MED DA 
DEPARTMENT OF THE ARMY 
Office of The Surgeon General 
Washington, 25, DC 
30 August 19U3 
SUBJECT: Report of Conference of Commanders of General Hospitals and 
Medical Centers 
There is transmitted herewith for your information a copy of the report 
of the conference of commanders of general hospitals and medical centers 
held on h~5 August 19U8 at the Pentagon, Washington, D. C. 
FOR THE GENERAL: 
/'■ / / 
• < 
t./J'. Hi1'RTFOflD 
Colonel, M. C. 
pbcecutive Officer 
1 Incl. 
Report of Conference Representatives of General Hospitals and Medical 
Centers Attending Conference Held on 
h - 5 August 19li8 
Major General George C, Beach, vrmy Medical Center, Washington, D. C. 
Major General John M* ”rillis, Brooke Array Medical Center, Fort Sam Houston 
Brig. General Paul H. Streit, Brooke General Hospital, BAKE,Fort Sam Houston 
Brig, General Harry Offutt, Percy Jones General Hospital, Battle Creek 
Colonel ,Asa Lehman, rmy & Navy General Hospital, Hot Springs 
Colonel George Reyer, Wrn, Beaumont General Hospital, El Paso 
Colonel Edwin /. Roberts, Fitzsimons General Hospital, Denver 
Colonel Philip P. Green, Madigan General Hospital, Tacoma 
Colonel John M, Welch, McCornack General Hospital, Pasadena 
Colonel Harry /, Clark, Murphy General Hospital, Waltham 
Colonel 0. H. Stanley, Oliver General Hospital, Augusta 
Colonel Kenneth Brewer, Valley Forge General Hospital, Phoenixville 
Colonel Kermit Gates, Letterman General Hospital, San Francisc© 
Colonel David E. Liston, Fort Totten army Medical Center, Fort Totten 
Colonel Leroy D. Soper, Tilton General Hospital, Fort Dix 
Colonel Arthur Redlands, Tilton General Hospital, Fort Dix. 
Colonel James N, Williams, Sta, Hospital, Fort Bragg, N. C. GENERAL BLISSs 
Good morning, gentlemen, • I think I have seen most of you personal- 
ly, I am delighted to have you here and to greet you, I am sure you 
know why you are here, but I want to review for just a moment - it mill 
be covered fully by members of my staff - why me are hero and what we 
have, to do. It comes down to personnel- again and I mill speak now prin- 
cipally of doctor personnel - the Medical Corps, 
As you know, the-draft bill passed without having anything in it 
to do *!ith medical moans, I want to give-a brief summary of the history 
of that bill, which General Armstrong will cover fully. Defeat of the 
draft bill for medical officers was brought about because of the opposition 
at the time of the American Medical Association. Thoy advanced three 
reasons for tho opposition; Oho, they did not believe doctors, as such, 
should bo drafted any more than engineers, lawyers, or other professional 
classes, "hich scorns to be perfectly reasonable. The second reason thoy 
had for opposing the drafting of doctors was that tho Array perhaps did 
not knoT:- how many doctors they required and that the stated requirements 
wore too high. This is subject.to critical survey, if 'anyone wants to 
bo critically, survey it. We have been studying our requirements since 
1775, particularly during tho last year and very critically during the 
last six months. Our requirements have been reviewed from every angle, 
particularly from experience tables. In comparing our experience with 
Tables of Organisation, I can stato,•roughly, that if wc hood 100 doctors 
today wc have 80, Our requirements, if wo state them as 100, may be 
open to argument to a certain extent but without any question wo certain- 
ly need 80$ of our computed requirements for tho present size Army, If 
we completely controlled our moans and used them with'the utmost intelli- 
gence wc might be able to provide proper-medical care with tho 80$ for 
a-reasonable-length of time. However, any form of critical survey will 
show wo cannot got along and givo the treatment we are supposed to give, 
and the total medical care and service ';’e are supposed to give with 80$ of 
the doctors 'we claim wo need now if the Army is increased in size, Tho 
third reason was that it r,?.s not 'necessary to draft doctors because they 
.would volunteer in the numbers needed. The American Medical Association 
has accepted responsibility for the non-drafting of doctors and they have 
further accepted the responsibility of endeavoring in every manner of 
getting the doctors we need in the numbers we need. If that does not 
succeed, tho AMA has further agreed to support and sponsor a draft bill 
for doctors, Me are working -in closo association and complete cooperation 
with the loaders in American medicine, , 
The. lack of doctors at tho present timo, where we have 80 instead of 
100, confronts us "dth a serious problem. It imposes a challenge on us, 
one which we have to moot by using the medical moans available to us to tho 
best advantage. It is for that reason that we have just had a-conference 
of all of the Army Surgeons and Air Surgeons and have asked you hospital 
commanders in hero noir' to talk over and have these problems presented to 
you. ’• • • - CONFIDENTIAL 
I think when we state we will keep up the standards we have 
established (and we have no intention of deviating from them) our 
computed requirements are perfectly sound. We have no intention of 
cutting down or curbing the training program whatsoever. We believe 
it should be expanded rather than curtailed, I hope you will all 
think of that. We believe that part of our program, professional 
training, is one of the real postwar accomplishments, and to curtail 
or stop it would be sheer stupidity, to use General 
term, I think it would be a very poor thing to do. 
It is the simple way to say that we will save doctors by not 
taking care of patients,- That is also a shortsighted policy as far 
as I am concerned,. In relation to that is the care of dependents,' 
We must continue this care because of the moral responsibility. It 
is always stressed in recruiting programs. It has always been done, 
and is expected of us. In salaries paid to service personnel it is 
expected and is a part of a salary, I don’t want to see any cutting 
down on their care. That is an overall statement and I could qualify 
it by saying we must furnish the care which is medically necessary 
but not necessarily all the attention which may be demanded. 
A number of people have suggested that we should not take veterans. 
Most of the veterans we are caring for are in our teaching hospitals, 
are receiving specialized treatment in hospitals near their homes 
which are otherwise unavailable. This specialized care is not only 
deeply appreciated by the veterans themselves but the teaching incident 
to it is invaluable in our resident training program, I think we should 
not attempt elimination of this type of veteran patient. It presents 
a serious problem. Doctors are required to take care of them - whether 
in our hospitals or others. All of the details of this will be covered 
by speakers.coming on later. 
I have just returned from Germany and have boon very much impressed 
with the care and quality of the medical services being rendered by 
our Medical Department, All of us can be proud of this service in all 
of its phases, not only in the curative care rendered but in the admin- 
istrative medical work by the hospital commanders and in the field of 
preventive medicine. The sick rate is as low as it has ever been. 
The patients are as few as they have ever had. It is interesting to 
note in the professional curative program some 76 consultants have 
gone over there. Every month we have three or more consultants, who 
represent a cross-section of the best in medicine, visiting Europe, 
They spend two or -three days each in pur 15 hospitals. Our top 
Regular Army men there in professional medicine are few in number. 
Most of the doctors are ASTP graduates and these young men are interest- 
ed, able, and doing excellent work. These visits by the consultants 
very definitely stimulate those young men. The consultants make rounds 
with them, perform operations, have clinics, efrfc. These visits assure 
us that we are keeping up with the highest standards in this curative 
medicine field. When the consultants come home (they have seen the 
excellent work being done and are very much impressed) they are asked, 
by the families how conditions are, how their boys are being carodjfog 
2 
CONFIDENTIAL • CONFIDENTIAL 
Tho families who talk to these doctors believe what the doctor tells 
them and the doctors having seen, believe, what they'are saying - 
because it is true. These’ top men come back and go to medical society 
meetings and talk about their visit - I-am astonished how they travel 
around- - they are at the meetings, are questioned by their colleagues, 
tell what they have seen and how, impressed they arc with Army medicine. 
All of this helps the Army Medical Corps and this help and goodwill 
is cumulative. 
Vie now have a challenge to meet, be have generally met our 
challenges, and we expect to meet them no?;, be need to conserve our 
medical personnel and that means the most intelligent use of our 
personnel. That’s what we hope to accomplish, be must prove to Ameri- 
can medicine and to ourselves that we arc making every effort to make 
the best and most intelligent use of our medical means, I sincerely 
hope and believe that this conference will be mutually beneficial. 
GENERAL ARMSTRONG: 
The-purpose of my brief remarks will be to go over the events of 
the past few weeks in order that you may know how we have been think- 
ing and worrying, and in order that you may share properly with us 
your appropriate part of this worry, I would like to go back in my 
orientation to the events which occurred immediately after the war, 
I would like to remind you particularly of the questionnaires sent out 
to several thousands of doctors, who served in the armed forces, by The 
American Medical Association, and the assembling of the facts brought 
out by those questionnaires, in which the Medical Service of the armed 
forces was not painted in a very favorable light. Perhaps the- two 
biggest causes of dissatisfaction among those individuals serving with 
us were (l) non-use, and (2) miss-use. In other words, people were 
left sitting around in training centers for irrnths, not doing any- 
thing, and also the matter of being assigned a job for which the indi- 
vidual was in no wise qualified. Immediately after we had shaken down 
after the war, this office began figuring cut ways and moans of avoid- 
ing those mistakes again, both in peacetime and in the event of another 
major mobilization. Eith all that have come some radical Changes in 
personnel thinking and actions, Crreer guidance is no longer an idle 
dream. Talk with Fred Fielding and let him show you, if you are not 
familiar with how it works, the method of properly classifying every 
individual going into this career pattern. In case of reserve units 
wo propose echelonment of personnel, as actually needed, rather than 
bringing units on and leaving them in Camp Bowie or some other 
post for a year or more before being utilized. The IG, together with 
the SG, has reviewed all of our installations world wide and reports 
today there are very few medical officers occupying spots that should 
be occupied by other than MD,’s, So, we have not been standing still 
for the past two years, and for the past several months we have been 
going over Tables of Organization, over our allotments to those not 
mentioned by the TO, and cutting down, not with the idea of trying to 
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reduce any ratio, to a lowcr1fraction, but to. got nun personnel require- 
ments in the lowest possible .terms .still render the of service 
The Surgeon General thinks-we should render.. All this mas’going on before 
the President asked Congress last March fnr three things: ’ the ERP, 
Universal Military Training and' Selective Service. I recall how everyone 
left the radio where r-fe had been listening to the. President and there 
were no comments, either serious or facetious, and everyone returned 
to their respective offices knowing we had a big problem ahead in the 
Medical Department, Someone remarked., "It never occurs by lysis, always 
,by .crisis," -So, we started to work. General Bliss insisted that wo 
have prepared, regardless of what turned up in the v;ay of Selective 
Service or military training, a piece of legislation to assist us in 
the event we needed medical and dental .personnel, Mo more not in on 
the early phases of the draft legislation, for, as usual, it was not 
with us, and it was only by chance that our Chief of Personnel 
was able to see the draft of this bill as1 it was going over to the 
Hill. I T;’ill not dwell on the dissactisfaction that the first draft 
of this legislation created, particularly in the medical profession. 
The first time wo really know how AMA. felt about it-"-’as. when Colonel 
Robinson happened to be invited to a session in Mr. Gurney's office and 
there were present representatives of the AMA; and there they agreed 
on certain-priorities: (l) Those who had participated in government 
financed schooling and had *nnt served on active duty upon completion, 
(2) Those deferred but who had not partiednated in government financed 
schooling, and (3) those-who' had served least. Some changes had to 
bo-made, such as not disturbing men who had been "dug in" in their 
communities. From that meeting Colonel Robinson returned feeling the 
Medical portion of the Selective' Service bill mould not be terrifically 
opposed. In tho meantime, me had not boon remiss. Unless some relief 
was obtained, we stated repeatedly that w.e mould-be unable to support 
tho draft from a medical standpoint,. and on the afternoon of IB June 
of this year '.’hen we learned they had deleted the medical-dental section 
from the law I mas asked why I was not doing anything. I called General 
Persons, and they said there was’nothing more to do. They stated they 
had met with General Bradley and Mr, Royal, only that morning, and 
that all thoroughly understood ,the implications. They."believed there 
would be some relief, even if in an A T T E N -T E..-D form, I loft 
that afternoon for Chicago thinking surely there: would be some relief, 
and r,hcn I learned the follow:’nr day that the entire section had-been 
deleted, you can imagine my feelings. It was during the week in Chicago 
that I first learned of. the opposition organized medicine had put up. 
At the same time wo learned that those individuals responsible for 
that deletion had not intended, nor did they know, that the portion of 
tho bill was deleted "’as the one which would have required ASTP's and V-12's. 
and the so others who had never given any active service -to bo brought into 
tho Armed Forces, '’'hen wo recovered from the shock of this situation we 
began grasping for mays and moans ‘to*do what wo could with what wo had to 
meet the crisis, knowing full roll - and I think this was not a defeatist 
attitude as anyone looking at the charts with Colonel Robinson will show you 
can see, that wq cruld not'meet it, and knowing Tho Surgeon General would 
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eventually have to go before Congress and defend this situation. 
No felt it was up to us to come up with every possible saving, and 
assure Congress and the public that we were properly utilizing and 
conserving the means at hand. We were called before the Board of 
Trustees of the AMA during the week of 21 June and asked to discuss 
our requirements and we refused to give any ratio, 6,5, 5,5 or anything 
below that, insisting that what we are trying to do is utilize the 
smallest number of personnel possible, knowing there is a nation-wide 
shortage of this commodity, and that after you have reached rock bottom 
it is immaterial if you want to turn it into a ratio. I think I can 
say that in general that attitude met with favorable response on the 
part of'the AMA, I also knew we could not just talk and not-act, when 
v;e returned to the office on the morning of 28 June we carried to G-l 
and the Chief of Staff papers in which we set forth what mg-thought we 
could do and some of the things we proposed to ask for. At that time, 
not knowing the exact plans of the General Staff, we made this blanket 
statement which later was turned back at us, Ue said at that time that 
without more relief than we could see without legislation, .and taking 
cognizance of every means by which we are going to try to conserve 
personnel, we could support the expansion only until the end of the 
year, providing the expansion took place in current facilities and 
current installations and that we could not undertake to open one single 
now post, Ue later modified that, as I will come to in a moment. 
During the first few days after 28 June wo had literally scores of 
suggestions as to how to conserve personnel. Many were sound, many 
crackpot, so I created a group, later known as the Harford Board, to 
go over these suggestions and determine which seemed sound and which 
we should explore. About that time wo began thinking of bringing in 
representatives from the field. The reason wo did not bring you in 
sooner was that we felt the boys getting the impact first would be the 
Array surgeons and Air Command surgeons, and so wo sat a date for that 
meeting, Ue gave them time to think over the problems, set a date for 
the 13th and lAth of July, and, fortunately, it was during that meeting 
we first learned definite plans regarding expansion on the part of the 
General Staff, so we were able to sit down and go over area by area- 
post by post, and in the meantime learned that actual induetion-iOf£vhe- 
men -was to bo postponed two months. So finally, on 15 July, we went 
to the General Staff again, and this time we said, ’’New knowing your 
plans -and now having conferred with our Army surgeons and Air Command 
surgeons,- we modify our previous statements, and it is our opinion we 
can medically support expansion as planned by the General Staff up to 
and including 28 February 19A9, and from then on we can support that 
strength, provided there is no further expansion,’ through March and 
April, and then we can no longer give any standard, even minimal, of 
medical service," As you know, beginning in May and running through 
June and July we lost ZLW medical officers. At first glance this 
seemed to be decidedly a more optimistic viev; than on 28 June, but 
actually it is not so optimistic, and when presented to General Bradley 
he saw it was not an optimistic picture* The seriousness of this 
situation has been such that the utmost consideration has been given 
by everyone in Washington regarding- further legislation as a.means of 
CONFIDENTIAL relief* There was drawn up what we believe is the most noncontrover- 
sial bill possible. It includes only*the.'drafting of those, individuals 
who were.deferred to pursue a professional course of instruction, whether 
participating*in a government financed program or not. It must have 
the official support of the AMA, They have met with us on two occasions 
and are in agreement regarding the wording of this law,.and their final 
full support of it depends on something, being considered by the Secre- 
tary of Defense, some sort of an advisory committee at the Secretary 
of Defense level. That is a very reasonable request on the part of 
civilian medicine. In the event of any expansion or mobilization we 
are entirely dependent on civilian support and our Medical Service be- 
comes very predominantly civilian, and it is only reasonable that 
civilian medicine have a say in the overall policies, at least in advice 
regarding them. It is expected, that we will know in a matter of hours 
whether such an advisory committee or counsel will come into being. 
The next question is whether we can get this before this Special Session 
of Congress, At the moment the outlook is very dim. In spite of the 
fact that I saw a statement just before I came to this meeting to the 
effect that at one General Staff conference it was decided hot to offer 
any piece of legislation except the bill of which I have just spoken, 
it is still very questionable whether such a thing will even bo sub- 
mitted, There are pretty good reasons why they do not want it. There 
is considerable dissatisfaction with a peacetime draft and that would 
be particularly true if we had news of a break in the Berlin impasse# 
I think if we.got word that the Berlin blockade had been suddenly lifted, 
it would endanger the very life of the Selective Service Act of 19AB and 
:'anything pertaining to it. It would create the possibility of getting 
amendments which might nullify it to the point where it would be a use- 
less instrument in the building up of our national defense# It is my 
opinion no action will be taken by this Congress to give, us medical 
relief. Coming to the opening of a new Congress in 1949, again we are 
going to have difficulty in getting any speedy action. You say, what 
about doctors and the people in organized medicine? V.Te have discussed 
this with the AMA, and frankly, they are no more optimistic than we, 
V'e are giving credit for 200 volunteers that will come in as a result 
of moral suasion** VJo are going into 1949 with a picture no brighter 
than today, We are afraid that even if we get the necessary legisla- 
tion we ?;ill not have one single additional person in uniform before 
July, It takes time to get laws and then implement them. So, when 
a person like Dr. Don Pillsbury says the Medical Department is facing 
the worst crisis in 25 years, I think ho is being very conservative 
in his statement. V.re brought you in hero primarily to impress upon 
you the seriousness of the situation, to impress upon you the fact that 
this.medical situation actually may interfere tremendously with our 
national security. Furthermore, when things do get worse, you will 
know what we are trying to do, and that is to preserve the national 
security as much as we wan and still do our job. It is also hoped that 
the tour hero may .enable the hospitals to get in some changes that have 
been bothering us for some time, and for that reason we have brought 
in Colonel Clark, Colonel Stanley, and Colonel Morgan for recommenda- 
tions as to revising some of our antique procedures which are turning 
some of our hospitals into hotelsl You are here not to be given the 
confidential 
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answers but to help us work for at-: least a partial answer, I want 
you to feel it is your meeting as well as ours, and be ready to come 
tip with even'the'most minor suggestions to he lp us in our goal to 
render satisfactory medical service in the hope that wo will not limit 
the expansion of the, armed forces. 
COLONEL ROBINSON:-Medical Dep’t, Personnel and expansion of the Army, 
I will fallow up General Armstrong’s preliminary remarks, Fhat 
I propose to do is to set down the facts as we now see them with regard 
to personnel and then to outline in some detail our plan for attempting 
to remedy the situation. You will notice on the agenda that Colonel 
Enperly, Colonel Maley,. Colonel Goriup, Colonel Vogel and Major Mannen 
will speak for very brief periods on the personnel they represent:-the 
Dental Corps, Nurse Corps, Medical Service Corps, Women’s Specialist 
Corps and Enlisted Personnel. We have left the Veterinary Corps out 
because we felt their problem in general hospitals is not so acute that 
it needs representation here. This is,with the concurrence of the 
Chief of the Veterinary Division, Apropos of tomorrow, I have been 
kidded about this, saying wc are going to solve the whole thing in 
thirty minutesi The session tomorrow is for the purpose of effecting 
mutual readjustments that have to be made to equalize the. Medical Ser- 
vice throughout. We did this same thing with the Army surgeons and 
Air Command surgeons and felt it extremely beneficial, -We have 4-;359 
doctors now and wo actually need 5500, 
(At this point Colonel Robinson gave a graphic description of 
information contained on charts pertaining to the Medical, Dental, ANC, 
MSC, VJMSC, and enlisted personnel.) • 
Now, I would like to come back to the general hospitals again, 
I don’t know whether or not this booklet covering the Army surgeons’ 
conference was delivered to you, but there arc a few things in it I 
would like to point out. One of the officers said, "It is just impos- 
sible to make an American Board man out of everybody that:Is going 
to be in the Armed Forces, I think it is anyway, and I think it is 
unnecessary, whether it is impossible or not,” Another: nTho Air Force 
has 796 total in the United StatesJ I mean World-Wide, 614- of which 
arc on duty with troops within the United State s,; That means that 514- 
doctors are giving the field medical care for 247,183 as stated on this 
-paper, or one doctor for every 4-81, There are available 4-350 doctors, 
I don’t* know how many the Array has overseas, I can’t account for where 
all of these doctors are, I’m,just trying ."to figure it-out in my own 
mind here. It looks like there might be a littlokmaldlstribution, I’m 
wondering if the General Hospitals are perhaps staffed to the point 
Where the people who are actually cutting the mustard with troops, where 
military medical men are supposed to be, I wonder if they are doing 
that at the expense of the proficiency of the Medical Service to our 
soldiers. Personally,I am convinced that military, medicine and the 
preventive aspect of military medicine are part- of pur primary duties, 
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that we should advertise them more, we should think in our own minds 
that they are more important, and to think in our ovm minds that vw 
are important that we arc engaged in it. And we certainly should 
convince organized American medicine to some degree that preventive 
aspects of military medicine are as honorable, and as valuable, and 
as necessary as any.other higher degree of specialization, I wonder 
if there is anyone that has any similar idea-e of that kind,” Another, 
"I do believe that we have failed in trying to got people, we have 
placed too much emphasis on the high specialization that we are trying 
to offer people. And I doubt very much if we can produce, I think 
that we should appeal more to the general practice people and try to 
get their interest in this program," Another, ''If we want to encourage 
men and’open opportunities to men-in a field of military preventive 
medicine, let's their turn tho .pages back to the station level and build 
up our hospitalization program there in the midst of their patients, 
in the midst of their'military dependents. Let's give them tho type 
of service'many of us can remember. The kind wo did at station level 
10 years ago before the war 'and considered it a very creditable type 
.of- professional service, I'd say we have a product to sell but we 
should sell it where the men"will come in contact with the Army and the 
Air-Force," Another, "Suppose everyone in the Medical Corps becomes 
a; Specialist, Are, they going to stay in the Army? I can see, if I were 
a young man coming- into the Service, and I was advised to report to 
Meade or some dull station where I had nothing to do but look after 
a few colds, I think I'd resign, I think we have gone too far in try- 
ing to sell the specialty, even though it is very important, I am 
inclined to believe you should go in and try to sell military medicine," 
Another,"And I think that we should come back and-establish some of our 
old ideas and principles and insist on following tho thing through in 
that line. If we don*'t, we are going to continue with this same situa- 
tion we have today. The function of medical officers at the bed side, 
we don't minimize its importance, is only one of our functions, and I 
certainly think that all of us agree that the prevention, keeping that man 
out of that bed and from being a loss to the Army, is certainly at least 
as important as treating him after he is no longer an asset to.the Ser- 
vice," Another, "There are some problems that have to be met, by laying 
your cards -on the table. Colonel Ogle mentioned about tho General 
Hospitals being over-staffed, I think they are. They have a big train- 
ing-problem and they have been doing a grand job. But as a matter of 
comparison, I have, a list from Letterman GH, I counted the MCfs on duty 
there. As of the.15th of June, they had 127 which include their interns, 
.and as of that* same date I had 107 for the 6th Army Area," 
~ I read these excerpts merely to show the fact that the way wo are 
carrying on this training program is not fully in accord with the ideas 
of all of our medical officers, I would like to say this, however; that 
for. two years a valient effort was made by the Army and the Medical Corps 
to get doctors on the basis of selling on military medicine and practice 
as we knew it before. Wo failed badly. We are convinced, after very 
careful study, that the only possibility of filling the Regular Corps in 
anything like a reasonable' length of time is to pursue a course somewhat 
as we have started, that is a medical training program in conjunction 
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with procurement, using civilian hospitals for those we cannot take 
into our own program, I want to expand our service, open Valley 
Forge not later than next July, and take 100 residents and 50 interns. 
We could do it if we could start now, I think that m■?o or less sets 
the background, and I would like to go over very briefly what the 
plan is for both long range and .short range personnel problems. The 
first thing in the long range program is to- fill the Regular Army 
Medical Corps. We feel quite sure from the response we have had to 
date on our Procurement-Training Program that we can fill the Regular 
Army Medical Corps in two years. The one question that stands out 
in our minds is whether we can hold them, ' VJe have to do something to 
change the situation so that doctors will want to stay in the service, 
I don!t think it is within our power to bring on a depression, which 
might be the best way to-.do it] We have analysis information in the 
past, year as to why doctors don!t want to be in the service and I 
would like to go into this very briefly. One of the pr* ~v reasons 
was lack of adequate training programs and facilities. chink we 
have a long way in the last two years in correcting that*- We do 
have a training program, one that civilian educators believe is among 
the best in the country. We have had some name us as among the top 
ten. As I say, we think that complaint is being corrected. However, 
wo don!t have enough facilities for the number we need to train to 
meet the Army Procurement Program, The second reason given was the 
lack of respectable housing, and this Is really a tremendous problem. 
Doctors in. civilian life do not have to subject their families to in- 
ferior living'conditions. Of course, one can say this applies to the 
Army as a whole. It does without doubt, but on the other hand the Army 
hasnT.t had the same trouble in the procurement of Army officers as we 
have had in procurement of medical officers, and we should like to 
convince our staff-that we should do something on this point. Another 
thing is that moves are too frequent. Our policy is the same as the 
Army, a 3 to 4- year tour of duty, but when three-fourths are on duty 
for only 24- months it is impossible to maintain the 3 to 4- year move 
policy, , Undesirable assignments, overseas and dispensaries, it is not 
possible to change. However, we should try to make them more attract- 
ive, Most frequently mentioned is.the attitude of lino officers in 
making servants of doctors, particularly true in the Air Force, but not 
absent in the Army,' Our doctors must bo taught how to combat those 
things, I hoard a doctor say an Air Force officer called him and told 
him to bring him a dose of sulfamcrazine, He was not a patient. The 
doctor was ordered to do it and when he refused he was called before 
the commanding officer and reprimanded. Our doctors have to be taught 
to handle a situation of that sort,. Regarding lack of medical control 
over personnel, it is probable The Surgeon General will get more con- 
trol over facilities. There is to be an experiment in the Third Army 
Area, and may're-establish technical channels, A very prominent 
complaint from the younger officers is that they have inadequate sup- 
port and guidance from our senior officers. We know of instances whore 
this has been true without any question. In general,.! hope it is not 
true, but if it is it would seem to us, a result of the fact that 
during pre-war days adequate training was not given to our officers 
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so that they could render the necessary guidance to the younger 
officers. We have initiated a public relations program within the 
Corps itself, which I hope some of you will read about from time to 
time in the Bulletin and other publications, in an effort to improve 
this condition by informing our officers of things that are going on. 
Inadequate pay is always, a.thing that comes up with everybody. I 
think I should pause hero and say the Army itself, the Defense Establish- 
ment, has been making a study of pay for.most of the past year. It 
was first made by the military and a proposed table and law were 
written up.with substantial increases in pay for all officers in the 
service. That report was referred to a civilian committee, the Hook 
Committee, which has been working on it for, almost six months, It’s 
method of working was this: Certain jobs were selected and a complete 
job description was written, I think Lettcrman and some of the others 
helped, us, producing their job descriptions for that committee. Then, 
they compared those jobs with similar ones in civilian life and have 
come up now with a now pay schedule. Actually, considering it in terms 
of dollars.which the medical and dental officers got, there is a reduc- 
tion in pay on the table the Hook Committee has proposed for Lieutenants, 
Captains, and Majors with a certain number of years of service, and I 
understand, their reasoning is that the younger doctors in civilian life 
do nbt make as much as Army doctors, I believe in some instances that 
is true. In the higher grades there is somewhat of a raise in pay. 
The Hook Committee originally’recommended that the $1©0,00 under Public 
Law 365, Both Congress, be done away with, but.representations have 
been,made to the Hook Committee, It is our understanding they are now 
going to recommend that the 5 year law'stay in effect as it is. Whether 
we should make a study of nay ourselves is a matter we have under 
consideration now. Ideas from this group would be helpful. The com- 
plaint of the failure of government to provide security has not arisen 
very often, but it is said the security of an Army doctor'does net 
compare with that of a' civilian doctor. Another complaint is too many 
non-medical duties, A campaign has been on for;two years regarding 
this, and it is,believed the matter is now well under control There 
are'very few doctors anywhere now doing duties outside of medical duties 
proper. No assurance that assignments will be the same as training is 
another complaint. You are all aware of our assignment problems. How- 
ever, in the current ’’Bulletin" our complete career .planning scheme 
is written up, I hopeyou will encourage the younger officers to read 
it. Actually, doctors are sent to all commands now under requisitions 
for specific specialties and qualifications, and, as far as possible, 
we, are doing it that way. We think this program can be continued and 
we think it will eventually be effective, but it will take many years 
to prove the system. In holding our Regular Army officers wo have to 
do everything wo can to correct these discrepancies, if they are dis- 
crepancies, We must commission only the highest type. We have to in- 
crease the respect of the Corps by training our doctors to‘the stage 
where they can take their place anywhere in medical circles all over 
the world. There aro a number of suggestions which have boon mentioned 
in the long rangp procurement of doctors. One is subsidy of under- 
graduate education. Throe plans are now in formulation on this subject. 
G ONFIDENTIAL CONFIDENTIAL 
Public Health has a -bill sponsoring the subsidizing of undergraduates 
and links mith grants for medical colleges. The Gray bill links mith 
R.O.T.C. The Committee on Nodical and Hosnital Services of the 
Forces has c nsidored a bill Tihich ’"ill be a medically controlled bill 
for the subsidy of medical arid dental education, T’e don’t know the- out- 
come of that. Another thing'->hich has been suggested is the establish- 
ment of an Army medical.school. It is estimated that the initial cost 
mill be >50,000,000, Some difficulties encountered mould be the obtain- 
ing of clinic indig' nt patients and another the obtaining of a faculty. 
No one can tell -’hat *»iil happen, but the thinging, as far as the office 
is concerned, is that the majority are against the establishment of a 
medical school, A number of us, however, are for it, Fc think our contacts 
T ith schools should bo continued through R.O.T.C, and 'P.N.S.&T, Fo think 
me have done a good job -ith these. Colonel Duke can give you figures mith 
regard to interns, and other contacts mhich make us feel it has been bene- 
ficial, The short range plan is to set interim standards for medical 
care, to continue the procurement training program, mork mith AM/* in ob- 
taining -volunteers, utilize all of the civilian physicians mo can and in- 
vestigate use cf government hospitals, endeavor to arrange so commissioning 
can bo accomplished rapidly and the doctors placed on duty as soon as 
possible after they .become available, and finally, mo mill try to get 
Congress to pass some draft legislation. 
COLONSL WALSH OF PLANS DIVISIONS 
The troop basis for general reserves has boon approved and pub- 
lished Try the General Staff, The phasing plan for that troop basis, 
extending from October to June 19A9, has also been approved. Some>; ■ 
units mill bo phased in 1950, The majority be under the command of 
The Surgeon General and.located in Class II. installations. We have 
prepared actions that are.going to bo taken vith regard to service type 
medical departments that mill bo located at Class II installations. 
It mill bo given to the Class II Compandors so they can do a little 
future planning by knowing in advance -’hat is contemplated in the lino 
of activation, reorganization and movement of those units, The: routine 
procedure to. be followed mill bo for The Surgeon General to request 
that action letters bo,issued by. The'adjutant General offooting all 
actions outlined in this paper. The action letter r,ill be addressed 
to The, Surgeon GcnJral, as in the past,' and then'indorsed over to the 
Class II Commander for compliance sn that the Class II installation 
mill issue all necessary orders to effect the action that mill bo out- 
lined in The adjutant Gen ral’s letter, Fo have specified on the third 
page clarification of t rms to be used as related to the locations 
specified and Class II installation. 
COLONEL FPECRLY:- Dental Personnel. 
The situation regarding the dental personnel in the i.rmy hasn’t 
changed materially since the last time you in at a conference 
’”ith The Surgeon General$ so little in fact that "e are still using the 
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samq charts you saw at that time. This can be interpreted as mean- 
ing that gains from procurement have about accommodated losses' due 
to separations and retirements. You have heard Colonel Robinson 
speak of the influence the shortage of medical personnel has upon 
the expansion of the Array, and I might say to begin with, that it is 
a good thing that.life and death or the expansion of the Array do not 
depend on dental treatment, as-I am sure we have been unable to 
satisfactorily care for military personnel in this respect’for some 
time. 
You have been shown a chart which shows the losses of Dental 
Corps personnel over a period of three years - at the end of which 
time the total number of dental officers on duty with the Army will 
bo down to 550, The chart I have here is a little more specific, and 
in reality shows that our big losses are occurring during the months 
of July, August and September of this year, and that the total strength 
of the Dental Corps will be down to that figure by the end of 194-8, 
You can also see from the chart that volunteer Dental Corps officers 
on. duty with the Army are remaining fairly constant, and procurement 
under Circular 51 for officers of the Regular Army has about taken 
care of thb losses which we have suffered from retirements 
In 194-7 there ¥jas a shortage of aboul; 33$ of our requirements in 
dental officers, at which time we were able to render about 62$ of the 
dental treatment indicated. By the time that all of the non-volunteers 
(Category V) are separated and the expansion of the Array hits its 
peak in 194-9, it can be seen from the chart that only 9$ of the dental 
treatment indicated can be taken care of. This is'believed to be a 
very conservative figure, as it is during such periods when definitive 
treatment must be deferred in favor of emergency treatment, and it is 
at such times that the emergency treatment gets very voluminous duo 
to the Definitive treatment being neglected. The time is very nearly 
here ¥/hen, not giving any consideration to any expansion of the Army, 
wo will be able to accomplish only 20$ of the dental treatment in the 
Army which should receive care, ... 
COLONEL REYER; 
What is going to be the policy on dependents when you get down 
to where you can only do 9$ of the dental Treatment, are you going 
•to discontinue it at the places now doing it? We are still trying to. 
COLONEL EPTERLYs 
We have received informal information to the effect that the 
treatment for dependents bars already been discontinued or curtailed, 
and The Surgeon General has forwarded to the Staff, for their con- 
currence, a proposed publication of a Department of the Army directive 
which will restrict the dental treatment for dependents to emergency 
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care only, I might say that this request has Just left the Office 
of The Surgeon General and whether it will moot with favorable con- 
sideration in the General Staff is unknown. As you know, the regula- 
tion covering this subject roads that ’’dental treatment to dependents 
will be rendered when practicable,” and leaves, such decisions entirely 
in the hands of the local people concerned. 
GENERAL OFFUTT: 
How is that going to effect your recruiting program? Is this 
not going to- have the same effect on the overall recruiting as re- 
fusing ,to give medical treatment would? 
COLONEL EPPERLY; 
1 There is no question about that - I am sure that we all feel 
that it will definitely influence individuals who are giving considera- 
tion to entering the service. We will, and always have, received 
plenty of complaints from all sources regarding dental treatment to 
dependents. We have always operated on a basis of. 2 dentists per 
1000 military personnel and 3 for trainees, and our requirements as 
wd speak of it in this respect, are certainly austere in nature. 
The figures that I have shown you on the chart do not give any con- 
sideration to dependents and you could see that we were not oven 
able to take care of all the treatment indicated for military personnel. 
We were asked not long ago about some factors which were influ- 
ential in the morale of our officers which were peculiar to the 
operations of the Dental Corps, and one of the first that was men- 
tioned was, the fact that in spite of any endeavors that might bo made 
to finish..the job, there was always so much left to bo done that it 
was' totally impossible to accomplish it all, I think it must be under- 
stood that even in the event we are fully up to pur requirements on 
the basis of 2 per-1000, that all the dental treatment indicated for 
Army personnel-and dependents cannot bo accomplished, and that is 
definitely a. morale factor within the Army, 
Some consideration has been given to having the dental treatment 
vjhich the Army is unable to do put on a contractual basis from civilian 
but in such consideration it was found that the cost, figured 
in terms of Veterans Administration prices, exceeded The Surgeon 
General’s entire budget by quite a bit. For this reason, and other 
objections to such a practice, this plan is not favored by many mem- 
bers in the Office of The .Surgeon General, 
- I will take'just a minute and briefly relate to you ithat has 
happened in.the way of procurement and separations among Dental Corps 
officers. During the "year 194-8, 142 applications for the Regular 
Army have been received, under the provisions df Circular 51, Of this 
number, 76 wore in the senior grades (Major, Lt, Colonels, and Colonels), 
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and 66 in the company grades. Of this number, 19 have received 
favorable consideration in the Office of The Surgeon General - 16 
of which were in the grade of captain or, first lieutenant; 2 majors, 
and 1 Lt, Colonel, I might state hero that the Dental Corps has 
about reached the saturation point in respect to the senior grades, 
practically all of them are filled now. Actually, we are 17 over 
our authorized allowance in the grade of major, but there arc sufficient 
vacancies in the two higher grades to accommodate this overage. There 
remains 19 vacancies in the grade of captain, and out of an authoriza- 
tion of 267 in the grade of first lieutenant 252 arc vacant. Procure- 
ment under Public Law 365 has not been too encouraging, and so far 
as applicants eligible for the first lieutenant grades have not applied 
in sufficient numbers. 
New Reserve commissionss Since the class of 1948 graduated in 
Juno, 34 applications have been received from this group for Reserve 
commissions, all of which were granted. Of this number, 27 requested 
and were ordered to active duty; 36 requests have been received from 
Reserve officers who were formerly on active duty for further active 
duty and all of this group were given assignments. This brings the 
total to 63 of the group of volunteers whom vie have on active duty 
since the beginning of 1948, 
The internship program which was conducted during the year of 
1947-48 was concluded on the first of July, and the results of this 
training, insofar as procurement is concerned, is not gratifying* 
Previous to the ?/ar most of our dental interns YJcre desirous of a 
commission in the Regular Army, and we considered this a source of our 
vorfy best officers. Of the 25 who wore' in training during the 1947-48 
period information; has boon received informally that only 9 are 
interested in the Regular Army; 11 have requested further duty on a 
temporary basis and 3 did not desire further duty with the Army. It 
was thought that the people in the general hospitals could convince 
these young officers that -a career in the Army was not so bad] This 
year the authorization for interns was increased to -50, of which number 
wo were only able to fill 32, Two additional hospitals have boon 
opened for this training, and it is hoped that the program will be 
more successful in gaining Regular Army officer material. 
Steps which might bo taken to provide more efficient utilization 
of the Dental Corps officers available are not too numerous, I think 
we all realize that when an officer is assigned duties away from his 
chair or office, that his professional activities are reduced in the 
same pntio such duties are assigned him, I doubt whether this is 
happening in many instances, but in the cases where it is occurring it 
must be curtailed, 
There are presently 19 officers assigned to ROTG units, each of 
which is receiving“training in one of the specialized branches of 
dentistry. This may be regarded by some as an exhorbitant expenditure 
of dental personnel for the returns vjhich might be expected, but in 
the years previous to the war these officers created a great deal of 
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interest in the Army and it is expected 'that this will occur again 
and that the procurement from this source will justify such assign- 
ments, In addition to the procurement factor in the assignment of 
these officers, they are all receiving' such professional training as 
the institutions.to.which they are assigned have'to'offer, ahd since 
this is about the limit to which our training program extends, it would 
not seem beneficial to terminate this program and reassign the officers 
where they could’perhaps accomplish the much needed dental treatment. 
I think the provisions have been related to you of the plan to • 
bring 150 doctors or dentists on duty with the Army on a Civil Service 
status. In accordance with the regular hours that have to be main- 
tained in Civil Service operation, this appears to bo very ideal for 
the procurement of some dentists at certain stations and hospitals. 
Since.most of the dental clinics operate on certain scheduled hours 
and usually in conformity with those of the Civil Service, it appears 
a little more suitable for dental rather than medical personnel. 
Some consideration is being given to the commissioning of students 
in dental schools, below the graduate level. They would bo commissioned 
as second lieutenants, Medical Service Corps, and'placed'on duty at 
the school with all pay and allowances until graduation, at which time 
they would bo expected to servo a like amount of. active duty with the 
Army,. There are certain criticisms to such a plan - such as the inter- 
ference that might bo expected with the ROTC training program and 
others, and since nothing could bo gained from such a practice for at 
least a year, it is not gaining favor from many sources, : There are 
some who have confidence in the procurement of a few dental officers 
as a result of the recent Selective Service legislation. It is believed 
that there must, bo a group of approximately 2500 or 3000 who aro 
between the ages of 19 and 265 however, the marriage and dependents 
clause of the- legislation will have to be obviated or net very many 
of if iqers .will .become available by this-means. 
■You have heard what has gone on between the American Medical 
-Association and The Surgeon General!s Office with respect to such 
assistance as they might- give in helping this situation. General Paul 
has queried the Office of The Surgeon General as to' what -organized 
dentistry intended to do, ahd 1 might state hero that a conference is 
scheduled with a representative group of the American Dental Association 
in this office in the very near future, .The problems confronting us 
will bo presented to this group,at that time - what assistance they 
might bo- able to give' is strictly problematical, I don!t think anyone 
is too optimistic in this respect. 
You have heard Colonel Robinson say that one of the big objections 
of Medical Corps officers to service with the Army was the interference 
commonly mot from people other than medical. The American Dental 
Association has reams of correspondence from dental officers who served 
during the last war with the same criticisms, but they commonly state 
that the interference comes from the Medical Corps, I am sure this 
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problem vjill bo ’discussed during the-• conference. 
General Smith, General Love and mysclf-ni.il be in the Dental 
Division during the days you are in town and if there are any indivi- 
dual problems or anything of a dental nature which you wish to discuss 
with any of us we will bo happy to have you do so. 
COLONEL MAIEY$- Nurse Personnel. 
. General Armstrong; and .Commanding Officers. In spite of the fact 
that vio arc doing fairly well with, our present- procurement, the 
Nurse Personnel picture is not a pleasant one. The Army Nurse Corps 
is fully aware that the situation is critical and that, with the future 
expansion facing us,-we will have to make preparations to run our 
general hospitals with fevjer military nurses, supplemented the best way 
possible with civilians. In order to give you a brief outline of the 
problems wo are facing, it is necessary to give you an overall picture 
of the Army Nurse Corps in figures. 
We' have on active duty as "of the 1st of August - 4-,282 nurses; of 
that number 1,466 are Regular Army and 2,816 are members of the Organized 
Reserve. Our requirements to meet our present day needs, not including 
expansion, arc 5,600; leaving us a shortage of 1,318 as of today. Since 
January 1948 we have'lost approximately 1,100 nurses and have gained 
only about 600. The reasons for the losses I•will give you only briefly: 
We lost 450 nurses by the expiration of category; we lost 450 AUS offi- 
cers who did not apply for the Reserve Corps. These arc the largest 
figures. We have Ir-sV'a great many in the last two or three months for 
reasons of marriage and declining overseas assignments. Since last 
July we have lost 100 Regular Army nurses, most of those married or 
retired. 
In March we launched an extensive procurement program... Nurses who 
served in the'Army Nufse Corps during the War were contacted by letter 
which included information' concerning the privileges, benefits, and 
facts about the Reserve Corps. At this time we were fully aware that 
we- would hot reach the quota for integration in the Regular Army, 
Schools of nurses in the United States viero -contacted. Packets con- 
taining literature of the Reserve Corps wore sent to Directors of Nur- 
sing Services, Placement-and Counseling Services throughout the United 
States, giving information.Concerning needs- of the Army Nurse Corps, 
From all of our procurement efforts wo have commissioned only 7,421 
nurses in the Reserve Corps,' Of that number, 2,816 arc on active duty, 
yet- there are approximately 381,000 registered nurses in the United 
States. Of course we know that thousands of these arc not eligible 
to join the Reserve Corps, but we should.-have more. We have approxi- 
mately 300 nurses on duty with no prior military service who have 
joined the Reserve Corps, We will have 75 or' more students in basic 
training this September, We can all agree that this is alarming from 
the figure,of 62,000 nurses who served during World War II, only some 
8,000 have joined the Reserve Corps. We do know that many are not 
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eligible by virtue of age, marriage, dependents, physical disability, 
etc. However, there must be something which needs immediate attention 
in the Army Nurse Corps to interest other nurses. 
Ho know of many reasons why nurses are not interested in the Army 
Nurse Corps, and have made every effort to correct thorn but, until ao 
have more nurses on duty, we will not be able to esta'. lish the personnel 
practices which we feel are so necessary to'the welfare and happiness 
of the nurses. 
Briefly, hero are some of the reasons we think arc keeping the 
nurses from coming on active duty; (l) Long hours of duty, in the 
majority of our hospitals they arc still doing 12-hour night'duty, I 
know of no institution in civilian medicine where the general- duty 
nurse works 12 hours either day or night; (2) Living conditions; (3) Un- 
desirable assignments; (A) Personnel practices; (5) Promotion policy. 
We have to look for a moment to what civilian nurse organizations have 
done for their nurses. They have taken great steps and have made 
advancement in offering to the nurse social and economic security, 
improving personnel practices and policies within their hospitals and 
generally recognizing that the nurse of today certainly should bo given 
the same rights and privileges of other professional groups. Nurses 
arc no different than 1A3 million other people in the United States, 
They too arc interested in shorter hrurs, better working conditions, 
recognition for the job they are doing, and most of all being considered 
as individuals, I sometimes wonder if we are making every effort to 
treat cur nurses as individuals, to listen to them, to make them feel 
that they arc an important part of our big organization, to do the 
things that make their working and living conditions as pleasant as 
possible, to make them happy in their jobs, because an individual who 
is not happy in his .or her work does not do a good job. 
VJc are still getting reports from nurses that being placed on 
night duty immediately upon reporting for duty in a hospital. This may 
once have been the policy used by chief nurses, but it should no longer 
exist in our hospitals. It does not take the word long to get out 
among other possible candidates for the Army Nurse Corps that a nurse 
was placed not. only on duty the day or hour of arrival, but bn night 
duty that night. They are not familiar with the-ward routine, the 
patients, or the,ward officers; consequently they have a grudge against 
the Army from the beginning. . 
In the last month we have actually had three reports from hospitals 
stating that this has happened to them. Positions in civilian nursing 
today are more plentiful. It is well known that nurses arc a transient 
gr~up, and they know positions are available to them in any part of the 
country for as 1 ng as they want., ■ They also know that there will be 
a great possibility upon joining the Army Nurse Corps that they may bo 
assigned in the wart of country which they may not desire. Every 
effort is being made in this office to assign a nurse as to the preference 
of her assignment, and the location of the hospital, as well as the size 
CONFIDENTXAL CONFIDENTIAL 
tho hospital, However, because of the service needs, it is net 
always possible to grant her choice. Nurses arc not always willing 
to take the risk, but in the office vie amend and revoke a great many 
orders daily, trying to place then as to their preferences, so that 
they themselves will advise -other nurses to join tho .army Nurse Corps, 
Our promotion policy at this time is a detriment to nurses coming 
in on extended active duty. We have not had previsions to promote the 
Reserve nurse any higher than a 1st Lieutenant since February 194-7, 
However, we did temporarily promote nurses with seven years service in 
tho Regular Army, until such time that we set up an examination 
policy proscribed by Tho Surgeon General, This caused great concern 
among our Reserve nurses; they felt that they had been forgotten, and 
that no provision was made for their advancement. Stops have been made 
to correct this, and it is hoped that P & A will soon authorize us to 
make temporary promotions in all the Army Nurse Carps• 
Wo have worked out our projected nurse personnel needs on bed capa- 
city, and not on actual number of patients. We find that this is neces- 
sary so that wo can get enough nurses to -take care of our dependents and 
clinics, Tho number of nurses needed on the basis of expansion of beds 
in areas, is an additional 2,500 to the already.1,500 wo are presently 
short. Where are these nurses coming from? Presently we are not going 
to get Army nurses to fill this need. Our only alternative is to utilize 
civilian nurses. It seems strange that we are able to employ civilian 
nurses in Army hospitals, but they are not interested in coming into the 
Army, This is because they work five days a week, the salary is good, 
and they can work in any hospital to their liking. 
Our plan is to remove of the Army nurses.in our larger hos- 
pitals where civilian nurses are available, and replace them with civilian 
nurses, and transfer the Army nurses to posts where there may not be 
civilian nhrses available. Let ~mo point out that civilian nurses will 
be counted against your military quota. Some of the Army hospitals may 
have only a skeleton staff of Army nurs-es remaining. If you have a 
hospital near a city where you may obtain civilian nurses, wo would 
appreciate your requesting an authorization,- for civilian nurses so that 
you. may bo able to assign some of your Army nurses within your area to 
a post where civilian nurses are not available-.. If wo arc to utilize 
the civilian, nurses entirely for the expansion, tho required, number 
would bo approximately 4-,000; because we must figure' one and one-half 
.civilian nurse for every Army nurse,, .This brings.up our next topic, 
and that is conservation of professional nursing personnel. It is 
evident that immediate' steps must be taken to conserve nursing service. 
Wq find in making' rounds through our hospitals, that the nurses are 
doing non-professional- nursing duties. The nurses have offered no 
complaint this past year, during, which time they have substituted in 
many instances, and carried out not only their work, but the work which 
should have delegated'to other personnel. They are .to bo commended, and 
we have been most proud of the splendid job our nurses have done during 
this acute.personnel shortage. The. blame is on the .difficulty in getting 
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nurses on duty and not with those who arc non on duty, Every effort 
should be made to conserve professional nursing service. It is 
hoped that some nurds may.be combined'so that the nurses- can take care 
cf more, patients'-’in’fewer wards. 
No can no longer use nurses in our convalescent sections to see 
that patients are in their wards on time meals, and that discipline 
is maintained. It is necessary that we- use nurses only in their pro** 
fession to maintain a high standard of nursing servicef It is hoped 
that we can conserve the nursing service by combining some of cur 
scattered clinics, and putting civilian nurses in our clinics. These 
are only suggestions on which we hope you will be able to advise us. 
There are many ways in which you may help in our procurement pro- 
gram, V.'e are interested and will help in every way possible to improve 
the personnel problems within your hospital, aAd- to improve the living 
conditions of the nurses. In all instances wo have werked very closely 
with the state and national organizations in soliciting their help in 
various programs, ■ At the present time the American Nurses Association 
is endeavoring to set up a quota system within the state in an effort 
to supply us with the necessary nurses. We are working very closely 
with the civilian associations, and trying to appoint an official of 
their association to work with the Army nurse. Quotas to be worked 
■out on a percentage basis would be assigned to each state on the basis 
cf the number of nurses available in the state, and the number of 
civilian hospitals to be staffed. This will be of interest to you 
because you may be asked to supply a nurse who will work vith the state 
nurses association. 
At this time, or any time during this conference, I would like 
suggestions from this group as to how wo may better utilize our present 
nursing personnel and suggestions for procurement. 
V.re need your help, and vie are grateful for any suggestions* 
Thank you for your attention. 
COIDNEL GORIUP s-■MEG Personnel. 
The shortage of Medical Corps officers, plus the increased utili- 
zation of Medical Servicc Corps officers, plus an overall increase in 
the Army and'Air Forces, has created a shortage in the Medical Service 
Corps, In the early months of this year of 194-8 wo vjerc overextended, 
had a surplus, which caused us to the receiving of applications 
for recall to active duty. About May of this year a shortage in Medical 
Service Corps officers became apparent. At that time wo reviewed and 
re-reviewed about 500 applications we had on file and contacted those 
people wo considered qualified to try to interest them in returning to 
active duty, Ue. did not get a very good response. It was in May that 
wo received procurement for recall of 300 officers. After the passage 
19 
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of tho Selective Service Act it was increased by 500, for a total 
of 800 recalls to .active duty. At this time the condition of MSC 
is such that we arc overextended in Pharmacy Supply and Administration, 
which caused us to close Competitive Tours for the Regular Army. I 
believe that created a situation whereby a lot of well qualified MSC 
officers left tho service because wo had nothing to offer them. I 
also believe that is one of tho-main reasons why wo donft receive too 
many applications from well qualified' NSC’s in civilian life to come 
back on active duty. At the present time we arc still short in certain 
sections. In the Optometry Section we have a procurement objective of 
20 have 1 on duty; in-Engineers wo have an objective of 80, and have 
16; in Allied Science Section wo have an objective of 300 and have about 
63 on duty today in the Regular Army. ' I believe that one of tho reasons 
why we can’t attract people in tho science groups is they still have 
some apprehension of being'grouped with MSC’s and appear most apprehen- 
sive that they arc not going to be utilized in their specialty, science. 
I believe we"can disprove that by using tho 60 or so wo have now in- 
telligently, I urge everyone to please make every effort to keep those 
in the * so-called ’’ology” groups in their specialty . From April through 
July we have received 23A applications for recall to active duty. Of 
that number wo have accepted 129. Wo have a committee and think wo 
are very conscientious and meticulous in reviewing their recommendations. 
In tho main, we do a good job r in fact, I believe we are being criti- 
cized for the groat percentage of rejects, so perhaps we are being 
too critical, I have been informed by Colonel Liston that he has one 
of his MSG officers about'to be tried and Colonel Healey has one about 
to go to jail, ’ Vre believe the biggest help you can be to us (we have 
only the 201 file, and have purposely made the committee large and try 
to leave -no unturned to see. that those picked are tho best 
possible of the ones who apply) is to be specific and not pull your 
punches on your indorsements, I believe that-our best qualified people, 
who were Reserves during the war, are'now'“back homo, well entrenched, 
and are reluctant to come back when wo don’t have too much to offer in 
the way of a Regular Army commission. The Army is putting on an inten- 
sive publicity program to interest.qualified Reserve officers to return 
to active duty. In addition, the Surgeon General’s Office has its own 
publicity program, A great number of well qualified Reserve Officers 
returned to the enlisted ranks, I believe we should make every effort 
to interest the best qualified to request extended active duty in an 
officer status. In .order that The Surgeon General’s Committee may 
make an intelligent evaluation of this personnel, I urge that the Class 
II Commanders, whenever possible, interview each applicant. It is also 
desired that all favorable or unfavorable comments bo reflected in 
your indorsement to the application. Only in this way can we insure 
that the best qualified are placed on active duty. Some other possible 
sources for recall to active duty will be those individuals commissioned 
under Circular 101, which authorizes direct appointment in the Reserve 
Corps of enlisted men who served during the war in tho first three grades, 
VJo have gotten 99 applications. Once more I would like to point out 
that of t?ose MSC’s initially integrated into the Regular Army that well 
over two years of their probatinnal period has passed. It gives us one 
CONFIDENTIAL CONFIDENTIAL " 
more year to evaluate them. They be 'constantly' evaluated and 
re-evaluated, be believe another previously untapped source will bo 
those individuals commissioned under Circular 210.dated 14 July, It 
has just been published and will implement Public Law 337, whereby 
wo will be able to offer direct appointments to those people who had 
no prior military service, but are otherwise qualified. We mentioned 
it 5 or 6 months ago in civilian meetings with professional groups. Wo 
have in excess of 500 letters of interst and the gratifying part is that 
about .35% are from the ”ologyn group. We believe that as soon as wo 
are able to-supply these people with the necessary forms, directions, 
etc., wo. will probably find a good number of individuals who will desire 
to on active duty,. especially in the science group. One other 
source is the transfer of Reserve officers from other branches into 
the MSG who appear to be fulljr professionally qualified. We have to date 
transferred 126 officers in this fashion. 
COLONEL VOGEL;47MSC Personnel, 
For several months this office has been conducting a vigorous 
campaign not only to interest new applicants in appointments in the 
VIomen!s Medical Specialist Corps in the Regular Army but also in the 
Officers1 Reserve Corps, In connection with this program radio broad- 
casts, newspaper articles and television which hqve been utilized have 
aroused considerable -interest. In view of the fact that this program 
was initiated when many individuals, considered to be potential candidates 
were on summer vacations, tangible -results from this program are not 
expected for several weeks. If the degree of interest continues at the 
rate indicated by correspondence recently received in this office, it 
is expected that procurement will soon be materially improved. 
“Wide distribution will be given to an illustrated brochure con- 
cerning the Aomen’s Medical Specialist Corps which‘will be available 
in the near future. As soon as published, packets will bo mailed to 
the Class II Installations for local distribution. ‘This brochure will 
contain pertinent information regarding the requirements for appointment 
and a brief description of the duties of officers in each of the Sections 
of this Corps, 
In- connection with recruitment, it is believed that Class II instal- 
lations situated near large educational institutions can be of con- 
siderable assistance, Personal contacts and observation in general 
hospitals are believed to bo a very effective means of interesting indi- 
viduals in a career in the Army, For example, tha Commanding Officer 
of McCornack General Hospital could invite the students attending Physi- 
cal Therapy or Occupational Therapy Courses.in Los Angeles to spend a 
dayat his hospital not only in observing Physical Therapy and Occupa- 
tional Therapy■activities but also.in a tour of the- entire hsopital. 
This type of local publicity be accomplished in several of general 
hospitals, fos all three^(3)- groups of specialists in the 17omen1s Medi- 
cal Specialist Corps, 
CONFIDENTIAL CONFIDENTIAL 
In order to give you a picture of the efforts which have been 
made to improve the procurement situation, I shall deal with the rroups 
separately beginning with the Dietitian Section, 
DIETITIAN SECTION 
During the past year dietitians have been utilized to bettor 
advantage in general hospitals than in previous years. To meet the 
shortage of commissioned dietitians and trained enlisted personnel, 
civilian men-and women,'who have had some previous food experience, 
have been employed in some hospitals. This personnel has.«-taken over 
many of the routine duties thus permitting the dietitian to devote the 
'major portion of-her time to the supervision of the Food Service -Program, 
”ith participation in training programs and further experience, it is 
believed that this personnel can be utilized to evon better, advantage* 
Planning: 
Short Ran.ro; 
Letters containing information regarding opportunities, both in 
the Regular Army and Officers’ Reserve Corps, have been sent to all 
former Medical Department dietitians. At the present time 200 have 
accepted Officers’ Reserve Corps commissions and requested, inactive 
status. 
The Chief of the Dietitian Section has contacted the president 
of the state dietetic associations offering to provide speakers for 
their mootings, and Dietitians from several of the general hospitals 
" have 'Participated in local meetings, A dietitian attended the American 
Home Economics Convention in June to familiarize Deans of School of 
Home Economics with the training program for dietetic interns conducted 
by the Medical Department, The training course at Johns Hqpkins Hos- 
pital was also reviewed. In all of these..c^ntpets information was dis- 
seminated regarding the opportunities for a career as an Army dieti- 
tian, ‘ 
A rocruitnent rally at Fort Jay, for approximately 50 dietetic 
interns in training in the New. York area, proved to be- a m-est intcrest- 
. ing experiment. Those•interns, who were invited by the Commanding 
.Officer'of the hospital to visit the station, were given a sight-seeing 
trip amund the Island, 'and oriented to--the.-various activities of an 
Army Post, In addition,-.they were dsfcortod-through the entire hospital, 
and the functions of the dietitian-were explained in detail. Interest 
displayed at this rally, and correspondence received in this office, 
indicate that such meetings not-only promote good public relations, but 
also are excellent recruiting measures. 
Articles prepared by the dietitian section which have also been 
published in the /jnerican -Dietetic Association Journal, have also 
stimulated considerable interest. 
' CONFIDENTIAL CONFIDENTIAL 
Lonrr Ranrro: 
The training course for dietetic interns, formerly conducted for 
civilian,students at the Brooke1Army Medical Center, in the future will 
be available only to individuals interested, ih the Regular Array as a 
career. Like the courses for Physical Therapists and Occupational 
Therapists, individuals Accepted for this training are commissioned in 
the Officers Reserve Corps, and must sirn a Category II statement and 
state in, writing that they .-will-apply for commissions in the Regular 
Array, Completion of the Basic Medical Department Female Officers’ Course 
is a prerequisite for this 12 months course,- which will be followed by 
actual experience as a.dietitian in the Medical Department, After not 
less than 6 months of'such experience these officers will be expected 
to make application for the Regular Army, Considerable interest has 
been shown in this program, and- it is expected that the quota for the 
September class,will be filled. 
Four dietitians will attend meetings of the American Hospital 
Association institute on hospital personnel relations in New York in 
October. Information acquired at this institute will be valuable to 
chief dietitians who arc responsible for planning and executing training 
programs for civilian personnel. 
During the coming year it is planned that an officer from the 
dietitian section will visit selected collog*es and universities not only 
to stimulate interest in the training of dietetip interns, but also 
to familiarize students with the opportunities for service in the Officers’ 
Reserve Corps and the Regular Army, Plans arc under way to conduct an 
active recruiting campaign at the dietetic association meeting in Boston 
in October, 
PHYSICAL THERAPIST '•SECTION 
Planningi 
Short Range: 
The number of AUS officers recalled to extended active duty has 
shown a definite increase and it seems reasonable to assume that interest 
will continue at the present rate, Frrmcr A my Physical Therapists have 
been contacted by letter and furnished a fact sheet regarding appoint- 
ment in the Officers’ Reserve Corps and opportunities for extended active 
duty. This information has also been forwarded- to Physical Therapists 
without former military service and to all graduates of approved civilian 
Physical Therapy Schools, Articles concerning the opportunity for 
extended active duty have'also.been published in the Physical Therapy 
Review as well as in the monthly News Letter published by that organiza- 
tion. To date, 14.8 Physical Therapists have accepted Officers’ Reserve 
Corps commissions requesting inactive status. 
Long Ranre: 
Long range planning includes the resumption of the Physical Therapy 
CONFIDENTIAL CONFIDENTIAL 
training course at Brooke Army Medical Center* This course will be 
available to individuals otherwise qualified, who are graduates cf a 
four (A) year college course with a major in Physical Education, The 
first group of students appointed as second lieutenants in the OfficersT 
Reserve Corps for the purpose of completing this training will report 
at .the Erobkd Apmy Medical Center on 1 September', After completion 
of the'Basic Female,-Officers1 Course-, the course in Physical Therapy 
will begin on 1' November, To des'slmlnatc information regarding this 
program over one-hundred ;(100) colleges were contacted by letter and 
furnished packets containing application blanks and information material 
for distribution to interested students. In spite of the fact that 
this information-was not available until the last week in May, twelve 
(12)•outstanding college graduates have to date been selected for this 
course. At the present time it is anticipated that only one (l) such 
course will be given annually. However, since the cgubso is arranged 
in two (2) warts, six (6) months of didactic training followed by a 
six (6) months applicatory phase in selected general hospitals, it is 
sufficiently flexible to permit two (2) such courses to be conducted 
annually if necessary. 
It is anticipated that a three (3) months course for enlisted 
physical therapy technicians (SSN 072) will begin, at the Brooke Army 
Medical Center early in 194-9, Since the details of the program have 
not yet been completed, formal announcement regarding this course has 
not been made. Graduates of such Courses will be ‘of considerable assist- 
ance in relieving physical therapists of routine duties which arc time- 
consuming, ‘ 
OCCUPATIONAL THERAPIST SECTION 
The Occupational Therapist Section is growing although it is still 
markedly under strength. On 15 June 194-8 there were 34- commissioned 
Occupational Therapists on duty in Class II Installations, It is expected 
that this number will be increased to 4-8 by the middle of September, 
This number will not meet the need however. It is therefore essential 
that the civilian Occupational Therapists who are now on duty in the 
general hospitals remain until such a time as they can be replaced by 
commissioned personnel. At the same time, it is urged that civilian 
Occupational Therapists now employed in general hospitals make applica- 
tion for appointment in the Officers’ Reserve Corps, 
A steady recruiting program is being carried out. Members of the 
American Occupational Therapy Association as well as the directors of 
all approved schools of Occupational Therapy have been contacted by 
letter and furnished information regarding the professional and personal 
advantages of a military career in this speciality. 
This year for the first time the Medical Denartment will be repre- 
sented by a group of military*Occupational Therapists at the annual con- 
vention of the American Occupational Therapy Association in New York in 
September. It is believed that it'Would be highly advantageous to nro- 
CONFIDENTIAL confidential 
curemont if a group cf uniformed Qcoupa.t3.onal Therapists could be 
present. It is.strongly recommended therefore that commissioned 
Occupational Therapists whose services can bo spared be urged to attend 
this convention in order to assist in an extensive recruitment drive. 
The Occupational Therapy training program established by SGO 
Circular 164- is still in operation, though on a small scale. It is 
expected that this program will be accelerated,’ The number of applica- 
tions recently received-appears to indicate that the interest in this 
program is steadily increasing, . 
Late in 194-9 it is anticipated that a 12 months* internship for 
Occupational Therapy students will be initiated in selected general 
hospitals. This 'course will be available to individuals, otherwise 
qualified, who have completed 4- years of college and who arc desirous 
of completing the clinical ohase of the a urse in an Army hospital. 
Persons granted Reserve commissions for that purpose will bo limited 
to those who have expressed a desire in writing to enter the Regular 
Army, 
Plans are also underway to establish a course for training enlisted 
technicians in the field of Occupational Therapy, 
MAJOR MONNEN:-Enlisted Personnel, 
First, I would like to show you a chart which gives the overall 
picture of our general hoswital personnel. 
(Ma jor Mermen then gave a graphic description of information con- 
tained on the chart regarding enlisted personnel,) 
Our enlisted personnel has dropped considerably in the last year, 
from 13,389 down to about 8,338. At this time there is a critical 
shortage of Medical Department trained enlisted personnel, but every 
effort is being made by us and the General Staff to remedy this. It 
was hoped that with the passage of the Selective Service Act wo would 
get a great number of enlisted men soon. As you know, it authorized 
the induction cf a great many 18-year olds. They will bo of no value 
to the Medical Department as they cannot be used for labor typo duties, 
and hospital orderlies are interpreted as being in that category, U0 
probably will got very few, if any5 however, when the draft is finally 
put into effect we will get relief when those drafted for 21 months 
come in. 
I would like to mention the Tables of Distribution, All of you 
have submitted them to us and we have sent them on to the General Staff, 
I would like to speak especially of enlisted personnel. It is planned 
to provide an automatic requisitioning system based on Tables of Distri- 
bution, Your present system will go out. It will show the personnel 
by grade and MOS that you are short,,and they will be automatically 
furnished you. Today we are getting in requisitions for personnel you 
CONFIDENTIAL CONFIDENTIAL 
people are asking for which are not in the TaMes of Distribution 
submitted, and I believe if a little more effort were put into the 
preparation of them you would get the personnel you needed, when 
you need then. * 
I would like to say something. ab$ut.Department of the Army Cir- 
cular 202, All of should read it. It has to do with enlisted 
grade structure, pay, titles, etc,, and I should also like to call 
your attention to Paragraph 88, which takes away from you the authority 
to promote enlisted men in the first three grades, I am informed 
by the General Staff that the authority -for promotion .cannot bo dele- 
gated but' must be handled by this office. 
RECESS 
CONFIDENTIAL CONFIDENTIAL 
1st part of afternoon 
session - 4 August 194-8 
MR. LA CROSS;- Employment of Civilian Doctors and Dentists. 
I feel it is hardly necessary for me to tell you commanding 
officers of our well run general hospitals how to procure civilian 
doctors, because it is just a slight variation from what you are doing 
every day with civilian employees. These civilian doctors and dentists 
will bo exactly the same as other civilian employees, once they are 
employed. I just want to tell you of the slight variation in the pro- 
cedure in retting them on your staff. The first thing to do, as you do 
with all other civilian positions, is to got the position establishedj 
that is, write up the job sheet, get the Classification Analyst to 
allocate that position, and then you are ready to make your contacts 
in order to got a doctor to fill that particular job. Your civilian 
personnel officer will know that the first stop after getting the job 
established is to see if Civil Service has any doctors on the local 
register. They generally don!ti Then you will want to contact the doctors 
locally to see if they arc billing to work for the pay and do the job 
you have established. That may take some time. From the lack of doc- 
tors already employed, the indications are there will not be much of a 
rush] If, however, you do have a doctor or dentist willing and ready 
to go to work, we would like you to either call by phone or send a TWX 
to this office, asking for authority to employ the man you have, or 
the woman (that question was raised this morning) whom you have avail- 
able to work for you as a doctor or dentist. You ?;ill be given authori- 
ty to employ the individual immediately, either by phone or TWX, which 
will increase your coiling and grade group authorized automatically. 
You will have funds available to pay the individual, and if your funds 
arc insufficient a request for additional funds will result in your 
getting your M&HD money increased. In establishing the position, get- 
ting it classifiedy specifications to bo followed in arriving at the 
grade are published by the Civil Service Commission in Series P-64.0 for 
doctors and P-510 for dentists. I want to emphasize that you at your 
hospitals have the authority to establish the position, set the final 
grade, and then ask us for authority to employ the individual you have 
at hand so he can be placed on the rolls. The reason wo are not making 
the allotment of physicians, both as to ceiling and grade group, immedi- 
ately is that we have been limited in funds by higher authority to 150 
for the entire. Medical Department, When wo see. we are employing that 
150, then we can go to hirher authority to get an ‘increase in our allot- 
ment, It is expected that 10% of your.grades will be in P-4, That 
has a per annum rate of $5232,00, a daily rate of $20,12 and an hourly 
rate of $2,51, That is your P-4 staff physician or dentist. You may 
be able to get some specialists which would normally carry a P-5 rating, 
and the per annum salary is $6235,20, a daily rate of $23,98 and an 
hourly rate of $2,99. It is considered rare that you will have anyone 
in a higher grade. If you should appoint a doctor or dentist as chief 
of one of your services, he would have a specialty and administrative 
responsibility which might bring the grade up to F-6, That pays $7432,20 
CONFIDENTIAL CONFIDENTIAL 
per year, $28,5B a day and $3.57 per hour* Those rates, of course, 
are not comparable to what many doctors are making on the outside, 
but this is a means we are now making available to you for procure- 
ment of these doctors, either on a full time or a part time basis. 
All other procedures in the employment of doctors are exactly the same 
as the employment of all other civilian employees, with '"hich you 
have extended, experience. Are there any questions about this procure- 
ment? 
GENERAL LILLIS; 
You say the first thing is to establish the position, work up 
the job sheet, etc. Now in positions we have had established, with 
job sheets worked up, and the individual employed from as much as 2 to 
26 years, they have been recently regraded, '..'hat assurance have we 
that the same thing will not happen to any position wo write up now? 
MR. LA CROSS; 
The reason the positions have; been regraded is because of a change 
in the duties that have been assigned to the individuals concerned. 
If you do not change the duties of these doctors, then there Would bo 
no question of regrading. 
GENERAL LILLIS; 
•.That is what you think is happening, but it is not true. Now, 
the-second question is, you say we send a TEX for authority to employ. 
That entails a delay. You say you get an answer back to us right away, 
but that is not true, VJhy not give a block of numbers to overcome this 
and let mo" employ and then notify you. I think, personally, that is one 
of our greatest drawbacks - the interminable delay in getting an answer. 
MR, LA CROSS; 
If you have had.experience of this sort, being delayed, I would 
suggest that, since Brooke’ talks with the,Surgeon Generalfs Office 
almost daily, authorization can be given at the moment we are talking 
with you, so there will bo absolutely no delay. 
GENERAL OFFUTT; 
In employing part time men, they are paid an hourly rate, are they? 
CONFIDENTIAL CONFIDENT ILL 
MR. LA CROSS; 
Yes, Sir, just a fraction of their day, 
COLCNEL GATES: 
Is there any hope of deviation from the Civil Service rate of 
pay? VTe can procure but not at that rate, 
COLONEL ROBINSON: 
I would like to say this. There is no question at all but that 
we could hire doctors if wo could pay what they demand, but what 
would happen to the morale of the Army officers if wo did that? Further, 
I might say we have a bill already prepared and in the hands of our 
Liaison Division to employ without Civil Service, 
COLONEL GATES; 
But that doesn’t give us any assistance now, 
GENERAL OFFUTT: 
How do Civil Service rates compare with Veterans’? 
MR. LA CROSS; 
They are the same except Veterans’ has 25$ for specialists, 
h 
COLONEL REFER: 
• I have a schedule from Veterans’ at Dallas, showing their rates 
of pay, physical examination, etc. They are starting at P-5, $5905.00 
per annum, P-6 paying $7102,00. On the physical, they don’t care 
whether they have except hands and feet intact - no mental 
examination and no physical examination other than that, 
MR. LA CROSS; 
Those rates you just quoted were the salaries before the current 
pay raise came out, 
COLONEL BRENER; > 
They don’t have to conform to Civil Service. 
CONFIDENTIAL CONFIDENTIAL 
COLONEL WELCH; 
Why do you think 70% would bo seloctod in grade A, bocauso of tho 
ceiling on funds? 
MR. LA CROSS; 
No, the reason we think they will bo in P-4- is because that is 
the grade for a repular staff doctor in a hospital and not chief of a 
branch or service, 
COLONEL REYES; 
You pave us specifications for a chief of service, Hon about 
chief of a section? 
MR. LL CROSS; 
That would probably be a P-5 or P-6, 
COLONEL REYER; 
I am highly in accord with Colonel Robinson on morale being lost. 
You have a dispensary physician and the Civil Service rate of 6 is a 
couple ‘of hundred dollars higher than a Captain in the Army with one 
fogy. These people are going to have to work with Regular Army people 
and it is going to be a moss but we are going to have to use them, 
MR, LA CROSS; 
In determining that we were going to use regular Civil Service 
in employment, consideration was given to tho effect it would have on 
our procurement of doctors themselves and, also, if wo used other 
methods available, the effect it would have on the Army, 
GENERAL OFFUTT; 
t 
Those men.would still be on a five day week? 
* • 
MR. LA CROSS; . - 1 
Yes, Sir. 
COLONEL REYER;- g- w 
* ' 
And at night 1-1/2 pay? CONFIDENTIAL 
MR. LA GROSS; 
Don't worry about working them overtime. They will get paid 
the overtime rate. At these grades it is considerably loss than the 
regular hourly rate during the day, A P-6 gets $28,58 per day. When 
ho works overtime for a day ho Tots $12,08 or $1,51 per as com- 
pared with $3.57 his straight time hourly rate, 
COLONEL LISTON; 
But they don't have to do overtime if they don't want to. You 
can't control that, 
MR, IA CROSS: 
They will bo the same as your other civilian employees. If you 
ask your laboratory technician to work overtime ho doesn't tell you to 
go and stay put, he works. We would presume as commanding officers that 
you ojould have the same control over those doctors as over your other 
civilian employees, 
COLONEL LISTON; 
I do have some civilians and they live a long distance away, and 
I can't got them back, A lot of these doctors pilling to come on part 
time under Civil Service are still intending to maintain their outside 
practice and I doubt if their availability would be high outside of 
that AO hours. Is there any way you have any pressure on his services? 
If ho doesn't want to work over AO hours you can't give him an unsatis- 
factory report if ho doesn't work over AO, There is nothing in the 
law that requires him to work, 
MR. LA CROSS; 
That's true, 
GENERAL ARMSTRONG: 
I hope you don't misunderstand. We are not saying this is an 
ideal situation at all. It is merely one of the 5-1/2 pages of sugges- 
tions by which wo can in some small way try to meet this situation. 
One of the thinrs we hear most frequently from civilian doctors, Congress- 
men, people on the General Staff, etc,, is, "Well, why don't you hire 
civilian doctors if you know a place where you can hire them?" I am 
not going into the merits or demerits of the plan. We cannot run the 
Medical Service by hiring civilian doctors. We have asked for $19,000,000, 
CONFIDENTIAL CONFIDENTIAL 
in tho 1950 “budget to have tho mouths of every enlistee and inductee 
rehabilitated so tho first year in the service the dentists will 
have nothing to do* You can't send him to a civilian doctor so no 
can have nothing to do for a year, r.Te can't run the Medical Service 
with civilians. On the other hand, we asked for and got these 150 
They were gotten primarily for tho Air Command and Area sur- 
geons, thinking maybe wo could utilize them. Thy 150? In the whole 
Army wo thought we might be able to fill that many, and wo felt that 
number would not interfere with the morale of the men in uniform. 
If wo do find 150, even part time, you Right be able to give up 75 
in tho larger establishments and thus run tho smaller establishments. 
You will have trouble. On the other hand,' in San Francisco you might 
find some youngsters,who do not qualify for consultants and who are 
trying to got started in practice, who would like a A-hour job. If 
you could get two like that, then you could give Robinson a medical 
officer. In* tho whole of the Sixth army they have one man they can 
shuffle around‘when any of the others are sick. Twice wo have tried 
to got a system like Veterans' to hire doctors regardless of Civil 
Service, VJo are trying again. This is just another stop-gap. If 
you can utilize it, it will help. 
CONFIDENTIAL CONFIDENTIAL 
COLONEL MORGAN AND COMMITTEE: 
ADMINISTRATIVE PROCEDURES AND STAFFING OF 
HOSPITALS TO CONSERVE PERSONNEL 
Report of an S, G, 0, Special Committee U August 194$ 
Members: 
Colonel Oramel H. Stanley, MC, CO, Oliver GH, Chairman 
Colonel Harry A. Clark, MC, CO, Murphy GH, .Member- 
■Colonel Clifford V, Morgan, MC, Deputy Post Commander, AMG, Recorder 
General Bliss: This Special Committee Report is respectfully 
submitted in response to a directive of the Acting Surgeon General, 
Brigadier General George E, Armstrong, 29 July 19AS, The original 
mission was to consider moans of expediting the disposition of patients 
from hospitals and thereby conserve personnel. This action is im- 
perative in view of our present crisis. Since The Surgeon General1s 
Staff is devoting its major efforts to the solution of this problem, 
General Armstrong implored the Committee to consider any administra- 
tive procedure and staff problem which would aid in the conservation 
efforts. 0ur thinking has considered changes of existing procedures 
and policies on throe levels, namely: (a) That of the Hospital Com- 
mander; (b) That of The Surgeon General’s Office| and (c) That of the 
General Staff, 
There has been little opposition to accepting the fact that the 
faults of administrative procedures lie primarily in the laps of the 
commanding officers. The chief attenuating'circumstance is the caliber 
of the subordinate personnel. Many lack experience and confidence to 
command and control their particular service, section or unit. The 
commanding officer is not at liberty to‘hire and fire as he sees fit, 
but is like the poor carpenter, who must use the tools which are given 
to him. These statements must' not be interpreted as dcroratory to our 
officers. Loyalty and effort tend to compensate for deficiencies in 
know-how. No commanding, officer of an organized social unit can demon- 
strate his full abilities as a leader T,,hcn he cannot pick to the fullest 
extent his own staff. This responsibility lies in the SGO, the General 
Staff and even Congress, who determine the laws which attract men to 
the military service, . . . 
The responsibilities for the conservation of personnel also lie 
on. all levels. Few of our hospital commanders are in a position to 
admit that they have too many personnel. They have all boon harrassod 
for the past two years by manpower experts, few of which know much 
about a hospital and none cf which are experienced C, 0,!s. The SGO 
statistics for the end cf May 194$ reveal that the operating personnel 
ratios per 100 authorized patient capacity is 107.2 in our general 
hospitals. This is exceedingly low v,hcn compared with a survey of 
CONFIDENTIAL CONFIDENTIAL 
ratios of personnel to 'patients in civilian hospitals made by ’barren 
P. Morrill, M.D,, American Hospital Association in January 1940 - B 
years ago. At that time the average in all U, S, civilian hospitals 
was 121, Texas and Colorado were the lowest at 108; Pennsylvania 110; 
Georgia 121; Massachusetts 133\ California 142; and the District of 
Columbia 170, The author stated that “figures were lu because of 
unaccounted volunteer or unpaid services;n and his statistics did not 
include visiting staff physicians or private nurses. (Reprint of this 
article has’ previously,been furnished to the Personnel Division, SGO), 
Civilian hospital ratios, as well as military, have no increased 
in the past eight years, duo primarily to the 8-hour day and 40-hour 
week, In comparison to them the military hospitals are operating with 
a high degree of efficiency. However, we must not overlook any means 
of improvement. This requires a constant attention to job, analyses, 
‘personnel qualifications, work measurements, organization, personnel 
supervision and procedural short-cuts. The latter is probably the 
least controllable at hospital levels, since, in nearly all instances, 
the procedures arc established by the policies and directives of higher 
authorities... You might be interested in learning that a study made by 
one of us, over tvjo years ago, revealed that 240 weekly, bi-weekly, 
monthly, quarterly, semi-annually and annual reports were required 
from each of our independent general hospitals to other staff; in- 
cluding the SGO, Armies, General Staff, Depots, Supply Arms and Services, 
and other agencies involved in the control of the operation of a mil- 
itary hospital. It is realized, of course, that an organization as big 
as the Army must exercise rigid controls of its operations. Few of 
these reports were cause for complaint, but it must bo realized by all 
concerned that the compilation and rendition of these reports demand 
an overhead. Therefore, our plea to- all staff 'officers is to think 
twice before requiring any additional reports and then donft do it 
unless absolutely necessary; realizing at the same time, that as staff 
officers, you could exert' even*greater influence in the conservation 
of personnel by spending your time in curtailing the reports now re- 
quired, In essence, the’responsibility for simplifying practices lies 
.on the staff level. ' 
It must be realized by .all t}at, the absolute control of the 
assignment and distribution of personnel is not within the prerogative 
of the hospital commanding officer,. .There are many jobs which are 
specified by higher authority, and many missions to.be performed, for 
which additional personnel are not’.always forthcoming from within the 
personnel ceilings allocated to them. During the war, certain lux- 
urious services and practices wore instituted which could hardly be 
considered as. paramount to the primary7, mission of the care of the sick. 
There is always the tendency to'all-^7 those.activities to continue. 
Every effort must bo made to abolish these non-essentials. Other 
activities have taken on revised importance; a typical example during 
the past year being the reorganization’of Food Service Administration, 
Re also venture the observation from the field, that there is a ten- 
dency on the. part of the divisions of The Surgeon Gcneral*s Office 
to operate independently in the.promulgation of their missions, projects 
CONFIDENTIAL confidential 
and professional enterprises without correlation with the Personnel, 
Fiscal and Supply Divisions; the wherewithal for which has not been 
anticipated or made available. The plea is, therefore, made that 
closer staff work bo instituted to provide for this .coordination and 
that there bo no newly assigned missions without the means. 
Per AR 4-0-5, last issued 22 years ago, ’’The missiontof the Medical 
Department is the conservation of manpower - the preservation of the 
strength of the military forces,” This concept' is certainly apropos 
to the Medical Department itself, as a component of the Army as a whole, 
and is far bigger than the primary duty, namely, ’’the medical, surgical 
and dental care of the sick and wounded personnel,” which has existed 
since our creation by the Continental Congress in 1775 - 173 years ago. 
In fact the Command and General Staff School and the National bar College 
would impress upon you that the primary mission of the Army, and hence 
the Medical Department, in peace time, should bo ”To prepare for war,” 
It is this situation in which we find ourselves today. If this mission 
were not so, we would have less excuse for maintaining our general 
hospitals in time of peace. It is conceivable that Johns Hopkins could 
bo enlarged to assume the functions of Palter Reed General Hospital, 
that the University of Pennsylvania could be responsible for the patients 
now in Tilton and Valley Forge, that Harvard could absorb Murphy General 
Hospital, the University of Michigan could take over Percy Jones, the 
University of California take over Lctterman and so on in many regions 
of the United States, However, ‘this would not fulfill the mission of 
the Medical Department, which in peace is to prepare itself for time of 
war. 
It is to be noted that the Army recognizes that besides the pri- 
mary function of the car.c of the sick, it* has many other important func- 
tions, including: . f 
(a) The proper selection, .-.classification and training of the 
Medical Department personnel (both in and out of the Regular Army); 
(b) The research and experimentation connected with diseases and 
sanitation and those connected with the development and improvement of 
Medical Department materiel; and 
(c) Production or procurement, storage, issue and maintenance of 
all supplies and equipment used by the Medical Department, 
Recognizing these paramount functions, the Committee predicates 
the balance of its report upon the premises: (l) That training must 
be completed to the maximum; (2) That the PMS&T assignments for ROTC’s 
in medical schools will be continued; (3) That research and development 
must be supported; and (4-) That dependent care must bo recognized as an 
obligation .of the Medical Department, oven though curtailed. 
.. bo must not forsake our training program even in civilian institu- 
tions, Anticipating that, by June 194-9 the strength of the Army and Air 
Force will be nearly 1,4-00,000 persons, they will require the medical 
caro of approximately 8,000 doctors. By Juno our net new requirements 
for doctors will be about..4-,000, Since we have only about 4-0 medical 
CONFIDENTIAL CONFIDENTIAL 
officers in training in civilian institutions, which is only one per 
cent of the net increased requirements, it is not worthy to consider 
withdrawing these medical officers from this training vrogran to meet 
the demand. 
r 
Dependent care is one of the host methods of internal pullie rela- 
tions, As a part of a socialized group, we owe it to the Army, The 
average competent Army officer or enlisted man could not afford, with 
their low salaries and high cost of living, to enter or remain in the 
Army if dependent care were not part of their compensation. Besides 
the civilian medical profession is in no position to take on the addi- 
tional load which would otherwise be thrown upon them. However, it 
behooves us to consider always, the early discharge of dependents from 
the hospital, as a part of. the next .problem which considers expediting 
the disposition of patients from our Army hospitals.. 
Our hospital commanders have been given almost complete authority 
in regard to admissions of patients other than military (Par, 6, 
All 4-0-590), ’ They have also been given the means for the disposition 
of patients (Par, 7, ,AP 4-0-590); disposition of the insane (AP 600-505) ; 
discharge of enlisted men by CDD (AR 615-361); the use 'f the Disposi- 
tion Board (AR 4-0-590); the reference of officers to the Army Retirement 
Board (AP 605-250); the transfer of enlisted patients to the Veterans 
Administration facilities; and other established procedures covering 
most every conceivable case. Hence it is up to him to constantly probe 
the professional services to see that these dispositions are accomplished 
expeditiously. 
However, there are two documents.which this Committee believes 
should be changed. The first one is .Sec, II, SG0 Cir, 73, 14- June 194-8 
(incl, #1), It was based upon Sec. I, Public Law 350, BOth Congress, 
This Circular states in part, Par, 2; * * * * "Sick leave may not be 
granted to an individual who has appeared before a retiring board and 
is then awaiting final action of the Department of the Array;" Pe recom- 
mend that this and the 4-th paragraph be deleted. The purpose of this 
directive appears to have been to force retiring officers to consume 
their accumulated leave prior to separation, but this has not operated 
effectively,. The officers bide their time occupying in the hospi- 
tals in order that they may receive the monetary credits of their 
accumulated leave upon departure. This has been brought to the atten- 
tion of the Hospital Division and-the Physical Standards Division, SG0; 
to the attention of Lt, Col, P, L, Hooper and Lt, Col, Thompson of the 
Personnel and Administration Division, General Staff; and to Lt, Col. 
Cullitan and:Captain Long, the Adjutant General’s Office; as well as 
'to Lt, Col, V.'illiam H, Purdin, Separation Branch, AGO, All of them 
have promised to give it their immediate attention. This condition 
not only causes the loss of hospital beds and the waste of personnel, 
but' is economically unsound. The Physical Standards Division, SG0, 
received in FY:194B a total of 5,533 cases for recommendation and deci- 
sion, as to retirement from the Army (Incls, #2, #3, & #4-), The average 
delay was six weeks from the time these records left the Array Retire- 
ment Board' until the- orders were received and the officer separated. 
CONFIDENTIAL 'CONFIDENTIAL 
Tho average cost of hospital caro is now about $14*00 per day| tho 
'average salary of tho officers rotired last year was approximately $11,00 
per day. The delay thereby cost the government $25,00 per day per offi- 
cer, or $138,000 oer day for the 5,533 pending cases. Averaging 42 days 
each, tho total cost is a rather startling figure of $5,810,000 in FY 
194-8, Therefore, it behooves the SGO and the General Staff to reduce 
this expenditure. The Committee urges that prompt and effective steps 
bo taken immediately. No doubt even a greater savings could be accom- 
plished within the hospitals themselves, prior to the time that these 
cases were referred to the ARB, Therefore, it also behooves every hospi- 
tal commander to expedite the clinical surveys, treatment and appearance 
of those patients before, the Disposition Board and then to the Army 
Retirement Board, \ 
In this connection consideration should be given to the reduction 
of the number of retirement boards. Six of our 13 general hospitals 
averaged less than 4- cases per week over tho past six months. Hence, 
it seems feasible to reduce the total number of boards to 7. The 
transfer of a small- number of cases would be cheaper than paying the 
staffs required. One caution should be observed to prevent the indis- 
criminate transfer of cases, namely, that those cases would be trans- 
ferred only ■'/’hen tho Disposition Board has recommended their appearance 
before an Army Retirement Board, 
Therefore on 30 June, 2,300 officer patients in our ZI hospitals. 
You should not ferret that the hospitalization of these patients was 
costing the government $60,000 per day. 
The next document we want changed is VD Cir; No, 23.8, dated 30 
August 194-7, (Changed by Cir, Nos, 12 and'68, Department of the Army 
1947). Cir. No, 238 concerns the Assignment of Hospital Patients, Para- 
graph 3 covers the transfer of personnel upon completion of hospitaliza- 
tion, be have no argument in the disposition of personnel carried as 
"attached from other organizations,11 This is in substance the station 
hospital type of case, r'o are deeply concerned about the disposition 
of personnel carried as "assigned,11 which is the Detachment of Patients, 
Far, 3b (l) (b) requires the commanding officer of a hospital to give 
Tho Adjutant General 15 days to determine future'assignments of officers 
and 5 days for enlisted men. The AGO has one point of criticism con- 
cerning, our general hospitals who write letters instead of sending TbX*s 
for these disposition orders. However, the experience at our general 
hospitals seem to be that the time required for orders on officers is 
nearly 20 days and for enlisted men nearly 10 days. Statistics arc not 
available as to* the tremendous, unnecessary hospital costs that this in- 
volves, be '•■’o know that during FY 1948 the ZI hospitals disposed of 
76,000 patients, 60 per cent from general hospitals, of which a great 
number must have had to await orders. The above named officers in AGO 
and P & A Division have been acquainted with these facts. In order to 
vacate our beds and relieve administrative overhead, as well as cost to 
the government, and difficulties arisinr from this type of patient loaf- 
ing around tho hospitals, the Committee recommends that the hospitals be 
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relieved--of this replacement center function. One solution the Committee 
proposes is that the commanding officers of the hospitals he allowed to 
transfer these cases upon completion of hospitalization to the nearest 
post of their branch, the CO of which will report them to The Adjutant 
General for orders. Another way would ho for'each Army to designate one 
or more places for transfer. In either event we could clear our beds 
and the military personnel could ho used;-at the same time ho associated 
with their active duty comrades. It is believed that this will increase 
their morale' and he an incentive to hotter soldiering. 
Enlisted men-.- Subparagraph 3h (l) (h) (2) states that "enlisted 
men who entered hospital from Zone of Interior installations, will be 
returned to the organization from which admitted, •provided organization 
commander concerned has requested such reassignment in writing,"• 
Obviously these organizational commanders want replacements when they 
lose men to the hospitals, for which they cannot be ‘blamed. However, it 
also gives them an out for getting rid of every man they donft want, 
particularly those undesirables who ought to be discharged from the Army 
under AR 615-368 or AR 615-369, The Committee docs not feel that the 
Medical Department should be required to wash such administrative linen 
for the lino, * 
Another document which should be re-read repeatedly by every hospital 
commander is AR 615-361, concerning medical discharge of enlisted per- 
sonnel, Every commanding officer of a named general hospital has author- 
ity under Par, 7, AR 615-360 to discharge enlisted personnel for cause 
prior to expiration of their term of service. Every general hospital, 
without exception no doubt, has many enlisted patients who will never 
return to active duty. Our professional staff seems to have a stagnant 
inertia in getting patients out of the hospital, particularly since we 
have instituted the training program. Every* case should be reconsidered 
in terms of. its value to the teaching program. There is certainly a 
time when each case ceases to materially contribute to this. There also 
seems to be a wide misconception as to what constitutes maximum hospital 
benefits,, and particularly an indefinite interpretation as to what is 
expected under AR 615-361, It is 'sufficiently important to review now, 
Par. lb, which states, "Then an individual with less than 20 years ser- 
vice becomes unfit for military service because of disability he will be 
hospitalized until his condition has reached the point where he can be 
returned to duty or until it can be determined that the disability is 
such that rehabilitation for military service is not feasible," The 
first important point to determine, therefore, is whether or not this 
soldier will over return, to duty. The next point is how long shall we 
allow him to remain in .a military hospital. 
Par, lc (l) continues,."No individual with a disability incurred 
in lino of duty except ,tiose listed will be discharged on GDE 
until maximum hospital benefit.has been attained," Then individuals 
having certain.types of diseases such'as tuberculosis, chronic psychosis, 
chronic degenerative neurological diseases will not be retained until 
maximum hospital benefit has been attained, A few types of cases should 
CONFIDENTIAL CONFIDENT IAL 
ho retained for treatment but it does say must. Those include those 
requiring skin grafts, rrafts, revision or amputation stumps, clo*- 
suros of colostomies, neurological procedures, etc., and those pith 
psychoneurosis, severe enough to require hospital treatment, ’’Chronic 
ncuropsychiatric disturbances mill not bo retained for definitive treat- 
ment,” Judging from common practice, it seems that there is a tendency 
to stop reading at this point. Let the Committee invito your attention 
to subparagraph 1c (?) below, which states, "Then the individual is to 
be* separated from the service on Certificate of Disability: for Discharge, 
irrespective of lino of duty status, and further hospitalization is neces- 
sary, he will be transferred to a Veterans Administration hospital, State 
or other institution, and there discharged,” The common 'practice seems 
t be to lot this subparagraph apply only to neuropsychiatric cases. 
Again, there is a reluctance on the part of soldiers to leave the Army 
hospitals in favor of Veterans Administration facilities. This subpara- 
graph is stressed as a means already established, by which hospital com- 
manders can clear the docks of chronic and- undesirables who arc occupy- 
ing cur much needed beds, during.this period, of dmergoncy; exceptions to 
bo made only for important teaching material. 
During FY 1948 the Z1 hospitals disposed by ODD 15,230 cases - 
12,303 from general hospitals, 2,927 from station hospitals. The deduc- 
tion is not too exaggerated to infer that over 100,000 bed-days could 
have boon saved by earlier transfers to Veterans administration. 
Using all these means covered above, it is estimated that wo could 
easily clear 2,000 or 3,000 beds in the Army in the near future, which 
would bo equivalent to a now general hospital. At this time when the 
SG0 staff is doin'’ everything to establish nearly 25,000 additional beds, 
this action-Should bo seriously. Besides it is economically 
sound, since it will cost the Medical Department over a thousand dollars 
per bed to reconstruct and equip these now hospitals, even consider- 
ing the cost of personnel and maintenance, A reconditioned general hos- 
pital, using existing temporary buildings, will .cost us over one million 
dollars each. 
The Committee, therefore- recommends the motto, ”Get Rid of the 
Patient,” or in the plumber’s vernacular, "Keep Your Drains Open,” 
Now thore are a few other topics worthy of mentioning for consider- 
ations 
Internal I .pi )ort.s. - Some General hospitals have found it advantageous 
to require monthly or at least periodic reports from their Registrar or 
•Chiefs Professional Services, carrying’the’number on each service, sec- 
tion cr ward of patients who have been in the,hospital throe months or 
longer, or some other specified tine, A mineorraphed form is useful to 
bo made cut by each ward officer showing: Column (l) Those patients by 
name| Coluun (2) Short diagnosisj Column (3) Prognosis| Gclumh (4) Pro- 
bable disposition as to duty, ODD'or ARB and the month in which they 
anticipate separating the patient. This is recommended for those hospi- 
CONFIDENTIAL CONFIDENTIAL 
tals which do not already use it, for it gives the commandin'’ officer 
some definite information on nhich to stimulate their dispositi- ns# 
Employment of Baticnts.- The conservation of personnel could again 
Eg facilitated by the employment of,patients as still reviled in para- 
graph 2b, AR 4-0-590, which reads: r,By order of the commanding officer 
of the hospital and under direction of the commander of the detachment 
of patients, convalescent patients may he'employed to perform such 
light duty in and about the hospital as may ho of therapeutic value or 
which may tend to improve their physical condition,11 It is realized 
that this is difficult to re-enforce after the laxity of mar# Disci- 
plinary problems may arise which are greater than the value received, 
hut their employment is legal and certainly worthy of reconsidering# 
Disposition or inapt officers and men.- One standard means of 
implementing conservation is to improve quality# Hence every effort 
sh uld 1'e made in this early stare to get rid of the inapt officer and 
enlisted man. The former can be separated as surplus| the latter by 
the AH' or 369 Boards, 
Enlisted staff vs. civilian employees#- During the past three years 
our general'hospitals have undergone two or more complete cycles of 
policies in regard to staffing pith enlisted technicians or civilian em- 
ployees: (l) At the end of the war no had a high percentage of civilians; 
(2) As the men came back from overseas, they replaced them; (3) As 
enlisted men became discharged, civilians again had to be hired; (A) Then 
funds mere cut and enlisted men again took over £he jobs;' (5) Later the 
Army decreased in strength and civilians once more mere alloyed; 
(6) Presently,- pith influx from draft, me anticipate enlisted men again# 
This turnover and instability has been costly in administrative overhead 
and especially in technical proficiency, V.'hile labor markets vary with 
localities, it is suggested that a policy of 58-5© ratio be adopted# 
A high-grade permanent civilian technical staff would give us stability 
and teachers; the enlisted men mould compensate for civilian AO-hour 
meek handicaps and furnish a cadre for overseas replacements or a 
national emergency# 
Medical Service. Corps Officers.?-- Me are of the opinion' that more 
MSET officers can be Utilized in our general hospitals as replacements 
for our professional officers# Every effort should be made to obtain 
them, V-o are just beginning to rely on the substitutions so far made 
and believe that their efforts should be extended into many more fields 
so long as quality.is obtained# • g ... ... 
1 ■ * • Nurses - Property Account#- Norn that nurses have been commissioned 
as officers in the. Regular Army, it- is only proper that they should 
assume'their responsibilities along path their privileges#-In most 
civilian hospitals the nurse’s are required...to assume the responsibility 
of property on their yard, clinic or department# . There'seems to bo no 
legal reason why they could not do so no?; in cur Army hospitals. Con- 
sideration might be given'to their employment in these capacities# Hoy- 
CONFIDENTIAL CONFIDENTIAL 
over, it is realized that we Fill be terribly short of nurses as Fell as 
doctors. 
Active duty for Retired Medical Corns Officers.- Without taking 
exception to the existing laws regarding retirement, At is urged that 
in this national emergency every effort be made to offer those retired 
officers, who are capable, an opportunity to return to active duty. It 
is believed that there arc many positions they could fill in a commendable 
manner. 
Contract Surgeons vs. Civilian Employees.- ’e all realize that 
when a contract surroonfs job gets to a certain point, that you can no 
1'n’cr obtain, for the pay. offered, the quality of physician required. 
Efforts should bo made to increase this nay by some means and/or get the 
jobs on a non-Civil Service employment basis# The idea should be ex- 
plored, that there may be sr'me very fine older doctors uho would be Tr,ill- 
ing to serve full time in this emergency who cannot pass the physical. 
Statistics - Operating Personnel and Cost .-ccounting, - Those 
presently issued by SCO are so modified by footnotes as to make them 
worthless for.comparative interpretation. It is recommended that the 
data be obtained on a firm basis, equal to all ronoral hospitals. 
Army Regulations.- ** review of the 4-0-ser5.es of Army Regulations 
reveals that many f them are five t twenty-some years old# Many of 
the others were written during the time of the Array Service F~rcc and 
Service Commands, Most f them have been modified in one way or ancther 
by Aar Department Circulars or ther official documents. It is desirable 
that vari us directives be c nsclidatod and that new concepts bo crystal- 
lized by early revision of those regulations, TM 8-262 was a splendid 
idea, but it is incomplete and seems to have been abandoned. It should 
bo revised and completed* 
Physical Examinations«- One of the nis.si''ns of the Medical Depart- 
ment is t c nduct physical.examinations for applicants for the service, 
Annual Physical Examinations, and a host of physical-examinations for 
civilians as , r vidqd in Par, 6, AR 4-0-505• The load cn some of our 
Institutions is tremendous and it is recommended that the SCO review 
•all of the authorities which require this done. Particular attentirn 
should be given t the examinati n of applicants for Civil Service jobs, 
especially tbrso f military posts having large numbers or engaged in 
production, sudh as arsenals. The feasibility of contract surgeons for 
this job, in addition to our medical staff, should be thoroughly explored* 
Veterans cases in Army hospitals.- The SCO authorized patient 
capacity at general hospitals by specialties as of 30 Juno 194-8, reflects 
that 3,035 beds have been allocated for Veterans Administration patients 
(See SCO Press Release, 8 July). Philo some of these c-uld be continued 
at certain hospitals, it is questionable how some like Tilton General 
Hospital can do so and werform the mission of the increased expansion 
planned for them. It is estimated that these 3,000 bods w uld require 
a 
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150 doctors and it is not understood hnm, in this emergency or until tho 
draft of doctors is consummated, nc can afford to continue this load. 
It is realized that commitments have been made, but it is felt that in 
this existing emergency that these commitments should be reconsidered. 
Housinr,- Besides the above points on staff adninistration and 
conservation of personnel, the Committee w-uld like to propose that ex- 
treme efforts bo devoted to providing h'using at our general hospitals. 
Fhen doctors leave medical school, their average ape is about 26, They 
have several aims in life: For example, (1) Tc bractice their profession 
in a successful manner; (2) To' pet married and establish a family: 
(3) To have security; and (A) To have a home. The Medical Department is 
in an enviable position to offer facilities for the practice of their 
profession in the manner they desire, “hile their salary is adequate 
they-at least have security. The one thinp me need most to furnish as an 
incentive to brinp doctors into the Army is housing, This offer is not 
so true at non-medical posts, because their rank pill usually entitle 
them to some acceptable quarters. Hopever, at peneral hospitals, the 
condition is renerally deplorable. It seems so unnecessary too, phen it 
is so economically feasible to furnish, these quarters. The averape 
Army house nop costs between $10,000 and $20,000, depending upon size, 
let’s say an averape of $15,000. To occupy the house the officer gives 
up about $1,500 per year. In 10 years* he pays for the house, the govern- 
ment has and opns, phich house, under modern specifications, pill 
last at least 50 years. This .one aspect of the problem in procurement 
of medical officers should again be presented to Congress in a most 
(Emphatic method possible. Re knop that the Bureau of the Budget and 
Congress have generally been opposed to revolving funds,'.but if the Army 
pore allied to use the commutations deducted and build more quarters, 
it pould bo a very fep years before the Army pas adequately and entirely 
housed and thus an equal number pquld be available for -civilians. 
General Bliss, your Committee is amare that they have not covered 
all subjects pertinent to the problem, nor any question completely. 
Time does not*^ermitk Homever, me trust that this brief may stimulate 
discussion and start some chain reactions, Ue regret that me cannot 
come out mith an approved and total solution from mithin our Medical 
Department but the demands are too great. To fulfill tho Medical Departi- 
ment’s mission, me conclude that the only adequate solution is to draft 
doctors. The situation is not only our crisis; it is a National Emer- 
gency. Tho civilian nodical profession, and the nation at large, must 
be made to realize that this is so. 
FOR THE COMMITTEE; 
/s/ CVMorpan 
CLIFFORD V. MORGAN 
Colonel, Med Corps 
Recorder 
CONFIDENTIAL coifxdential 
DISCUSSION ON PERSONNEL 
GENERAL ARMSTRONG; 
Now as to the matter of trainings You gathered from Colonel 
Robinson's remarks this no min." that the hr my hr ©a and Air Command mere 
heartily against this plan. I think there mill not be so much opposi- 
tion if you can ret them to carry more of the Service,You will elimi- 
nate criticism of the training promram if you can pet the residents to 
carry their load, , There are certain things mo feel that can he curtailed. 
In the first place, I helieve there are men in the training propram that , 
can just as moll he rotten cut and put in a C or D rat In.", men mho mill 
never reach the top, never take their Boards, Vo think the Educational 
Committees in the teachinp hospitals should very carefully look then over 
and see if any individuals are wasting themselves in the , Some 
hospitals have dene this and have rotten word hack that Joe Doaks mill 
continue in the propram, Norn, there may be some rood reason for this, 
hut X believe this office should l-'ok into it. Take another groups 
The Boards have changed their requirements as to the amount of .formal 
traininr necessary to take the-Board examinations. There may he men 
in the propram qom mho do not need any additional formal traininr, and 
those are needed in nom hospitals, Another policy mo are going to pur- 
sue is that it mill he very rare durinp this critical period that a 
Rorular Army doctor mith five years or more of service mill he put into 
the program unless ho has had a commitment' already, . As far as civilian 
traininr is concerned, there has been a lot of criticism about the 
number of people going into civilian traininr. That, too, is going to 
be cut domn to, the minimum - sending them rut for training whore it can 
be, done in the Army, 
COLONEL ROBINSON: 
I think maybe I may have misled you. Net all of the procurement 
me are doing is for the traininr program. That is net exactly right, 
be have UU doctors and out -of - that only two- are going into the residency 
program. Only 25% are on duty, Re are actually makin” some demands. 
Of the- 44, 4-2 mill bo working people. 
GENERAL OFFUTT: 
You say that no officer in the Regular Army mith over five years 
of ‘service •mill be- taken f~r the residency program at the -resent? 
GENERAL ARMSTRONG: 
That's right.. 
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GENERAL OFFUTT s 
Does that five years include constructive work? 
GENERAL ARMSTRONG; 
I an thinking: of a man who has boon out of his internship for 
five years. For the past year, men have pone in with 5 to 15 years of 
service. Vie have actually put men in around AO, In some of those 
cases it was either that or lose the man, but durinp this critical 
period we feel is no tine to put the older men in. 
GENERAL BEACH; 
I think normally those people now going in for residency train- 
ing should be selected from the interns wo have in the service now 
because if we are going to train a man to be a specialist we should 
start in his internship, -In about a year or so we will have it com- 
pleted except for the very now coming in the Army, Another thing we 
will have is graduation of our interns, be have 27 interns reporting 
the first of July, Those 27 next July will make application for the 
Army provided they can have a residency. Are we going to give all those 
men a residency? I don’t believe ,‘ie' will be able to do it. That is 
going to happen in every general hospital, I think 95% of the interns 
will stay in the Army if they can have a residency for the next three 
years, but the Army isnTt going to be able to do it, be should be 
able to take a good percentage, but not over 50% or 60% at most. The 
rest may be selected for a residency after-a year’s duty in the field, 
be are going to lose men that way. 
GENERAL OFFUTT: 
be also have another proposition coming up. Men overseas have 
applied for the Regular Army because we have assured them they will have 
an open shot for a residency. Some of them will have had over 5 years 
of constructive work. 
GENERAL BEACH: 
I think it is a mistake to take anyone over 35 for a residency. 
COLONEL ROBINSON: 
As a matter of fact, most of these older men are already in a 
residency program. There are only 10 who have been deferred for one 
reason or another who arc desirous of getting into a residency program. 
CONFIDENTIAL CONFIDENTIAL 
GENERAL OTFUTT : 
Some men overseas have been more or less assured that they 
would have a chance, and I think you are breaking faith with them if 
you don’t rive it to them, 
COL (EEL ROBIMSONs 
uTo have no intention of not carrying out what we have obligated 
ourselves for, and we think wo can do it in civilian hospitals too, 
riving a residency in 1950 or 1951 and rive him a certificate to that 
effect, 
COLONEL AMSBACKER; 
If wo promise a man one in 1953, ho will pot it, because unless 
an opening is there we would not tell them so, 
COLONEL ROBINSON: 
I think that will help straighten out part of the problem, 
GENERAL OFFUTT s 
If you can assure a nan that eventually ho will ret it, you will 
hold more of them. 1 - 
GENERAL BELCH; 
I don’t think you will, I can’t sec how you can build up a corps 
of specialists in the Medical Corps, ' o v-m have to have some doctors 
and general practitioners, V'o will have to soil the younger men on 
•being ronoral practitioners and just specialists, At least half 
should be the common, ordinary variety of doctor that could go out on 
a post and do anything, deliver a baby, take out an appendix, etc. 
If you interest some in a residency as a general practitioner 
that would not lead to a Board, 
GENERAL LILLIS: 
I agree with General Beach. LTe are going to have too many spe- 
cialists, I also agree with him on the 35-year age limit, A groat 
many cf the older residents you speak of have had 1 or possibly 2 years 
and are.interested in changing from one residency to another because 
they have a good assignment, good quarters, etc. That is~ the group 
CONFIDENTIAL CONFIDENTIAL 
so badly needed at tho larger station hospitals, with camps opening up. 
COLONEL ROBINSON: 
Ee have established at Madigan on a small scale, the clinic 
physician, 
COLONEL GREEN; 
How many have applied? 
COLONEL ROBINSON: . . 
It hasn!t been a problem at all - only about 15 applicationsJ 
COLONEL GATES; 
Is it appropriate for a man after ho goes in on general surgery, 
if the individual shows a desire to continue the' specialty, to stay in 
one type? 
COLONEL ROBINSON; 
i ; 
I believe that is a mood idea,- 
COLONEL. IEHMAN-; 1 
Have you given any thought to being a little less rigid on tho 
requirements from a physical standpoint? A good many, for instance, are 
a little myopic and cannot make the 20/100 requirement. It might be 
worth while considering a waiver for between 21/100 and 22/100, 
COLONEL MUDGETT; 
,1'think we are‘accepting those individuals, I believe it is done 
up to 22/100, 
GENERAL BEACH; 
I would like to ask if anyone has any idea as to how we are going 
to interest these younger men coming in to be doctors and not special- 
ists, It is the same thing in civilian life. Before long we will have 
CONFIDENTIAL CONFIDENTIAL 
to wake up to the fact that everyone can't be a specialist. They should 
constitute somewhere between 25% and 35% of the Regular Amy Medical 
Corns* 
COLONEL ROBINSON: 
Our books are set up so only 26% of the Corps will be specialists. 
Re, have not had to face that problem yet, 
CENTRAL BEACH: 
That are we going to do with those men who will come in if they 
can be a specialist and then ¥;hen they pet through they get out of the 
Army? I don't think wo should promise them so much, and I believe we 
should put them in-a position where they can't doublecross us so much, 
I think a man should have to sign up for three years after he gets 
his Board. Civilian Boards aren't going to like it either. 
COLONEL LEHMAN; 
I think so, too. I agree, 
GENERAL OFFUTT; 
I think the basic difficulty goes back to the medical educational 
system.■ Re.start talking "Board" right from the beginning. 
COLONEL GATES: 
How about the dental part? No outside help is being considered. 
There is no program-on that.,- 
COLONEL ROBINSON: 
You mean, wetting work done by civilian dentists? On military 
personnel, if you don't have enough dentists to do the work for the 
military you can et it done by a civilian dentist on a foe basis. That 
has been in regulations for time, 
COLONEL REYERs 
Hqw ab'-ut dependents? Re had 644 patients in July and over 400 
were dependents. For a town of 130,000 there are only 530 doctors. 
CONFIDENTIAL CONFIDENTIAL 
COL ONE, L ROBINSON; 
On the dependent ’ToMeni, you heard what General Bliss had to say, 
which corresponds with General Bradley’s views; however,Ron out-patient 
calls and elective work, curtailment is beinr- made, A directive will 
he issued on this, 
COLONEL SOPER; 
At Tilton we have authorized 275 veterans’ Beds. Those cases re- 
quire more personnel in the way of professional nursing and Medical 
Department care than any other 600 patients in the hospital, and not one 
has a service-connected disutility, be have cardiacs, malignancies, 
etc,, requiring extensive surgery, multiple blood transfusions, requir- 
ing special nurses and special corpsmen. They-present the greatest 
disciplinary.■problem and the greatest financial outlay, 
GENERAL ARMSTRONG; 
I am going to state that Colonel Schwiqhtenberg,'who is just back 
from the Far East, is moing to go into this very darcfully. The first 
reaction might bo very unfavorable in asking Veterans’ to take back their 
3,035 beds wo now have allocated. In the first place, there are two 
groups we don’t want to give up. The first is in the teaching hospitals. 
You got cases in under that-bed allotment which are valuable for that 
purpose. The-.second group-are in hospitals--like Puerto Rico, Guam, 
Honolulu, and like Fitzsimmons, where we are furnishino beds to keep the 
Veterans’ Administration from constructing hospitals, ‘'bother we will 
ask them to take back beds such as like at Tilton will be studied, be 
are also making quite a study of places vjhere we may want to ask them 
to give-us beds, be don’t want to have Array patients in VA hospitals if 
we can help it, but in a few places'we-can save construction of a hospitaj 
By so doing we may obviate being told to do it, alsoj 
COLONEL SOPER; 
You are right about the value of them for teaching purposes, 
GENERAL ARMSTRONG; 
Actually there are 66? beds like that which wo could give up with- 
out interfering with teaching, 
COLONEL IELCH: # • ■ . g: 
One typo is geriatrics. If they once get in, you can’t get rid of 
them. They are no use for teaching purposes. 
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CENTRAL OFFUTT;* 
Soldiers’ Home cases, that’s what it amounts to, 
********** 
ROUND TABLE DISCUSSION ON SPECIAL COMMITTEE REPORT 
GENERAL , JU'ISTRONG: 
Before starting the discussion, I would like to thank Colonel 
Morgan, Colonel Clark and Colonel Stanely, I feel that their report is 
a very fine contribution, and I want it reproduced so each of you can 
have a copy right away and won’t have to wait until you et the minutes 
of the whole meetinp, ; 
COLONEL IEHM/,N; 
I believe the amount of clinical material that, our hospitals pet 
in the care of veteran patients is too important to consider asking the 
Veterans’ Administration to take them away, I do feel, however, we 
might ask VA for a certain amount of professional help in a ratio per 
bod, say of 1 to 30, 
• 
GENERAL ARMSTRONG: 
I believe that point is worth exploring, 
COLONEL MORGAN; . ' ■- 
I would like to say that in a, lot of the smaller hospitals it 
would, not make much difference, but it certainly would in the cases of 
Tilton and Fitzsimons, I question very much if you got a thousand or 
fifteen hundred tuberculous patients, for instance, whether 700 or more, 
will give you any more value in the way of teaching material, 
CENTRAL STREET; 
It would a-pp’ly at Brooke. The 4-00 beds wo have for veterans con- 
stitute our most valuable types for teaching purposes - the cardio- 
vascular-renal cases, malignancies, degenerative old ago diseases, and 
innumberablo acute accidents wo take care of, all of which .are an im- 
portant part of our teaching program. One point in your recommendations 
which I don’t agree with and would like to comment on is with reference 
to transfer of officer patients to a- number of general hospitals where 
they would be disposed of by Retiring Boards, The recommendations said 
CONFIDENTIAL CONFIDENTIAL 
they should be worked up completely before transfer, It ha.s boon, my 
experience that no professional group will accept the recommendations of 
any other hospital, so these men, no matter horn completely the patient had 
been perked up, would want to work him up amain, and I think it would be 
much better to have the staffs make up their minds whether or not they 
have a Retiring Board case and then transfer immediately. 
COLONEL MORGAN; 
The committee feels that if this were true the Retirin': Board hospi- 
tals would really met an influx, I don’t see any reason why one hospital 
would not accept another’s statistics. Certainly, after the patient has 
mot a Disposition Board, the fellow who is the medical witness for the 
Retirin'’ Board is not always the follow who worked the case up. He has 
to take the records, ’Chen the case pets to The Surgeon General’s Office 
they have to make their decision on the records, and they don’t sec the 
body’ I don’t see why, if the records are any rood, that they wouldn’t 
be accepted. 
GENERAL BEACH; 
Re find, even at baiter Reed where the case is worked up right there 
for the Retirin'’ Board, that very often the witnesses have not known any- 
thing about the case until it has rone through the Disposition Board and 
in turn they come in and look the man over and there are lots of thinrs 
they want done, rirht in their own hospital. This has happened so much 
that wo now require the medical witnesses on a case coming up before the 
Disposition’Board to sit'in with the Disposition Board so they know all 
of tho reasons why the Disposition Board has come to their conclusion, 
and now, so far as tho medical witnesses arc concerned, they can take the 
man up before tho Army Retiring Board the day after he meets the Disposi- 
tion Board, I think your point is a rood one, because I believe you will 
certainly have trouble with one hospital accentin'’ the word of another 
one, and then, too, the man will have- time to read his record, which they 
send, along with him. He has then developed, a lot of new complaints. If 
he,wants t;o be retired and they haven’’t recommended him for retirement, 
he will show up with a lot of-new complaints, - 
GENERAL STREET; 
In that way the case appearing before the ARB would have the stamp 
of approval of examinations at that particular hospital, and the staff 
at that hospital would not be responsible for those recommendations and 
finds without having verified then. 
COLONEL MORGAN; 
Perhaps the committee did not make itself very clear. It was not 
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intended to deprive the hospital receiving the natient from doing any- 
thing they ranted to. It was to prevent the hospital from sending you 
100 eases cat a time instead of perhaps 10. 
C CLONE, 1 REYER: 
I drn’t Relieve they would that. They would only send those eases 
the5r felt were roinp to cone before an ARB. 
COLONEL LEHMAN: 
The chief objection to having more than one Disposition Board pro- 
ceedings on a case coming up before the ARB was stated by General Beach 
when he said the ’watient was "iven a transcript of his Disposition Board 
and if there is a difference between the recommendations of the two hos- 
pital Disposition Boards, then the next stop may well be The Surgeon 
General’s Office, 
GENERAL OFFUTT: 
You will have disagreements on a certain number of borderline cases 
anyway that you will have to bring up before an ARB, 
'COLONEL MORGANJ * 
• r » ■ 
I juclgc the argument then is nr t to heave the Disposition Board before 
hand., but just send the case in, i 
COLONEL LEHMAN: * • ’ ' , . ' ’ 
•On a ease c- min” up for retirement, after we get the case and the 
other hospitalls Disposition Board has recommended retirement and we 
disagree, that man has grounds for complaint, and, he will take full ad- 
vantage , and the next stop ”ill bo the General’s Office, Letter- 
man says he should be retired and Army and Navy says ho should not. The 
worst complaints I have had were between Disposition Boards, 
COLONEL MORGAN-s 
That’s happening all the tine. One hundred ninety-eight cases were 
sent back for review last year and sent to another hospital, 
GENERAL LILLIS: 
The principal complaint from the officer when he is not satisfied 
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with the action of a Retiring Board is the foct the witnesses were 
the who -norked up his case, and that observrtion is made from experi- 
ence as a member of an ARB and an administration standpoint at Brooke, 
COLONEL ROBERTS; 
That’s true, 
GENERAL WILLIS; 
/ 
be try to have the ward officer bo the man’s witness, 
GENERAL BEACH; 
I would like to modify my remarks because I believe I am plagued by 
the fact I'am afraid Murphy and Tilton and Valley Forgo or maybe some of 
the hos'itals down YJould be pin sending all their retirement cases to 
Walter Heed, and ‘alter Reed cannot absorb any more. The ARB could, but 
we can’t, be not have any more in there without delaying their work- 
up, It would take just as long if they came to baiter Reed as if they 
stayed where they were. If things strairhten out, we could possibly take 
more, '’e have 150 cases now being worked up for retirement. The ARB 
could take more”, be have d uble ARB’s, taking 6 a day, but I don’t see how 
yjo any more there, I don’t know what disnosition you 
make about sending them to baiter Reed, but I assume one would be at baiter 
Reed, which means we would immediately have retirement cases from 3 or 4 
other hospitals, and I just don’t see ho?j we could absorb them. That 
probably is my main objection. It might work ■fthero you did not already 
have the hospital overloaded, 
COLONEL LEHMAN: 
be don’t have.enough to put’any great burden on us, I would like 
to continue handling the arthritic cases, be have gotten used to them, 
have gained?specialty training. We have both Patterson and Davidson, who 
have;been to Mayo, 
GENERAL BEACH; 
I think the cases you have should be disposed of at your hospital, 
because they are specialized cases, 
COLONEL LEHMAN; 
As long as we head our own Board and have our own witnesses. 
CONFIDENTIAL CONFIDENTIAL 
COLONEL SOPER: 
The Retiring Board at Fort Dix never runs over 4 or 5 cases a week* 
At the same tine there are quite a numVer of officers in the hospital 
awaiting action of the Retiring Board. I have trier1 to expedite those 
cases through the hospital, but I can’t seem td rot more than 4 or 5 in any 
one week, Last week we only, had 2, It seems a waste, 
GENERAL ST RE ITs 
At Brooke-in 1946 we had 1100 cases appear before the ARB and in 
1947, 1260, In 1948 for the first six months mo have had less than 200, 
There has boon a very-sharp drop in cases appearin': before the ARB, and 
wo at Brooke can take on an additional-200 to 300 cases year without 
overtaxing our officer facilities or Retiring Board personnel, I believe 
that, with few exceptions, it wuild not bo a problem for specialized cases 
to appear before Retiring Boards at a limited number of hospitals. Ac do 
have specialists. Our reneral hospitals as a rule handle most types of 
cases, 
COLONEL MORGAN s 
Our mission was to find ways of conserving personnel. How many people 
do you have overhead at Army and Navy? 
COLONEL LEHMAN: 
Re don’t have any, 
GENERAL STREET: 
Re don’t at Brooke cither, 
COLONEL LEHMAN; 
It takes a little time, but wo have no overhead, that is, people 
definitely assigned the Retiring Board alone, 
GENERAL PEACHs 
I think "alter Reed is the only 'lace we have a Retiring Board 
full time and r*ith that the only duty. 
.CONFIDENTIAL CONFIDENTIAL 
GENERAL OFFUTT: 
I think that along the line of your discussion you c< uld save a 
great many hospital days if you could speed up the LG in returning papers 
when asked for. You ask for a man’s record and it takes the LG three 
weeks to 30 days to get it to you* 
COLONEL MORGLN; 
he did discuss with LG that point. Colonel Hooper has promised to 
look into it. You used to be able to write in in advance when you antici- 
pated the man would meet an LRB, Now, they say they have to have the 
Disposition Board first, 
GENERLL OFFUTT % • 
Fell, it takes from 3 weeks to 1 month to got records, 
COLONEL HiJITFORD; 
Is there any reason the records could not be asked for a little 
sooner? 
GENERLL OFFUTT: ’ 
Thoy will not rive them to you until the Disposition Board has been 
held. During the war there was authorization for you to :et the papers 
as soon as you anticipated the man would meet an LRB, 
GENERLL STKEIT: 
Lrc you talking about the Regular Lrmy? 
• I 
GENERLL OFFUTT; 
No. 
GENERLL STREET; ’ ’ 
Fell* unless it has-been changed within the last throe-weeks 
COLONEL STLNIEY (interrupting); 
That’s just it. It has been changed within the last throe weeks and 
CONFIDENTIAL CONFIDENTIAL 
that is the point of the whole debate. 
COLONEL HARTFORD; 
o can et thorn horo, but I yuess out in the. field, it’s different, 
GENERAL BEACH; ’ 
A lot they have to act from St, -• ■ 
COLONEL HARTFORD: 
» I don’t know of any case like this. 
COLONEL STANIF.Y: • • . 
That’s the clinical records that from St, Loui,s,. It’s the 
201 file which the AG has. 
GENERAL ARMSTRONG; 
May I introduce a new. subject and one which, as I remember, was 
not touched upon in your document? be are havinr to continually defend 
the lenpth of stay in Class II installations of the so-called "station 
hospital type of patient," The .Eir Force medical in conjunction 
with cur Statistic Section, made a study of that some time aro on the 
number of patients we C' nsidcr the station hospital type of patient, that 
is, hemorrhoids, appendectomies, herniorrhaphies, etc. If I am not 
mistaken, they found that in reneral this type of case required four 
times, the lonrth of stay if performed in a reneral hospital as if per- 
formed in an AF station hospital, an fivcrape of 8 days, and in reneral 
hospitals, 30 days, I realize that in.many of these instances that may 
be a part of a: reneral picture which is not betrayed, in the statistical 
picture in this office. On the other hand, and I am a product r'f the 
reneral hospital rroup professionally, so I think I can speak fittingly 
on th subject, we who aro accustomed to service in reneral hospitals 
ret in the habit of thinkinr of all patients as the rfcneral hospital type, 
so when a patient comes in for somethinr like removal of a hemorrhoid 
the tendency is to do a lot of laboratory work, just as on the reneral 
hospital on the bare possibility that the patient is ~oinr to come 
before a Disposition Board and you are roinr to have to ret it any way 
so why not start the day he enters the hospital, I plead with you to 
try to think how you can inculcate into your hospital staff ways of pet- 
tinr the station hos’ ital out. It is not particularly a problem 
at Madiran where the oercentare of station hospital type is not very 
hiph. It will be true of Oliver when they take Camp Gordon under their 
winy and therefore the commanding officer, hospital inspector, or someone 
CONFIDENTIAL CONFIDENTIAL 
should push to ret these men back to duty, 
COLONEL MORGAN: 
We donft have many of that type but Colonel Stanley has about 36% at 
Oliver, I would like to refer that to him, 
COLONEL STANLEY; 
I think General Armstrong has given us pretty much the solution. 
There is somothinf I mifht add, which occurs. We have an enormous num- 
ber of the station hospital type of AF men sent in. An illustration 
is the farrison prisoner. Prior to rutting them before a court they 
send them in for a neuropsychiatric consultation, Well, when they bring 
that man in (they fly him in) the guard will check him in, then ret on 
the plane and leave. It may take three weeks to get a guard to come 
after him. In 98 out of 100 cases it takes only a common doctor to 
tell that the man is sufficiently capable of knowing right from wrong, 
so I* hold the plane, hold the M,P, on it, give him a certificate, and send 
the man back out on the plane. There is another problem - the nocr-do- 
well - they will send him in and we canft get rid of him because the 
commanding officer will immediately write and say ho doosnH want him 
back. We have to go all the vjay to the Chief of Staff of the Air Force 
to "ct him reassigned,. We have no Air Force Liaison Officer, Other 
than that, the rest, as you stated, is up to 'the hospital commander to 
to get behind his staff and ret rid of them, 
COLONEL- MORGAN: 
In discussing that it was mentioned that perhaps the hospital 
should have something cn the 55-A to designate whether the patient was 
the station hospital tyoc or Detachment of Patients typej in other words, 
tho station hospital tyre could be tagged so -that he would be expedited 
through the mill, 
GENERAL OFFUTT: 
I would like to ask if in your statistics there was any separation 
made between the station hosoital case transferred and the ~ncs that 
come in direct? 
COLONEL MORGAN: * 
No. 
CONFIDENTIAL CONFIDENTIAL 
GENERAL OFFUTT: 
. g have an enormous amount cf transfers from Air Force and else- 
where which are transferred through to our Detachment of Patients. They 
come in as part of Detachment of Patients, and you can’t get rid of them in 
a few days. They have to go through the vjholo chain, 
GENERAL ARMSTRONG; •; 
That may he the.answer’ to the statistical data, 
COLONEL HEYERs 
Do take care of all of the air fields in Arizona and Now Mexico, 
V:o have the same trouble. No admission is authorized. They will send 
them down to a clinic. The plane will fly in and dump them, have no 
orders, and will just go off and leave them, b'c have a terrible time. 
Every case they transfer to the Detachment of Patients and once you ret 
them you can’t ret rid of them, 
COLONEL STANLEY; 
I might tell you a little- secret, I established the custom of 
sending those orders back to the man who issued them, pointing out we did 
net recognize their authority to transfer to our Detachment of Patients, 
COLONEL MORGAN: 
One solution might bo for your staff to follow up the Air Force 
staff the same as with the urny staff, and that is, to dump them on the 
closest post and lot them ret the assignment, 
GENERAL OFFUTT s 
Vie had quite a problem early in the emergency before this last ymr 
in trying to unload the reneral hospitals, and I fnight with G-l and G-4. 
constantly for m nths trying to "et established centers at which patients 
ready for duty could be unloaded. The best solution wo could :gct then 
was that finally they authorized the service commands to set up such cen- 
ters and eventually all of the service commands did sot up some center to 
which hospitals in their Area were authorized to return patients who 
were ready duty. It was taking a month tn six weeks to ret orders. 
New, if wo could establish something like that, 
COLONEL SCH ‘IGHTENBERG: 
I have just come back from the Far East where the problems are a great 
CONFIDENTIAL ■ CONFIDENTIAL 
deni different. My thought is tc take this up right away with the 
Air surgeons and Air staff and work out a more intellirent and rapid 
solution to. the problem’thaii vjo now have. 
COLONEL ROBERTS; 
I W' Uld like to ask one question. Most of you know that 4- or 5 
days ago an order cane out that no Army installation could discharge any 
Air Force man. Now, if hospitals can!t discharge patients, whether 
Air Force or not, what is the solution? 
GENERAL ARMSTRONG; 
General Hargreaves and I were discussing that, I donTt know whether 
it will he possible to give you a solution before the end of this 
conference, Vo will try. If not, you will ~ot it as soon as possible. 
It will have to bo a modification of that.;. otherwise, we cannot continue. 
GENERAL STREIT: 
I would like to say just a word in commendation of the Air Force, 
Re lost our Liaison Officer a few weeks ago, and prior to his departure 
the Air Force patients at that time were handled more expediously than 
the Army, so far as getting orders was concerned and arranging for their 
departure,, and at Brooke today we are having loss trouble than with the 
Army, so far as getting orders. 
COLONEL ROBERTS; 
I believe if we could get authority to send all these patients who 
have completed their treatment and are awaiting orders to the nearest 
Air Force field or station we could save several thousand hospital days 
per year. 
COLONEL HARTFORD: 
I think the question of dependent care came up, and I would like 
to rive you the status of that to date. Insofar as dental care is con- 
cerned, the proposed circular states that dental care will bo given to 
active duty military personnel only. Insofar as medical care is concerned, 
we arc only justifying the situation which occurs put In the field. In 
this proposed circular wo require the commanding officer of the installa- 
tions having medical facilities to conduct a survey to determine the maxi- 
mum amount of dependent care they can render and then publish it to the 
command. 
There followed an off-the-record discussion, and then the meeting adjourned 
for the day. 
CONFIDENTIAL CONFIDENTIAL 
Morning of 5 Au list 1948 
COLONEL MUDGETTs-General remarks on physical standards. 
The final plans for the induction, and physical examination of mili- 
tary personnel under Selective Service Act of 1948 have not as yet 
been formulated. The present tentative plan is ready, however. All per- 
sons inducted through the Selective Service System mill be channeled 
through Joint (Army, Navy and Air Force) Examining and Inductions Sta- 
ti ns. Army-Air Force Recruiting Main Stations mill ‘serve as Joint Examin- 
ing and Induction Stations, in addition to their present voluntary en- 
listment function for the Army and Air Force, Use of these stations for 
joint induction mill eliminate the need for a new organization requiring 
additional installations and military personnel; in addition, these 
stations already provide a network which blankets the country; thus 
affording practical distribution of the expected workload and minimiz- 
ing travel required by examinees. Army and Air F rco personnel have 
already been allotted to operate these installations, and the Navy will 
provide personnel to be attached to each station at such time as the 
Navy and Marine Corps commence accepting inductees. 
The Commanding Generals of Armies (Zone of the Interior) will con- 
tinue to Do responsible; for all Induction Stations within their 
respective areas, and for effecting coordination with the State Directors 
of Selective Service, Immediate supervision of these stations will con- 
tinue to bo exercised through the Army Recruiting District Headquarters, 
It is- tentatively planned to increase the present number of Main Recruit- 
ing Stations to a total of approximately 288 for the country as a whole. 
Under the present tentative plan, the number of persons examined each 
day will average ,10-20 per day at each station, and this number would 
include those examined; and rejected. 
present plans call for the screening of inductees at the local 
board level and the elimination of the obviously unfit, thus tending 
to lighten the load at the Joint Examining and Induction Stations, The 
pro-induction physical examination will ’e done at the,Joint Examining 
and Induction Stations, The examination will be a complete mental and 
physical examin ti n, including physical profiling. After this the 
registrant will return to his h me for from three weeks to 120 days. 
The latter limit is set to insure the validity of the physical examina- 
tion, and preclude■the necessity of repeating the examination at the 
time of-actual induction. Individuals, including suspected malingerers. 
whoso physical status cann t be definitely determined at the Joint Induc- 
tion Station will be ordered to army of other service hospitals, desig- 
nated by-Array Commanders,, to establish-their status, prior to their . 
return home to abaft induction. In this connects n, general hospitals 
may be called upon to assist in the determination of certain.Registrants1 
fitne;ss for induction, , * . • ; 
Present plans call far the use of civilian physicians on a foe basis 
CONFIDENTIAL CONFIDENTIAL 
as provided for in Department of the Army Circular No, 58, Air Force 
Letter No, 25-8, dated 5 March 194-8, for the actual conduct of the 
physical -examination. The x-ray examination of- the chest is to be made 
at military installations wherever the facilities exist, and the same 
is true for the serological examination. General hospital x-ray and 
laboratories may be called upon by. Army Commanders to assist in complet- 
ing this mart of the examination, in certain areas. At other places where 
military or other service or Federal facilities do not exist, local 
civilian facilities for the completion of x-ray and serolorical tests 
may be used. The responsibility for this phase 'is the Army commanders. 
Fees fcr x-rays vary from 50 cents in certain areas, to Oil,75 in Miami, 
Some limitation on these foes is currently being studied by the Fiscal 
Division, SGO, It has been estimated however, that for a complete examina- 
tion including x-ray and serology would cost on an average of glO.OO 
perV-oXamination, if done by entirely civilian sources, With the use of 
all available service and Federal facilities for x-ray and serological 
tests this estimate can be"materially reduced, and facilities wherever 
conveniently located must necessarily be used. This may 1 -g an added 
load for a few of the woncral hospitals in locations where no other 
service facilities exist. 
The revised Mobilisation Regulations, No,,1-9 (now being redesignated 
as AR 4.0-115, entitled ’’Physical Standards and Physical Profiling for 
Enlistment and Induction), Department of the Army (194-8) is to be used at 
Joint Induction Stations as the universal method of physical examination, 
and as-the uniform physical standards for the induction of personnel in- 
to the Armed Services, and for physical profiling, • Now standard physical 
examination Forms 88 and 89. revised to include certain Selective Service 
data will bo used for the physical examination report and the report of 
medical history,, it is probable that the standards for acceptance will 
include fcr general and limited service. In the now regulation, the terms 
”,general and limited service” are not being used. Instead, certain levels 
of physical fitness are designated as Physical oroflie serials 1, 2, 3 
and 4-« It is'probable that induction.will include some #3 'profiles, ex- 
cept with suffixes R and T, which moans that those with remedial, or 
temporarily disqualifying defects will not be immediately inducted, and 
will be deferred until correction of defects has-been accomplished. This 
sh uld lessen the number of the individuals who might require hospitali- 
zation and treatment soon'after induction. The final determination of 
acceptance on a physical fitness basis has not as yet beenpaqde• 
On 2 August, instructions wore issued by Forrestal regarding Medical 
discharges. No person, whether enlisted or inducted, will be discharged 
for medical reasons by any military department, during the life of the 
Selective Service Act, if his reclassified physical profile serial is at 
the minimum or higher than the minimum profile serial -acceptable for induc- 
tion under MR 1-9, No list of specific injuries, diseases or other 
medical c will be established ”as cause of discharge for physical 
disability” and the nodical evaluation (physical profile serial) of the 
person’s physical capacity will be determining for discharge in the same 
manner as for induction. In general, the following Joint statement of 
confidential CONFIDENTIAL 
policy will govern: to wit, an individual shall ho discharged from the 
Armed •Services for medical reasons only* 
a. bhen in the judgment and opinion of competent medical 
personnel he has 'become functionally incapable of per- 
forming useful duty during the remainder of his service 
with due consideration given to whether his scaled-down 
physical profile serial is consistent with any assign- 
ment wherein ho c uld perform useful work within the 
military department in which ho is serving, 
b. Or when he has a medical condition of such nature that, in 
the opinion of competent medical personnel, to retain him 
for further active duty would aggravate such condition to 
the detriment of his future health and well-being, 
* 
c. Or.when his retention W'uld, in the opinion of competent 
medical personnel, jeopardize the health or safety of 
his service associates. 
I would like to stress again that much of what I have just stated 
is in the form of tentative 'planning which has not as yet the final 
approval of the Secretary for Defense, Definite plans are expected.to be 
issued in the near future. Suffice it to say that the general hospitals 
will have little to do with the actual examination of Registrants except 
to assist the Army' commanders with their medical facilities when called 
upon to do so, either by the use their x-ray and laboratory-facilities 
or the- study of selected cases in the hospital to determine their physical 
fitness for induction at the time of the pro-induction physical examina- 
tion, ’ 
. I W' uld like to say a few words about Army and Air Force retiring 
boards. Recently, as you know, the Air Force'has appointed additional 
officers of the Air Force to comprise Air Force retiring boards to hoar 
retiring board cases at general hospitals, in the case of offleers.of the 
Air Force, using the regularly assigned Medical Corps officers of tho 
board, the regularly.assigned Recorder, It is not believed the number 
of those cases will be'groat at any orie hospital. The number of retiring 
board proceedings reviewed in Tho Surgeon Generalfs Office for tho first 
six m aths of - tho fiscal year, 194-8, was 3715> “of which 4-12 or 11$ wore 
reconvened boards. The number reviewed in the last six months,'ending 
30 June 194-8, was 1818, of which 198 or 10,9$ wore reconvened boards, 
Tho general trend of the numbers of retiring boards: is still downwards, 
as is tho percentage of which are being, returned f or re-hearing. 
It is likely that this will continue, oven with the probable increase in 
the numbers of officers which may be'called tco extended active duty in 
connection with tho increase in tho size of the Army coincident with,. 
Selective Service, The number of individuals’requesting the:-Department 
of the Army to reopen their cases has likewise been reduced about ono- 
half during tho. oast 12 months. Those requests are still being received 
.for review at the rate of approximately 200 hundred a month, however. 
’CONFIDENTIAL CONFIDENTIAL 
The Adjutant General is presently issuinp: instructions to general hospital 
commanders relative to the care and treatment of former officers returning 
to general'hospitals on -a civilian status for re-evaluation of their cases. 
In this memorandum it is stressed that hospitalization is being authorized 
only for re-evaluation. It is also stated that it is not contemplated that 
elective medical and Surgical treatment not related to the conditions for 
which' re-evaluation has been authorized will be given. 
A committee under the Secretary of Defense has currently been studying 
the feasibility and desirability of having but one review of retiring 
board proceedings, in each Department, (that is, Array, Navy or Air Force 
as the case may bo), It has been recommended by this committed that a 
board of review be set up under each Secretary (Array, Navy, and Air-Force 
to review proceedings in the name of the respective Secretary, If such 
a procedure is finally adopted, a review of retiring board proceedings 
in the office of The Surgeon General will be discontinued and will expedite 
Department of the Army action, A decision in this matter may bo forthcoming 
within the next month. At the present time Army retiring boards are reviewed 
in the SGO, and by the Army Personnel Board. Air Force Retiring boards are 
being reviewed by the Air Surgeon1 s office, the Surgeon Generali office, 
and by the Air Force Personnel Board, 
The discontinuance of_sick leave following the meeting of the retiring 
board, while waiting for the action of the Department of the Array or Air 
Force will bo again' studied to see if it must be continued Legal opinion. 
This was considered a necessary decision, by Pelfarc and Emoluments, nGO, 
that had to bo made in view of Section I, Public Law No, 350, of the 80th 
Congress, The question-as to whether to require an officer to use his 
accrued leave while waiting for the final decision in his case has also 
been under discussion,. From the standpoint of the hospital commander the 
desirability of this being■required can bo understoodj however, it has not 
been the policy of the Arioy in the: past to re quire any officer to avail 
himself of his accrued leave. It. seemed unwise to insist that he use his 
accrued leave at a. 'time, ■'■'’hen his separation from the Army is to take 
place, in view of the terminal leave pay act. On 23 ■’July 1918, the Adjutant 
General dispatched 7GL A2723’, '.with which I am sure you are familiar. This 
authorized commanders of general-, hospitals with retiring boards to issue 
orders in the name of the applicable secretary granting leave for any 
period in excess of number of days leave authorized by Section 1, Public 
Law 350, 80th Congress, in the ca.se of awaiting orders on disabili- 
ty retirement proceedings. This is the authorizetion for granting leave in 
excess, of. accrued leave. ; . ’ ’ 
Recently an inquiry was sent the commander of each,general hospital, 
ZI, asking his opinion as to the.,desirability of concentrating1’"retiring 
board actions at A-5 general hospitals. The comments from these inquiries 
arc presently being studied, and a decision in this matter is'expected to 
be made in the near future. The advantages to this'procedure seem rather 
obvious to those who would no longer have retiring boards. The disadvantages 
to individual patients who be necessarily transferred comparatively 
long distances to meet retiring boards is equally obvious. To those hospital 
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commanders who vj uld continue to have retiring boards, tho load of 
patients mooting retiring boards would be increased about 50% ever the 
present load, in some instances, in all likelihood. If certain retiring 
boards are discontinued, it-would seem that transfer of the patient 
following completion of his necessary hospital observation and treat- 
ment, but prior to meeting a disposition board might bo the logical time 
for such transfer. The receiving hospital, should then need to do very 
little in tho way of additional examinations, in order for tho case to 
be presented to the board,for a hearing, in most instances. The data 
from the sending hospital should be used to its fullest extent, without 
repetition of the clinical studies, except whore necessary. On tho 
other hand, it might make for more efficient handling of tho case if it 
were transferred at the time it was determined that retiring board action 
would eventually bo required, and prior to the completion of hospital 
treatment. The latter may prove to bo tho more desirable, though some 
patients might be transferred unnecessarily if this policy wore adopted, 
Tho use of traveling boards does not seem feasible or desirable. 
COLONEL HARTFORD: 
Are .thero any questions you wish to ask Colonol Mudgott? 
GENERAL OFFUTT: 
I would liko to ask a question about the telegram in regard to 
leave. Am I interpreting that right when I say - If a man has 30 days 
leave coning and it is ~'ing to take him 4-5 '’ays to get his gapers back, 
you c uld give him A5 days,* 
V , 
ANSI .Ell ;• a 
* 
In the name of the Secretary5 that is right, 
GENERAL OFFUTT; 
You could' give him any amount of .time—*of leave while awaiting rc- 
tironqnt? ' •• • ' 
ANS. ,’ER; 
Except sick leave's that is right, 
COLONEL HARTFORD: 
Any other questions? 
63 
CONFIDENTIAL CONFIDENTIAL 
GENERAL Hi*YES;. 
I have a.comment on the X-raying of inductees in the interest 
of economy and also in the interest of conserving X-ray film. Probably 
most r'f you know how serious our X-ray film situation has been for the 
least three years, I would like to urge that photorcentgen equipment 
be used, to tho maximum possible extent in this induction work, Ac 
have a orcat, deal of that equipment out in the Army, Areas -now and in 
the Air E-rco station also, and some of the Gene ral Hospitals; also have 
phctcroento'on equipment, .So I w- uld like to see, that it be used to 
the?, fullest extent. 
COLONEL HARTFORD: 
Re will now have so no ’eneral remarks by COLONEL JOHNSTON, 
COLONEL JOHNSTON:- General Remarks on Hospitalization* 
General Armstrong and Gentlemen; Since Dependent Care was dis- 
cussed so well yesterday by Colonel Hartford, I will forego that and 
take up the other subjects* # • 
First, as you know in Atlantic City,last September the weather was 
very bad and some of the equinoxial storms swept away the board walk, 
and all sorts of things happened* 
Letters of invitation went out to the Hos: ital Commands for the AHA 
Gnvcntion at lantic City, At the time these letters went out it 
was preliminarily checked, supposedly, and funds were found available 
so that wo c uld invito one and possibly two to ro as cur nests to the 
Hospital Convention, However, when everybody accepted, wo thought wo 
had better run a re-check to make sure, and we found that funds were 
not available*. •. ..... , 
Last year (FY 194-8) The Surgeon General had about 97,000 in funds 
available to send Army Officers to civilian meetings, This fiscal year 
wo have less than that. Our grandiose program as we had planned.it, 
would have used about 93,300 of the 97,000, so that something had to 
bo d"no| and a decision was made that th so officers-who were closer 
to Atlantic City, and these *who had a shorter period of command, experi- 
ence in the Gen ral Hospitals should i e given the chance to go to 
Atlantic City, -w 
This is the way it is set up now— and we will.get out.the instruct- 
ions later to those who will attend. If anybody is in doubt as to 
whether they are g; inr or not, I will bo glad to let them know, 
Mr, Royall, Secretary of the Army, has instructed the Inspector 
General to make a survey of the TR00F INFORMATION AND EDUCATION PROGRAM, 
i CONFIDENTIAL CONFIDENTIAL 
Apparently, thoro have been a fev: suggestions for improving the Service or 
deleting certain portions of it 'and adding certain parts which might be 
better. At any rate, The Surgeon General has been instructed to survey 
the Class II installations in regard to the Troop Information and Educa- 
tion Program, V’e are getting out some letters. They are being typed 
now, and me mill ret them to you by this afternoon5 they rive you the 
various forms which will have to be filled out—the necessary forms—or 
wo wouldn’t send them to you. On a few of the letters is the expressions 
’’Reply not later than the 23d of August”. This is very poor staff work. 
However, in their zealousness to ret these letters out,-they put that 
expression in the first few letters. So, anybody who rets a letter with 
that on it, please ignore it; because we know if we have to have certain 
information by such and such a date, we will have your cooperation. 
The last matter which I have to take up is one which took the 
Hospital Division by surprise. It was first brought to our attention 
by General Beach out at 17ALTER REED and Colonel Stanley down at OLIVER. 
It concerns Public Law 755 of the 80th Congress, passed 'in the closing 
days of the pre-comback session and it was approved the 25th of June, 
This law, which I am sure you are all familiar with now, in effect, 
prohibits the General Hospital Commander or any Army Hospital Commander 
■from having Courts Martial jurisdiction over any Air patients in 
his detachment of 'patients. Assembling the legal minds and all the research 
people we tried to look into the background a little bit, i.’o find the 
Army is entirely at fault, and I don’t say that in a derogatory manner. 
Research shows that the Air Force JAGD initiated the law with the recipro- 
cal phrase in there r,hich would have made the nrmy patient in the Air 
Force Hospitals under the jurisdiction of the Air Force Command, and 
vice-vorsa. which have straightened out evorythinr. However, when 
it came to the JAG of the Army the ”vico-vcrsa” phrase was red-lined. 
The Surgeon General, so far as I can find, was never consulted. He 
never saw it until it came out in the Public Lev, then we received Colonel 
Stanley’s and General Beach’s letter relative to the law, the same day. 
This is presently under study and we expect something to come out as 
soon as we get the wheels tn turn and bring it out. In the meantime, wo 
will have to Inok for an interim measure. One of the ones that has been 
su posted is that we treat these Air Force patients, in the detachment 
'of patients, the same way we do the Navy patients in the nrmy Hospitals 
and refer either the charge-sheet or a letter of transmittal explaining 
what has happened to the nearest Air Force installation, V.'alter Reed 
does that with the Navy patients nop, I presume that is done throughout^ 
I don’t know. 
Re are now implementing one of the first HARIEY BOARD recommendations 
down in the Portsmouth Area by sending Army patients who require general 
hospital typo care that the Navy can furnish down there, tn the Portsmouth 
Naval Hns-'ital, That is the procedure that we arc going to follow with 
patients who come under Courts Martial jurisdiction in the Navy Hospital - 
CONFIDENTIAL CONFIDENTIAL 
their charges mill he referred to the Army for processing. The final 
decision viill have to he in a Joint-Army & Air Force Publication, or an 
amendment to the Public Lav, 
One ' r tmo suggestions mere made that they po to this Session of 
Congress non and ask them to amend the Public Lam| hut, since the ink was 
hardly dry-on the previous- law, me felt it was better not to act started 
on that, he mill try to yet something ’out on it - possibly an SCO Circu- 
lar coordinated with everybody, including the JAG upstairs, to give us 
an interim measure. 
COLONEL HARTFORD: 
Any questions? 
■GENERAL T "ILLIS: . p " 
The speaker just mentioned the TIE Program. - a survey of this lias 
already been requested of cur Center - The Brooke Army Medical Center, 
by the Fourth Army, is nor in the status of preparation, c have to pre- 
pare duplicate reports of these things -.mill a report to The Suracon 
General be required if v'c submit it through the Fourth Army? 
COLONEL JOHNSTON:•••- 
This*has come up frequently. In this specific' instance, I think 
it 'Should come through the Surgeon General’s Office, •• ..’.A...* 
GENERAL LILLIS: . 
It has gone' through the Fourth Army. 
COLQMEL -JOHNSTON: 
fe are making the consolidated report for all Class II installations, 
GENERAL LILLIS s * ” 
■ The .second thin;” - is in reference.,to the disciplinary actions in 
the case rf Air Force patients,. Ycu should include in your decision 
or directive, such as is applicable to the, school as moll as at Brooke 
Army Medical Center, T'o have some six hundred cases to uhich it is appli- 
cable, sonc 150 or 200 in the school and the balance in the hospital. 
CONFIDENTIAL CONFIDENTIAL 
COLONEL JOHNSTON; 
I am' sorry, I failed to mention that, V'o mill take that into 
consideration, I have your letter here non, sir, 
CCLCNEL HiulTFOKD: 
Colonel Schv'ichtenberrer mould like to have a feu rinutes. 
COLONEL SCHMICHTENEERGER; 
Purina a mart of 19/+3 and early 19A4 it became evident that this 
Office.mas losing with the'hospitals and the Field generally. Our 
problems had reached serious proportions before this office found out 
about them and nag able to initiate action of a corrective nature. We 
had, at the same time,- individuals, from the various sections in the office 
going out and making their routine staff visits’, each one of which was 
making a report, The circulation of that report generally being rather 
limited within the office, and each one in itself further being limited 
by the fact that the individual'concerned looked at the hospital from the 
standpoint of the surgical consultant or the medical consultant and so 
on, and no one, therefore, was able to come up with‘an evaluation of the 
problems arising in the hospital and the suggested solutions for them, 
in a well rounded manner. As a result, we evolved a system of visiting 
hospitals whereby members of each of the major staff sections of The 
Surgeon General’s Office furnished, generally, their top or second from 
the top man. So we had in the group that left this office and proceeded 
around t’o the various hospitals representatives from all of the major 
sections of the Office, and we stopped In hospitals, usually spending 
a day in each one. 
The procedure was that, generally, we would arrive in the evening 
having spent the day in one hospital and proceeding by air in the late 
afternoon to the next one. Usually there would be gathered at the hospital 
Chiefs of Services and Sections and the key personnel, and there would 
usually be an informal meeting qf the two 'groups and pi ns were layed for 
tho following day’s activities. 
The way in which the group worked in the* hospital was very simple 
and evolved as time went on along these lines: That, The Surgeon Consul- 
tant went along with the Chief of Surgical Service in the Hospital— 
the Nodical Consultant.from this office went vith the Medical Chief of 
Services, rre had some from resources & Analysis Section, The action 
which he frequently did—he would go to the Registrar and various people 
who prepared rooorts and ho used them, as a basis for his informative 
material in this office.,. 
Me had representative from Construction and he would go with your 
hospital engineer and so on down the line. Thereby each individual 
really having at the moment then a representative of this office in tho 
CONFIDENTIAL CONFIDENTIAL 
hospital. 
I cam sure that what I am saying is a repetition of what some of 
the-Hospital Commanders already know, since they are familiar with it 
from those dpys, » 
After spending the morn’ng in the hospital and after lunch, usually 
there would be a conference of the entire group. At this point every- 
body would have a chance to speak his piece and come up with recommenda- 
tions that were going to be made in the written report which followed. 
Wo felt that that was the most helpful thing that was done in my division 
and in the entire Surgeon Gen real’s Office during that period, for it 
not only kept us abreast of the problems that were arising, but I think 
it gave the individuals in the various hospitals that wo visited a chance 
to see what our problems were in the over-all way. 
As you see, there was no time- for any social activities at all be- 
cause of the face that,we didn’t spend more' than about a day in each hos- 
pital, I think that would probably bo the way"it will have to be done 
again, I. realize and I that all of us r- alize that it isn’t possible 
to learn all about a given installation in that short a period of time, 
.Wo felt, however, that it was possible to learn the most important features 
during..that interval, and so wo felt that it was about the best compromise 
that.could be made—the initiation of a similar program in the near future 
is partly conting. nt upon our securing a largo aircraft to take the group 
around, but I -feel sure that that can be done. 
So,-with the possibility of that problem not becoming insuperable, 
you can expect to see us as r group once or t’-’icc a* year as conditions 
permit, 
COLONEL HARTFORD: 
I have hoard nothing but good reports about Cploncl Schwichtonbcrgor 
and the old ’’Flying Circuses”, But I am reminded of a little joke that 
one of our rather prominent generals., now in the bar Department, pulled, 
towitj ”If all the YTar Department Inspectors wore layod end-to-end, he 
thought it would be a good idea,” 
In our invitations that vent out to you on the- 19th of June—in the 
confidential letter T'hich General Armstrong sent, uo asked for your ideas 
on certain subjects such as employec-nt of civilian doctors, training pro- 
gram and so forth. I think, perhaps, some of you have prepared something 
in writing-on that, VJr have received some of them already. If others 
have those along-, I uould like to get those by nnon today.' I have General 
billis1 letter. 
Gentlemen, v,o have arranged a little recess now. We thought it per- 
haps should come a little early this morning (now 9:4-0), and wo would like 
to start again promptly at 10:15. 
CONFIDENTIAL CONFIDENTIAL 
COLONEL HARTFORDs 
Gentlemen, tho question came up vest rday afternoon in the discus- 
sion of several hospital commanders relative to transfer of Air Corps 
patients. There is an Air Corps letter, Personnel News Letter No, 5, 
Department of the Air Forces, dated 1 July 194-8, mhich probably is just 
arriving in tho field. In regard to administrative procedure, it says 
tho folioringi Normally mhon it is determined that a patient pill be 
transferred to a General Hospital for 90 days or less hospitalization 
and rill not be required to meet a CCD disposition or retirement board, 
the transfer should bo accomplished as a temporary eh ngo of station, 
A provision should be included in the transfer order that on completion 
of hosnitalization the individual concerned rill return to his proper 
station unless other disposition becomes necessary. In this connection, 
a decision by tho Office Comptroller, Headquarters, U. S, Air Forces, 
indicates that a temporary transfer botmeen hospitals is probably 
chargeable on LTM for temporary duty travel, Fhon it*s believed a 
patient viill be hospitalized for a period in excess of 90, or rill bo 
required to moot one of the boards, etc,, tho transfer should bo accom- 
plished as a permanent change of station. Then there is a final ad- 
monishing paragraph rhich it may be necessary or desirable to call to 
the attention of the commanders in tho field as folloms: Invicm of 
the fact that some stations have misinterpreted certain directives, this 
office has recommended that the Office of Tho Surgeon General and Depart- 
ment of the Air Force publish a joint directive to supersede tho afore 
mentioned circulars. That joint directive is being prepared. It may 
be desirable to call their attention to it because they actually may 
not have it yet. 
The Committee report that you heard yesterday - the mimeographed 
copies which acre distributed to you - wo have a feu extra copies and 
if anyone has any need for them wo would bo* glad to furnish them to you. 
Next vc would like to take up Hospital Construction and Rehabilita- 
tion Wiich will be presented by Colonel Tynos, 
COLONEL TYNES;-Hospital Construction and Rehabilitation, 
Last fall ■'■’hen it became increasingly evident that favorable legis- 
lation was going to bo passed by Congress in support of Universal Mili- 
tary Training, vie were directed by the General Staff to make a survey of 
the camps .and posts which aero tentatively selected for use by the 
Universal Military Training personnel. Accordingly, representatives of 
the Hospital Construction Branch and a representative of the Chief of 
Engineers representatives of the respective Army Commanders made 
a rather thorough physical survey of the 23 stations which were proposed 
at that time for use in the universal military training program. 
Since the individual surveys were made by the same group using the 
same standards as a basis for evaluation, we r,ere able to fairly compare 
CONFIDENTIAL CONFIDENTIAL 
tho physical condition of the facilities comprising these 23 hospitals. 
Furthermore, we were able to compile a list of the work items necessary 
to renovate and reactivate these particular hospitals on a sufficiently 
high standard, Tho summary of our report with recommendations was sub- 
mitted to Logistics and at that time was approved. Later, when Congress 
shifted from Universal Military Training to Selective Service, our recom- 
mendations remained unchanged and, of course, tho requirements for renova- 
tion of those hospitals remained unchanged. When the Bureau of tho Budget 
requested the Medical Department to support its proposed renovation pro- 
gram of these hospitals to provide for the selectees, wo found that wo 
were in a very good position to defend the proposed program to renovate 
and rehabilitate our hospitals. For rehabilitation of posts and camps 
(that is, to renovate barracks, build roads, etc,), tho Office of the 
Chief of Engineers asked for $50 per man for the increase in strength 
of the expanded Army, The Medical Department asked and obtained approval 
for $1,025 per bed -for each additional bed which be required for 
the expanded Army, When tho Selective Service Act was passed. Congress 
appropriated only two-thirds of the funds requested, therefore, the Medical 
Department had to take its cut along tho rest of the Army, There 
was, however, $8,250,000 allocated for the Medical Department which was 
to be used for renovation of General and Station hospitals in the Zone 
of the Interior, exclusive of the Air Forces Station Hospitals. On 
19 July we addressed a letter to Director of Ligistics asking that the 
Chief of Engineers be immediately directed to start the renovation of our 
hospitals as we had previously recommended in order to bring them up to 
a sufficiently high standard to meet the rfquirements of the Selective 
Service Law, I have a few copies of the letter here. I’ll pass them 
around and wo can got additional copies for you tomorrow. This letter 
listed the number of beds that The Surgeon General recommended be set 
up in both Station and General hospitals. The list, I might say, has 
changed somewhat and I’ll give you a plan showing the actual bed capacities 
as now proposed. Also listed in order of priority are those steps which 
we had previously recommended as being necessary in order to renovate 
our hospitals and bring them up to the required standard. I’ll discuss 
that list in detail in just a few minutes. 
On 29 July, General Aurand sent a letter to the Chief of Engineers 
which I think will be of interest to all,of you since it is relative to 
tho renovation of your hospitals. This letter in effect instructed, the 
Engineers to use our previous letter as a guide for planning purposes| 
it did not definitely direct them to accomplish all of the work items 
which we had recommended as necessary to renovate and rehabilitate these 
hospitals. It did, however, specifically state that $8,250,000 of the 
money appropriated for renovation of.camps and stations was earmarked for 
use on hospital facilities, and- further, that the hospital facilities 
would bo renovated, to a higher standard than those of the rest of the post. 
We were most anxious to get this across and we felt that directive form 
Was necessary. Previously, a L tter from The Adjutant General dated 12 
May 194-8 had been sent to all camps, stations and engineer offices, defin- 
ing tho standard of rehabilitation and improvement of inactive stations 
for Selective Service, Three standards T,ere established: ’’Standard ”A”, 
CONFIDENTIAL CONFIDENTIAL 
which is the minimum standard necessary for the accomplishment of the 
mission; Standard !tBn, which is a little higher; and Standard ”C,T, defined 
as, desirable or sufficient to establish and support good morale - in appli- 
cation equal to economical standards normally applied in good' commercial 
or State programs for comparable medical facilities* Now, the directive 
from General Aurand states that, insofar as the available money lasts, 
we will -effect Standard nCu in our hospitals. It will be the responsibi- 
lity of you people in the field to make certain that a higher standard 
is given to our hospitals, when that money is spent. If you'don’t assume 
that responsibility, I don’t know that wo mill get our fair share of 
this money. Of course, there is one joker - the money mas not given to 
the Medical Department and wo have no direct control over it as vio former- 
ly had in the control of C and R of H funds. The money has been allotted 
to the Chief of Engineers, mho, in turn, mill allocate it to the various 
Armies, We are on very good terms with the Chief of Engineers’ Office, 
and mo have been assured that everything in their .power mill be done 
to see that mo get our share of the money. 
Naturally, -the hospitals that have been closed that are to be reacti- 
vated, such as Pickett and others, mill require the expenditure of more 
money for renovation than those hospitals that arc in operation. Also, 
the cantonment type hospitals that are in operation now require more 
money and should have more money for renovation than our more or loss 
permanent hospitals. These points are not mentioned anywhere in this 
directive but they should have your considered judgment in the programs 
you mill submit, 
Coming back again to the list of individual items which me recommended 
in this renovation program: 
First of all, mo must protect the buildings from the elements. That 
is, replace or repair roofs, gutters, downspouts, porches, steps, etc. 
The second item is to correct any structural weaknesses. Buildings 
must bo made safe. 
The next item is to repair or replace existing plumbing fixtures 
electrical fixtures, heating units, ventilating equipment, air condition- 
ing equipment, etc,, as necessary. All window glass and insect screens 
on windows and doors should bo repaired or replaced. We have a tentative 
agreement with the Chief of Engineers that certain of the hospitals in 
northern sections of the country probably need not have the screens re- 
placed on the open porches of the cantonment type wards, I think it 
was a mistake in general ever to have built those porcl es in the northern 
part of the country; they have never boon used and they cost extra money. 
Repair of porches will be left to your discretion; if you want to use 
them and have used them, they should be screened. 
Fixed medical cquipemtn should be replaced or repaired wherever re- 
quired, Wo'found that in a number of operating rooms the sterilizers 
had been removed; in other cases, water stills had boon taken out and 
CONFIDENTIAL CONFIDENTIAL 
other equipment of that typo had been removed. We want to install a com- 
bined washing and flushing tvpe bedpan sterilizer in the utility rooms 
of all the wards. In order to expedite the procurement of these items 
of fixed medical equipment, wo have agreed that unless they are avail- 
able locally or can bo provided by a medical supply depot, the responsibi- 
lity for their procurement will rest with the Engineers and. will bo made 
a part of the contract for renovation of the building. The money for 
this purpose will be made available from the M&HD fund. Items other than 
medical equipment, of course, must be repaired or replaced as required. 
The Quartermaster has indicated that his funds are small and therefore 
wanted to install what ho terras ’’Class 4-" items of equipment in the messes. 
The Quartermaster has just as much money as we have, in fact, he has more 
money - considerably more than wo have - and I believe he can afford to 
purchase now equipment more ably than we can. Certainly "Class 4-” equip- 
ment for the kitchens and the diet kitchens is not in accordance with the 
defined "C Standard", 
■ I have discussed this matter with the Chief of Engineers and requested 
that they insure the provision of good quality equipment by the Quarter- 
master, .the procurement of which is the Quartermaster’s responsibility, 
I hope that you will follow up this matter, and if you do receive "Class 4-n 
equipment for your kitchens, you will reject it and insist that better 
quality equipment be supplied, 
We feel that many hospitals will require interior painting through- 
out, therefore we have placed that item next in our list of priorities. 
Again, however, you should use a little discretion and *don!t insist on ne?j 
paint in all of your buildings if in some of them the paint is in satis- 
factory condition. We know our funds are insufficient and this may bo one 
item on which we can save and thus accomplish other items. 
The floors of the buildings in a number of hospitals are in very bad 
shape| they should bo improved to "Standard C", You may find that sand- 
ing is sufficient in some areas, 'T:'hilo other areas will require complete 
now surfacing or patching of the surfacing material. In all cases, the 
floors of hospital buildings should be in good condition throughout. 
Certain buildings will require alterations, the extent of which will 
depend somewhat on your individual requirements. We found that practically 
all of the X-Ray clinic buildings had deteriorated very badly and would 
require a complete renovation throughout. 
Wo are very anxious to accomplish the item of alteration of enlarging 
private rooms, in at least half of the. W-2 type wards of the cantonment 
type ...General Hospital, to provide more.space where,we treat our sickest 
patients. All of you are well aware of the fact that these very small 
rooms (72 square fedt) are entirely inadequate to furnish proper nursing 
care- to patients who are r>. ally sick. Plans have been prepared and aro 
available in the Office of the Chief of Engineers, showing how the W-2 
ward can be altered to provide twic.e as-much space in each one of these 
private rooms. The alteration consists -of removing the partition between 
72 
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every other private room. By this alteration we lost 4 bets in each ware 
we converted but the over-all loss of beds is small and is out-weighed by 
the advantage to the patient and to our doctors and nurses. I have prints 
of the original sketches here showing this proposed alteration which you 
may look at and, if you need them, you can get copies through the Office 
of the Chief of Engineers. (Passes around prints.) 
Tie hope to have sufficient money to alter the nurses' quarters. A 
recent survey of Army and Navy hospitals of this country showed that the 
difference in the standards of living accommodations of our nurses and 
those of the Navy nurses was appalling* The General Staff is aware of 
this fact and is very sympathetic, realizing that better living conditions 
for our nurses are required if we-are going to have a successful recruit- 
ment program for the nurses. Unfortunately, alteration of the cantonment 
type nurses’ quarters is an expensive job and you may not have sufficient 
money to do it, however, the Staff is sympathetic and may possibly appro- 
priate additional funds later to complete alterations to nurses' quarters 
if you want it as a part of this program. These prints show suggested 
alterations to the nurses’ quarters of single story cantonment'type 
quarters and provides at least a private room for each nurse and a connect- 
ing bath for each two nurses* A glance yd.ll show that this alteration will 
bo expensive but may have sufficient money to complete the program. 
These present quarters for nurses are ferrible and we definitely want to 
improve them in every one of these hospitals* The Staff is willing to 
raise the priority of this item if we request it. 
¥e hope that you will have sufficient money to install in your 
hospitals a radio system and utility outlets for each bedside table, at 
the hospitals where these do not presently exist* I think most of the 
hospitals have some type of nurses’ call but those that do not have it 
should, if possible, save enough money to provide a complete installation 
throughout the entire hospital* 
The remainder of these items in this letter arc too low in priority 
for us to believe that funds will bo sufficient to accomplish them at 
this time, but if you do have money available, we feel that connecting 
corridors should be ceiled the same as other buildings that arc not now 
ceiled. Also, we feel that something should be done for the enlisted 
personnel in the hospitals. That is, improvement to their barracks, such 
as floor repair and improvement and installation of surfacing material on 
walls and ceiling. Along that line, may I stop just a minute and state 
that we arc not actually fighting a’warj our emergency is nothing like 
as great as it was in the latter part pf the last war when wq were forced 
to take over our barracks to provide patients’ beds. Tic do not believe 
this should be done at this time and ire do not recommend it, Mr. Cogan 
is anxious to get every bed possible] but additional patient beds should 
not be provided at the expense of our enlisted men’s barracks unless 
suitable cantoamcnt typo barracks ape available in close proximity to 
the hospital. 
I have here the latest proposed beq. capacities of the General 
Hospitals. I’m not going to ask you tp comment on these now because 
General Hays is going to talk about this in a few minutes* These 
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capacities arc still not official but I think we will probably go up to 
Staff following this meeting and ask that they be made official if you 
concur in them. 
Now, make every effort to assure that the money is spent on our 
hospitals and not spent on fixing up somebody's swimming pool. Let me 
repeat, we don't have sufficient money to do everything that is necessary, 
but those who request funds first will, in all probability, get the 
lion's share of funds available, so let me urge you to talk over the 
matter with your Post Engineer, when you return to your station, and 
apprise him of this recent directive to which I referred. Have him work 
out a program for your particular hospital, immediately, and request the 
funds to effect your program. If wc can help you, we will be glad to do 
so. At the present time,Major Allan, of this office, and Mr. Hasle, Chief 
of the Food Service Program, Office of the Quartermaster General, are 
making surveys of the messes and the diet kitchens in an effort to effect 
much needed improvement. If these representatives have not been to your 
hospital and you.have urgently needed changes, I suggest that you write 
in and ask that they visit you as soon as possible before you purchase 
improper or unsuitable equipment. I repeat, if anyone from our shop can 
help you in designing alterations or changes to your facilities, as may 
be necessary, we'll be glad to assist you as far as we arc physically 
able. 
COLONEL HARTFORD! Are there any questions? 
GENERAL OFFIJTT: As I understand it, you say. you don’t want us to 
go into barracks? 
COLONEL TINES; Your hospital is one of the exceptions. At Custer 
we foci that, since you have the entire post, you can take over canton- 
ment type barracks next to your hospital. That would possibly bo true 
of Gordon and I know it will be true of Attcrbury, 
COLONEL HARTFORD: We have made a little change in the agenda and 
General Hays is going to speak next on EQUIPMENT AND SUPPLY PROBLEMS; 
GENERAL HAYS: I would like to go right ahead from where Colonel 
Tynes stopped and wo have all had a chance to look at those expansion 
figures so are there any comments as to the practicability or non- 
practicability of the proposed expansions? 
GENERAL STREIT: Can you tell us whom we can go to, to find out how 
much money will be available to our hospitals? 
COLONEL TYNES; We do not control the money nor do we have any part 
in determining how it will actually be spent. The R & U Branch of the 
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Chief of Engineers will allocate funds to respective Armies. You submit 
your project in the same manner as you would any repair or maintenance 
project, however, ask that it be financed from money made available for 
hospital facility renovation as a result of the Selective Service Act. 
GENERAL WILLIS:' Will any of that money be available for hospitals 
not included in this expansion program? 
COLONEL TINES; Yes. 
GENERAL WILLIS; Why don’t’we clean up what we already have? 
COLONEL TINES; If we could clean up all the projects we have on 
hand it would be good, however, the final approval does not rest with us. 
It is a job that must be done immediately and the Army Engineers are 
going to carry it out. It is based on obtaining adequate General Hospital 
beds for the entire Army wherever they can be provided, 
GENERAL HAYS: Arc there other comments on the practicability of 
expanding the hospitals to the sizes proposed? Do any of the commanders 
feel that their hospitals should be larger than is indicated here? ' 
COLONEL WILLIAIIS; At Fort Bragg we have 3 main hospitals; if. we 
expand to 3*000 beds we will have-to have new construction. 
COLONEL TYNES: There will be no new construction authorized by this 
program; that is the law# 
GENERAL HAYS;- Does that require-a-change? .... 
COLONEL WILLIAIIS; It will require a change in our capacity, I 
think, by utilizing space, we can convert to take care of 2,000'patients. 
COLONEL TYNES: We intend to go down to Fort Bragg next week and 
survey your hospital; lot us wait until then. 
GENERAL HAYS;- Equipment and Supply Problems. 
As far as the supply picture is concerned, I would first like to give 
you a little background on the fiscal side. As you all know, our 1949 bud- 
get was computed by this time last year or a little earlier, and it was 
then cut a little bit by the Budget and Advisory Committee by the Bureau of 
the Budget. In the last few days of Congress we were told to put in a sup- 
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pleracntal appropriation but we were given a very small limiting figure . 
According to bur computations, we actually received for supplies and equip- 
ment, little more than will take care of the maintenance of the increased 
troop strength, plus 04-25,000 for initial equipment. The initial equipment 
is not only for hospitals but for troops, medical battalions, etc. We 
figure that this 0425,000 represents less than 15 per cent of the money 
value of the supplies required to take care of complete initial equipment. 
I bring that out as background so you will understand that this year we 
arc going to be very very tight on money. We will, in all probability, 
have to to to the next Congress in January or February, and ask for a 
deficiency appropriation; your guess on what our success on that request is 
as good as mine. The modernization program which we undertook at the 
beginning of this calendar year will definitely’have to go into a state 
of suspension until we are able to meet our expansion requirements. We 
are not' throwing it out of the window, but it is going to have to be 
suspended until we can equip all of the new hospitals that arc involved 
in this expansion program. In equipping these new hospitals, as far 
as we know they are going to be just as permanent as any of the existing 
hospitals. Consequently, they should receive the best equipment that we 
can afford to put in them. In other words, we shouldn’t install in these 
new hospitals, poor equipment which wo have taken out of our existing 
hospitals. So I*hope that you will bear with us on the delay in the 
modernization program. 
We arc trying to determine now just what assets wo have in the way 
of equipment. As you all know, there wore a good many stations placed in 
stand-by status during the last few years. A certain amount of equipment 
was kept at those stations of which we have no record. Some of the 
General.Hospitals have a considerable amount of stand-by equipment on 
hand. We are attempting now to find out how much equipment there is 
nationwide so that we can gear out procurement program to our actual needs. 
I would like to emphasize that we want to beat the bushes and get into 
use every bit of this stand-by equipment, T7e have asked the cooperation 
of the Army areas and the Air Force Commands in utilizing all the stand- 
by equipment they have on hand in stations which are not being expanded, 
before they call on the depots for equipment for expansion. There is 
also a great deal of equipment that is out in the field that is unservice- 
able. lie are conducting a vigorous program of repair wherever it is 
economically feasible to repair that equipment rather than purchase new 
equipment, lie conduct a maintenance and repair school at St. Louis. The 
last * two months of that course is on-thc-job-training. He have 7 
officers and 35 enlisted men that have entered that phase of training 
and we have made them available to each of the distribution depots to 
send out to various stations on assignment in this maintenance and repair 
work. If you want to get these teams in your hospitals, call on your 
depots and if possible they will make these men available to you to assist 
in inspecting your equipment, actually repairing what they can, or assisting 
you in getting it repaired. 
He are also making use of our modernization committee, headed by 
Colonel MORGAN, to- assist you in your expansion program. That committee is 
going to visit installations all over the United States which arc to be 
opened or undergo expansion. They have already been to Fort Devens which 
is to bo opened very -shortly. If you ’want assistance from that group drop CONFIDENTIAL 
me a note or let me know Ydiile you are here, and we will sec if we can 
work your place into their schedule. I think they will be of considerable 
help to you. The expansion is going to force us into the use of certain 
sub—standard equipment. For example, we are going .to have to utilize to 
some extent the field-type folding beds and cotton mattresses, rather than 
innerspring mattresses. Y/e arc now investigating the possioility of con- 
verting some of our cotton mattresses into innerspring; our studies to date 
indicate that this is not economically feasible, however, we may find that 
it will be. If it is economically feasible, then I can assure you that all 
of your expansion beds can be equipped with innerspring mattresses, perhaps 
not initially, but at least before the end of this fiscal y ar. The bed- 
side' table situation is particularly bad. T/c entered into a contract a year 
ago for 16,00.0 bedside tables. The manufacturer has been unable to procure 
steel for those commodities except in small quantities to date, and deliver- 
ies are very very slow, so it may bo that you are going’ to have to use the 
field-type of bedside table; at least until deliveries do come in, which may 
be a good, many months. I mentioned photoroentgenographic units this morn- 
ing. During the war we'procured approximately 300 of those units and they 
were put in use all over the country. Theoretically they are still on hand 
because they were never on the list to be declared surplus. The information 
that we have been able to gather to date as to where they are is quite 
sketchy, be are pursuing this and trying to get all those photoroentgeno- 
graphic units into use. You may very well find that you have some of that 
equipment on hand stashed away down in your 'warehouse someplace. I wish 
you would give particular attention to that in trying to help uncover it 
and then, if you can, use it in the induction program. In other words, if 
your place is going to be used to take chest X-rays, then use it, otherwise, 
turn over to the Army Surgeon to utilize at the induction station. Arc 
there any questions that anyone has? (No questions) 
COLONEL HARTFORD; • . 
Several references have been made to physical examinations during dis- 
cussions here and Colonel BORNSTEIN rail present the subject and what we 
have been able to do up to date on this subject. 
COLONEL BORNSTEIN;- Physical Examinations. 
Gentlemen, I am sorry that the Chief of the Physical Standards Division 
is- not with us here today; Colonel Nylon is -presently convalescing at 
'./alter Reed General Hospital and we hope to have him back with us in the very 
near future. 
1 have been 'asked to say a few words on the subject of physical examina- 
tions.- I will attempt to present some of the recent "highlights" relative 
to this subject. 
At the request of The Surgeon General, a committee is presently making 
a complete survey of the problem relative to the types of physical examina— 
C0NFIDENTIAL CONFIDENTIAL 
tions accomplished in the Army. This, survey, of course, requires a thorough 
review of all directives pertaining to this subject including a review of 
all pertinent Federal statutes, he arc studying the frequency of all 
physical examinations and, after a complete sutyd, we hope to arrive at 
a definite recommendation as to the essentiality or non-essentiality'of speci- 
fic individual physical examinations. T/e hope, as a result of this study, 
to arrive at some beneficial recommendations so that all personnel concerned 
will be spared the burden of either accomplishing or undergoing what may be 
considered t© be an "unnecessary” physical examination. Thus far, we have 
made a fairly complete review of the various directives re? tivc to the 
subject of physical examinations. It really is surprising go learn the 
great degree to which references are made to the subject of physical examina- 
tions. It sure would be very helpful if we could have a single Army regula- 
tion pertaining to the subject of physical examinations, whether it per- 
tained to application for Extended Active Duty, Commission in the Officers1 
Reserve Corps, etc. Such an Army Regulation could contain all necessary 
data suchjap_required channels, pertinent physical standards, reviewing 
authority, etc. . . ! . 
I might mention that we have already taken some active-steps with res- 
pect to the subject of active duty training. Vic have received quite a bit 
of correspondence on this subject, particularly whore it concerns individuals 
ordered to active duty training for periods not in excess of 30 days# I 
believe that, by this time, you have all probably received a copy of’War 
Department Clear Message A2583 dated 23 July 19AS which, in effect, states 
’that an individual ordered to active duty training for periods of 8 to 30 
days may, in lieu of the presently required physical examination (unless 
indicated) accomplish a certificate provided such individual certifies that 
he has been found physically qualified for active duty as a result of a 
physical examination accomplished within one (l) year preceding the date 
of active duty training. 
I might add that liar Department Memorandum 600-150-1.dated 11 September 
19A7 (as amended), which pertains to the entire subject of active duty 
training for members of the Officers1 R.serve O0rps and Enlisted Reserve 
Corps has been re-i/rittcn and it is expected that the proposed directive 
will be approved and distributed to the field within the very near future. 
It is expected that this new directive, when placed in oper-.tion, will 
serve to eliminate the accomplishment of any "unnecessary" physical examina- 
tions and also help to expedite the administrative" procedure relative to 
the entire problem of short tours of active duty training. In this proposed 
directive we have recommended the following: (a) individuals, ordered to 
active duty training for a p riod of 7 days or less will not be required 
to undergo a physical examination unless indicated; such persons will only 
be required to accomplish a certificate (relative to their physical status) 
upon reporting and upon relief from active duty training; (b) Likewise, 
individuals ordered to active duty training for a period of more than 7 days 
but not in excess of 30 days will not be required to undergo a physical 
examination unless indicated; such persons will also be,required,‘however, 
to accomplish a certificate (relative to their physical status) upon report- 
ting and upon relief from active duty training; (c) Finally, individuals 
ordered to active duty training for a period in excess of 30 days may either 
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undergo a final typo physical examination or accomplish a certificate prior 
to reporting for active duty. An individual who undergoes a final type 
physical examination prior to reporting for duty will only be required to 
■accomplish a certificate upon reporting for duty and also upon relief from 
active duty training (unless the accomplishment of a physical examination 
is specifically indicated). 
An individual who accomplishes a certificate prior to reporting for 
duty will be required to pass a final typo physical examination upon report- 
ing for duty and accomplish a certificate upon relief from active duty 
training (unless the accomplishment of a physical examination is specifically 
indicated). 
i 
The qu stion of granting of 'waivers has also been a big problem. To 
help this situation, we have recommended, within this proposed directive, 
that authority to approve waivers of physical defects in the case of those 
individuals whose tour of active duty training is not to exceed 30 days, may 
be delegated to commanders of such installations as the Area Commanders may 
direct. In the case of those individuals "whose tour of active duty training 
is to exceed 30 days. Commanding Generals of Area Commands arc authorized 
to approve waivers of physical defects (below general'service requirements). 
Thus, in order for an individual to be considered phys cally qualified 
for active duty training, ho must meet general service or general service 
with waiver requirements. The physical classification entitled, "General 
Service with liaivcr" refers to an individual who has a physical defect (s), 
which in the opinion of the reviewing authority (a) is static in nature 
(b) is not subject to complications or aggravation by reason of military 
duty (c) •'.rill not interfere with the satisfactory performance of full mili- 
tary duty and (d) will, in all probability, not necessitate hospitalization 
or tine loss from duty. 
In considering this physical classification of "gen ral service with 
waiver", one should take into consideration an individual’s age, grade, and 
branch of service. 
The tern "General S rvice with Vaiver" should not be used synonymously 
"with the term "Limited Service." 
Colonel Mudgett made reference this morning to the fact that all reports 
of physical examin- tion utilized by the Service have been standardized. A 
single set of nodical examination forms has been designed to replace the 
large number of such forms presently in use .by all Federal agencies. (Army, 
Navy, Civil Service, otd.). As you probably recall, a field trial was 
carried out last year within all Army Areas for the purpose of testing the 
practicality of these forms. In general, these forms were accepted enthusias- 
tically by the field. The report of Medical Examination will be known as 
Standard From No, 88 and the Report of Medical History "will be known as 
Standard Form No. 89. The distribution of these standard forms will probably 
be made during the early part of November of this year. As far as is known, 
the use of these forms will probably be mandatory after 31 December 194-8. 
These forms have-been design-ed so that they may be used sep rately or in 
combination in accordance "with administrative requirements. 
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Before closing I would like to touch very briefly on a point with 
which I am sure' you are very familiar - that is, the subject of incomplete 
data on reports of physical examination. Gentlemen, I do not mean to be 
facetious, but wo are required, not too infrequently, to return 
of physical examination to the field for the inclusion of supplemental 
data, lie do not enjoy doing this, and I am sure that you gentlemen do not 
enjoy receiving such requests. However, it is necessary, of course, to 
have sufficient medical data upon which to evaluate each case. If sufficient 
supplemental information was supplied when indicated .in a specific ease it 
would surely obviate a great deal of administrative work and expedite the 
processing of each ease by this officef For example, we may receive a report 
of physical examination with an entry such as "30 degrees limitation of 
flexion of right elbow"; unless such report is accompanied by more detailed 
supplemental information in the form of an orthopedic consultation we are 
required, in most cases to return such report of physical examination to the 
field requesting the necessary data. 
Medical officers performing physical examinations should be thoroughly 
indoctrinated with pertinent regulations and directives* 
Medical officers who conduct physical examinations in an indifferent 
manner arc not b ing "fair" to themselves, to the iadividual being examined, 
to the medical profession, or to the Government* 
I see that my time is up — if there are any questions I will try- to 
answer them. 
Thank you, Gentlemen. 
GENERAL OFFUTT; 
hill you give me again the number of that message you made reference to? 
COLONEL BORNSTEIN: 
har Department Clear Message 4-25B3) 23 July 1948. ; . 
GENERAL LILLIS: 
You spoke of certificates in lieu of examinations* Is a certificate 
by a civilian physician acceptable in lieu .of physical examination,? Lots of 
reserve officers come in with certificates from a civilian physician,stating 
that they arc alright. 
COLONEL BORNSTEIN; * 
The certificate, General Lillis, is stated in such a manner.that J 
believe it would have to be accomplished by the individual, himself* May I 
read a sample of the proposed certificate which is accomplished when the 
individual reports for active duty training. "I now consider myself sound 
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and well and physically qualified for full military duty*■ I was considered 
physically qualified for military service at the tine of accomplishment of my 
last physical examination on or about (date) at (place) . To the best 
of my knowledge and belief, I have no physical ' defects or conditions except 
as noted below, which would preclude the performance of full military duty.’1 
GENERAL LILLIS j 
Docs it make any difference who accomplishes that last physical examina- 
tion - whether it is a civilian doctor or a medical officer? A lot of people 
state that "I was examined by so and so and Ifm alright*” There is no 
record at all of such examination* 
COLONEL BORNSTEINi 
That last physical examination (referred to in the certificate) does not 
necessarily have to be accomplished in an Army medical facility* A physical 
examination accomplished by a civilian doctor would be considered acceptable 
inasmuch as current directives permit the accomplishment of physical examina- 
tion by civilian doctors in conjunction with an individual’s application for 
commission in the Reserve Corps* 
GENERAL STREIT: 
How do you figure that this is going to reduce the number of examinations 
by requiring this man to have a certificate that he was examined within 
the last year; that won’t reduce the great lot of people that are being called 
back to active duty for shorter or longer periods who have not had the 
physical at all? 
¥ 
COLONEL BORNSTEINs 
You mean the ones who have not had the physical examination within the 
past year? 
GENERAL STREITj 
Yes. 
COLONEL : 
Recently, Colonel Johnston went to Now York City and found out some 
facts after the issue of that particular telegram; they still had to examine 
75 per cent and were trying to work it out so that they would have to give 
them only one physical during any one term of appointment in the Reserve 
Corps. 
81 
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COLONEL STREIT: 
I think that w ould bo something.more practicable* At Brooke they have 
got to do almost a htmdrod a day q.t the present time, exclusive of Civil 
Service officers coming on* promotion examinations and all that sort of thing 
and it seems to me that wo ought to work on accepting a certificate from these 
people to come on active duty that as far as they know, they arc well and 
let them do 20 or 30 or 4-0 days duty. I don’t see the point of having a 
physical examination when you come on duty and 7 days later giving you another 
COLONEL BORNSTEIN: 
Individuals coming on active duty for a period of 1 to 7 days arc not 
required to take a physical examination-unless indicated# Under the proposed 
directive relative to active duty training, the certificate accomplished upon 
relief from active duty will read as followss ”1 certify that during the 
period of active duty training from (date) to (date) . there has been no 
change in my physical condition and that I am not suffering any disability or 
defect which was not present at the beginning of such tour of duty#’1 
COLONEL GREEN: 
Uhy not have the individual accomplish' one certificate to take the 
place of the two certificates you mentioned - that is, upon reporting and 
upon relief from active duty training# For example, "I think I’m well and 
the 7 days I have been on duty I don’t think I got hurt.1’ 
COLONEL BORNSTEIN: 
That is something we will take into consideration# 
GENERAL 1 NELLIS; • 
I don’t think what you have done to reduce the number of examinations 
will help a great deal# 
COLONEL BORNSTEIN: 
General, we have only touched the surface so far; we arc studying this 
matter at the present time. This liar Department Clear Message 12583 to which 
I have referred is purely an emergency measure to help in expediting pro- 
cessing of individuals coming on active duty training for periods,of 8 to 
30 days# 
GENERAL WILLIS: 
Did.you take care of that question of the audiometer test for hearing 
and the refraction that is required for every ROTC student that is examined 
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at camp? It was taken up at the Army Surgeon General*s conference hero 
and got a temporary reprieve so that we didn’t have to do these tests on all 
studenas* 
f 
COLONEL BORNSTEIN: 
This is a recommended change that has already been sent to the staff* 
With reference to that point, the recommended change reads as follows: 
"The physical examination made at the camp will be made primarily with a 
view-of determining the student’s physical qualification for a commission 
in the Officers’ Reserve Corps* The scope of the physical examination, how- 
ever, will be hs prescribed in AR 40—105 for original appointment in the 
Regular Army. Individuals who arc manifestly physically disqualified for 
appointment in the Regular Army because of visual, auditory, or cbther physi- 
cal defects will not bo required to undergo refraction or audiometric test, 
unlc s s indicatod.” 
GENERAL LILLIS: 
That only takes care of a very small portion of students* It is those 
that don’t have any obvious defects in hearing that have to be tested by 
the audiometerj that is the great delay in processing those ROTC students. 
COLONEL BORNSTEIN: 
I will make a note of this, General Lillis, and we will look into this 
problem. 
GENERAL LILLIS: 
♦ 
But these students have to be examined again when they come up and they 
won’t come up for at least 2 years and maybe 3* Why should vre have to make 
a test of every ROTC student and why should we have to refract every student 
that has a minor error in vision just so he can stay in camp 6 weeks and, 
if he has anything, then you waive it and if he comes in the Regular Army, 
he has to go through that same thing 2 years later? 
COLONEL BORNSTEIN: 
That is a good pointj we will look into it. 
GENERAL WILLIS: * ’ 
Every one has been to a doctor for a physical examination when he 
enters camp and gives a certificate when he leaves camp* If you try to re- 
fract every one of those ROTC students, you run into something. If you take 
CONFIDENTIAL CONFIDENTIAL 
an Audio test, you can’t do it in..loss than ten minutes; that is 6 an hour 
and with 700 people that is quite a job. This can be omitted in cases of 
obvious defects but that is not important; those cases amount to only 2%* 
COLONEL BORNSTEIN; 
lie will make an immediate study of that problem, 
GENERAL OFFUTT: 
Did I understand you to say that you donTt waive the physical examina- 
tion on less than 30 days? 
COLONEL BORNSTEIN: 
The accomplishment of physical examination is waived in the case of those 
individuals coming on active duty training for periods not to exceed 30 dpys, 
A physical examination is not required unless indicated, 
GENERAL OFFUTT: 
Thirty days or loss you don’t give them a physical examination? 
COLONEL BORNSTEIN: 
That is right, sir; the certificate will suffice unless*a physical 
examination is indicated. I’ll make some true copies of War Department 
Clear Message 4-2583 of 23 July 1948, and sec that they arc distributed to 
those of you who do not have a copy, (Several raised'hands indicating they 
w-juld like copies.) We will do t at this afternoon, 
COLONEL HARTFORD: 
Colonel DUKE will now give his presentation on PROFESSIONAL TRAINING, 
COLONEL DUKE: 
I’m not going to bore you with the Professional Training program be- 
cause* you arc operating it; I merely want to bring you up to date and then 
discuss very briefly one or two phases which may be affected by the current 
shortage of personnel. You were told that the decision has been made to 
continue the Training Program as it is. The program in our 5 teaching hos- 
pitals is almost completed. I mean it is completely approved and firmly 
established as far as the AMA and Specialty Boards are concerned., (Referring 
to Chart), There are 77 programs on this chart; 70 of which arc approved. 
In other words\ there arc only 7- of the 77 on which we do not have final 
CONFIDENTIAL CONFIDENTIAL 
approval, so I say that the program is almost complete in these 5 hospitals# 
TTe have been criticized by some of our officers in’Army Areas and Field 
Forces as to the number of people we arc training. We arc not trying to 
make every officer in the Medical Department an expert or specialist. This 
whole training program is formulated on very definite requirements. You 
will remember sometime ago I showed you figures where our Personnel and 
Resources Analysis Division indicated we need about 800 men of the expert 
category. Tic need at least 700 if we are going,to provide the type of 
medical service that wc think should be provided for a peacetime Army# We 
have about one-seventh of the number ve need# If we continue the program 
as it is now, it will take us from 5 to 6 years to meet our minimum require- 
ments of this caliber of personnel; so the time may come within 5 or 6 years 
when wc will have to curtail this program and cut down on the number in train- 
ing. Certainly wc don't want or need a Medical Service with 99 or even 50% 
specialists# Wc arc merely trying to meet our minimum, requirements over a 
period of 5 to 6 years. Due to current personnel shortages, we will have to 
curtail our civilian institutional training program. This is especially true 
of the long term courses. Wc can't afford to’send 12 to 14 officers every 
year out to the Public Health course; wc are going to have to cut it down 
to half, or one—fourth that number. We are going to have to insure that 
we arc not sending out to civilian institutions officers fo: training when 
we can provide that training within our own residency program. 
We must weed out of our Residency Program, the men who arc not up to par# 
Wc know that there are certain residents in our training program right now who 
arc coasting and who probably never will be the high-type professional man 
that wc want as Chief of Services and Sections of our hospitals. We are 
depending on you and your educational committee to tell us who those men arc# 
Your first evaluation reports didn't help us very much because they looked 
alike. Wc gave you a different type of report and required that you line 
them up in each specialty from one to five to let us know who was number one 
and number five# Wc want your Educational Committee to call a spade .a spade; 
bo very frank with your evaluation of these men and tell us the man who 
you think should not be in resident training. In general, when an individual 
has had 3 years of training, he will leave the General Hospital and go into 
station hospitals for duty in his specialty. We have about forty-six 
officers completing their 3 years of specialty training this coming year# 
Most of those will be available for station hospital assignments# It will 
be necessary to leave a few of then in our teaching system. Our teaching 
hospitals are not yet one hundred per cent perfect# They still need 
strengthening in some specialties. 
One word about this new training program that we jbegan at Madigan which 'v 
we call training for clinical physleans. We found only 15 men who are inter- 
ested in this type of training. Wc have, assigned these 15 officers to Madi- 
gan for 3 years of general training, I don't know-the future of this train- 
ing program; I believe it will grow, I know it is in line with wheat 
American Medicine .is doing. Many civilian hospitals and universities arc 
now establishing 1, 2 and 3 yccCr.S' training programs for men who wish to stay 
in General Practice, so I know it is at least in line with w'. .at they are 
doing. Some universities arc definitely.against it; they believe the day of CONFIDENTIAL 
the General Practitioner is rone and that group practice is the answer, 
At the sane tine, most everyone will admit that some*’here between 60 to 
75 per cent of all people who seek a doctors services can be cared for 
adequately by a good general nan. I like to think of it this way, it 
is generally agreed among Medical Educators that one year’s rotating 
internship is not sufficient to train a man adequately. So I like to 
think that wo arc putting these 15 men out there and give them 3 years 
of rotating training in order to qualify them as good doctors, I think 
the time will come in 5 or 6 years, when we will cut down on this train- 
ing program for specialists. At that time we could establish more spaces 
for the clinical physicians training, I think the time will come T-hcn 
we will be able to give every young doctor who comes into the Army 3 years 
of general training. This would insure that every Army doctor is an ade- 
quately trained ■'general physician. Many may go on to specialization from 
hero. That is a thought for the future. We hope next year to get an 
added interest in this 3*years training program and open Percy Jones for 
that type of training, 
low a word about R.O.T.C, 'We are expanding our Medical R.O.T.C. from 
4-3 units - to 53 units this fall. We are also establishing 16 dental 
ROTC units| 6 veterinary, and A pharmacy. We (just- returned frorrtho 
Medical Field Service School at Brooke Army Medical Center where the 
ROTC summer camp is in progress. We have 634- students at the present time 
there in the second week of training; 88 per cent are former service men. 
Many of then were enlisted men from private to Master Sergeant; 100 were 
former officers. Because so many were veterans, r,o eliminated some of 
the Military Training and gave them more hours in the hospital* After 
talking to that group I don’t think wo will have * any difficulty in 
getting all the interns that we need next year. 
One word about intern training. At the present time, you know, wo 
have 108 interns in these five hospitals as far as I can learn from talking 
from some of th internes, they* arc all a well satisfiC',:' group. They like 
their internship; they feel they arc rotting good training. Next year 
wo are going to open up 3 additional hospitals to intern training. This 
next year, we will place interns in Madigan, Pc rcy an'1 in the new 
Triplcr Hospital, At the present time, Dr. Arostad from the American 
Medical .ussociatibn is in Hawaii inspecting the Triplcr Hospital for intern- 
ship and resident training. Wo possibly will bo able to put residents 
in Triplcr within a year from now, We must expand this program slowly, 
I’m thoroughly convinced that we made a very ’“’iso move in limiting our 
Residency Training Program to 5 hospitals,. It is a big procurement incen- 
tive right now, I know that the pcr*S' nncl division, is very anxious to 
expand further than the 5 hospitals but I feel it would bo a mistake to 
open Valley Forgo at this time, ’ There abo certain definite requirements 
by AMA which must be fulfilled prior to establishing intern training. 
Fifteen per cent of your deaths must be autopsie;-you have to have a mini- 
mum of 35 autopsies, your. Staff must be acceptable to AMA, Obstetrics' 
and Gynecology training must be, adequate. At Valley Forge, that isn’t 
true at the present time. Dr, Reed, one of the inspectors from the AMA 
inspected Valley Forge on 16 December 194-7 and ho wouldn’t approve it for 
CONFIDENTIAL CONFIDENTIAL 
internship training* 
I1m going to conclude mith this one little thought. In tho formation 
of our future training programs in the Army, I feel v,e must never lean, 
as ’"o have done in the past, too much to the professional side or too 
much to tie administrative side. We must always realize that mo have te 
very definite missions to perform. One, a peacetime mission of professional 
care of patients for a peacetime Army and their dependents, and tmo, tho 
staff and command training necessary for mobilization. 
Wo must bo able to furnish tho medical leadership in that particular field. 
One mission is as important as tho other. Wo should realize this and 
formulate cur training programs to meet both of those missions5 me can’t 
'got am ay from it, they arc ours and they ■'■'ill aim ays be our. 
The Medical Reserve Training program is not adequate at the present 
time, Tho training of reserves is still a responsibility of field forces, 
it is not a primary r«. sponsibility of the Chief of Technical Services, I 
think it mill eventually come under the Technical Service; I!m net sure 
of that but I think it mill. There is one thing which is going on in 
one of oUr General Hospitals mhich I mguld like for you to know about 
and maybe assist ‘In this Reserve training. Colonel Gates mould you mind 
saying a fern words about the set up at Let toman; about the local affilia- 
tion mith the Army people to provide a little on tho job typo of 
duty for the reserves? 
COLONEL GATES: < ‘ - 
The result of an inquiry by local medical officers in our program - 
inquiry mas made whether credit could bo attained as a result of taking 
on a voluntary basis some of the local teaching program that mas going 
on. By mutual agreement betmoen the Army Surgeon and Headquarters, Re- 
serve Section, our training officers maintain a register; any reserve 
officer, medical department, dental or MFC may sign a book and attend our 
training facilities and «o report that to the Service Headquarters and 
they take care of giving that officer credit. Also members of our attend- 
ing staff if they come on tho hospital at a time other than mhich they arc 
paid, if they come voluntarily for conferences and participate in it, 
then they may sign a register book and also' obtain credit on their reserve 
training, 
COLONEL DUKE 1 ■ 
There is coming out very shortly from the General Staff, provisions 
for reserve promotions. There mill be provisions mhereby an officer can 
take part in any reserve training program for promotion. Sc, if you can 
make a little affiliation the local Field Forces people, Army area 
or Reserve people, and without interference at all, and I don’t think it 
is interference mith the training program at these individuals 
c uld come in for .2 .or 3 hours a'day and that could'bo turned over to the 
local Reserve people and"that man ca.n get credit for being at the hospital 
for 2 or 3 hours a day.- Are there any questions-, that you may have on any- 
thing that I said? 
CONFIDENTIAL CONFIDENTIAL 
GENERAL ST RE IT ; 
Tho qu; stion of terminating the residency of those residents who 
arc nr't doing satisfactory work, General Armstrong mentioned yesterday 
that there had been some difference of opinion or difference of policy 
in different sections of Tho Surgeon Gen ral’s Office in reference to 
this matter. At Brookes me have recommended tho termination of residency 
and the number of cases I had. We decided to continue these men for the 
remainder of the year, is that correct? 
COLONEL DUKE.: 
When V'G first set things up, me said, here we put a man in residency 
training and me mill evaluate information on his progress and at the 
end of a year.mo -'.-'ill determine whether he gets a second year. Wo left 
him.there for the full year because of tho necessity of getting a house 
and m ving a family and so onj me left him there for the minimum of a 
year. .The' men that you have reported on and given a very poor record, 
mo have said, "Yes, me mill leave him until the end of the year, except 
for certain reasons mhorc a man should come out now," 
COLONEL ROBINSON; 
There is no scientific method of determining mhothor a man has the 
qualifications to go into tho Residency program. Wo .have been exploring 
that field of having some may of determining whether a man is residency 
caliber mith the number of universities mho have reserve projects, and 
it is entirely possible that me hay set up something so that later me mill 
bo.able to select our residents and thus avoid that, but nom there is noth- 
ing r,c have ■ on it. Docs anybody think that is worthwhile to undertake? 
GENERAL ST REITs 
I think it is very important because me care getting a certain number 
of people into this residency training program v’ho are just average men 
and r’ill never make the type of qualified men that me ’r'ant. They don’t 
have the enthusiasm for the specialty they have chosen or the aptitude or 
ability to' carry on. Some of the universities have proposed a personal 
interview and I mas pondering rhethor it mould be porthmhile for The 
Surgeon Sonera1 or one of his team to interview those applicants? 
COLONEL DUKE.: 
I think this mill take care of that. Before too long, not all of our 
residents but a great majority mill come from our Army interns, Then each 
hospital mill have had one full year to evaluate that man as an intern be- 
fore he goes into residency and you and your Educational Committee mill bo 
able to toll us the one. It is very difficult, cut of all the men mho 
CONFIDENTIAL confidential 
graduate in the Medical Corps schools, to say which ones should go into 
residency training. 
COLONEL GREEN: 
I think the real trouble is getting an honest evaluation from the 
Edue ationa1 C omnit tec, 
COLONEL DUKE: 
Thank you. It is true that many of the reports look just alike, 
GENERAL BE. EH 2 
But va don’t use that numerical evaluation non, 
COLONEL GREEN: 
We are doing the sane thing by not being honest. As it should be 
given, ho has failed - there is no question about that, 
GENERAL BEACH: 
I don’t think there is any question at ’'alter Reed, The Consultant 
makes the evaluation; the Chief of Service and the Chiefs of Sections talk 
it over. They arc interviewed very critically. 
COLONEL DUKE: 
Don’t depend too much on the Chief of Service; surely he is the princi- 
pal one but oner urage the Educational Connittoc insofar as possible to get 
acquainted with every one of them at social affairs or staff conferences, 
etc,, so that he has his own decision. It is an Educational Committee 
opinion that wo want, 
GENERAL BEiXH: 
There is one other thing that helps in the evaluation and that is 
to have a Director of Professional Training, He handles all the interns, 
ho handles all the residents; ho sees them every day. It is his duty to 
keep in touch then; he knows what they are doing in the conferences, 
etc. He is comparable to the Doan of a graduate program in the large medical 
centers or universities and You have to have somebody riding herd in addi- 
CONFIDENTIAL CONFIDENTIAL 
tion to Chiefs of Services and Chiefs of Sections, 
COLONEL DUKE : 
Wo ranted to have a Director of Training in every one of those 5 
hospitals, , I realize re are short and until re get this over this shortage 
executive officers rill have to do it, 
GENERAL FEiXHs 
Then rho rill dr the Executive Officer's job? This officer's job 
is a full tine job? 
COLONEL DUKE; 
I have been trying to convince Colonel Robins -n of this for some 
time, 
COLONEL HARTFORD; 
’ We rant to convene promptly .at" 1:30 this afternoon. We arc going to 
have a rather informal meeting, 
MEETING ADJOURNED AT 12:20 p.n. 
CONFIDENTIAL CONFIDENTIAL 
Afternoon Session - 
5 August 19AS 
COLONEL ROBINSONs 
This is just a working session - not for the record, Fhen -you 
..have something that you r:ant included in the record, say "for the record", 
and r,e mill pause there and put vhatever it is in the* record. Colonel 
BPgxMLITT has some remarks at this time mhich T,ill be a part of the record. 
' COLONEL BRAMLITT s 
After Colonel Robinson made the statement that t’o mould try to pro- 
cure some doctors, me had to find out rherc T,o could yet them. We had 
to', have some sort of criteria as to mhat fc V' uld leave in the hospitals 
r.'hero mo obtain the doctors. On the basis of that, mo started out 
mith a plan mhoro me authorize the hos- it a Is 16 basic officers - 
for General Hospitals, and then on top of that, fc mould autharize one medi- 
cal officer for 50 bods. That mas calculated using authorized beds. We 
figured that out and sam that that mas going to be'a little heavy, so me 
marked it oUt on the actual beds mhich, at the present time, there isn’t 
too much difference, and came to 2 different figures, Norn me hope 
to eventually get domn to rihcre mo mill bo in betmeon those tmo figures 
all-the. time. The knomn teaching hospitals me determined arc operating 
at the present time, or before this last cut_, mith approximately that 
number of people; I am referring to Medical Corps officers entirely. 
The officers that mo believed should be in the hospitals and there 
is some difference of opinion on this, mas as follomss 
The Commanding General, 
The Commanding Officer, 
The Executive,Officer, ••••.• 
■ The Chief of Surgical -Service, 
The Chief oftGeneral Surgery, 
A Chief of Orthopedic Surgery, 
Chief 'f Ear, Nose and Throat Service, 
Chief of Urology, and an 
Anesthetist, 
You notice ”o left off OB and GCN and that is one of the specialties that 
tjc may have to compromise on, Fe left it out because some hospital carry 
him on the out-patient service and others carry him on the surgical service. 
But by giving one doctor to 50 authorized beds me thought perhaps that 
v uld take care of the service. The medical service c nsisted of Chief, 
Medical Service, An Assistant as Chief /'f. Central Medical Service, Another 
Assistant as Chief of Communicable disease Section, and an* thcr Assistant 
in the Pediatrics service. The others that y.e enumerated in this 16 wore 
Chief of NP Scrvicej Chief of X-ray Service;:Chief f Laboratory and the 
Chief of Physical Medicine, 
CONFIDENTIAL For our largb centers r»e considered one additional medical officer. 
In making this study tic had to come to some determination as tc hen a resi- 
dent and an intern could count. That is Senior Resident and assistant 
Resident and intern. There arc many nays of counting those; a full nan, 
for the Senior Resident, an Assistant resident as three-quarters of a man, 
right on down the line to intern who counts nothing. On the over-all, we 
thought that a nan in teaching should count something and as an over-all 
average, Tie settled on 50 per cent for each officer in training. Vie know 
that is open to argument. It is just a planning figure and we would like 
to have suggestions on that. 
On this register - (indicates sheet) - that is in each folder, is a 
summary of what would bo left after the personnel that are shown on the 
small roster - (indicates small sheet) - were removed. Now, the non- 
teaching hospitals that were not affected would-not have the small roster 
since-it is not contemplated thinning them out. In the upper left-hand 
corner of the roster of the Hospital you-will find the calculations for 
the specific hospitals using the plan as outlined 16 basic officers plus 
one officer for 50 beds. It shows hrw many medical officers wo figured 
for that hospital. That is an iddal figure and as time goes along and 
we loose 2,100 doctors next Juno unless wo can talk those 2,100 doctors 
into staying in, we don’t know whether we can reach this figure or not. 
We have shown in the raster under the various services a breakdown of 
personnel as cl-se to the system that re had here, and the various Chiefs 
and Assistants as you have them today. These names T'!ere taken off the 
roster as of the 30th of June, Since that time, various changes have 
taken place; men have .pome out and others have gone-in, but on an over-all 
basis - and re wanted to sho™ you specific names - I think it comes pretty 
close to being -"hat -ne have here in numbers. We know that people were ( 
enroute and we have assigned some ASTPs at the present time that are not 
shown and wo didn’t Intend for them to bo shown. Men are retting ~ut this 
September, October, November who are net this list and YOU can keep them 
gratis and they will be there to help you until the time they are separated. 
Now, any man that we can talk into staying in the. Army is that much more 
help to that specific hospital. We also have people on this list who are 
going out. If you have some that ro have checked to be reassigned that have 
been promised that they would stay in.the hospital for another year if 
they signed up for that year, then those men Tie will scratch from the list. 
In Colonel Robinson’s plan. We have to have approximately 100 doctors 
to make this expansion work and Colonel Robinson and myself will be glad 
to discuss the release of officers from the individual hospitals a little 
later, • • • 
COLONEL ROBINSON; 
I want you all to work with this as a tentative measure. We are 
going to get doctors; ’there isn’t any,question about it - how, I don’t 
knoT-’, but it will be next spring befdho ye get them. Either that or the 
expansion has to fold up; it is,one of two things that has to be done. So, 
92 I m uld like for you all, in working mith this, to realize that mhat 
it is - it is a method tr keep the J.rmies and Air Forces from absolutely 
having to fold ud as far as medical service is concerned and, at the 
same time, leaving the General Hospitals running along smart] ly and quietly 
and that, of c~urse, is something none of us could face before the Nation. 
In other mords, me are going to have to spread mhat re have thinner to do 
aur job until re get the relief. 
I vould just like to arid, for the record, that the Training Program 
is going on in the five Teaching Hospitals, Also the Basic Science Course 
uill be given in January - starting January, 
COLONEL DUKE; 
Have those been deleted from this list? 
COLONEL ROBINSON; 
Which? 
COLONEL DUKE; 
The Director of that Course and the 10 or 12 men assigned to it? 
COLONEL ROBINSON s 
I d"ubt very much that they have, 
COLONEL DUKE; 
Well, you can’t pull them nut and donduct the ccurse too, 
COLONEL ROBINSON; 
Fell, me uill have to take some of thenj vie uill take about 10 and 
leave 7, 
COLONEL BRJMLITT; 
86 per cent of the people on the rosters that vie uill take out arc 
Company Grade Officers and I don’t see hou they can be involved in a 
teaching program, Actually, they are taking up teaching material that 
should be taken up by internes or residents* 
UN OFF-THE-RECORD INFORMAL DISCUSSION FOLLOWED). 
-93