AAF Medical Independence

Throughout the war, Air Surgeon Grant disagreed with the Army Surgeon General over the amount of independence the AAF medical system needed to fulfill its mission. Grant agreed with AAF leaders that the special matériel features of air warfare required a separate air force supply 2 and logistics system, and he urged his military superiors to recognize the special needs of aerial combat and to give the AAF medical service the same degree of independence from the Army that most other portions of the AAF already had been given.

General Grant had developed his ideas on medical independence before World War II. In 1938, he graduated from the Air Corps Tactical School, the home of air power theory, which held that air power was a separate arm deserving a separate commander and support structure. The Tactical School produced many leaders who promoted an independent Air Force during World War II. Grant was the first and only medical corps officer to graduate from the school before Pearl Harbor. He was influenced by air power theory and by his readings on Dr. Theodore C. Lyster, the air surgeon in World War I who achieved a small measure of independence. After graduation from the Tactical School, Grant was assigned to England as an AAF medical observer—an assignment that allowed him to study the aeromedical problems of the Royal Air Force (RAF) in the Battle of Britain. In October 1941, Grant became Chief Air Surgeon of the Army Air Corps.

At the start of World War II, military airplanes were flying much faster and higher than ever before, creating new medical problems for aircrews. This technological revolution in aviation was yet another argument for a medical service specialized in aeromedical support. In fact, the AAF achieved some medical independence in March 1942 when a reorganization made the AAF equal with the Army Ground Forces (AGF) and Services of Supply (SOS). General Arnold, the AAF commander, was granted authority over some medical facilities, their patients, and the medical staff who cared for them. Air bases soon received surgeons and a medical reporting system was established. But official control of major logistical functions, including medical support, was delegated to the SOS, which evolved into the Army Service Forces command. The Army Surgeon General, who was subordinate to the SOS command, continued to claim ultimate jurisdiction over AAF medical services, a claim that crossed organizational boundaries. This boundary crossing caused problems. First, it prevented the highly mobile AAF, which sometimes created bases far from Army bases, from setting its own sanitary standards and procedures to prevent infection. Second, in combat theaters the AAF lacked its own station and general hospitals. Without them, it had to transfer many patients to Army theater hospitals where those patients often became administratively lost to the AAF. Because patients’ medical reports were routed through long administrative channels, the AAF theater commander found it difficult or impossible to get reliable information on the health of the command.

Grant argued that there were other problems. Early in the war, there were not enough Army specialists trained in aviation medicine to adequately staff both combat units and Army hospitals abroad and in the United States. To AAF leaders, it seemed that the theater SOS handled the medical logistics and facilities of AGF units much more rapidly and effectively than it handled those of AAF units, thereby forcing AAF medics to devise their own makeshift supply lines and facilities. In sum, the Air Surgeon thought that the Army Medical Department was not committed to giving the AAF fair and adequate medical support.

Although Grant failed to win medical independence abroad during World War II and was denied permission to set up AAF general hospitals in the United States, he obtained a considerable level of independence in 1943 for AAF station hospitals in the United States. He issued to the station hospitals equipment normally found only in general hospitals, and he used those hospitals to receive AAF patients directly from abroad.

The Army Surgeon General opposed Grant’s independent actions. In November 1943, citing a shortage of surgical specialists, the Army Surgeon General proposed a virtual prohibition on elective surgery in AAF 4 hospitals in the United States—an action that would effectively reduce them to dispensaries. In February 1944, Grant and Arnold countered with a request for a separate, integrated AAF hospital system, both at home and abroad, to furnish continuous care for AAF patients in venues from combat theaters to highly specialized stateside AAF treatment centers. Grant noted that the AAF had already created their own repair and maintenance depots in Great Britain, separate from the Army theater SOS. But the Army Surgeon General was convinced that the AAF did not need its own hospital system.

To deal with this crisis and with complaints about the medical care given AAF combat crews in Great Britain, President Franklin D. Roosevelt sent a special team to Europe in March 1944. The team chief, Dr. Edward A. Strecker, then consultant in psychiatry to the secretary of war, was accompanied by Grant and Army Surgeon General Maj. Gen. Norman T. Kirk. Strecker and Kirk reported that the alleged problems in Europe were exaggerated. Grant was reluctant to make major changes on the eve of the Normandy invasion and he accepted the majority opinion, even though surveys showed that many workdays were being lost because of the lack of a separate AAF hospital system.

The same issue arose in the Pacific theater. Starting in August 1944, special medical problems of the Very-Long-Range Bomber Program against Japan prompted the Air Surgeon to ask for a separate AAF hospital system for the XX Bomber Command in the Pacific. This request also was rejected.

Despite setbacks, Grant had almost realized his ambition by 1945: the AAF medical service was basically independent in fact, if not in name. In January 1945, the AAF controlled almost 70,000 beds. Most of the beds were in the United States in 200 station hospitals, thirty regional hospitals, and seven convalescent centers. Abroad, the Air Transport Command (ATC) operated its authorized dispensaries basically as station hospitals, and many other AAF dispensaries overseas operated in the same mode.