medical care not only at the station hospital nearest his place of duty, but whenever possible at the flight line; in actual flight this care was extended through the services of the flight surgeon.

On the other hand, The Surgeon General, traditionally concerned with the professional care and administration of ground forces, viewed medical requirements in the historical pattern. As senior adviser in the War Department on the medical aspects of war and logistical planning, he appears never to have recognized the combat potential of the plane or the military significance of the March 1942 reorganization. Rejecting the basic premise that the Army Air Forces had a major combat mission beyond support of the ground forces in a conventional theater of operations, he did not therefore accept the corollary premise that this combat mission must be independent of the traditional system of hospitalization and evacuation which supported land forces. To appreciate The Surgeon General's position, it is necessary to understand the traditions affecting his policies. In his capacity as Special Staff member, The Surgeon General was traditionally responsible for developing the medical elements in war plans. Overshadowing this function, however, was the service function. in the Zone of Interior. The War Department was organized into arms and services comprising the various corps. The Medical Corps supported all arms and services of the Army in peace and in war. In peacetime the Medical Department, established by Act of Congress, functioned with considerable autonomy in matters relating to the Army. The Surgeon General enjoyed the status of a Special Staff officer in the War Department and at the same time operated a hospital system in the Zone of Interior which included (with certain exceptions) general and station hospitals. Whereas in the Army Air Forces the focal point was the flyer, the center of gravity in the Army medical system was the general hospital with its staff of specialists in the Zone of Interior. Through a vast and complicated wartime administrative system, the sick and wounded were moved from the combat zone to the rear and thence to the Zone of Interior where, if necessary, they were sent to general hospitals for definitive care. This system had proved effective in previous wars.

Thus the fundamental differences among line officers as to the Air Force mission were reflected in the professional aspects of military medicine and medical administration. Medical planners alike were members of the Army Medical Corps as contrasted with line officers of the Air Corps; but traditionally "Medical Corps" was equatable with ground medical doctrine, and it was apparent that there must now be a dichotomy in the application of the principles of military medicine as aviation medicine became the "field medicine" of the Air Force.

Finally, any discussion of the wartime medical program must reflect the status of The Surgeon General in relation to the total War Department organizational structure as well as the scope of his responsibilities in determining global medical policies. Had he perceived the full significance of the wartime reorganization, he possibly would not have tried to retain both staff and operational functions within his office. Since he did not make himself felt when the War Department organizational planners were evolving the March 1942 system, no provisions were made for a senior medical staff officer to serve at the War Department General Staff level as coordinator of the medical activities for the three major forces. Because he controlled the general hospital system, The Surgeon General was placed with the other technical services at a relatively low echelon under the major noncombat force, The Services of Supply (SOS), later designated the Army Service Forces. The merits of organizing the noncombat elements into a major service force are debatable. In World War II when this was done the major goal was production. Thus, the major emphasis was upon commodities, subject to the techniques of mass production. There is also some question as to whether a service such as that provided by the Office of The Surgeon General, which was concerned with the health and welfare of the fighting forces, properly belonged with the supply agency. Nevertheless, because he had not initially established his position clearly as senior medical adviser to the Chief of Staff, The Surgeon General found himself under the command of the Commanding General, Army Service Forces. He was thus limited in his access either to the Chief of Staff or to the Commanding Generals of the Army Ground Forces and the Army Air Forces. Under these circumstances, the medical service element could become isolated from the milieu of day-to-day thinking from which tactical planning was evolved. Since The Surgeon General was not an active senior medical adviser to the Chief of Staff, he could not so well keep abreast of top-level planning. Nor could he plan or recommend in terms of strategic thinking since his superior, The Commanding General, Army Service Forces, was not a member of the Joint Chiefs of Staff. But General Arnold, a member of the Joint Chiefs of Staff, was able to consider his medical requirements in terms of the strategic mission. His senior medical adviser was therefore in a position to press for a dynamic medical program to meet the combat requirements of the Army Air Forces.

These factors must all be kept in mind as contributing to the sequence of events during the war which led to policy decisions, their modifications and sometimes their reversals. In summary, there were three problems: the reluctance of traditionally minded line and staff officers to recognize the plane as a part of an air weapons system rather than a special weapon to support

the ground mission; the basic issue of whether the Army general hospital or the individual aircrew member should be the vital center of the air force medical support system; and the military principle involved in wartime control of a major combat force medical service by a noncombat force commander. Tradition was on the side of The Surgeon General, who continued to view himself as the senior medical officer of the Army and, as such, responsible for the health of all the Army, including the Army Air Forces. Conditions favored the Air Surgeon.

The two medical officers who defended these principles were both highly regarded in the medical profession. Maj. Gen. David N. W. Grant, the Air Surgeon, had been a career officer since 1916 and was a graduate of The Army Medical School, The Air Force Tactical School, The Chemical Warfare School and the School of Aviation Medicine. He was recognized as an able administrator as well as an outstanding obstetrician. General Arnold was to place increasing trust in his judgment, as indicated by the support he gave to his recommendations. In the Army, General Magee, The Surgeon General, was to retire before the war had gotten into full swing. Maj. Gen. Norman Kirk, who became The Surgeon General in May 1943, was to be the principal exponent of the Army viewpoint. An outstanding orthopedic surgeon, General Kirk was a strong defender of the general hospital system. As the war progressed, these two officers came to symbolize two schools of thought. Their common goal as medical officers was, of course, identical: to preserve the optimum health of the fighting forces. As members of the medical profession, both officers alike desired that the fighting forces be provided the best possible professional care. The differences therefore were primarily in terms of military doctrine, placement of functional responsibilities and of method rather than of objective. Sometimes, however, this fact became obscured in the day-to-day struggle to maintain the health of the newly mobilized forces and to provide for their care as they were dispersed to all areas of the globe. One manifestation of this fundamental and irreconciliable difference was in the inevitable personality clashes between the two major protagonists, General Kirk and General Grant. Another manifestation was the partisan loyalty of their respective staffs. In The Surgeon General's Office the specialists, not necessarily geared to military procedures in wartime, apparently believed that their professional judgment was being questioned when they were called upon to justify a position. In the perhaps over-sensitive Air Surgeon's Office, on the other hand, every restrictive action of The Surgeon General was usually interpreted as a direct blow at the Army Air Forces. It was fortunate indeed that Brig. Gen. Raymond W. Bliss, Chief of Operations and later Deputy Surgeon

General, recognized the very real problem of the Air Surgeon as well as those of The Surgeon General and was able to serve as a moderating influence at times when in the heat of the moment the fundamental issues at stake might have been forgotten. His able assistant in these matters was Col. Albert H. Schwichtenberg the flight surgeon assigned by the Air Surgeon to the Office of The Surgeon General as air liaison officer.

The Issues Emerge: 1942

Since the Army and the Army Air Forces could not reach a common ground in determining the basic air force mission, it is debatable whether medical planners under any circumstances could have agreed on a unified medical service to meet wartime requirements. General Grant, the Air Surgeon, had been initially hopeful as demonstrated by his attitude toward The Surgeon General's Office prior to the war period. During the months preceding the war he had viewed The Surgeon General as his superior, but at the same time recognized that The Surgeon General's Office did not take seriously his recommendations for the air force medical program.

This fact was brought home with force in 1941 when he returned from England where he had served as a medical observer. Upon his return he prepared a plan whereby the sick and wounded could be evacuated by air. The plan was transmitted to The Surgeon General for approval or comment, but was pigeonholed without action. After nearly 9 months of waiting the Air Surgeon by-passed The Surgeon General and went to the War Department General Staff with a carbon copy of the plan. On the following day General Magee, The Surgeon General, went to General Arnold's office where he demanded that disciplinary action be taken because the Air Surgeon had by-passed proper channels. General Arnold brought the two medical officers together and stated his position in the matter. In the future the Air Surgeon was to be directly responsible to him and not to The Surgeon General.

The clarification of General Arnold's position represented a major milestone since prior to this time there had been some uncertainty as to how Air Force line officers reacted to the service element. From this time forward, however, the Air Surgeon was to enjoy a position in relation to his Commanding General that The Surgeon General was never able to attain with his Commanding General.

The first tangible step in establishing a wartime medical service to meet Air Force needs was taken in the spring of 1942 when the Army Air Forces established its own procurement system to obtain medical officers. The expan

sion program of the Air Corps prior to the entry of the United States into World War II had created an immediate demand for Medical Corps officers. This requirement was greatly accentuated after the entry of the United States into the war. The established procedures for producing doctors by the Office of The Surgeon General and allotting a quota to the Air Forces failed to provide the necessary medical officers to meet the situation. This was admitted by The Surgeon General when he advised the Secretary of the General Staff of the War Department that it had been impossible to fill the 1,500 places allotted for Medical Corps officers prior to the war.*

The Medical Department of the Army had turned first to the American Medical Association for aid in recruiting doctors. This agency was asked to prepare and maintain a roster of civilian physicians, properly classified as to specialties and proficiency, who would be willing to accept commissions in the Army when needed. The Surgeon General would place one or more representatives of his office on duty at Headquarters, VI Corps Area, to implement the program. Should there be no Reserve officer available for a vacancy in allotments for a corps area, The Surgeon General would notify his representative at VI Corps Area Headquarters, who in turn would request recommendation from the American Medical Association for a civilian doctor to be commissioned for the vacancy. The Corps Area Commander was responsible for having the candidate examined and securing from him a completed application for commission. All papers were then sent to The Adjutant General for final action."

To insure that the limited supply of doctors be given equitable distribution among both Army and civilian agencies, a central agency for procurement was projected. The initial step in this direction was taken by the Subcommittee on Education of the Health and Medical Committee in the Office of Defense, Health and Welfare Services, which recommended on 31 March 1941 that such an agency be established." This recommendation was transmitted to the Committee on Medical Preparedness of the American Medical Association which, in turn, presented it to the House of Delegates of the American Medical Association. The House of Delegates recommended "the establishment of a central authority with representatives of the civilian medical profession to be known as the Procurement and Assignment Agency for the Army, Navy and Public Health Service and the civilian and industrial needs of the nation."

A commission appointed by the Health and Medical Committee drafted a plan for this service which was incorporated in a letter written by Paul V. McNutt to the President on 30 October 1941 and approved by the President on the same date. The new office was to be known as the Procurement and As