer were transferred car sooe thing also happened tint there was a vacancy — then one out of the eighteen In the division* no opportunity to be a nontenant colonel at any tine in any Amy organiza- tion; X nean oosabat Amy, field Amy. That was one of the big objections to proa&tloa, and then the table of or gaol- sail on linitatioae uhloh apply to everybody. I think that applies equally to aanpower except in this one inertanoo la the Amy la a oosabat organisation. SEAS AUCCBAL BAtBff t Tho Havy did not ten* tbst problem 1>eoavm> «• hav» th» r»ni«g«B»te qratoau All staff officers, medical and dental officers, go «y with the run- ning eats ia the Uae» Xa can or two instances that uns discarded during the ear, but very, eery little, and it didn't become a problem at all. HSKH nDRUIUi 33ft XStM UktPKL CWjgPBi our personnel alXossmess, uhieh cmnnwyond to year table of orgradtatlosa, are nans elastic„ The pereoasnl allnaaneaa 853 of a given unit rasy call for a lleutoaaat on a ship. Yon auy find a nontenant coataonder serving. Is that true? REAS ADMIRAL RAULTs Bight. BRIGADIER GEEEHAL EEMCKi If he were a lieuten- ant there, could he be promoted to a lieutenant coaoemdert HEAR A2MERAL AHDERSOH: Only promoted when his run- ning ante le eligible for promotion.. « * • Off the record . . * HEAR ADMIRAL AHDEKSCH (continuing) 1 I an usable to 900 how aqy equitable eyotea of proraoticao. cm be estab- 11 shed vhore promotion depend0 caa vacancies in the table of organlstation. It Just can’t ho done* MAJOR GENERAL vMTH r And if you have a Job, fear instance, that warmrrte a promotion, and you would be taking a skip of personnel to fill that. It would work all right if the nan were in the Job and qualified for it. If there is a vacancy, ha can be projected. REAR ADMIRAL HAULS’: Ve took care of that in the war in rare instances where people got spot promotions. That was very unusual. While they occupied that particular position, they held a spot promotion; when they transferred out of that, they went beck to permanent rank. HEAR A3DKERAL AHDERSCH: Meet spot promotions were reserved for officers assigned to high positions, staffs 8Sk of ccamndere. MAJOR GEHE3AL £KETHt I don’t thiak It could be equalized due to the different systems of promotion. BRIGADIER GEHERAL K12'3IE221JCIv: There has been aooe crlticlBBi from the Havy officers of the Dental Corps vho have been working side by side with Arny officers that the Aray officer can be promoted after one year; while the Savy officer goes through two years now without easy pronoticxu Each of them work side by side • HEAH A3KIBAL AHDSHCOH: That's in the lower rank. BKEGA3XEEH GEHERAL KSSSESSECKt That's in the rank of Junior lieutenant. HEAH ADMIRAL BAUIffj Ve took that up, incidentally, with the Havy Department, and the official reply was that they believe in the run that our people would be as well off. If not better off — sad I sa inclined to be- lie to it Is so — with the ruming sate principle. That was the reply officially. . Off the record HEAH AMCERAL ABD£HO03ft Is there anything further? HEAR AIMERAL EAULTi Bo you went to put this Sa the record t here is a reference that will be in the Bureau of Medicine and Surgery Manual of the Medical Department of the Havy — 855 h "hlb2.2 An officer on the active list of the Axwgr of the United States and an Array aviation cadet serving in locality where Anaj dental service is not obtainable shall be furnished dental tre&taont, both out patient end in pa- tient, at Bevy dental facility cn mm basis as dental treataent is accorded Bawl personnel. mile tod persons an the active list with the drey of the United States shall be furnished dental treataent at Baval dental facility In accordance with par- agraph 41^2,2," Ve were going to reooMaeafl — I didn’t have an op- portunity to disc use this with our Costal ttec — that tbs Aragr regulations be nade parallel to that reooaaenflatlcp. I know that, at the present tloe, the Anqy and Bavy both are taking oar© of each other’s personnel, but this would clarify it in the regulations. MAJOR GEHERAL SMITH: 1 nay add that that has been \ routine for the past five years in Any installations for Any dental personnel to take care of Bevy personnel — not only personnel, but dependents also* REAR AHCE3AL HAULTj Let’s not put that la the record. (laughter). EFA8 AUCT8AL /BDE880B* Before job gentleman leave, for the record would you please give your nwaee and a brief 856 et&teaeat of your earfloat MAJOR GEESERAL SMITH: Thcnas L. Salth, Major General, Chief of Dental Service of the Angr, HEAR ADMIRAL RAUUTi Bear Admiral C. V. Baalt, DC, ®M# Aaelatant Chief of the Bureau of Medicine and Surgery fear Don tie try, and Chid of Dental Division, BRIGADIER CEHERAL DBBHEBBCKt Mgadlw General George R, Kennebec*, Dental Corpa, U3AF. • • • The mooting ms adjownasd at 3il0 p*», * • » 857 TJL Nmom Military Umiiimm OFFICE OF THE SECRETARY OF DEFENSE SUBCCMMUTEE ON THE EMPLOYMENT OF MUJTAEY MEDICAL RESOURCES Friday, 14 May - Room 3D675 - 3:05 p.m. APPEARING-: CAPTAIN LLOYD R. NEMHODSER, (MC), DSN Chairman, Subcommittee on Training and Education of Medical Department Personnel Washisgtos, D. (j Conference Reporting Section Reported By: V. Savonla Extension, Room 3C717 . NO. 220 858 OFFICE OF SEE SECSSCdHT OF nCTTyag SXJBOCKKEEIEB OH THE EMTI0XKEST OF KILTE'JQr MEDICAL KSXJUBCES Friday, 14 May 1946 • Boca 3D675 - 3,05 pasu In Attendance; Bear Adiairal T. C. Anderson (MC), OBIT, Brigadier General *To». I, Martin, MC, OKA, Hraabor Colonel Louie K* PohJ, MC, OBAF, Member Appearing: Captain Lloyd H, ifeufcoueer, UGH, Cfcalnaan Gubccaaaittoe on Training and Education of Hodlcal Dapartawent iiwraoan©! 859 • • • The laeetlng convened at 3:05 p.su, with Peer Adniral Anderson presiding . • . KEAB AXMRAX ASI£S£iOHi Captain Ifewbooeer, wo hare been directed to discuss with your Sttbecndttee the subjects which are nore or lees oowaon to both comalttees chiefly in order to hsmcniee our views and provide recceneadations to all the CosBlttee that are not at too great variance. The first subject that as have which we think over* laps with the wort of your eosaittee 2i (b) la our list here, Troreoslcml Military eaergMcy training program within '’be Axaed Forces*” Sw, oar ecfeedttee hare ooneldered this subject in 'elation to Mobilisation* It includes the emergency training in case of another national emergency, end w here considered the subject firm the standpoint of Military and professional training nsoeeeary for doctors, for nurses, sad for enlisted nnahere of the nedioal services vbo are the service in ease of ear* She question ernes up whether doc ton qmA taalc Military training* There was criticise about doctors being assigned to M |ottg tteroogh possibly of training and then when a—Igned owmm ware mployad in hospital* where it eeened to than at least the Military training they had received had little bearing upon whet they were acted 860 to do during the war. I don't know that your ccanlttee hare considered that aide of the question, bat we would appreciate am expres- sion of opinion as to what your Idea la about the amount of basic military training that the average physician should • receive when called Into the earvlosi and also where that basic military training probably could boat be given* Cdmsr HEHB0OSERt We did not make any definite reocgMopdatlon obi that line, although ve disoussed it at eons length, we questioned whether or not that use within our province. The ocossnsus of oar group mo that it maid bo rmry advantageous, ouch «o the Assay field Service School, or its equivalent, end that it mold bo advisable if all medical off loom could attend fur a period oajr of appreaimtely a month to get oqmo slant on that they Might swountsr, sad that's about aa far aa m mat with it* We didn't w)e vgr definite reooa- smhlkBi, aud dotbar m do in our final report, it la ques- tionable. It vill depend on hem nut baa bean coveted by aaae other i. heas msam, msmcat «bat voau be your ream* ■enftation about profesiitcnel training that shemid bs gim to physicians Him palled into tbi bmttImI CAmar mm&mt wan, the Majority of the doctors 861 called into the service had had a reasonable amount of professional training, and I don’t believe that it will he necessary to give them other than short courses. For example, you may have a fairly good general surgeon who hoe had no traumatic surgery. You might want to give him a short course / in traumatology, Users will he selected eases of that type, for example. Others, who have had a certain duty in civilian Ufa, State, Public Health jobs, and so forth, we might want to give them short courses In preventive medicine. For the most peart, they would he very short courses. They would already have a background in that general specialty, hut you might want to teach them 4uet the military phases of it. In ether words, they would he short courses and not Icsag courses. KEftU A2MESA1 AJSEBBCK: Vhat would you reccanaond about the training necessary for nurses when brought Into the service? Should they have scns military instruction, or should they have professional training? CAF2MM SEWH0U3SH: X don’t fwl that they need professional training. They need indoctrination training primarily. She nurse has already trained in the cere of patients, and that’s shat we will want moat of them for* She has had plenty of experience in that, hut she mmt find her way around In an Army or Kfevy installation. I think we would expect Quite a lot from her if we expect her to do it the first 862 wek she is on duty. ®TOAIXtE3 GSHERAL MWRTBJr Off the record «• • . * THE BECOKB . . , ORBmnr IEWHDIBEBi There axe eaneptlcna. I should think that nurses who will he on duty on evacuation flight* should have Beam training other than Indoctrination. I aa not an expert along that line at all. WS3ASJER am&AL MftHOT; That's belx« done. CAKCA2H KEWBOUSEBj But that vooM sec® only logical, BR3GAXJIER GEKERAX Wi&'XMt Tfc was done during the wr, HERS A3KCRAL ASUSSOBi l«ll you outline your, idea ©f i*at training the enlisted nan of the nodical aerrice xfeen inducted into the service t mmmmt Well, I think all enlisted sum should 611 ttnderetandlsg of what we call the hoot •-I hare forgotten idiot the Arty calls it, basic trainis%f x believe—to orient the®, acquaint then with service tewateology, service conditions, they have to change their node of living considerably* then I think that they—speaking of hospital corpaaen—should receive training la Medical Separtaaent activities, such m nursing, the elementary pharmacy ? firat eld# the various things that I think the Army and Bevy teach an enlisted sen. Then I think we certainly vant to select tho umt 863 proBdslxjg of that {group for specialized training* In other saris, asm qualified for independent duty with the Hkt?, sularoxiaes, end so forth; if It's Air Force, it will be with certain units of the Air Force; and I don't know conditions in the Azbqt* Our Consittee didn't thirfr the Axbqt bed so sstxor pieces that they would use—what we call aen qualified for independent duty, as perhaps the Jftrvy end Air Force would use. Shat wee the opinion of our group; hot the xepre-* osotatlwee of the Air Force thought they had a very, waxy definite need of highly-trained enlisted sxm—uhat we m& qualified for independent duty, and they believe it chough that they would lift* to aand scar ma to oar schools when It's possible. KSAB ASK3BAL ASEEHSOBt Are there other features of this training program that we should discuss t J notice that their precept includes Joint utilization of marine echools, coordinated post-graduate training, coomb bulletins — is that Included in your precept T C5AISOS HMOOSaSi Too, air, I believe it is, bulletins. KSAH 3JKSBAL AMEEBBORt Twining nssnsls, mad to forth, as they apply to both ccwdeelosed end enlisted and clrlllim scHtponsste, Joist use of elTlllsa consultants. I 86U tMidc poBslhly w wight ask vhat tbe Coaaaittee keep* decided •Ixmt the onploynent of consultants. that** one of our toplca tet« CAmm ma&OOuEHj I would like the first peart to he off the record. . . . Of? 2HE KEOCICD . . . CAPEAIK KEWECKESBi In the first place# we oanaot hero econcn utilization of consultants hfirnnas our training hospitals are not located in the suae areas. She only pos* slhility would he the latteaaaa General Hospital and the ThOrlenrt Havel Hospital. One hospital is at the col of the Golden Gate Bridge end the other one la out at San lesolro, way miles away. 2h®«e ccmultaafea are w? busy sen. They doa«t vast to spend acre than two afternocne a weak at the noat In connection with training wdioal offlcora of the anasd forces. Joist utilisation would raoan they would bsve to apeni four amsnoow a wok, let's say, oar instead of cm afternoon « wek, they would have to spend two afternoon® a weak, they aw unwilling to do it. Jwt taking Lottewtt Oomral, became that U mm of the few places wamuMataa eanwple, you e«yi an yoar resident® c€b» over to Oakland cm tIre. Oar residents will go over to lettsswa General tbs wart tlw. 865 You have fron en hour to an hour and a half haul between the two hospitals* Ebora la a lot of work to he done in hoepitals today end there Isn’t the tine* Shat seem too auch lose of tine. So the Joint utilization of comultants is and will continue to he practically nil. Z Acfi’t see how it can he otherwise. Afcslral, you see this consultant situation. You &» located at the Medloel Center. Wouldn’t you agree that IVe sot feasible to have joist utilization of consultantat Wall, Any Medical Crater end ISteval Medical Center la another piece them it eight he dene to a Malted degree. I happen to know the Amy eowultanta—a few of then are alao Bevy consultants. The Washington area la the heat place where we can ham Joint utilisation of ccneultasta end yet it can’t he too great even here. We have had, I halier©, a couple of conealtenta drop oat heoaaee they couldn’t teach over at the Amy Medlonl Center and teach at the Bary Medical Canter at the cnee tine. It took too auch of their tine. KEAi? Ancnax Asmsmi Would the joint use of ccneult«ate~»I gBM that's the way w would express It—cantor jaeeixt orrangonent result in «sgr eeoocsQr frora the stand point of expenditure of fund* t CAPTAIN HEWHOTEES: Hone whatsoever, because we can’t expect a doctor to spend hie warning at the Any Medical Grater 866 and then his afternoon at the Efeval Medical Cantor and accept $50,00 for the day when he could do far tetter today by spend- ing a couple of hours In his office. If vs tried that v© would both lose ‘because they would refuse to he consultants for either service. m£R AfMEHAL mm&OE: Off the record — . . OFF m 1M®D . . CAPEAJB SSHHOOBEHt I might add that that Is also the opinion of our Gubccaxalttee after considerable discussion. Ihe only place that we might be able to utilise consultants for the Axbqt or the Army use our consultants — there are times when consultant® froa the Boston arm xsy be at a medical meet- ing In Ben Francisco, so they want a little something extra to do, end they will go into either the Army or Ttevy hospital end mko rounds and give talks, but wo don’t pay them f«r It. Wo have no way of paying then for that because the services of cur consultants must be anticipated is advance of the visits or vs cannot pay than. BEAB AIKEKAX kSm&ms I then that ywir Suhcoaslttee have no Objection to a given qualified consultant serving "both the kray and the ISnry? • C&FTAIH Hone whatsoever. KSAB AUdRAl ASXERSOHs But lt*s a natter of local 867 CAPTAIN E2WE0IBEH: That's right. HEAR AIKERIa AHTEBSOH: That we should sot adopt a policy and insist that the consultant --any given consultant serve both services. CAPTAIS mM&MBBt I certainly thick It would be a mistake. CQ&KL PQHX: It seems to ns where you have eon* sultant* at a high level asking field trips you might utilise the sene individual time where they go to a situation a few days end study a situation like a flu epidemic; might use Joint individuals in that spot only, but that is a distinct typo of consultant • HEAR mtmtCL MOT! I was going to say that is not In the teaching field especially. CAPmm mmowmi I might soy VO have had to km all of our aamanptloce, recceamodatloaoB on about throe premises: that the services will continue as at the present tins, time will be three services beaded by the Joint Chiefs of Staff with nodical representation, or there will be one nodical service. Any rsoomendatlon ve moke, we have to think of those three possibilities, end we can't tell which any cobs about. ms AimmL ASEEasOHi I think that ve might very veil ask Captain Jfsvhouser to give us sons Information under 868 this subject of aedlcal logistic* In military OQ&gRl&m, about the supply of whole blood to theaters of operation In the wr. CAPTAXS SSUHOUSHRs I aalglrfc oay that I wss Just ssitou the other day hew Batch blood end blood substitutes would bo needed In event of war, I sure I would have no way of figuring It out unless 1 knew © whole lot aoro than I know sew* HEAR A3KCHAX mWSO&i Oft tho record — . . . (m 1SE RECORD , . . CKPSAI8 Aa you recall tbo Axsgr, under General Rankin sad Colonel Kendrick operated the pregram *° W and Z bed © program la the Pacific, Conditions there were different* Wot ewusple, we bed to haw lighter-weight containers, Zhsy used at first 50 per cent blood ©ad 50 per ceast diluent, When shipping to the Pacific our distances wore great, VI© had to cut down weight all we possibly could, therefore, we used the ACD solution, which is even today as good a preservative as w can find for whole blood. It cut our weight in half to the Pacific. Vie had to do it. later, after they got e little better organized and didn't have quit© the demand, they shifted to ACD also, but they had to rush the program considerably and the Assay had a groat atockpile of these bottles cm hand and they were the thing to use so the program could be started almost over nl^jt. 869 It may be that the armed forces will not need a great deal of blood. Maybe the civiliana will need the meet, the majority of them. Certainly if five or six boohs ere dropped on neyor cities, wherever they may bo, there ore going to be anywhere free 2-1/2 jaiUlcn to three million pints of blood needed within a setter of ten weeks, the majority of which will bo needed within the first three to four weeks. That cannot be furnished unless there is an existing national program in effect before the disaster occurs. Ifofortunetely at the present tin© there is considerable bickering between two national arganlratlone, end what will case out of it, I don't know, Neither one is going ahead too veil at the present time. The poocetlae function of the national irogren would be supplied where needed in ccarsaunlty end oo forth, that do not here blood at the present time. There la probably not half the amount of blood furnished in till® country today that should be furnished. Then If you have a good nucleus organization—os was shown on December ?th, 'hi—cry blood bank that is then in operation can be stepped up tenfold during the night without greatly added personnel, end they con hold that pee# for approximately three weeks, which gives you a chance to bring In additional pereoaoel. If the next war la the type of war that we might poeelbly anticipate, a tremendous 870 amount of blood will be seeded} by that, I neon the rasount would run into millions of pints Instead of the amount that we used In the lent war. Wo collected 15 xallHari platfe over « period of over four years in the lust war. That would have to be reduced to months. HEAP AIKERAI AHIlSSQHj Off the record — OFF TSS KSCCKD REAP AIMXRAX AHEERDO!?* One problem that the Sub- ccoslttee have discussed in the question of upon whom should the responsibility be placed for the operation of the whole blood yrogrean eo far as the Military services are concerned. Should it be node a special unit under the direct control of the Surgeon General, should it be assigned to the service of Medical supply, or should it be node a pert of a responsibility of the laboratory service 1 Daring the last war it was operated by a special unit, as I understand, directly under the Surgeon General's office. GAP2AIK HP&fOCGERj Tos, sir. I flraly believe that it is necessary to have a specialised group handling blood frm the source until it's handed error to the hospital or activity that will use it. BR2DASIFH C83BSRAX MARTIN 1 Off the record — OFF THE RECCE® CAPTAIN mteMEERt During the early pert of the 871 war we Ttm&o pleas for a eeparato transfusion service and out- lined the whole progress. It eaeaaed to us that it was fairly easy to put It In effect in the Az»y because of your laboratory service end your organisation. However, it was not very easily put Into operation In the Ktevy at that tins, and we vers not too well organised along blood Unas. A number of individuals bad separate ideas. It vas hard to get any one plan into operation, and this was taken before the national Research Council, They gave ua a latoewana blessing but didn't insist that we put it In operation, and it ves left down the vise, so to apeak. OST THE IIEGQR2D HEAP, A3KESAX AIEEKSCHj Thank you vary ouch. The meting adjourned at ttOO pao. • « • DL MUIAL -tliumY UmiM.ismfr SUBCOMMITTEE OH THE EMPLOYMEOT? OF MILITARY MEDICAL RESOURCES Tuesday, 11 Kay 191*8 - Room 3D675 - 10:00 a.m. Appearing? Roar Admiral Paul M. Albright, (MC),US3J Chairman, Subcommittee on Programs for Hospitalization Wjshiigtoii, D. d Conference Reporting Section Reported By: V, Savonla Extension, Room 3C717 NO.211 CSjTICJ: OF TiB a®CSECflBY CQ? EE$!5te OUBCOMCnZEIE QS SUE Qg> HI1M MSLICAX HESOUaCEB 19*6 • Bock 3D675 - 10:00 «.m* la Attendaccoi Ma±ml T. C. Andoroon (MC), CSK, Otolmm General Joa, I. Martin, **2t \EAf Colonel loula K. Poia, MC, I5^AJ# MbbSmt Appearing* Bear A&dml J*ul M, Albright, (MC), X3SB, Cb&tamm Sttfccconittoe on Trogemm far H.o«pitallaatlon 33b© xaoetlcg convened at 10*00 eao., with Bear Admiral Anderson presiding HEAR AiKHiAl ASQBRU1I: Wo have boon anted to confer vlth other GubccwBlttooe In vhlch there ia GPrarhapplng, Tim subjects ubich m harm been aated to Investigate, vhich might overlap vlth the voark of your SubcoaBilttoe, are Hated in the letter that la addressed to you. The ftret one ia hoepltallz^tico and evacuation policies irltMn the combat zone and evacuation to the eon* ■uulcationsene, and to tho sene of the interior. General ia nanrUlng the consents tev» lag up our ideas in regard to that particular subject. I think perhaps It would he best for you to give to Adadml Albright the Ideas we have reached in regard to that subject. Th& first question that occurs to no Is; has your Subccaaaltto© given eomldexatlon to hmjdtoli nation In tho theaters of operation in case of a future national aaorgetncy ? HEAR A33KJHAI. HHQKSZT: At the proeont thee our Subcowdttcc on Progress for Hospitalisation has been United to uSstiag facilities within the continental limits. It is anticipated, however, when this study has been oflejftctod grogxnaa for hospitalization--that is, existing facilities—* outside the continental Unite will be considered. SEfiB AUCSSftl ASEEHSCKj Will yoor Sufeeamltt®® give cocoiderBtiaax to in easudiftlicn mom In eem of ft xtttla&l osezgoocy? mm mm&L aimesst* w® mi»*t doing that, no, In view of tfc© diet that*® & field operation and not * fixed boepltiU isatlon prqgraaa ncsr ©xlotit^. BEAR AIH3BAX AIBISRSQBIt Any action of our Subecsfr* »ittoo that wo sight take then would sot concern the other Subooraittee. Thsre would to so chance of conflicting reccct* smtetioea Iraawuch m that Onbcaaslttoe io not to ea*- oidetr hoeplteJJLtatlon In the forward arse* in caea of mmxymof* SEAR AJKERAX AIBRS3HPi Hay Z look over briefly the charges to our Duhcoaslttoo 7 I haven't re-read it recently. In view of the fact we have had plenty to eoBeider within the continental Unite with existing facilities. X don't recftll e«y such cteB© to our ccaaltteo. X, however, here it with ns, and X would like to glaaes over it hurriedly sod see if there exists ouch a Ears you ty ehsnoe assn our directive! (X)I£3SEX rOELs Zoa, sir, I hare it here, an extract of whet X thought were the precepts. . . CKT TBS RECORD EEftE A1MIRAL ATEEHXB: Would you give Adadral Albright acne of tbs considerations that we have given to 876 is the field, of the ccnh&t cannaekloatlons **rf* Sm carter that should the cooulttoe ecesldor hospitallsatlcti la thoee areaa he will know whet our ocanittee feel* about itl BH3QAD2EH GEKSRAL MAB335$ Our concept of our part in this field is cons trained to any fixture war effort* Hi here surveyed the prohleoe 'which we can expectla ***1» «• well *4 In any theaters of war la total war* It le our belief that the need for hospital last Ion in the sane of the Interior west he provided for mot only hgr civilian •pein| hut ft met he cloeely eocrdlmted with sssede end I eight mk hee pour ccmdttoe gene Into that field at all? HBIB AUHPAL AIBOTSTj Do I taactaretaxrt. you, General, to hep3y that In the event of total sroMIiaetlc® it le oar itwponaihlllty to provide hospitalization fear civilians in civilian ccmmttles? wmmm csmmi MAHOT: She foots any call for that wwy provision In anny areas, we hellers* Off the record — • • OFF SEE RECORD « « SSffiR AMORAL ABCTSf, Of course, I have very definite Ideas on theee* I an not speaking fear the ocnadttoe* BS8SAD9SIB GESEEtAL MfiSS32li Bo, neither ns X* HSAB AUCCRAL AmOBBTi I ns speaking fer ayeelf * 877 When the Batloml Xfcfene© Act was passed a year ago, the Congress Made very definite provisions fop the National Military I&tablishsaeat. Berhape sy irAorpretaticn of these Provisions say he faulty. Outolde the Military Eatahllahmnt of the Ifeticwa Defense Act we have sot up the Ifetioml Resources Board, which le a clvillan-control outfit who, of course, evaluate all mil. tary piano and take Into consideration abet thle country will * be able to do with vhat resources are available la order to meet the strategical plan wfclch 1b developed by the military. In civilian life and assy free* aUltaxy at the present time, we have, of course, aery civilian organlsatloni, includ- hog out Aaorlcol Ifcdloal Aseoclatlon, and la thle group •todies i»ve been aede and are continuity to be node relative to aanpewer particularly as applies to medical trained personnel, aaad also there axe ccsaalttoeo which have studied the $rdblem of civilian hospitalisation. I third: it is known as the American Board on HoapitaUzotlon which have estimated the required bode ** civilian ccBmunitlo* the country. Bareomlly, I believe it would be a terrible to mix the Military with the civilian in hospitalisation quee. tloos. MUltaxy needs tar hoepltola should be developed by the Military themselves. Vhc is there that is better qualified to do this than an expert in Military madlcine? If such personnel are available la the allitasy farces, they gala +-M« knowledge bar exierlejac© of nsny years* service, and they should be raido responsible for the determination of the Military needs, vhleh I don’t think should include civilian needs. Waen these thlags aro deteralrnd, I these ere personal opinion© —bolievo that those Betters pertain- ijag to hospitallaatloaa end public health truest lens not be questions of the ollltary at all. Certainly ve shouldn’t, eactsept la wxxx&t»y, use military hospitals fear civilian purposes. iiSAB iUHEM, AHEIEiSCEf To return again to hoopltailza- tlon end evacuation policies In the combat and I believe re can conclude that reecanBodaticns re BE?ke trill set be at variance vlth those of this Subocei* ditto©. Apparently they are not considering hospitalization In the ccsahet and coasamlcatIon zones. Kbw, to return again to hospitalization In the zone of the Interior and to the details that hare been assigred to c«r Gubocasaittee, construction, distribution, and stefflrg* Conctruction Is a matter under consideration by another eubecaaaltt©® than that which you are Chairman, I bs» Here? SEftB AUHBAI, AIMQCBTt That’s correct, sir. mm A3XERAL mmmt Distribution. Do you rent to talk to him about distribution? 879 G52EB&X, Off the rocorct -• * • * OFF THE HECOm) . , . SSAH A3KEfcL Amwm: 3h the distribution of boa- pitala la the sow of the Interior, our Subcowlttee hare fait that acne coordinating agency would bo noooeaexy. It's oar ecwcapt that your Subocaadtteo will submit the detailed rocaa- aaendatlcns as to distribution of the existfacilities. If I Bight put It that way, «od that after the weak of your Sabccwdttes is ccnpleted, there should be sens coordinating agency idilch would continue to function in order to distribute hospitals of the three Annd Forces to effect eccaacny* We here felt that a .Joint medical board cm a high level would be aseessaxy not only fer coordination end the distribution of hospitals, but for the coordination of other ftaactione in the Medical eearricee, sad the caaaaltto© jropoeed to Include in their recawendatlans that such a board be established. Vm have considered that the baud should be oagneed of either the Surgeons General sad the Air Surgeon, or of representative* of theee off leaps, sad that they should fbnctlcn at the Joint Chiefs of Staff level, sad that future hospital develojnsat would be coordinated by this board. Our ccBsdfctee has felt the need of such a oentinaine hoard. On what level it should bs, I as in no position to 880 Since the pressat board, homrror, reports directly to the Secretary of Defense, I would personally rather Ism tho fvtomi board on the me level instead of the suggested Joint-chief#-of-staff lerol. That however nay act he possible. To clarify trm oar hoard's viewpoint the question of hospitalisation or hospital provisions within the Anssd amviam, we appreciate very mch the feet that the r mltttj of asdkbSi whitch is furnished to the «ae& eerrloes, end wbish Includes of sours# hospitals, station hospitals, sad ddspenearlee, here been leeatod in the past in certain arsis *mm this stmtsgio support can be best given to 1dm aevvieee* Share has been overlapping of sash facilities, and I personally believe where such overlapping assure, eosnon utilisation of eoch fscilltlse wherever it oea te justified, should be carried out. Tn doing this we should not lass sight of the feat that future rsquirsnente my necessitate the use of sash over- lapping fseilitiaa which, for the Una being, ass inactivated, and we believe it should be an iaustivmtion rather than the disposal of such facilities so that in the event of meMUm* tlcn they nay be available. SBAR AHOHdl Ammm j Shane is another feature on this question of duplication of hospital facilities that our adbof—dttee here considered, that a thousand-bed gmeeel hospital represents probably the greatest efficiency frees the standpoint of sis®, and that a thouaaaad-hed hospital Might readily he expended to two thousand "beds, ar possibly to greeter capacity in the event of urgency; hut that in consider* Ihg the overlapping functions the nodical departments •▼old ocrtblalng hospital facilities in ary given area that will require a general cap novel hospital to operate con* tinuously on a nonal basis at moot greater then a thoucaol- hed capacity. . . . an m record KSAH AIKISAX ASDEHSOXIj Hew, do vs have any material In ocsmon concerning the staffing of military hospitals I Has your ccnaittee taken up the question of the staff of mval end general hospitals t WXR AJMIBkL AmiMW.ti HO, sir, not to this date. I noticed here — have you got your finger on that one little thing? I night ro-read one of these suhccssaittes things; hut w haven't gone into it. This paragraph k I think would cover that, which gives us — let as hear your question again, please. EEAB AJKERAX AffiESBfSft Off the recced — (WF THE RECORD . . . AIKTRAX AlSRBSBTg Wo haven't cone to that, hut nay 1 read this paragraph here in oar charge? •Che Ccsnittee 882 desires also to explore the desirability and feasibility of developing to the highest practical degree greater imiforcdty and closer coordination smug the nodical services In adminis- trative standards, policies, practices, procedures, and person- nel requlrenente relative to natters pertaining to hospitalisa- tion," Of course, we had looked at this fro© a broad view- point of joint staffing and whether or not it night be possible in certain institutions to reduce the over-all personnel In one or the other service so that ha sight be nade available in a certain specialty for assignment to eons other activity* We have discussed that — if that answers your question* mB AIKTRAL ASDEBGCms Does your Subccciaitto© subscribe to joint staffing of a hospital of am service by nodical officers frc© the other services 7 m*B AIKERAL AmOTs Again I ea epcjchirg for nyeelf and not the Ccamlttoe. I have taUteod a good deal on this subject to a great maaber of individuals, including the Surgeons General of the Anoy and the Ttoxvj and the Air Force Surgeon* I pexBcaacJOjr saa. of the opinion that joint staffing is not coly practicable, but I bollim* It to be Mvantegecas in certain Instances, particularly in such Irsrtltutiono where there is only one existing hospital but where personnel fro© 883 the three forces ere present. I refer particularly in con- sidering future plane for heopitcllzation in Q&m, Adak, and Honolulu, wiser© there is an overlapping of Military requlro- aeaota, but whore ecomasies can certftlnly be effected in build- ing porsssnmit institutions. Why should there bo more then cm© perasnenfcly constructed hospital of a thousand beds, or less. If that in all which is required for the three Military forces ? For this erne reason, I feel that there can be & true economy in personnel assigned to such institutions, a balanced staff from the three arsed services. This would effect econcey not only In construction, but also in the utilisation of highly - trained Medical personnel. mm Ammo. psmmos: should th© staffs of nsvai hospitals and general hospitals be zs&de up entirely of specialists end residents who are specialising, or ahull tbs tables of organisation include a generous proportion of general professional mm ? HEAP AIKERAL AIBECCar* In replying to this ques- tion, I wish to state that I em speeding only from the view- point of a nodical officer Jn the Bevy, In the Bevy we have hospital ships and vo have naval hospitals, including raany dispensaries, sosso of which are comparable In size end mission to that of station hospitals within the Amy. The only excuse for ary sheer© activity within the Bfeyal Eetahliabsetib la in support of the fleet# Medical sen asset he supplied to the fleet# When aboard ship or in the field of the Merinos, the Bory expects its nodical officers to he good all-around mdiorJ mo# In training naval nodical officers at tbs naval nsdioal school, these young doctors are taught how to do all types of emrgspoy operations, including scute wastold, sent# appendix, and other sargloal procedures# It Is true that cur naval hospitals and our ami hospital ships require In certain apeolaltlee s fairly well-balanced staff• Shis does not man that tfaeae doctors are all certified by an American hoard in any one particular specialty* It is deaimhl© in teaching institutions to have a halsnesd staff of certified individuals, hot certainly tbs needs of the Itery prioarily are that of supplying aadlcine, tnelallng eurgsry, to those "within the Bevy, particularly the fleet. HEftE AIM2BAL A33SEK5C®: Again In connection vith the ff ' staffing of hospitals our Guhoonalttee ho* discussed the adartiiistretiva duties assigned nodical officers aad mamas particularly* te vise of the acute shortage of this type of personnel la the event of aa energeney, oar ecnslttse feels tables of organisation and personnel aHosaaoee should he ncdifled nth a vise to assisting professional work only to aedicuJ officers end nurses. V© feel that certain positions u*ust b© fined by aedlcal officers, tie ccasraandioe officer, tbo executive officer, and certainly the functions of the office of the chief nurse ohouid he perfoaasd by a nurse| but there are wajy admlnle- trative duties In a hoepit&l uhlch ve believe «hr»yid be perfcaosed by aedloel service corps officers end other non- professional personnel. 1 aentlcn this conclusion as one that our Gubocaaslttoo vtll for the Inf Croatian of your Subcoaaittee. Would yowr Oubcoeaaitte© subscribe to such a change in tables of QgBECisatlonT KEftH AEK3B&1 iUJKBar, May I oak in shat way ian’t there being utilised to th© fullest extent a&dlcnl and nursing Personnel within our hospitals T BEfiE AJKQ&L Well, I believe that the professional eaaplcgraent of doctors and nurses la hospitals is \ vxaeo carefully observed than it 1« in other units, particularly la field unite during notional emergency > ani perb&pe the question appllee sure to enplagraent of those professional people daring national emergency in field and waller mdioal angaalxatlooe • fhsre has been xanch consent by rsoerve officers on their swployswnt in ncnprofessianel work. j believe that a 886 awaaary indicates that about 30 per cent of the time of rasdical officers In the Amy was employed in administrative duties end about 26 per cent of the tine of medical officers in the Hsvy. RSAB AlKEBftX AIBH3GKT: I believe you am speaking about the poll uhich was conducted by tbs American Medical Association directly after the cessation of hoot 1 litloc in this last war. HEAR AMORAL ASS3SQS: Yes. RSAS AUGBAL AXBH3jC3IT: I reviewed the reports of this poll with a great deal of Interest when they were published in the Journal of the Anoriccn Medical Association. I heller© the criticism advanced by many medical officers who were In the earned forces at that tine were mad© on the basis that they wre not being utilised the greater part of their time within the service In their particular specialty. They also expressed certain percentages of inactivity without any occupation. Hf personal opinion on this natter Is that certain groups «t medical officers comprising of staffs fear proposed hospitals foot assignment sere held at ports of aobarte-tlon for certain periods of tins ’before being assigned to thslr oversea stations, t appreciate only too veil there eas considerable loss of tine while waiting for the progress of the war to reach a point where their services sere required. It la true they were in a stand-by statue* This of course is a military requirement In that they have been held at a certain point so that they will be available to move fcorvazd when their services are required and when the military nisolon has reached the stage where their services will be needed* In other words, the necessity fear having the right thing at 1 the right place at the right tine in the right amount Is re- quired in all military operations. OFF SEE BSCOKD . KSAH AIKJmi Aim&SCB; The lest one here is •Fectars cootrl'outlug to alleged overlapping." I think vs have discussed that as far as your Gubcocmittee is concerned* It refers particularly to the distribution of hospitals. BEAR AjKOML And I talked shout that Just a while ego. HEAR /U-OmL AKBEBSOIft I have nothin further to bring up. COIOKSL P0EL$ I have two setters hero, sir, if X «cy zaesntloa them* ISAB AUm&L /JHEERSOEj Xes. CQIjOKEI PGELt I have reviewed the replies to approxirattoly 60 questionnaires, and I thick we have touched en most of the subjects relative to agreement go also, the seed for modem architectural design as compered vith the 888 apparent lack of it, arid ve ar© thinking about vfeat should be don© for future In the cone true tlcsa aspect • There were criticisms on location and on staffing, V/© he.von*t touched on the use of oiecial treatiasnt centers In the last emergency, and I believe it’s up to us to rake eosae of reccmendatlon In regard to such utilisation. SEAR AHCEBSOH: I tidhk Admiral Albright has referred to — COLOHEI- KEls Not special centers in thoiasolves for specific type cases. i£SAH AIKEEAL AXQXIHSONi The problem la as to whether specialised hospitals should be ostebllahod and utilised, or whether the troataaeat of the special types of cases should be included in the work of the naval or general hospitals. C01vS£L tfOUXt Hey I go on from there, sirt REAS AJDKHAL A3SE2S0N: Yes, C0LD5EL KHLj The difficulty that was encourtored ©as the conflict of such special treatment centers with the hosplteXiEetion of the Individual near his home because they didn't have adequate distribution of those s pec lei centere. HEAR A2K3BAI. AISRHSlTj What would be the opinion of your Bubccwaitte© in regard to the use of special types of hospitals? BEAK A3KERAI KXSSBO&t Well, there 1b certainly plenty of precedent for the ©stabllahawt of special type© of hospitals for tbs nnaod forces. For a master of years tbs Assay end Ifewy General Hospital at Hot Arkansas woe utilised by the Arosy end tho B&vy. At Hts&fiiaoos Generol Hospital at Denver for acay years the Array took cere of our tuberculous cases. Cast the other band, during this peat emergency when it was necessary for the Bavy and X believe also the Assay to get out of Saint Elizabeth’s Hospital* the Bevy did enter into an agree* sent or an erruegewont tilth Fart Worth Public Baelth Service Hospital for the care of their psychiatric cases. As 1 understand at the present time this vill he a consideration vtdeh soy have to he considered by our particular hoard in that It la ity that Fltzcisoocs vill not have (sufficient capacity for the care of tuberculous \ cases fraa the three arced services. In such event, it ary he accessary to have another hospital to take care of cases of tuberculosis vithln the ©arvleee. In such case, I thick It vould bo advisable to have ooo of those hospitals located at sens distance from Titzmtssam (Seasonal Hospital so that people fren any particular part of the country could ho hospitalised la such a hospital. 890 This could be carried further In the hospitalization of psychiatric cases. If wo ero able to so limit far the beet utilization of highly-specialized poroomel and vlth a Joist use of a particular hospital for the psychiatric cere of patients from the military services, that would be an economical factor. COLOKSL PCEX* I have om last thing, sir. If I asay. I wondered. Admiral, if you could give as seas aunaary or concept of what your Subccenittee has considered with regard to specific needs of the Air Forces for hospitalisation if that natter has case up at alit HEAR AIJGRAL ALSKSJST: 0ft the record, please. OFF THE RECCED . . HEAR AJ2KUIAX AHCTJBT* Tee, consideration is beiz« given for hoepltallxaticn of Air Fence personnel. The meeting adjourned at 11x30 a .a. •*8 15454