Health and Medical Care
Responsibility for providing medical care for the 160,000 Wacs and nurses of the Army was placed upon the Office of The Surgeon General, both in Auxiliary days and after the change to Army status. As directed by The Surgeon General, any inquiries received by Director Hobby concerning medical problems of members were sent to his office for reply.1 The Surgeon General's responsibilities were threefold: setting medical standards for enlistment, providing suitable medical care after enlistment, and recommending hygiene courses and other preventive measures to maintain women's health.
For the year of the Auxiliary's existence, these responsibilities toward Waacs were handled as part-time duty by a Medical Corps officer. Shortly before the conversion, the responsibility was delegated to the first woman Medical Corps officer, Maj. Margaret D. Craighill, former dean of a woman's medical college in Pennsylvania. 2 Major Craighill gradually acquired an assistant and two secretaries, and undertook visits to training and field installations and overseas theaters.
Her unit was, she reported, handicapped from time to time not only by its small size but by lack of sufficient authority or delineation of responsibilities within The Surgeon General's Office.3 There also existed a divided responsibility with Military Training Division, Army Service Forces, which sometimes issued directives on medical training for Wacs without coordination with either Major Craighill or Director Hobby.4
By the end of 1943, Major Craighill was nevertheless embarked on plans for a coordinated health program for women. If it had taken a year for The Surgeon General to recognize that "there are problems of health peculiar to women," 5 it was to take the rest of the war to solve most of them.
Medical Standards for Enlistment
One of Major Craighill's first actions after her appointment was a tour of Army induction stations to seek the cause of medical examiners' errors, which had seriously affected the early recruiting program. The cause, she discovered, was simple: most stations were not giving any
MAJOR CRAIGHILL, the first Consultant for Women's Health and Welfare in the Office of The Surgeon General (right). Dr. Elizabeth Garber (left), a member of the WAAC on the hospital staff at Fort Des Moines, later sworn into the Medical Corps of the U.S. Army.
pelvic or gynecological examination at all; neither were many giving a psychiatric examination. Instead, the prescribed examination for men was being used, which made it understandable why the rejectable gynecologic defects were overlooked.6
Upon her return to headquarters, Major Craighill at once secured a directive that gynecological and psychiatric examinations would be given every WAC applicant. Instead of leaving exact gynecologic standards to the medical examiner's imagination, as formerly, she secured appointment of a board of Army doctors to set standards of acceptability, and these were shortly published. Exact directions were given for administering a suitable pelvic examination, the list of disqualifying gynecologic defects was ex-
panded, and it was required that the menstrual history be recorded.7
In spite of the publication of standards, the circumstances of WAC enlistment did not lend themselves to sudden improvement. Wacs were enlisted at many widely scattered stations, where the relatively small numbers of women processed made it necessary to use the medical staff that processed inducted men; it was impossible to provide every small station with a gynecologist. Also, medical examiners were generally uninformed about the work the WAC would do, and admitted a tendency to underrate the physical and mental strain of military life. In addition, examining officers pointed out that they were frequently urged by recruiters to overlook "minor" disqualifications, particularly in matters involving personal judgment, such as stamina and personality defects. Doctors were also hurried by recruiters who wished to swear in an applicant before she changed her mind, without waiting for a full check on her records of civilian hospitalization.
As a result, while the number of psychiatric and gynecological rejections increased, 1944-and the beginning of the Corps' third year-found the situation still unsatisfactory. Almost 75 percent of WAC disability discharges continued to be for psychiatric and gynecological reasons, most of them occurring within a few months of enlistment, and rates from different service commands still varied widely.8 Training centers continued to send reports of causes for which new recruits had to be discharged at once: dementia praecox, schizophrenia, manic-depressive psychosis, epilepsy, fibroids of the uterus, tumor of the ovary, and advanced pregnancy, as well as other matters such as diabetes, arthritis, goiter, peptic ulcer, tertiary syphilis, and tuberculosis.9 By February of 1944, all responsible officers were seriously concerned about the situation. The Surgeon General, Maj. Gen. Norman T Kirk, informed General Somervell at this time that "the physical examination of Wacs at induction stations and other stations is not being conducted satisfactorily and is not sufficiently thorough.10 The Director's staff noted that "the enlistment of unqualified women continues to create serious problems for recruiting, for the Corps, and for the individuals concerned." 11 Reports from service commands noted that among the "worst deterrents to recruiting" was faulty psychiatric screening. It appeared to be equally bad to accept an applicant known to her community to be "queer" or seriously delinquent, or to select one well thought of is the community who immediately broke down and had to be discharged.12
The Administrator of Veterans' Affairs, Brig. Gen. Charles Hines, wrote to the Secretary of War concerning cases in which women had been discharged for neuro-psychiatric disorders immediately after enlistment, and thrown upon veter-
ans' hospitals for what appeared to be indefinite future care.13 Brig. Gen. William C. Menninger reported that the need for good psychiatric examinations was even greater for women than for men, because of the greater number of peculiarly motivated individuals who applied for a volunteer corps as contrasted to those called up in a nationwide draft, and also because of the higher age limits for acceptance of women.14
During these months every possible means of improving the situation was explored, with disappointing results. At The Surgeon General's request, the National Committee for Mental Hygiene made a study of neuro-psychiatric induction procedures for both men and women. The committee recommended that women psychiatrists examine women-a suggestion that could not be adopted for lack of women psychiatrists at the hundreds of recruiting stations enlisting Wacs.15 The committee also recommended an elaborate system of investigation of each applicant's medical and social history, which was found to be too time-consuming to be practical.
Director Hobby next proposed that Selective Service boards assist the WAC "in securing medical history on prospective WAC recruits." For men, such histories were compiled by Selective Service boards and their medical field agencies in the home locality. They included verification of identification, education, medical and social history, and other material of much assistance to induction examiners, who could not otherwise have detected certain traits in one interview. However. General Hershey refused to allow his local boards to extend this service to Wacs, stating:
The gathering of information in connection with WAC recruiting would not appear to be part of the duties for which they are appointed or compensated . . . it is not deemed advisable that the agencies assume the additional work.16
As an alternative, Director Hobby proposed a "New England Plan," used successfully by WAC recruiters in New England, with information derived from both local Selective Service boards and from social agencies. Typical of cases thus detected were that of a woman who had "a call from God" to enlist but many home anxieties; a well-educated and presentable woman found to be unable to hold a job because of fits of depression and hysterical blindness; a woman whose father wept and begged that she be taken away from association with his younger children. However, this plan was frowned upon by ASF''s Military Personnel Division, which feared it might give outside agencies undue control of acceptances.17
The Surgeon General's Office next turned to an attempt to get WAC enlistments limited to the few large stations where qualified gynecologists and women psychiatrists could be stationed.18 To this end. Major Craighill worked for some weeks with The Adjutant General's recruiting staff, preparing lists of stations and plans for detailed instruction. Unfortunately for this idea, it came at a time of manpower shortage, when the Army was
redoubling efforts to get WAC recruits, and when posts and air bases were contributing additional teams. Recruiters, from a study of the reactions of hesitant prospects, felt that it was difficult enough to secure an enlistment when the applicant could be rushed through processing in her own home town and sworn in before she repented her decision. It was deemed impossible to persuade most applicants to take leave from their jobs and travel several hundred miles for an examination which, if unsuccessful, would leave a woman in the embarrassing position of having publicly announced her intentions and then having been publicly rejected. Therefore, the whole plan of centralized screening was dropped, and the number of enlistment stations was actually increased instead of decreased.
Finally, in March of 1944, a conference of all interested agencies adopted a plan proposed by Director Hobby's representatives. This solution, similar to that which had proved successful in The Surgeon General's Office and in other agencies, called for centralizing responsibility in a WAC specialist. Accordingly, a highly qualified WAC officer was appointed in each service command to improve screening procedures as best she might. She was responsible for giving medical examiners the proper background material for an understanding of Corps jobs, and for obtaining for them such reports on doubtful candidates as would assist their judgment, such as case histories and hospitalization records. If qualified psychiatrists were unavailable locally, she was authorized to pay $2.50 per doubtful applicant to recognized social agencies for a full investigation-a small investment compared to mustering-out pay and veterans' benefits, and one that left the final decision in the hands of military personnel. It was also required that a qualified WAC officer be placed in each recruiting station where WAC enlistments were processed, to render much the same assistance and to assume responsibility for a final review of acceptances.19
The Surgeon General called the attention of service command surgeons to these measures and directed that they assist the WAC liaison officer in every possible way. A conference was also called in May of 1944, of one member from each service command, to clarify procedures. In August of 1944. a more forceful directive to recruiting stations reiterated the requirement that the neuro-psychiatric examination must be made by a qualified neuro-psychiatrist, and that the gynecological examination must not be omitted. It was stated that "experience has shown unequivocally" that there was an undue discharge rate of women accepted by stations where such examinations were "omitted or inferior." Finally, in the fall of 1944, a medical technical bulletin gave an extremely clear statement, in medical language, of the conditions of WAC life that medical officers must consider in approving an applicant .20
This last combined effort seemed to be moderately successful. The rejection rate rose markedly and the disability discharge rate dropped.21 It appeared that the work of educating medical examiners to WAC
enlistment requirements had been done as well as possible under the voluntary enlistment system where recruits of any sort were at a premium. As Major Craighill pointed out, these results were not achieved until the main WAC recruiting effort was over, but the system remained on record for later use.
Rejection and Discharge Rates
Toward the end of the war, The Surgeon General's Medical Statistical Division completed a study of the factors affecting enlistment. It was now confirmed that applicants over 40 had only one chance in three of passing the entrance physical examination, while those under 25 had an even chance; also, that Wacs over 40 were three times as apt to get a disability discharge. Less easily explicable was the fact that married applicants also had less chance than single women of passing the physical examination, and married Wacs were almost three times as likely to get a disability discharge. Disability, in all these cases, did not include pregnancy rates, so that there was no easy explanation of the poorer health of married women.
Also unexpected was the factor of education. Women who had not completed high school got four times as many disability discharges as did those who had completed high school or better. There were three times as many psychiatric discharges and six times as many gynecological discharges among the less educated group. Grammar school graduates received seventeen times as many disability discharges as did college graduates.
There was a similarly unexpected relationship to previous employment. Wacs who had never held a paying job, including housewives, got three times as many disability discharges as those who had held clerical or professional jobs. Domestic and service workers were almost as bad a risk as the unemployed and housewives. Those never gainfully employed had three times as many psychiatric discharges as self-supporting women, and four times as many gynecological discharges. These "unemployed and housewives" were not a large group, however: 95 percent of married Wacs and 96 percent of single ones had held paying jobs outside the home before enlistment.22
According to this analysis, the lowest possible disability discharge rates would be achieved by the WAC if it were possible to restrict its membership to young women who had never been married, whose schooling included at least high school graduation, and who were previously employed in paying jobs as other than service workers or housekeepers.
It was always emphasized by The Surgeon General's Office that medical rejection rates for WAC applicants should not be compared to the higher rejection rates among males, which might have given the impression that the nation's women were
healthier than its men. The rates were not, in The Surgeon General's opinion, strictly comparable, since the WAC was a self-selected group, in which only those women applied who had reason to believe that they could meet the requirements, and who desired to do so.23
Monthly Physical Inspection
After passing the medical enlistment examination, a normally healthy Wac next encountered the Medical Department at the monthly physical "inspection" required for all Army personnel. By Army Regulations, this included, for men, inspection of the feet, mouth, and teeth; investigation for venereal disease and vermin infestation; and observation for chronic diseases. 24 When the Auxiliary was organized, no indication was given the field as to whether or not the requirement applied to women.
In October of 1942, the post surgeon at Fort Des Moines called this omission to the attention of The Surgeon General. He pointed out that venereal disease in women could not be detected by inspection, as in men, and suggested that the more complicated pelvic examination required to detect it be given only every six months, since it called for hospital facilities. In reply, The Surgeon General refused to set a policy, recommending that the training center determine for itself "such special examinations as may, in the opinion of the Surgeon, be required for the prevention and spread of communicable disease.25
This information was given only to training centers, and field stations shortly began to inquire about the same problem. At one, the post surgeon refused to fill out the necessary monthly venereal disease reports for the company unless he could give a complete pelvic examination to each woman each month. Such inquiries were answered to the effect that, pending publication of instructions, stations should hold the inspection but omit the venereal disease check. Since this information was given only to the stations that inquired, Director Hobby's office in December of 1942 requested The Surgeon General to amend the Army Regulation to make the matter clear to all, and to forbid routine pelvic examinations.26
By the time of establishment of the WAC, some seven months later, no such action had been taken, and reports from the field indicated that at some stations pelvic examinations were given monthly. Such practices invariably called forth protests from the women, since the examination was often a painful business which most women were willing to undergo once or twice in a lifetime, but scarcely every month. AS the public pointed out to Mrs. Roosevelt, who pointed it out to Director Hobby, a woman might suffer pain for a week after a rough or inexpert examination.27
Therefore, one of Major Craighill's first acts after her appointment was to secure
publication, in the summer of 1943, of a medical circular giving detailed directions as to the proper procedure for conduct of the monthly physical inspection for female troops. This definitely made it clear that a pelvic examination would not be given routinely; if it seemed indicated by other symptoms, it might be made in a dispensary or hospital. It was also specified that the pelvic examination would be made rectally "where indicated"; this provision met the objections of young unmarried women to enlistment. It was required that the monthly inspection be simple and private, preferably in the WAC barracks, with the subject suitably draped; inspections in the nude were forbidden.28
Even after this action, objections continued to come in. Company commanders pointed out that their women were of excellent moral character and found the monthly inspection embarrassing. Women also frequently questioned the necessity for any examination at all, since it could not detect venereal disease and was so brief15 seconds in one training center-that in their opinion it served no purpose but to waste time and require undressing and dressing. Major Craighill in reply urged WAC commanders to educate their women to the purposes of the examination, which was not intended to imply a suspicion that they had contracted venereal disease, but rather to detect any deterioration in physical condition before it became serious, and to promote a friendly doctor patient acquaintance that would make medical care easier in the event of illness.29
To this end, another Surgeon General letter was sent out, advising doctors that more care should be taken to consider the modesty of the individual and to explain the purpose of the examination. It was added that a female company officer should be present at all times; that personnel would wear underwear in addition to being covered with a sheet or blanket, and that an inspection of the pubic hair would not be made routinely. This last requirement alone did much to end the near rebellion with which many women had regarded the monthly inspection.30
Women's higher degree of modesty in physical matters obviously posed a continuing problem for examiners, and one which, in the opinion of medical authorities, was not likely to be changed in the current century. General Menninger noted, "Girls are raised in a manner entirely different from boys in relation to the emphasis on modesty and privacy in dressing, bathing, and toilet." 31 Equally important was the fact that examining physicians were of the opposite sex in all but the very few installations that employed women doctors. It appeared that male personnel likewise might have offered some objections to monthly nude examination by women doctors. Well toward the end of the war, The Surgeon General's Office continued to receive objections based on this factor, and to find evidence that some medical officers were still unfamiliar with the precautions prescribed in medical directives, particularly that concerning the presence of the female commanding officer.32
Sick Call, Dispensary Care, and Hospitalization
In every type of medical facility, the necessary segregation of the WAC minority presented a problem to medical officers. The easiest solution was possible to the larger hospitals, that of merely designating one or more wards for female patients, including Wacs, nurses, and soldiers' dependents. Smaller hospitals could ordinarily designate several rooms for the same purpose. Even at best, Major Craighill noted that the small number of women involved made it inevitable that types of personnel and of cases were not always segregated in the manner customary for hospitals. Sick call and dispensary care presented the greatest problem. Separate dispensaries were provided only where large groups were handled; otherwise different hours were set for women. A practice generally objectionable to WAC commanders was that of having Wacs report to sick call in the orderly room of men's units, which frequently required a sick woman to walk for some distance, or made her unwilling to report at all.33
A particular problem for the WAC company commander, because of the nonactivated nature of her unit, was sometimes that of securing reports, which were frequently sent instead to the commander of the men's unit or section to which the Wac was formally assigned. Some WAC commanders were able to make local arrangements by which they were allowed to keep the women's sick book entries, these being relayed by telephone from the various units of assignment; others had more difficulty in checking on the women's status.
In either case there was noted a certain difficulty in maintaining the confidential character of medical records. In fact, evidence from all overseas theaters indicated that, whether reasonably or not, women objected so strongly to having records on their gynecological disorders handled by male cadre and civilians that the efficiency of medical care was lowered by the women's failure to reveal difficulties. Objections especially centered around such practices as writing the diagnosis on the passenger list for Wacs returning from overseas, or on the card attached to the Wac's coat. Major Craighill noted:
Privacy in regard to medical conditions is deplorably lacking in Army hospitals, as was pointed out in War Department Circular 310. . . "Maintenance of Ethical Standards by non-Professional Personnel." The practice of passing the records through numerous hands . . . quickly makes a diagnosis common knowledge and a topic of conversation. This is particularly embarrassing to women . . . and leads to hesitation about seeking medical advice.34
Partial local solutions to this problem were sometimes achieved by using WAC medical technicians in dispensaries during hours of service to women, or by special precautions in handling records.35
WAC Morbidity Rate
A complicating factor in medical care for women was the higher WAC rate of morbidity, a term used to indicate the frequency of reporting to sick call. Industrial surveys had indicated that civilian women sought medical advice twice as frequently as did men, but that as a result the average duration of an illness was less for women. The British women's services had
noted an identical effect. Industry found that the excess of medical visits by women was not due to female disorders but to the common cold and other minor respiratory disorders and digestive upsets. Men, when they finally sought advice, were more apt to have pneumonia, heart disease, or other more serious illnesses requiring longer absence from work.36
When the WAC began to note an identical phenomenon, Director Hobby was at first distressed and, in company with many medical officers on posts and stations, felt that the women were perhaps "goldbricking" or malingering. She therefore consulted The Surgeon General's Office as to whether steps should be taken to indoctrinate WAC company commanders to discourage women from reporting to sick call for minor ailments. Major Craighill and The Surgeon General's Office strongly advised her to take no such action, since the tendency was considered a desirable preventive medicine practice.
Army medical statistics soon confirmed this fact. While the WAC sick call rate was found to run about 36 percent above that of the rest of the Army, some 30 percent of WAC cases could be treated in quarters, as contrasted to 8 percent for men. As a result, the rate of admission to the hospital was about the same for women as for nonbattle cases among men, and the length of stay was less. Wacs actually lost less time from work because of hospitalization than did men, a fact attributed by The Surgeon General to the less serious character of the illnesses common among women. Thus, while women reported about 70 percent more colds than did men, and twice the amount of dysentery, men had about twice the WAC rate of pneumonia, measles, mumps, scarlet fever, rheumatic fever, and other more serious diseases.37
These statistics seemed to confirm The Surgeon General's belief that a higher sick call rate was good preventive medicine. Therefore, in order to eliminate the resentment of medical officers against enlisted women appearing on sick call, The Surgeon General's Office published a summary of the findings in several of its progress reports, stating, "The higher morbidity of the WAC need occasion no concern ...." 38
The WAC's smaller loss of time by hospitalization could not be attributed to especially efficient gynecological care, which in Major Craighill's opinion was largely nonexistent in Army hospitals. Such hospitals, naturally enough, were not originally set up with a view to caring for female patients. Even after the Army ceased to be exclusively male in composition, Major Craighill noted:
Gynecological and obstetrical conditions have not been given the recognition which the size of the problem warrants when it is considered that over 156,000 women were in the military service at one time, and that there were approximately 31,000 deliveries occurring in dependent civilian wives during 1944 in Army hospitals.
An exactly parallel situation had been found by inspectors of British women's services, who recommended the appointment of more gynecologists, preferably women.39 In late 1943 The Surgeon Gen-
eral's Office made surveys of the locations of Army doctors who had been civilian specialists in gynecology,40 but Major Craighill noted that it was not until after the victory over Japan that a systematic effort was made: to place such specialists in hospitals serving the largest numbers of women. She also reported:
Equipment and supplies for use in these conditions have not been readily available in many places because these items were not included in the early equipment and medical supply lists.
It did not appear that, while the WAC remained a tiny group in the Army, the Medical Department would find it possible to fulfill its responsibilities to women soldiers as well as it did to men on all of the scattered stations employing a few Wacs. Major Craighill was of the opinion that at least one consultant in gynecology and obstetrics could reasonably be appointed in the Office of The Surgeon General, but this was not done, these specialties instead being handled by the Surgical Service.
For this reason, very little information was collected on the extent of gynecological problems among Wacs and nurses. Only scattered reports were made on the causes and cures of the various disorders in menstruation and menopause, or the extent to which they were influenced by military service or were a handicap to it.
In 1943, a brief and sensible discussion of the anatomy and physiology of menstruation was included in WAC training courses. This was supplemented in 1941 by a general hygiene film, brief sequences of which mentioned menstruation by way of exploding popular superstitions and fallacies on the subject and teaching women a sensible health regime.41 No further attention was given the matter. However, it was ordinarily apparent to a woman, even before completion of basic training, that one of the most frequent effects of military service upon her physical condition was some change in menstruation. Some women noted considerable improvement, with less painful and more regular periods. A few experienced an increased and often debilitating loss of blood (menorrhagia), or the absence of one or more periods with consequent gain in weight and general sluggishness (amenorrhea), or increased pain and disability for a day or more each month (dysmenorrhea).
Incidental notes made on the subject by medical officers were frequently contradictory. Thus, British reports indicated that "the best menstrual health prevails among women doing strenuous and active work," and that the worst disorders were found among clerical, medical, and communications personnel and waitresses.42 This view was supported by Major Preston of the Fort Des Moines consultation service, who noted a complete lack of serious menstrual difficulties among student drivers, as contrasted with higher rates among cooks and clerks.43 On the other hand, a survey made near the end of the war noted that drivers and women who had been long in other strenuous outdoor work suffered from menorrhagia to an extent that was a distinct occupational hazard, although they experienced less
pain than other workers.44 In the absence. of any more specific studies on the subject, the validity of these observations appeared difficult to determine.
The only agency to undertake any serious research on the problem was the Army Air Forces, which reported that numbers of women at certain stations in the Florida swamps were all but disabled by menorrhagia. Some study was made of the effect of climate upon menstruation, and of the relative effectiveness of different treatments, but with little conclusion except that the sufferer usually recovered if transferred to a climate or duty to which she was accustomed.45
Unfortunately for this solution, previous regulations of The Surgeon General provided that a soldier who was a noneffective at any station would not be transferred to another to secure his recovery, but would be discharged. This regulation had been designed for male patients with asthma and similar complaints, and was intended to prevent the Army from becoming immobilized by too many members who could work only in certain climates or situations. WAC authorities protested its application to menstrual disorders, since badly needed WA(' typists and clerks who could have given good permanent service were discharged because of it. Nevertheless, no change was made in the ruling, since The Surgeon General considered it impractical to amend Army Regulations for one type of case.
Another amendment thought desirable by WAC advisers, but never granted by The Surgeon General, was one to allow post surgeons to authorize two hours or a half day in quarters for women with menstrual cramps. These ordinarily abated in the time required for aspirin to take effect, but meanwhile, under Army Regulations, a medical officer was required to commit the woman to a hospital if she was unable immediately to return to work. Since several days were ordinarily required to secure release from a hospital, increased loss of work time resulted. Industrial advisers noted an identical problem:
Industries can reduce the time lost due to dysmenorrhea by providing a place for the women to rest, hot drinks, local heat, and simple medication . . . . If such provisions are made, many women will be able to return to work after a short period, whereas otherwise they would leave the plant.46
The Surgeon General was never willing to authorize any such solution, although reports indicated that some stations had solved this and similar problems by maintaining dispensaries in which any patient might be allowed to rest for a brief period. Such dispensaries, if locally devised, had to be managed through unofficial reallotment of grades, since they were never authorized on any Tables of Organization.
Even without the recommended amendments, the efficiency of the Corps as a whole was riot perceptibly affected by menstrual problems. This fact appeared the more remarkable in view of expressed opinions before the war that woman's menstrual function rendered her so "abnormal, unstable," and so on, as entirely to disqualify her for military service. Instead, while individual women had been disqualified for certain duties or for military service, there was no instance in which the sex as a whole had been disqualified for this reason from serving in any particular Army job or in any station,
climate, or area. Industrial surveys similarly concluded that "it would appear that the ability of women to perform mental or muscular tasks is not essentially altered by the menstrual cycle.47
A strictly parallel conclusion was indicated by the more complete records kept for civilian women pilots by the Army Air Forces. Here, the Ferrying Division had at first forbidden women to fly from one day before the beginning of the menstrual period until two days after it, since the Civil Aeronautics Board handbook stated that "many women pilots have fainted while flying during this period with fatal results." This statement, the Ferrying Division noted with interest, seemed to have no foundation; many women flew steadily without fatal results, and the rule could not be enforced because
Actually, without the rather intimate cooperation of the women pilots concerned, it is difficult to understand just how the Group Commander could tell when a Waf was in a period. . . There was little anyone could do if a Waf denied being in that condition.
Even among those women who observed the rule, it was noted that few were forced "to take to their beds," but instead used this time for the required paper work and ground school and therefore lost no more flying time than men.48
Menstrual disorders tended to merge into menopausal difficulties in a few older women or in younger women suffering from surgical menopause. These disturbances were ordinarily more distressing than those of menstruation, and Director Hobby, soon after the formation of the first WAAC companies, called the problem to The Surgeon General's attention, asking whether medical examiners could not reject women who would be problems because of menopausal difficulties. The Surgeon General replied that there was no way in which the approach of menopausal difficulties could be foretold, and believed it unnecessary to take any specific action. 49 No provision was made for treatment or discharge of such cases. Upon her appointment, Major Craighill reported the policies regarding menopause to be in "a most confused state."
Throughout the next two years, WAC inspectors were informed by company commanders in the field that the problem was more important than the number of affected individuals would indicate. A company ordinarily had only one or two sufferers, yet the morale of an entire barracks could be affected by one such individual's constant complaints and chronic depression. Such women, although no asset to the Army, could not be discharged under any existing Army Regulations unless their difficulties became disabling or their conduct punishable, which was usually not the case.
Because of the number of such inspection reports, the Army Air Forces recommended to The Surgeon General that there be authorized a separate type of honorable menopause discharge for women "for the convenience of the government," similar to the special pregnancy discharge. However, this was refused by The Surgeon General on the grounds that menopause was a normal condition and not cause for discharge unless it became so
disabling that a disability discharge was appropriate.50
The Surgeon General in return repeatedly proposed that the maximum age for enlistment in the WAC be lowered from 50 to 38, to avoid admitting women liable to menopausal difficulties. Statistics revealed that the disability discharge rate for women over 40 was almost three times the average rate. Director Hobby and The Adjutant General's Office refused this suggestion, pointing out that the WAC badly needed recruits. Even under the higher discharge rate, 9 out of every 10 older women remained, and many of the most valuable skills were in this group. It was therefore believed undesirable to bar many useful mature women in order to avoid finding some means of discharging the few who had difficulty.51
Medical supply catalogs, which originally authorized only those items needed for the treatment of men, were belatedly amended to add the drugs and hormones needed for women. However, many medical officers, according to inspectors, were unaware of this, and required enlisted women to buy necessary supplies if they wished treatment.52
Major Craighill therefore in 1944 proposed to The Surgeon General that some definitive policy concerning treatment and discharge be established by headquarters. She reported that discharge of menopause cases was often refused to genuine but not "disabled" sufferers, while elsewhere disability discharge was "being used loosely, especially to avoid the stigma of psychiatric conditions, or to get rid of people who had undesirable traits of character or could not adjust." About a year later, a policy was published in a technical bulletin; the type and length of treatment was specified, and discharge was authorized if a patient showed no improvement after six months.53 By this time, as Major Craighill noted, the advice was not greatly needed, since, with V-E Day past, the Army had already authorized the discharge of any man or woman over the age of 38.
By the guarded title of Social Hygiene, WAC authorities usually avoided potentially sensational terms such as sex hygiene and venereal disease control, believing that they would affect recruiting adversely if they appeared in the public press. The Surgeon General's Office, however, although silent on the innocent problems of menstruation and menopause, had a large and active program for combating venereal disease, headed by an officer with the title of Director of Venereal Disease. This office, where dormancy would have been welcomed by WAC recruiters, promptly sprang into activity at the prospect of setting up a thorough venereal disease control program for women. In its efforts to devise a program comparable to that for men, this office was always to feel itself hampered by the Director WAC, and Director, Army Nurse Corps, because of their belief in different moral standards for women.
Thus, in the initial and all wartime admission standards, venereal disease was made a cause for rejection of women, although The Surgeon General's specialists believed that from a public health stand-
point it would be better to take such women off the community's hands and treat them, as was done with men.54
In August of 1942, there occurred a clash over what Director Hobby described
. . . the calling of a meeting of civilians, at the request of the Surgeon General, to discuss the details and scope of the sex hygiene instruction to be given by the WAAC, without reference to the Director WAAC either as to the necessity for or the advisability of such a meeting . . . to the serious jeopardy of the military and civilian acceptance of the whole idea of the Corps.55
The civilians thus consulted were scientists of the National Research Council, who were accustomed to advise The Surgeon General on venereal disease control among men, and who emerged with a proposed venereal control program for women so thorough as to disconcert even The Surgeon General. The scientists proposed that Waacs, like men, be taught all of the facts of life concerning sex and how to prevent venereal disease and that, since unmarried women would be too modest to request issue of prophylactics as men did, these be dispensed from slot machines in WAAC latrines.
WAAC Headquarters, shocked but not speechless, denounced this idea, and The Surgeon General hastily rejected it. This apparently Victorian reaction was not so exaggerated as it appeared to disciples of pure science, since the decline of WAAC recruiting a year later was in fact closely connected with the unfounded public charges, possibly based on this incident, that the Army issued Waacs prophylactics which it expected them to put to good use for "morale purposes" among the soldiers.56 Director Hobby stated that The Surgeon General, in calling such a meeting without her approval, might have wrecked the whole WAAC program had news of the meeting reached the newspapers. To this The Surgeon General replied, "It has never been considered necessary to request the permission of the Chiefs of the various Arms and Services to discuss health problems.57
The problems of preventing and treating venereal disease in women were admittedly more complex than those for men, partly because of social taboos and the double standard of morality, and partly because the physical organs involved were less easily protected from infection and less accessible to treatment. Medical officers gave fleeting consideration to setting up prophylaxis stations for women such as those for men, and to providing women with suitable prophylactics comparable to those given to men. Chemical agents, however, were known to offer little protection to women. Mechanical means were not much more reliable, and had an associated contraceptive use that made their issuance even more dangerous from a recruiting standpoint. Also, it was realized that women, unlike men, would not spontaneously avail themselves of such a station's facilities.
In any case, the whole idea was never remotely considered by the directors of the women's services. Early medical meetings concluded that, because of the high type of woman expected in the Corps, no control measures would be needed except a good training course in physiology and hy-
giene such as was given in some women's colleges. In December of 1942 Director Hobby requested that The Surgeon General's Office prepare such a course for WAAC officers to use in instructing women in health and hygiene.58
This pamphlet,59 after a rewriting by Director Hobby's office, sounded more like a moral than a medical discourse. "We all desire the Corps to be the finest organization in the world," officer candidates were taught. "Every member must insist that the conduct of the Corps be irreproachable . . . . It is difficult for one person to realize the damage she can do the Corps by her conduct alone."
After further pages in this key, a certain amount of medical information was given: woman's physiology and the proper functioning of her reproductive organs in menstruation, childbearing, and menopause; the frightful effects of venereal disease upon herself and her children; the difficulty of protection and treatment. Prospective WAAC officers were taught that war traditionally placed many stresses upon standards of conduct, and that their women must be protected against these and should be encouraged to bring all such questions to the WAAC officer. Officers were cautioned to avoid letting their women be led into injudicious conduct because of boredom, poor recreational facilities, lack of appreciation and praise of their work, or ignorance of the facts regarding sex and of how to control their own desires.
All references were in moral terms: venereal disease was "a national menace"; illegitimate pregnancy "a personal tragedy as well as a loss in womanpower": and as for abortion, "no woman should resort to this." There was absolutely no reference to prophylaxis except to say that, for women, all means were "neither effective or practicable." There was no discussion of the various chemical and mechanical means of avoiding infection and pregnancy, nor were women told where to get these prophylactics, or how to use them. In the opinion of annoyed medical officers, a more Victorian approach to the facts of life could scarcely have been contrived.
Nevertheless, it was shortly after the restricted publication of this course of instruction that there ensued the newspaper attacks of the slander campaign, which charged that a "secret document" directed that contraceptives be issued to Wacs.
The training course was not withdrawn, although the Navy Department delayed from 1943 to 1944 in distributing the WAVES' sex hygiene pamphlets and films because of the "publication of erroneous and distorted information regarding a similar program of the WAC."
The Surgeon General's Office desired to follow the pamphlet with a letter to Army medical officers in the field, directing them to assume the same responsibility for venereal disease control that they had for men, but this was discouraged by WAAC Headquarters. Instead, selected WAAC instructors were sent to a meeting discreetly titled A Conference on Preventive Medicine, and thence to a tour of the field to lecture to those company officers who had not had the new course in basic training. This avoided the possibility that some field medical officer, uninstructed in the explosive possibilities of the subject, would say something in his lecture to Wacs that the American public could consider immoral.
The Surgeon General's Office also made repeated recommendations that training
material and films on disease control be sent to the field, as well as pamphlets and posters. These ideas were all rejected by the War Department for almost another year. Finally, in 1944, permission was granted to show certain Public Health Service and Canadian films especially designed to avoid shocking the public. A carefully rewritten pamphlet was also approved, and finally a second one for women overseas, although, as Major Craighill pointed out, this appeared just as most women were nearing the end of their overseas service. All of these training aids continued to have a moral tone and gave no instruction in prophylaxis.60
Director Hobby's chief fear during this period was that, in the hundreds of stations to which Wacs were now assigned, some medical officer would erroneously apply the regulations governing men, and thus supply enemies of the Corps with grounds for stating that Wacs were urged to use contraceptives. The danger was redoubled in that the Medical Department and Military Training Division, like almost all other headquarters agencies, occasionally forgot that all Army Regulations were applicable to the WAC unless otherwise specified, and published directives that made no exceptions for women.
Thus, in April of 1944 the circular on Training in Basic Medical Subjects was already cleared for publication by Military Training Division before Colonel Hobby discovered, from an information copy, that it prescribed instruction in "individual methods of preventing venereal disease" for "all military personnel.61 To prevent such accidents in the future, Director Hobby secured publication of a War Department circular stating plainly:
It is contrary to War Department policy either to provide instruction in venereal disease prophylaxis for female personnel of the Army of the United States, or to issue venereal disease prophylaxis materials to such personnel. The provisions of Army Regulations and directives concerning these matters are intended for male personnel only and are not applicable to female personnel.62
The Director also secured publication of a circular stating that WAC unit commanders would give or arrange the periodic instruction in social hygiene that was required by Army Regulations.63
These precautions proved useful, for as late as 1945 an Army Regulation declared that "Commanding Officers will make readily available to all military personnel such venereal disease prophylactic items as are prescribed and furnished by the Surgeon General," and that instructions would include "routine use of prophylactic methods during and following possible exposure."64 In such cases it could only be hoped that field authorities were aware of the earlier circular and would not interpret "all military personnel" as including women.
If any danger to women's health resulted from a disease control program based on recruiting considerations rather than medical ones, such danger was not apparent in the rates of infection. In fact, it quickly became clear that among Wacs venereal disease was so rare as to be a neg-
ligible health problem. Although the rate for civilian women in the United States was only slightly lower than that for men-87 to 90 percent of the men's rate in 1945-the WAC rate was in all reports considerably below the men's rate, being estimated finally by Major Craighill as only about 18 percent of the men's rate. It was especially noted that, in overseas areas designated as "epidemic," where men's rates considerably exceeded the rates for the United States, the WAC rates showed no notable difference.65
The lower WAC ratio seemed partially due to the fact that the WAC excluded women infected at the time of application or with a history of venereal disease. While infections existing before enlistment were also not counted in the yearly incidence rates for men, the WAC system tended to prevent admission of "repeaters." Another factor was the smaller number of Negroes in the WAC, which had only 4 percent of Negro personnel as against 10 percent for the Army. Since rates for both men and women were higher in the Negro race, an additional 6 percent of Negroes might have raised the WAC rate somewhat. Also, the moralizing approach used by the WAC was later tried in several postwar groups of men, with some indication that, at least for younger men, it appeared to result in lower infection rates. 66
These statistics were repeatedly made available to investigating groups, but were never fully credited by the general public. Thus, toward the end of the war, a congresswoman received a letter complaining, "The rate of venereal disease among the women in our forces is increasing at an alarming speed." Director Hobby again called at the Capitol in person with the statistics, and again secured written Congressional assurance that "the matter has been answered wholly to my satisfaction. I think you should feel exceedingly proud of the Wacs." 67
At only one early period was the Corps' ability to maintain this high standard in doubt. This occurred during the Auxiliary period just before control of recruiting was taken over by WAAC Headquarters, when lowered entrance requirements caused an influx of diseased women into training centers in such numbers as, in a few units, to equal or surpass the men's rates.68 This trend was checked before it produced any notable fluctuation in the over-all rate, but gave evidence that a women's corps was by no means exempt from the Army problem, and that of civilian society, except by strict maintenance of enlistment standards. The Surgeon General ruled that women with venereal disease, although barred from enlistment, could not be discharged if admitted by faulty examinations.
The diagnosis and treatment of syphilis in women presented no particular problem for medical officers, since it was similar to that in men. The diagnosis of gonor-
rhea in women was more difficult, as smears were found unreliable and cultures required expert laboratory technique which was available in few places. The Medical Department expressed an interest in experimenting with the hitherto-unproved penicillin treatment for gonorrhea and salpingitis in women. A treatment center was established, but, said the disappointed authorities, "Unfortunately for study, very icw cases were discovered for this treatment," and the test had to be completed by civilian agencies with civilian women. Effective standards for this and other treatments were eventually developed and published.
The WAC pregnancy rate, like that of venereal disease, was never great enough to require any special studies or recommendations from the Office of The Surgeon General. The total rate varied from 0 to 7 per 1,000 per month at different times. Toward the end of the war a noticeable increase occurred, which was attributed to the return of husbands from overseas, their wives' desire to get out of the Army, or "a family was desired before becoming too old." Even so, the final average of 4 per 1,000 per month or 48 per 1,000 per year was considerably less than the rate of 117 per 1,000 per year for civilian women in comparable age groups.69 Since the WAC rate was computed on the basis of pregnancies, and the civilian rate on actual births, the gap was obviously even greater.
Medical authorities were of the opinion that the lower WAC rate did not indicate that military service was damaging to the fertility of women. It was in fact reported that many married women who had never before been able to become pregnant now did so, perhaps because of "a routine healthy life, plus the temporary separation from the husband . . . [or] high emotional states while on leave." 70
As for the necessary medical considerations for treatment of pregnant servicewomen, the Office of The Surgeon General found that these differed from existing provisions for nurses and soldiers' wives only in that most Wacs were enlisted personnel with certain service records to be kept. Thus, soon after the Corps' organization, inquiries were frequent from station hospitals as to whether pregnancy should be entered in the: individual's records as incurred "Not in line of duty," and if so, whether time lost should be required to be made good, as it was for certain other "NLD" cases, and also how these decisions would apply to the complications and sequelae of pregnancy, such as hemorrhages, toxemias, abortions, and miscarriages.71
In 1944, the Army Regulations were amended to make clear that, while pregnancy would be recorded as "not in line of duty," the individual would not be required to make good lost time, and neither AR 35-1440 nor AW 107 would apply. The same ruling was applied to the sequelae of pregnancy, except for illegal abortions. 72
A particular problem for medical officers was that of quick and accurate certification of pregnancy in order to expedite discharge. Where delay occurred, protests were frequently received from husband or
parents that miscarriage had been caused by work assigned during that period. One, for example, charged that loss of a much desired heir was "due entirely to the long hours and constant work, and the fact that as soon as her condition was known she was not discharged.73 Legal action against the responsible medical or company officers was sometimes threatened. Also, delay was highly undesirable from the public relations viewpoint, since women whose condition had become obvious were seen by the public in near-outgrown uniforms and were invariably assumed to be unmarried.74
In Auxiliary days, WAAC Headquarters had requested The Surgeon General's Office to work out a means for applying a laboratory test to ensure very early diagnosis. However, the request was rejected by The Surgeon General as "not practical" because it required a large supply of nonpregnant rabbits and quarters for the same, both being difficult to find.75 Late in 1944, an addition to Army discharge regulations required that "the diagnosis will be certified as early as possible in pregnancy . . . . This does not preclude observation for a reasonable period of time in which to make certain that the diagnosis is correct.76 At this time, medical officers were also authorized to use any biological or other tests that they desired, without cost to the patient.
The only further step that Director Hobby was able to obtain to expedite discharge was an administrative one, which prevented transfer of a woman to another station or overseas before a medical officer had completed his observation: "No transfer will be effected if there is reason to suspect the existence of pregnancy until clearance has been obtained from the medical officer responsible for the care of such personnel. 77 Even with this safeguard, Major Craighill noted that in overseas theaters, "Cases of pregnancy which were reported as likely prior to overseas shipment have been sent overseas, even against the protest of the unit commander." 78
While the incidence of unmarried pregnancy was not regarded as great enough to merit any special studies, Major Craighill and her staff on field visits made incidental notes of the factors that seemed to them to lead unmarried women into misconduct and resulting pregnancy. It was noted that the rate varied surprisingly in detachments within the same area-from only 1 pregnancy in 15 months in one detachment, to 7 times that many in a neighboring one. Several factors were isolated that appeared to have some relationship:
Detachments with a good company commander
had low pregnancy rates.
Most pregnancies occurred, oddly enough, where women were subject to the most restrictions, bed check, etc.
Detachments with the least recreation facilities had the most pregnancies.
Length of service was a positive factor, and possibly length of assignment to one station, with resulting fatigue and boredom.
Women a long distance from home were more susceptible.
None of the cases occurred in women who were accustomed to drinking. 79
Major Craighill upon her appointment found that no action had yet been taken toward the study or analysis of women's psychiatric disorders. Upon visiting training center hospitals, she noted that they "were being filled with inadequate persons whose cases presented a major problem in disposition." At recruiting stations, she found that all types of psychiatric examinations, or none, were being given, with psychiatric rejection rates varying from 3 per 1,000 examined to 89 per 1,000. It was evident that the first figure was too low, since four out of five of all discharges for neuro-psychiatric reasons followed quickly after enlistment.80
In an attempt to meet the problem, Colonel Hobby requested that psychiatric examiners be given better instructions and that mental hygiene units be set up in WAC training centers, to screen out the worst of the examiners' mistakes before they reached the field, and to salvage recruits with minor difficulties. 81 Little action was taken on the request until the spring of 1944, when Col. William C. Menninger was appointed to head The Surgeon General's Neuro-psychiatric Division. Colonel Menninger's attitude toward the problem was expressed in a memorandum to his staff-
I raised quite a little hell about the fact that psychiatrists in the field who were supposed to examine Wacs didn't know about the WAC program in many instances . . . . What did you ever do about it? Let's get going.82
By the end of 1944 Colonel Menninger had secured explicit directions to medical examiners, and had also established a pioneer mental hygiene unit at Fort Des Moines under the direction of a Menninger-trained psychiatrist, Maj. Albert Preston, Jr. During the eighteen months of its existence the unit compiled, from 18,000 interviews, extensive statistics on the psychiatric problems of women in military service and the differences of such problems from those of men.83
Much of the success of the project was attributed by Major Preston and by the commandant of the training center to the fact that the unit, called the Consultation Service, was not attached to the hospital but worked closely with classification and assignment officers. According to these authorities, women would seldom voluntarily seek out a psychiatrist at a hospital, knowing that his duty was to use their disclosures against them in obtaining their discharge, but when a psychiatrist was available in a separate office, to give advice and counsel on job difficulties and adjustment, women would and did flock to see him.84
Such a unit was also found more suitable than the Auxiliary's earlier system of employing a civilian resident counselor, similar to the British system of traveling counselors called The Twelve Elder Sisters. Such counselors, while badly needed in the absence of any others, were found to be handicapped by the danger that their
advice might be regarded as civilian interference.85
The Consultation Service rendered "psychiatric first aid" to Wacs, advised commanding officers and classification officers, and gave mental hygiene lectures. It was discovered that women showed less resentment than men to psychiatric referrals, which Major Preston attributed to "the fact that in women the socially acknowledged and permitted emotionalism is accepted and not judged as a conflict, stigma, or weakness, as in men." About 25 percent of the women treated by the Consultation Service were discharged; the remainder were salvaged with some degree of success.
The success of the unit prompted the WAC's National Civilian Advisory Committee to recommend, at its meetings in October of 1944 and again in February of 1945, that more mental hygiene facilities of the same type be provided, with mobile units to reach those companies too small to merit permanent consultation service. This measure was believed impracticable for either men or women by The Surgeon General, who reported that "this office is unable to see clearly the need for mobile mental hygiene units. 86
Material collected by the Des Moines unit convinced psychiatrists that "women faced definite psychological factors of significance" in attempting to adjust to military life, where they must "'subordinate traditional feminine attitudes and functions." By the "adoption of a severely masculine and identical style of dress," women were believed to have lost one traditional feminine means of "individuality, competition, and gratification," a problem not experienced to a like degree by men, who were customarily more regimented in dress and expressed their individuality by other means. Because of their early training, women were also believed to require a greater effort at adjustment to the lack of privacy in bathing, dressing, and other living arrangements.
Most important, General Menninger believed, was the conflict with public opinion. Inconsistently enough, the approved feminine role was "a passive and dependent one . . . even in our own democracy," while at the same time "the modern girl child in America is not taught to be the passive, dependent individual our culture has conceived of as the normal of adult femininity." This conflict, although existing for all American women, was intensified for Wacs, even as contrasted with the Army Nurse Corps, whose military status might meet public disapproval but whose profession was at least '.universally regarded and accepted as a feminine function." On the other hand, military service was believed to offer some psychological compensation through an opportunity for women to release many feminine frustrations and become active, independent individuals.
Psychiatrists also noted that the Corps as a whole faced one special problem because of its volunteer nature. Volunteers, as contrasted to draftees, included more "unsuitable individuals such as the maladjusted and those seeking glamour." They were also apt to feel "some inherent right to have some choice in their assignments, duties, and locations." If improperly assigned they were more likely to be
"wondering if they were contributing enough," or contrasting Army jobs with those for which they might more wisely have volunteered elsewhere.87
The control group of 18,000, which Colonel Menninger called "a cross-section of WAC's," contained 10,000 patients and only 8,000 normal women interviewed for other purposes. It was therefore not surprising that, as expressed in psychiatric language, almost all volunteers' motives appeared alarming to the layman: those who wished to play an active part in the war effort were displaying signs of "masculine identification"; those who wished to share war's sufferings with the men were termed "masochists," while those who thought the WAC would be enjoyable were "escapists"; and even those carried away by patriotic emotions were probably "hysterical."
Major Preston observed, "It was found that neither emotional, practical, or intellectual motivation was a guarantee for success in the WAC . . . . The greater the opportunity given for fulfillment of the motivation for enlistment, the greater were the gains both personal and military." Thus, a former file clerk who enlisted because of a desire to do outdoor work appeared to be more useful if allowed to work in that capacity than if forced into a sedentary or "feminine" field.
Among patients of the Consultation Service, as contrasted to Wacs generally, Major Preston found "selfishness predominant . . . the hoping to gain something from the Army. They are much more anxious to gain than to give." Many had also hoped that the Army would be more pleasant than their homes, would "'make them well," or "make a woman of them." Others hoped that they would be treated harshly, desiring to punish themselves for some reason. One candid individual observed that "her husband was such a good man and spent so much on her and her family, that she was so happy, that she felt she didn't have the right to be so happy, so she enlisted in the WAC.88
A composite picture of "the maladjusted WAC" was compiled by Major Preston as an example to recruiters of a type which could easily be detected and avoided:
She is 26 years of age; she is careless and untidy in her personal appearance . . . . She has completed the tenth grade at an advanced age, stopping school after several failures because she was embarrassed at being older, or was tired of it. After leaving school she usually stayed around home doing nothing, being dependent upon her family financially and emotionally, and then is apt to have had multiple periods of brief employment of an unsatisfactory type, clerking in 5 and 10 stores, being an elevator operator, waitress, grocery clerk, or some similar occupation.
She has had several abdominal operations, perhaps even a complete hysterectomy in her early twenties, or if she has not had such a history, the patient describes several episodes of what she terms as a "nervous breakdown." . . . Most frequently she comes from a broken home and had poor relationships with her step-parents . . . one or more of whom have been in some difficulty, legal or psychiatric. She married impulsively at 18 or 19 and chose a man whom she had known for only a brief period of time. Her first marriage usually ended in divorce and again she married impulsively. She has had a life of constant conflict between herself and her environment . . . . Finally and again impulsively she enlisted in the WAC as an escape from an intolerable home situation, often leaving a dependent child at home to be cared for by her parents. She states that when she was re-
cruited, she was promised a good job, early promotion, a furlough . . . that her lack of education did not matter and that she would not have to do physical training, drill, Glasswork . . . . When this utopia has finally exploded, she comes to us again seeking an escape from an environment which is too rigid for her quotient of adaptability.89
As compared to a well-adjusted group of women whom he approved for leadership school, Major Preston noted that the disturbed group had twice as many cases of broken homes as did the normal group, four times as many divorces, five times as many abdominal operations, seven times as many "nervous breakdowns." It also had at least twice as many married women.
If any material was collected by the Consultation Service concerning the technical manifestations of neurotic and psychotic traits in women, or the treatment of the same, this did not remain in War Department files.90 The only exception was the subject of homosexuality, which was investigated briefly because of the apparent public impression that a women's corps was the ideal breeding ground for it. One accuser stated that Fort Oglethorpe was "full of homosexuals and sex maniacs." 91 Director Hobby upon receipt of this allegation at once requested the Army's Inspector General to determine the true situation. The Inspector General complied, but was able to find very little evidence of homosexual practices; the incidence seemed no greater and probably less than in the civilian population.92
The only explanation that could be found for such accusations appeared to be the vague and erroneous nature of popular ideas on the subject: any woman who was masculine in appearance or dress, or who did not enjoy men's company, was apt to be singled out for suspicion. Medical authorities pointed out that the true female homosexual was only occasionally of this type, and more often just the opposite. WAC company commanders were especially cautioned to avoid witch-hunting based on such amateur impressions.
The problem was complicated by the fact that emotional demonstrativeness was an accepted trait among women, who thought nothing of kissing or embracing female friends or walking arm-in-arm with them, while medical officers sometimes viewed these traits with the alarm that would have been attached to identical behavior among men. It was also true that the nation, where masculine comradeship was commonplace, had few traditions of friendship between women; a woman who was capable of liking other women was popularly regarded as slightly peculiar. In actual fact, many members of the women's services noted that there was possible a comradeship among women quite similar to that which men had traditionally enjoyed, and which for honesty, loyalty, and freedom from tension and selfish motives often surpassed the average man-woman relationship. Army psychologists encouraged this loyalty of woman to woman, as an aid to growth in maturity and leadership.93
Because the problem of homosexuality
occurred so rarely in the WAC, The Surgeon General believed that no course of instruction in the problem was needed, but merely a reference to it in lectures by the psychiatrist. There were some indications that in a peacetime career service the problem might require more specific action, but that a wartime "citizen's Army" would present no more problem than did the rest of the nation.
Accidents and Injuries
All evidence indicated that the rates of accidents and nonbattle injuries were almost identical for enlisted men and women in the Army. The rates as recorded for a six-month period in 1944 showed 72 injured per 5,000 strength each year for women and 70 for men, while an eighteen month survey near the end of the war corrected this figure to show a slightly lower rate for women-about 50 per 1,000 per year for women against about 55 for men. No studies were made by The Surgeon General's Office that would have indicated the nature and causes of the accident rate for women. 94
The only detailed study in this respect was made by the Army Air Forces, which employed a WAC officer in its Ground Safety Division. There was found to be considerable difference in the type, place, and cause of injury for men and women, according to the Air Forces statistics in a limited survey. It appeared that women had less than half as many motor vehicle accidents as men, either on or off the post. When assigned to perform technical work, women also had less than half as many accidents on the job. In mess hall work and kitchen police, women might have more strained backs but had fewer other injuries, so that total rates were much the same for men and women.
On the other hand, the advantage of women in driving and technical work was evened in the total rate by the fact that when a Wac was placed on some level or generally harmless area she would, a third again as often as men, fall down and acquire a sprain or strain. The Air Forces noted with curiosity that most of women's injuries had no relation to their jobs and that "one of the most common types is falls-falling on stairways and curbings, falls on ice, or stumbling while simply walking on the post .... About one half of all the injuries studied thus far are stumbling, tripping, and falling on the same level."
Recurring frequently in reports were falls while entering and alighting from vehicles or jumping from the backs of trucks; falls due to running in barracks, especially on stairways; falls due to jumping off porches or down stairs; slips and falls on freshly mopped floors; back sprains due to improper lifting; slips while climbing on boxes and chairs to reach high places: and tripping, sliding, slipping, or colliding in games and sports. Surveyors were unable fully to account for this Wac propensity, noting only that "the question of why women have such accidents is complicated."
There appeared to be some relation to the fact that a wholly satisfactory women's military shoe had never reached some stations, and that in any case a woman's medium-heeled oxford was obviously less suitable for action than a man's shoe. Even if the proper footgear for sports had been issued, it appeared highly probable that the average woman was also less ac-
customed to baseball, football, and other active sports and athletics for which an Army station had facilities.
While the total rates for both men and women appeared relatively tiny, the Air Forces made every effort to lower them, pointing out that the rate showed one injury per 28 women each year, with about 8,000 workdays lost. Women's injuries appeared to be slightly less serious than those for men; for each injury, women remained hospitalized a total of 15.59 days as against 18.19 for men.
Some commanders reported good results from warning signs or posters at spots in halls, stairways, and porches where members were particularly prone to run or jump. On the other hand, civilian studies indicated that such an approach might actually increase accidents by implanting unconscious ideas of a fall in such locations, and that the best preventive measures required psychological assistance to those "accident-prone" individuals who ordinarily accounted for a disproportionate share of accident rates. If any later emergency should require large-scale use of women in more active physical work, some further evaluation of preventive measures seemed useful. 95
Weight and Diet
The WAC master menu, published by The Quartermaster General in 1944, came too late to prevent what appeared to observers to be a widespread condition of overweight among Wacs, who for two years had eaten Army menus while performing chiefly sedentary jobs. A somewhat inconclusive sample of Wacs in training indicated that 82 percent gained weight, to an average gain of 6 pounds, during the six weeks of basic training, at the end of which period some 45 percent were overweight; some 42 percent had gained an inch in waist measurement and 59 percent of them in hip measurement.96
The Director, perceiving the trend, consulted The Surgeon General's Office in 1944 as to the best means of bringing to Wacs' attention the relationship of weight to health. The result was a War Department circular appearing late in 1944, entitled Weight Control in the WAC. Unfortunately, its chief result, insofar as could be determined, was to bring down on Wacs in the field an unmerciful ribbing from male personnel who found the circular enjoyable reading matter. Any more beneficial results, although possible, had not been reported by the end of the war.97
Fatigue and Health Impairment
As the war neared its end, one of the more important medical problems began to be the onset of fatigue, with corresponding adverse effects upon health and efficiency. As distinguished from combat fatigue in men, the problem for women appeared to be just the opposite, caused by unrelieved sedentary work that had long since lost any visible closeness to the war effort.
In order to define the problem, and counteract it if possible. Director Hobby
in April of 1945 requested The Surgeon General to make a survey of the Factors of Fatigue Influencing the Effectiveness of WAC Personnel. 98 Little was known on the subject. Industrial surveys recognized that there existed "a decreased capacity to work as a result of previous work or activity," but were unable to state exactly what caused it, except that it did not appear to be related to strength, health, injuries, or blood cell count. 99
Returns from The Surgeon General's survey indicated, as hoped, that the situation had not yet caused any noticeable diminution of WAC efficiency, in the opinion of Army commanders. When asked to what extent their Wacs' efficiency had declined since the beginning of the war, section chiefs replied overwhelmingly that it had not declined but increased. It was estimated by these section chiefs that they would have rated 74 percent of the women excellent or superior when they first began their jobs, and that by the end of the war 85 percent were considered excellent or superior.
On the other hand, the opinion of medical officers and of the women themselves was that fatigue and health impairment were rapidly mounting with each month of service. Almost one half of the women were found to be more nervous than before they enlisted, about one fourth suffered from increased mental depression, and one fourth had more colds. Only negligible numbers were found to be in better health, less nervous, or less depressed, and less than one percent had fewer colds. A startling 40 percent were diagnosed as suffering from "true fatigue," defined as decline in efficiency, loss of interest in outside activity, and listlessness, accompanied by "the weariness which does not respond to the usual form and amount of relaxation." Medical surveyors did not count as "fatigue" the mere weariness that vanished after proper sleep or recreation.
It was found difficult to isolate the factors that had caused this fatigue. It appeared that some factors which had no perceptible effect in six months or a year began later to exert influence. Thus, it was found that 50- and 60-hour work weeks were the rule, and that many Wacs worked more than 60 hours a week, but these showed no more fatigue than those on an easier schedule. Similarly, the type of messing facilities seemed to make little difference, and the availability of recreation facilities made only slight difference. However, length of service was an important factor, with fatigue growing in direct proportion to months served, until in those with over two years' service, half were fatigued. This factor was puzzling, since the duties were not greatly different from those of which civilian women made lifetime careers without any such adverse results.
The type of housing proved to have a direct relationship to fatigue, with those who slept in rooms being considerably less fatigued than those who were in barracks. The Surgeon General's Office noted, "The rooms [for two to four women] were well ventilated; the women had similar working hours and were able to choose their own room-mates. This led to similar sleeping habits and congeniality."
The effect of age was the opposite of that expected, as older women were less
tired than the younger ones. Women with family responsibilities, particularly those worried about their parents, were slightly more tired. The number of months a woman had gone without a promotion also had some influence, but slight.
One single factor appeared to have more influence on fatigue than all the others combined, and this was occupation-the woman's job and her interest in it. The group of women not interested in their work showed almost twice as much fatigue as those with keen interest. Medical surveyors reported:
The women felt that they had entered the service to do a job; they expected many changes in their lives and many inconveniences, but if they had work they liked and felt was worthwhile, the unpleasant things paled to insignificance.
In every occupational group, this held true. Cooks, who were fatigued in spite of little actual damage to health, were revealed to have least interest in their jobs; drivers were very little fatigued, in spite of heavy work, because they thought their jobs interesting. Greatest fatigue was found among shift workers whose sleeping, eating, and recreational habits were necessarily irregular.
Medical surveyors also attempted to judge the impairment of health by military service, and the causes of damage. As in industry, it was found that poor health and fatigue had no necessary connection, since some women in perfect health were suffering from fatigue and decline in efficiency, whereas others whose service had actually damaged their health still enjoyed their work and felt no fatigue or loss of efficiency. About 20 percent of the Wacs appeared to have suffered some loss of health through military service, including more days of illness, more visits to sick call, more respiratory and menstrual disorders, and more headaches and nervousness.
Again, a woman's job appeared to be the greatest factor influencing her health. Clerical workers showed the greatest health impairment, due largely to frequent respiratory infection, headaches and nervousness attributable to poor office ventilation, unbroken sedentary work, and eye-straining jobs. Drivers were second in health impairment. Surveyors noted, "The very factor of constant driving which gave drivers a variety of scenes and associates and was functional in decreasing their fatigue was resultant in their menstrual difficulties." Cooks were well below other groups in respiratory infections and sick call visits.
Although the survey came too near the end of the war to effect changes in current personnel, housing, or medical practices, it appeared significant that military service in the type of work of which civilian women made lifelong careers should, after a mere two or three years of military service, produce "true fatigue" in 40 percent and health impairment in 20 percent.
There was no provision for women in the physical and occupational reconditioning programs provided for men. There were no accommodations for women at convalescent centers. In the last year of the war, the WAC's National Civilian Advisory Committee recommended to The Surgeon General that women be included in the Army's physical and mental reconditioning programs, but the recommendation was never favorably considered, for unspecified reasons presumably related to
the expense of facilities for such a small group.100
When WAC demobilization began, the Office of The Surgeon General succeeded in getting the system of a few centralized stations for medical examinations of women, which it had never been possible to get in recruiting. Although men were demobilized through dozens and later hundreds of points, women were processed through only six, where women medical officers made certain that adequate gynecological examinations were given. Major Craighill felt that the process was "a most interesting and valuable medical procedure in indicating the health of large groups of women of varied social, economic, and age distribution" -a cross section more varied and therefore more valuable than a similar number of examinations of more homogeneous groups in industry and colleges. She recommended, "This mass of information should be more carefully studied by analysts for the future welfare of civilian women."
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