THE MEDICAL DEPARTMENT: HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR UNITED STATES ARMY IN WORLD WAR II The Technical Services THE MEDICAL DEPARTMENT: HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR by Clarence McKittrick Smith I MILITARY 1NSTRVCTDN I OFFICE OF THE CHIEF OF MILITARY HISTORY DEPARTMENT OF THE ARMY WASHINGTON, D. C, 1956 This volume, one of the series UNITED STATES ARMY IN WORLD WAR II, is the first to be published in the group of Medical Department volumes in the subseries THE TECHNICAL SERVICES. All the volumes will be closely related and the series will present a com- prehensive account of the activities of the Military Establishment during World War II. A tentative list of subseries is appended at the end of this volume. Library of Congress Catalog Card Number: 54-60005 For sale by the Superintendent of Documents, U. S. Government Printing Office Washington 25, D. C. - Price $4 (Cloth) UNITED STATES ARMY IN WORLD WAR II Kent Roberts Greenfield, General Editor* Advisory Committee (As of 1 June 1954) James P. Baxter President, Williams College Gordon A. Craig Princeton University Elmer Ellis University of Missouri William T. Hutchinson University of Chicago Charles H. Taylor Harvard University Maj. Gen. Elwyn D. Post Army Field Forces Brig. Gen. Verdi B. Barnes Army War College Brig. Gen. C. E. Beauchamp Command and General Staff College Brig. Gen. LeonardJ. Greeley Industrial College of the Armed Forces Col. Thomas D. Stamps United States Military Academy Office of the Chief of Military History Maj. Gen. Albert C. Smith, Chief Chief Historian Kent Roberts Greenfield Chief, War Histories Division Col. G. G. O’Connor Chief, Editorial and Publication Division Lt. Col. T. E. Bennett Chief, Editorial Branch Joseph R. Friedman Chief, Cartographic Branch Wsevolod Aglaimoff Chief, Photographic Branch Maj. Arthur T. Lawry *General Editor of the Technical Service volumes, Lt. Col. Leo J. Meyer, Deputy Chief Historian. V History of THE MEDICAL DEPARTMENT prepared under the direction of Maj. Gen. S. B. Hays, The Surgeon General, U.S. Army . . . to Those Who Served Foreword Few Army activities are subject to closer scrutiny than those of protecting the health of the troops and binding up the wounds of those who have borne the battle. As in the matter of feeding and clothing, the general public has well- established civilian standards against which it can measure the efficiency of those responsible for the Army’s medical service. When conducted with speed and professional competence this service is a source of comfort to both the man in uniform and his family and friends; when it fails to equal or excel the system of medical care to which American society is accustomed it is subject to imme- diate and strong protest from a people able and willing to criticize. The success- ful conduct of a military medical service therefore requires not only a knowl- edge of contemporary civilian medical practice but also administrative talent capable of adjusting the demands of the public and the medical profession to the Army’s needs in time of war with the minimum of friction. This is the first volume of a series which relates the hospitalization and evacuation experience of the Army in World War II. It should prove enlighten- ing both to military men directly or indirectly concerned with the Army’s medical service and to that large group of doctors and hospital administrators who daily face policy and management problems similar to those recounted here. A. C. SMITH Major General, USA Chief, Military History Washington, D. C. 25June 1954 Introductory Note The medical histories of the Civil War and the First World War which were published under the auspices of earlier Surgeons General contain lengthy descriptions of hospitalization and evacuation in rear areas. The present volume therefore continues the Army Medical Service’s tradition of presenting a detailed account of these operations during a great war. The contrasts between World War II and earlier wars in matters of hospitali- zation and evacuation are of course striking. The Army provided—at a maxi- mum—more than twice as many hospital beds in the United States in World War II as it did in World War I, although curiously enough the number of beds in the zone of interior hospitals of World War I was very little larger than that in the Federal rear-area (“general”) hospitals of the Civil War. The process of transporting and regulating the flow of patients to these hospitals in World War II differed in important respects from the methods used earlier. Yet despite these—and many other—changes, real elements of continuity existed. The convalescent hospitals and specialty centers, which became outstanding features of the World War II hospital system, existed on a smaller scale in World War I. The horse-drawn ambulance of the Civil War gave way to the motor ambulance of the two world wars, but hospital trains carried large numbers of patients in 1864 as in 1918 and 1945. Even the use of airplanes for transporting Army patients in the United States, an important factor in evacuation during World War II, had its small beginnings in World War I. These observations are not meant to imply that the recent changes in hospitalization and evacuation outside the combat areas were less numerous or important than the features which remained essentially the same. They are merely a reminder that the full meaning of this volume can only be grasped if it is read with some knowledge of earlier events. Even without this background, however, readers who now or in the future are engaged in the work of hospitali- zation and evacuation should find much in the account to help them build on the achievements and avoid the pitfalls of the past. If the book serves that pur- pose, the work of the author and his assistants will be amply justified, as will the interest of the many officers and civilians who responded so freely when called upon for their personal knowledge of the events described. The author of Hospitalization and Evacuation, fpne of Interior, Clarence McK. Smith, is a graduate of Newberry College, South Carolina, has an M.A. degree from Harvard, and except for a dissertation, has completed the requirements for a Ph.D. degree at Duke University. He taught history at Newberry College from 1940 until he entered the Army in World War II. During the war he served as an officer in the Medical Administrative Corps of the Army. From 1946 to 1954, he was a member of the Historical Division of the Office of The Surgeon General. Washington, D. C. 11 January 1955 GEORGE E. ARMSTRONG Major General, U.S. Army The Surgeon General XII Preface This volume is one of several planned for a series on the history of the Med- ical Department of the United States Army during World War II. It deals primarily with the logistics of hospitalization and evacuation. As used here, therefore, the term “hospitalization” means all of the instrumentalities— buildings, equipment, supplies, and personnel—which directly served sick and wounded soldiers1 in the attempt to restore them to physical fitness; and the term “evacuation” includes all of the means necessary to move patients from one place to another, whether from the battlefield to a hospital in the rear of combat zones, or from one hospital to another in the United States. The pro- fessional care of patients is not discussed in this volume; this subject will be treated fully in other studies being prepared by specialists in the various fields of medicine and surgery. Nor are details of the internal administration and operation of hospitals and evacuation units described here except to the extent necessary to explain the evolution of general policies and practices affecting the system of hospitalization and evacuation as a whole. Also, this volume confines itself almost entirely to events in the zone of interior (that is, the United States). This approach excludes any account of overseas hospitaliza- tion and evacuation operations, but not a discussion of the plans and prepara- tions for them in the United States. Hospitalization and evacuation in theaters of operations will be covered elsewhere in this series. Treatment in this volume of the evacuation of patients from theaters to the United States might seem illogical unless the reader understands that the Army considered this operation a function of the zone of interior. While hospitalization and evacuation are closely related, each is a compli- cated operation within itself. For simplicity and clarity they are treated in this volume as separate subjects, the first three parts dealing with hospitalization and the fourth with evacuation. Any account of hospitalization and evacuation involves some consideration of such elements as supplies and personnel. This volume therefore necessarily overlaps to some extent the subject matter of other volumes planned for this series. An effort has been made to keep such duplica- tion to a minimum, with the result that some subjects may seem to have been slighted and others—such as the services of the Red Cross in hospitals—over- looked. Fuller information on these topics will be found in other volumes being written by the Army and by other agencies. 1 A system of hospitalization and evacuation for army animals was also maintained by the Med- ical Department, but was of small dimensions and is not dealt with in this volume. Though many agencies of the War Department were involved in the actions required to provide the Army with hospitalization and evacuation services— the War Department General Staff, especially its G-4 Division; the offices of The Surgeon General, the Air Surgeon, and the Ground Surgeon in Washing- ton, and of surgeons of local commands elsewhere; the headquarters of the Army Ground, Air, and Service Forces; and the offices of chiefs of various tech- nical services—emphasis has been placed in this volume on the work of The Surgeon General and his Office. While the history is not written with any con- scious partiality for the viewpoint of The Surgeon General, it is written from his vantage point. There are several reasons for this approach. Most important is that The Surgeon General by tradition and directive is the chief health officer of the Army, and it is to him that the public looks when matters of health and medical care are concerned. A more practical reason is that the records of the Surgeon General’s Office were more readily available than those of the offices of other surgeons. Finally, concentrating upon activities of the Surgeon Gen- eral’s Office is a very useful means of limiting the scope of this work and of giv- ing it focus, without excluding consideration of actions affecting hospitalization and evacuation by agencies on higher, parallel, and lower levels of authority. This volume is based almost entirely on records filed in various collections under the jurisdiction of the Department of the Army. With minor exceptions the author had free and unlimited access to them. Because of The Surgeon General’s decision not to request “top secret” clearance for historians, the writer was not permitted to use the few files retaining that classification. This limitation is believed to have been of little consequence, because most of the once top-secret documents either had been given lower classifications or had been declassified altogether by the time they were needed. The author was also denied access to files of The Inspector General containing confidential com- plaints made to his representative during inspections of individual installations, but reports of more general inspections and investigations of hospitalization and evacuation by the chief medical officer on the staff of The Inspector General were made available. Compared with the records actually used, those to which access was denied are probably insignificant in quality as well as quantity. Publicity already given to the “tons of documents” through which one must search in the preparation of a volume of this kind makes it unnecessary to com- ment further on that subject. Because of the nature of the source material for this volume, the form of its footnotes may appear unconventional to some readers. The following general observations will help in understanding them. Normally, a document is first identified by its type, file number (in some instances), sender, addressee, date, and subject. Its location is then given by indicating the collection of files and the specific folder in that collection in which it is found. The security classifica- tion of documents is not given. Numerous technical terms have been used in this work, despite an earnest effort to avoid employing words and phrases in a manner understood by mem- bers of the military establishment but not by general readers. As a rule, tech- nical terms and general terms given a special meaning by the Army are ex- plained when they are first introduced in the text. Abbreviations have been used freely, especially in the footnotes. In most instances they are those author- ized by the Army. Reference to a list of abbreviations at the end of the volume will help the reader interpret many of them. The problem of how to designate Army officers whose ranks changed from time to time has been settled by giving the rank an officer held at the time of the action discussed. An effort also has been made to mention at some point in the work the highest rank an officer held during (but not after) the war. A word of caution is in order about the statistical data in this volume. They were compiled from documents used in wartime operations, and further investi- gation by statisticians may eventually result in figures that are somewhat dif- ferent. Nevertheless, it is believed that any variations will be inconsequential and will not diminish the historical significance of the data used here. It is impossible to acknowledge in detail all of the help which the author received in the preparation of this work. Many acknowledgements will be found in footnotes throughout the volume. As for others, the author is especially indebted to Miss Zelma E. Mcllvain and Mr. Hubert E. Potter for their assistance. Miss Mcllvain did the major portion of research for Part Four and prepared preliminary drafts for much of Chapters XXII, XXIII and XXIV. Mr. Potter assisted in research for parts of Chapters XXII, XXIII, XXIV and XXV, and prepared preliminary drafts for certain portions of them. In addition, he assisted the writer immeasurably in obtaining impor- tant, hard-to-find documents. The author is also indebted to the entire staff of the Historical Unit. Mrs. Josephine P. Kyle, Chief of its Archives and Research Branch, and her staff were indefatigable in searching for and locating not only large blocks of files but also individual documents requested by the writer. Typists of the Admin- istrative Branch spent many weary hours making extracts from documents and typing drafts and final copies of chapters. Editorial clerks of this Branch pre- pared the tables in this volume and carefully checked and rechecked the manuscript before it was finally submitted for publication. My colleagues in the Historians Branch, and especially its chief, Dr. Donald O. Wagner, who supervised the preparation of this study, reviewed the manuscript and made many helpful suggestions for its improvement. The Armed Forces Institute of Pathology prepared the organization charts, under the supervision of Miss Sylvia Gottwerth, formerly of the Historical Unit. Finally, Col. Joseph H. McNinch, MC, Col. Roger G. Prentiss, Jr., MC, and Col. Calvin H. Goddard, MC—successive chiefs of the Historical Unit—gave the author and his assist- ants unflinching support, especially by their scholarly attitude toward the preparation of this volume. A word of appreciation is also due to many persons outside the present Sur- geon General’s Office. Many officers who participated in events discussed in this volume—now retired or serving in other assignments—gave the author valuable help. Those interviewed usually spoke freely and frankly of their ex- periences. Others made excellent critical comments on drafts of chapters submitted to them for review. The information which they thus furnished was especially helpful in filling in the background of important documents and events. The names of many appear in footnotes throughout the volume, but two deserve special mention here—the wartime Surgeons General, Maj. Gen. James C. Magee and Maj. Gen. Norman T. Kirk. The author is also grateful for criticisms and editorial assistance from Col. Leo J. Meyer, Deputy Chief Historian, Office of the Chief of Military History, and from members of the Editorial Branch of the same Office. Washington, D. C. 10 March 1953 CLARENCE McK. SMITH Contents PART ONE Hospitalization during the Emergency Period, 8 September 1939—7 December 1941 Page INTRODUCTION 3 The State of Army Hospitalization, 1939 3 Effect of the War in Europe 6 Chapter I. ORGANIZATION AND RESPONSIBILITIES FOR HOSPI- TALIZATION 8 The Surgeon General’s Position in the War Department 8 The Surgeon General’s Office 9 The Surgeon General’s Control Over Hospitals and Hospital Units . . 10 II. PLANNING FOR AND EXPANDING HOSPITALS IN THE UNITED STATES 13 Hospital Construction 13 Hospital Administration 26 HI. PLANS AND PREPARATIONS FOR HOSPITALIZATION IN OVERSEAS AREAS 38 Mobilization Planning 38 Preparing Hospitalization for Overseas Areas During a Peacetime Mo- bilization 43 PART TWO Hospitalization in the Early War Years, 7 December 1941—Mid-1943 INTRODUCTION 53 IV. CHANGES IN ORGANIZATION AND RESPONSIBILITIES FOR HOSPITALIZATION 54 Reorganization of the War Department 54 The Surgeon General’s New Position 55 The Wadhams Committee 61 Changes in the Surgeon General’s Office 61 A Dispute About General Planning for Hospitalization and Evacuation. . 63 XVII 304244 0—55 2 Chapter Page V. HOSPITAL PLANTS IN THE UNITED STATES 68 Types of Construction 68 Estimates of Hospital Capacity Needed 78 Location, Siting, and Internal Arrangement of Hospital Plants .... 88 Maintenance of Hospital Plants 94 Conformity of Hospital Construction to Needs 100 VI. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR HOS- PITAL SYSTEM 103 Command Relationships of Hospitals 103 Special Types of ASF Station Hospitals 109 Port and Debarkation Hospitals 113 Designation of General Hospitals for Specialized Treatment 116 The Question of Establishing Convalescent Hospitals 117 VIE MINOR CHANGES IN HOSPITAL ADMINISTRATION . . 121 Question of Simplified Organization and Internal Administrative Pro- cedures 121 Efforts To Shorten the Average Period of Hospitalization 124 Early Changes in the Size and Composition of Hospital Staffs 131 Problem of Furnishing Supplies and Equipment for Hospitals 137 VIII. PROVIDING HOSPITALIZATION FOR THEATERS OF OP- ERATIONS 140 Meeting Early Emergency Needs 140 Modification of Hospitals for Overseas Areas 143 Hospital Units in the Troop Basis 149 The Question of Equipping and Using Numbered Hospitals in the ffone of Interior 151 Preparing for the Support of Offensive Warfare 160 PART THREE Hospitalization in the Later War Years, Mid-1943—1946 INTRODUCTION 169 IX. FURTHER CHANGES IN ORGANIZATION AND RESPON- SIBILITIES FOR HOSPITALIZATION 171 Relationship of The Surgeon General With Other War Department Agen- cies 171 Expanding and Strengthening the Surgeon General's Office 176 Chapter Page X. ADJUSTMENTS AND CHANGES IN THE ZONE OF INTE- RIOR HOSPITAL SYSTEM 181 Closure of Surplus Station Hospital Facilities 181 Establishment of Regional Hospitals 182 Development of Convalescent Hospitals 188 Merger of Adjacent Hospitals 190 Attempts To Limit the Use of General Hospitals as Debarkation Hos- pitals 191 Extension of the Practice of Establishing Specialized Centers 194 General Hospitals for Prisoners of War 195 Establishment of Hospital Centers 198 XI. BED REQUIREMENTS IN THE ZONE OF INTERIOR. . . 200 First Attempts To Base Requirements on an Estimate of the Patient Load . 201 Movement To Reduce the Number of Hospital Beds in the United States . 202 Changes in the Manner of Reporting Beds 207 Meeting Increased Requirements for the Peak Patient Load 208 XII. ESTIMATING AND MEETING REQUIREMENTS OF THE- ATERS FOR HOSPITAL BEDS. . . 214 Factors Influencing Bed Requirements 214 Establishment of Bed Ratios for Theaters of Operations 216 Efforts To Provide Theaters With Authorized Quotas of Beds .... 218 Estimating Requirements for Major Combat Operations 224 Movement To Reduce Authorized Bed Ratios 227 The Problem of the European Theater in the Winter of 1944-45. . . . 234 XIII. CHANGES IN POLICIES AND PROCEDURES AFFECTING THE OCCUPANCY OF HOSPITAL BEDS IN THE ZONE OF INTERIOR 238 Problem of Limiting Hospital Admissions 238 Measures To Shorten the Length of Patient-Stay 239 XIV. CHANGES IN SIZE AND MAKE-UP OF THE STAFFS OF ZONE OF INTERIOR HOSPITALS 248 General Nature of Changes 249 Wider Use of Administrative Officers 250 Alleviation of the “Shortage” of Army Nurses 251 Greater Use of Limited Service Men 253 Replacement of Military by Civilian Employees 255 Use of Wacs in Army Hospitals 256 Use of Prisoners of War in Army Hospitals 259 XIX Chapter Page XV. IMPROVEMENTS IN THE INTERNAL ORGANIZATION AND ADMINISTRATION OF HOSPITALS IN THE UNITED STATES 261 Simplification of Administrative Procedures 262 Work-Measurement and Work-Simplification Programs 265 Additional Activities and Their Place in The Organizational Structure of Hospitals 266 Effect on Hospitals of the ASF Standard Plan for Post Organization . . 267 Emergence of Standard Plans for Hospitals 268 Details of the Medical Department's Standard Plans 271 XVI. CHANGES IN THE ORGANIZATION AND EQUIPMENT OF HOSPITAL UNITS PREPARED FOR OVERSEAS SERVICE. 279 Trend Toward Use of Larger Units 279 Cuts in Personnel of Hospital Units 280 New Hospital Units 282 Changes in Supplies and Equipment 283 XVII. HOSPITAL CONSTRUCTION AND MAINTENANCE. ... 286 Providing Housing for Additional Beds in General and Convalescent Hos- pitals in the United States 287 Construction of Additional Facilities at Existing Hospital Plants . . . 289 Improvements in Existing Hospital Plants 293 Housing for Hospitals in Theaters of Operations 296 XVIII. RETURN TO A PEACETIME BASIS 300 Redeployment and Demobilization of Numbered Hospital Units .... 300 Contraction of the ffine of Interior Hospital System 302 PART FOUR Evacuation to and in the Zone of Interior INTRODUCTION 319 XIX. ESTIMATED AND ACTUAL REQUIREMENTS FOR EVAC- UATION FROM THEATERS OF OPERATIONS .... 323 XX. DEVELOPMENT OF PROCEDURES FOR EVACUATION FROM THEATERS TO THE ZONE OF INTERIOR ... 331 Procedures for Sea Evacuation 331 Procedures for Air Evacuation 337 Procedures for Debarkation 340 XXL MOVEMENT OF PATIENTS IN THE UNITED STATES . . 346 Regulating the Flow of Patients 346 Procedures for Rail Evacuation 349 Procedures for Air Evacuation 357 XX Chapter Page XXII. PROVIDING THE MEANS FOR EVACUATION BY LAND. . 360 Motor Ambulances 360 Hospital Trains 369 Problems in Manning Hospital Trains 388 Supplies and Equipment for Hospital Trains 391 XXIII. PROVIDING THE MEANS FOR EVACUATION BY SEA. . . 394 Ships' Hospitals and Hospital Ships 394 Medical Attendants for Service on Transports 414 Hospital Ship Complements 419 Problems in Providing Supplies and Equipment for Hospital Ships and Transports 422 XXIV. PROVIDING THE MEANS FOR EVACUATION BY AIR. . . 426 Aircraft 426 Medical Flight Attendants 437 Efforts To Supply Appropriate Equipment for Air Evacuation 441 XXV. EVACUATION UNITS FOR THEATERS OF OPERATIONS. 447 Organization, Personnel, and Equipment 447 Activation, Training, and Use in the United States 457 SUMMARY AND CONCLUSIONS 463 LIST OF ABBREVIATIONS 471 BIBLIOGRAPHICAL NOTE 477 INDEX 485 Tables No. Page 1. Comparison of the War Department’s Plan and The Surgeon General’s Recommendation for Fixed Beds for Theaters of Operations 40 2. Army Hospitals Established in Converted Civilian Buildings by End of 1943 73 3. Building Schedule for Type-A Hospital, General Hospital Plan 77 4. Positions and Ranks in Zone of Interior Hospitals Permitted but not Required To Be Filled by Medical Administrative Corps Officers, 9 April 1941 132 5. Hospital Units Shipped Overseas, 7 December 1941 to 1 July 1942 . . . 144 6. Affiliated General Hospital Units 157 7. Affiliated Evacuation Hospital Units 158 8. Use of Nonaffiliated General Hospital Units Activated during 1941... 161 9. Use of Nonaffiliated Station Hospital Units Activated during 1941 .... 162 10. Use of Nonaffiliated Evacuation Hospital Units Activated during 1940 and 1941 163 11. Use of Nonaffiliated Surgical Hospital Units Activated during 1940 and 1941 164 No. Page 12. ASF Debarkation Hospitals 193 13. Hospitalization Data as of 29 June 1945 211 14. Evacuation Policies and Authorized Bed Ratios, Major Theaters of Operations 235 15. U. S. Army General Hospitals in the United States during World War II. 304-13 16. Patients Debarked in the United States, 1920-45 324 17. Hospital Car Procurement Program, 1940-45 374 18. United States Army Hospital Ships in World War II 406 Charts No. Page 1. Status of Station and General Hospital Beds in Continental United States: August 1940-December 1941 25 2. Hospital Organization as Suggested by TM 8-260, July 1941 27 3. Organization of Lawson General Hospital, 1941 29 4. The Surgeon General’s Estimates in 1941-42 of Bed Requirements in General Hospitals in Continental United States and Actual Beds Reported January 1942-July 1944 85 5. Status of Station and General Hospital Beds in Continental United States: December 1941-June 1943 102 6. Organization of Baxter General Hospital Compared With Standard Plan for SOS Post Organization, 1942-43 125 7. Organization of the SGO for Hospitalization and Evacuation, 1943-45 . 179 8. Hospital Beds Authorized and Occupied by Type of Hospital in Con- tinental United States: 1943 and 1944 204 9. Hospital Beds Authorized and Occupied, and Patients Reported in all Hospitals in the Continental United States: June 1944-December 1946. 212 10. Hospital Beds Authorized and Occupied, and Patients Reported by Convalescent, Regional, General, and Station Hospitals in Continental United States: June 1944-December 1946 213 11. Fixed Hospital Bed Capacity and Occupancy in Overseas Theaters: March 1943-December 1945 220, 221 12. Organization of Mayo General Hospital, 1944 269 13. Comparison of Standard Plans for Organization of ASF Posts and ASF General Hospitals, 1945 272 14. Standard Plan for Organization of ASF Convalescent Hospitals, 1945. . 274 15. Organization of Percy Jones Hospital Center, 1945 276 16. Standard Plan for Organization of a Hospital Center (ZI), 1945 .... 277 Illustrations Page Plan for Cantonment-type Hospital 16 Lawson General, a Cantonment-type Hospital 17 Valley Forge General, a Semipermanent-type Hospital 24 Plan for Theater-of-Operations-Type Hospital 71 Oliver General Hospital 72 Plan for Type A Hospital 74 Birmingham General, a Type A Hospital. . . . 75 McGuire General, a VA-Type Hospital 79 Location of General, Convalescent, and Regional Hospitals During World War II 89 Placing the Fourth Litter Patient in a Field Ambulance 362 Field and Metropolitan Ambulances Used in 1942 363 Motor Ambulances 364 Exterior View of Multipatient Metropolitan Ambulance, 1945 368 Interior of the Multipatient Metropolitan Ambulance 369 Stationary Beds in Hospital Ward Car, 1941 372 Dressing Room in Hospital Ward Dressing Car, 1942 375 Plans for Hospital Cars, 1941-42 376 Plans for Rail Ambulance Car and New Hospital Unit Gar 384 Ward in New Hospital Unit Car, 1944 386 Receiving Room in New Hospital Unit Car, 1944 387 Surgical Ward on USAHS Shamrock 408 Surgical Ward on USAHS Louis A. Milne 409 Dressing Station on USAHS Louis A. Milne 410 The USAHS Larkspur 411 C-46 Transport Plane Ready To Unload Patients 429 Interior of C-46 Transport Plane 430 Interior of C-54 Transport Plane 431 Loading a Patient on an L-5 Plane 436 All illustrations are from the files of the Department of Defense except those on pp. 386, 387 which were obtained from American Car and Foundry Co. PART ONE HOSPITALIZATION DURING THE EMERGENCY PERIOD 8 SEPTEMBER 1939—7 DECEMBER 1941 Introduction The State of Army Hospitalization, 1939 When President Roosevelt proclaimed a “limited national emergency” on 8 Sep- tember 1939, just one week after Germany invaded Poland, the Medical Department of the United States Army was operating 7 general hospitals and 119 station hospi- tals. Five of the general hospitals were lo- cated in the United States—Walter Reed at Washington, D. C.; Army and Navy at Hot Springs, Ark.; Fitzsimons at Denver, Colo.; Letterman at San Francisco, Calif; and William Beaumont at El Paso, Tex. The other two were in overseas posses- sions—Tripler in the Hawaiian Islands and Sternberg in the Philippines. Of the station hospitals 104 were on Army posts in the United States and Alaska, while the remainder were divided among the Philip- pine Islands, the Hawaiian Islands, and the Panama Canal Zone. Each station hos- pital was designated by the name of the post on which it was located and each general hospital, except one, was named for a deceased medical officer. Hence, sta- tion and general hospitals in the United States in both peace and war, as well as those in overseas possessions in peacetime, were called “named hospitals.” Station hospitals and general hospitals had different functions. The former served local and ordinary needs, usually receiv- ing patients from stations where located and treating those with minor ills and in- juries only. General hospitals, on the other hand, were designed to serve general and special needs. By transfer from station hospitals they received patients who suf- fered from severe or obscure diseases as well as those who needed complicated surgery. Capacities of named hospitals depend- ed largely upon troop populations served. Other factors also influenced their capac- ities, such as climate, prevalence of dis- ease, general physical condition of troops, and types of activities in which the latter were engaged. Hospital capacities and hospital requirements were expressed in terms of beds, which in the Army meant not only beds themselves but also shelter, equipment, utilities, and personnel that went with them. For an Army strength of 135,749 in the United States and Alaska in June 1939 there were 4,136 general hospital beds and 8,234 station hospital beds. This represented a bed ratio to strength of approximately 3 percent for general hospitals and 6 percent for station hospitals. For a strength of 10,993 in the Philippines there were 317 general hospi- tal beds and 360 station hospital beds. In the Hawaiian Islands, the most healthful of overseas possessions, there were 350 general hospital beds and 360 station hos- pital beds for a strength of 20,601. The Panama Canal Zone, with next to the highest sick rate in the Army, had only 269 station hospital beds for a strength of 13,533, a ratio of 1.98 percent. This un- usual situation resulted from the fact that civilian Canal Zone hospitals—Gorgas, Colon, and Corozal—staffed with Army Medical Corps officers but under the con- trol of the Governor of the Canal Zone, 4 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR cared for a considerable portion of the Army’s patients in that area.1 The Surgeon General believed that the Army’s hospitals were inadequate, even for peacetime needs. He had begun a long- range program in 1934 to improve and ex- pand them but funds appropriated by Congress for Medical Department con- struction had been sufficient for little more than essential maintenance of existing buildings. As a result, the Army’s hospitals in 1939 were poorly suited to any increase in its strength. In Panama only fifty beds were located in a hospital building. The remainder were crowded into buildings erected for other purposes. Hospital plants in the Hawaiian and Philippine Islands needed repairs and alterations. In the United States hospital buildings were small and widely scattered among a num- ber of permanent Army posts. Erected twenty-five to thirty years before, many lacked facilities for the separation of pa- tients according to grade, sex, and disease, and for such modern diagnostic and treat- ment procedures as basal metabolism, X-ray, and oxygen and physical therapy. Of the entire number, The Surgeon Gen- eral considered only twenty-five as mod- ern, fire-resistant buildings and only fifty of the remainder as worth modernization. The others, he believed, should be re- placed with new buildings.2 For the care of patients in theaters of operations in wartime the Medical De- partment had a doctrine of hospitalization and evacuation that dated from the Civil War and had been successfully applied during both the Spanish-American War and World War I. Casualties were given emergency treatment at a series of medical stations established in the forward areas of combat zones. To provide such treatment as well as the transportation of patients, when necessary, from one station to another farther to the rear, every regiment and separate battalion of all arms and services, except medical, had a medical detachment, and every division had a medical regiment, medical battalion, or medical squadron. To furnish as near the front as possible a higher type of treatment than first aid or emergency medical care, hospitals designed for easy movement and hence called “mobile hospitals” were as- signed to field armies. They were of three types: surgical hospitals, evacuation hospi- tals, and convalescent hospitals. Surgical hospitals were planned for use in either di- vision or army areas of combat zones. In division areas they were to carry out emergency procedures, such as treatment of shock, control of stubborn hemorrhage, reconstitution of blood following hemor- rhage, and fixation of complex fractures, in order to prepare men with serious in- juries for further removal to the rear. In army areas they performed much the same function as evacuation hospitals. Evacuation hospitals normally served only in the rear areas of combat zones. They provided definitive treatment for evacuees from forward areas and for the sick and 1 Annual Report of The Surgeon General, U.S. Army, 1939 (Washington, 1940), pp. 170, 250; 1940 (Wash- ington, 1941), p. 1 (cited hereafter as Annual Report . . . Surgeon General). Only Puerto Rico, with a mean annual strength of 1,312, had a slightly higher admis- sion rate than Panama. Puerto Rico had no Army hospital in the middle of 1939. 2 (1) Annual Report . . . Surgeon General, 1937 (1937), pp. 167-68; 1939 (1940), p. 253; 1940 (1941), p. 265. (2) Hearings before the Subcommittee of the Committee on Appropriations, House of Representatives, 76th Cong, 1st session [H. R. 6791] Supplemental Military Appropriation Bill for 1940 (Washington, 1939), pp. 157-58. (3) Statement of MD Activities by Maj Gen James C. Magee, SG, USA, for the Subcmtee of the House Gmtee on Mil Approps (1939). HD: 321.6-1. (4) Pre- liminary Estimates, QMG, FY 1941 (25 May 39). Off file, Hosp Cons Div, SGO. (5) An Rpts, CA Surgs. SG; 319.1-2. (6) C. M. Walson, “Observations at Army Hospitals,” Army Medical Bulletin, No. 42 (1937), pp. 65-72. INTRODUCTION 5 injured of surrounding areas. They re- turned some patients to duty after short periods of treatment, transferred others with prospect of early recovery to conva- lescent hospitals, and prepared still others for transportation to general hospitals for continuation of treatment. Convalescent hospitals were not staffed and equipped to perform major surgery. Their chief func- tion was to restore to physical fitness pa- tients received from evacuation hospitals, to treat cases of venereal disease, and to care for patients from units located near by. For service in communications zones there were station and general hospitals. The latter received patients not only from station hospitals but mainly from evacua- tion and surgical hospitals. They returned some to duty in theaters of operations and transferred others for further treatment to general hospitals in the zone of interior. Since it was expected that hospitals in communications zones would rarely need to be moved, station and general hospitals were called “fixed hospitals.” When sev- eral were grouped in one location they might be combined into a hospital center with a 1,000-bed convalescent camp. All hospitals in theaters of operations, whether fixed or mobile, were designated by num- bers rather than by names and locations, and hence were called “numbered hos- pitals.” 3 Unlike named hospitals in the United States, numbered hospitals had standard capacities, staffs, and equipment that were established by tables of organization, tables of basic allowances, and equipment lists. Tables of organization for hospitals showed the capacities of installations which different units were designed to operate. While tables of basic allowances listed equipment authorized for units and their members, they did not itemize such articles as drugs and biologicals, surgical gauzes, surgical instruments, dental sup- plies and equipment, laboratory supplies and equipment, X-ray supplies and equip- ment, and operating-room equipment. These were included under one heading as an “assemblage.” Items for hospital as- semblages were listed individually and by amounts in Medical Department equip- ment lists. For use in theaters of operations in June 1939 the Medical Department had little more than doctrine. Only five Medical Department field units were in existence— four medical regiments (two of which were overseas) and one medical squadron. Ac- cording to The Surgeon General, failure to have other units in training resulted from a shortage of Medical Department enlisted men. Congress limited their num- ber to 5 percent of the strength of the Army, and use of more than 4 percent in named hospitals and other peacetime in- stallations left few for field units. Early in 1939 The Surgeon General had sought an increase in the Medical Department’s allowance of enlisted men, but without success.4 To provide officers for wartime hospi- tals—physicians, dentists, and nurses— The Surgeon General had proposed in March 1939 the revival of “affiliated units.” These were reserve units sponsored by civilian hospitals and medical schools. Such units had been organized by the American Red Cross during World War I and had contributed substantially to Army hospital service in France. “I am convinced,” wrote Surgeon General Charles R. Reynolds, “that the Medical Department can have reserve hospital 3 AR 40-580, MD, Hosps—Gen Provisions, 29 Jun 29. 4 (1) Cmtee to Study the MD, 1942, Testimony of Col Albert G. Love, p. 2. HD. (2) Annual Report . . . Surgeon General, 1939 (1940), pp. 179-82. 6 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR units ready to function as required . . . only by civil institutions sponsoring these units, especially those needed within the early periods of mobilization. . . 5 In August 1939 the Secretary of War ap- proved in principle The Surgeon Gen- eral’s plan to organize affiliated units to staff 32 general, 17 evacuation, and 13 surgical hospitals. Full approval was given several months later.6 The only reserve equipment which the Medical Department had on hand was that stored after World War I. It was “of 1918 vintage, incomplete in modern oper- ating-room equipment, wholly deficient in essential laboratory equipment, totally lacking in X-ray, physical therapy and hydrotherapy equipment, and stocked with scientific items now obsolete and rapidly becoming obsolescent.” 7 More- over, with few exceptions, tables of or- ganization and tables of basic allowances for field medical units, including hospitals, had not been changed since 1929, and the preparation of new equipment lists for them had just been begun in January 1939.8 To prepare for war the Medical De- partment had to start almost from scratch. Effect of the War in Europe The period of the emergency in the United States was for the Medical De- partment a time of partial preparation for war through the provision of the hospitali- zation actually required for an expanding Army. Its steps in this direction were sometimes painful and often halting. Sev- eral factors accounted for this. Formal mobilization planning of the Medical De- partment, like that of the rest of the Army, was based upon a belief that the antici- pated force of 1,000,000 to 1,200,000 men would be called up only if the United States or its possessions were attacked. It was therefore essentially defensive in na- ture. Moreover, there was uncertainty about the nature of increases of the Army—whether rises in the authorized strength of the Regular Army were tem- porary or permanent and whether or not the mobilization that finally occurred was for a year of training only, as it purported to be. Furthermore, funds which the Gen- eral Staff could secure for the entire Army, let alone the Medical Department, were limited by the caution of the President and the sentiment of Congress. Finally, The Surgeon General and his associates, like many others in the Army and the Government at large, found it difficult to break peacetime habits of thought and action in order to plan imaginatively for a second World War.9 5 (1) Ltr, SG to TAG, 17 Mar 39, sub: Affiliation of MD Units with Civ Insts. HD: 326.01-1 (Affiliated Units). (2) The Medical Department of the United States Army in the World War (Washington, 1923), vol. I, p. 102 (cited hereafter as The Medical Department . . . in the World War). 6 (1) Cmtee to Study the MD, 1942, Testimony, pp. 8-10. HD. (2) Annual Report . . . Surgeon General, 1940 (1941). pp. 177-78. (3) For a full discussion of the re- vival of affiliated units see John H. McMinn and Max Levin, Personnel (manuscript for a companion vol- ume in this series). HD. 7 Ltr, SG to TAG, 6 Apr 40, sub: Status of MD for War. AG: 381 (4-6-40) (1). 8 (1) Tables of organization and tables of basic allowances that were available in June 1939 are on file in HD. (2) Incl 2, Ltr, Brig Gen Harry D. Offutt to Col H. W. Doan, 10 Jun 48. HD: 322. (3) Interv, MD Historians with Gen Offutt, 10 Nov 49. HD: 000.71. 9 Mark S. Watson, Chief of Staff: Prewar Plans and Preparations (Washington, 1950), pp. 15-56, 126-71, in UNITED STATES ARMY IN WORLD WAR II, discusses plans and preparations of the General Staff, along with limiting factors and influences, in considerable detail. Robert E. Sherwood, Roosevelt and Hopkins: An Intimate History (New York, 1950), pp. 157-62, discusses the difficulty Government Depart- ments displayed in adjusting to planning for a global war. INTRODUCTION 7 The war in Europe had almost immedi- ate effects upon the Army and the Medical Department. In September 1939 the au- thorized enlisted strength of the Regular Army was increased from 210,000 to 227,000. The next spring, as the Nazi war machine rolled toward the English Chan- nel, it was again raised—to 280,000 in May and to 375,000 in June. Then, in the latter part of 1940, after the fall of France, Congress approved a peacetime mobiliza- tion. From September of that year until December 1941, the Army’s strength grew from 438,254 officers and enlisted men to 1,686,403. The Medical Department had to expand its operations accordingly. This involved mainly building up facilities in the United States, where 85 to 90 percent of the troops were stationed, but hospitals in overseas possessions also had to be ex- panded and additional ones provided for new Atlantic defense bases. While a regu- lar system of field hospitalization and evacuation was as yet unnecessary, medi- cal units had to be organized and prepared for such service.10 The expansion of hospital facilities in the United States involved many consider- ations. Decisions had to be made as to the types of housing to be used and the num- ber of beds that would be needed. Means had to be found for providing suitable hos- pital plants in as short a time as possible. New hospitals had to be manned and the staffs of old ones augmented. “Green” offi- cers had to organize hospitals and establish procedures for their administration. Sup- plies and equipment had to be placed in hospital plants at appropriate times. Finally, it was necessary to develop proce- dures for the operation of the greatly expanded hospital system. The preparation of hospital units for field service sometimes conflicted with these activities, for such units also de- manded personnel and equipment. The amount they should be given while in training was a moot question. The number of such units to be activated had to be de- termined. After they were organized they needed to be trained. Before most of these steps could be taken, tables and lists gov- erning their organization, manning, and equipment had to be revised and modern- ized. The challenge of an expanding Regular Army and a peacetime mobilization affected only slightly the organizational structure of the Army for hospitalization. Yet this structure and its changes must be understood before the actions of various agencies in providing hospitalization are discussed. 10 Biennial Report of the Chief of Staff of the United States Army, July 1,1939 to June 30,1941, to the Secretary of War (Washington, 1941) (cited hereafter as Biennial Report . . . Chief of Staff, 1939-41). Figures on strength of the Army were supplied by the Strength Account- ing Branch, AGO. CHAPTER I Organization and Responsibilities for Hospitalization Hospitalization, like other activities of the Medical Department, was planned and supervised by medical officers called surgeons. The commander of every non- medical military organization, from head- quarters of the Army in Washington (War Department) to battalions in the field, had on his staff a surgeon whose duties were both advisory and administrative. As a staff officer he advised on matters affecting the health of all members of a command and exercised technical control (that is, professional and medical as opposed to administrative and military) over all med- ical activities under the jurisdiction of his commander. As an administrative officer he also exercised command control over his own office and in some instances over certain medical units and organizations such as hospitals.1 The Surgeon General’s Position in the War Department The chief medical officer of the Army was The Surgeon General.2 He served as medical adviser to the Chief of Staff and was directly responsible to him for the planning and technical supervision of all Army hospitals. In his capacity as head of a service he commanded, beside the per- sonnel in his own Office, medical “field installations” of the War Department. Like the chiefs of other arms and services, such as the Chief of Infantry, the Chief of the Air Corps, and The Quartermaster Gen- eral, The Surgeon General was subject to supervision by the War Department Gen- eral Staff. The General Staff, while it had no authority to command, in actual practice did so, issuing directives and orders and approving or disapproving recommenda- tions of The Surgeon General. In such in- stances it acted in the name of the Chief of Staff or the Secretary of War. The Staff had five divisions, each of which repre- 1 (1) AR 40-10, MD, The MC — Gen Provisions, 6 Jun 24. (2) Blanche B. Armfield, Organization and Administration (manuscript for a companion volume in this series), has a full discussion of the organization of the Medical Department. 2 The War Department capitalized the definite article in the formal designations of certain general officers, presumably to distinguish them from others with similar titles. ORGANIZATION AND RESPONSIBILITIES FOR HOSPITALIZATION 9 sented a functional grouping of duties of the Chief of Staff. They were the Person- nel (G-l), Military Intelligence (G-2), Organization and Training (G-3), Supply (G-4), and War Plans (WPD) Divisions. The Supply Division was charged by Army regulations with the preparation of plans and policies for hospitalization and evacuation and the supervision of such activities. In peacetime it limited itself in this field primarily to matters of construc- tion and supply. The Personnel Division handled matters pertaining to personnel that were Army-wide in scope; the Organ- ization and Training Division, those relat- ing to the organization, training, and use of field units. Direct communication be- tween divisions of the General Staff and any chief of service (such as The Surgeon General) was authorized by Army regula- tions, but formal requests and decisions were normally channeled through the Office of The Adjutant General, the War Department’s office of record.3 In the latter part of 1940, after mobiliza- tion began, medical officers were assigned to several War Department agencies hav- ing a direct interest in hospitalization and evacuation. In October 1940 Brig. Gen. (later Maj. Gen.) Howard McC. Snyder was assigned to the Office of The Inspector General and remained in that position until the end of the war. Shortly afterward a medical officer was transferred from the Surgeon General’s Office to General Headquarters (GHQ), an organization established in July 1940 to supervise the training of field forces, including medical units. About the same time Lt. Col. (later Brig. Gen.) Frederick A. Blesse was placed in the G-4 division of the General Staff. During 1941 he was transferred to GHQ and was succeeded in G-4 by Maj. (later Col.) William L. Wilson.4 The Surgeon General’s Office When President Roosevelt proclaimed the emergency, The Surgeon General was Maj. Gen. James C. Magee. He had suc- ceeded Maj. Gen. Charles R. Reynolds the preceding June. Most divisions of his Office had something to do with hospitali- zation and evacuation. Particularly con- cerned was the Planning and Training Division, headed by Col. (later Brig. Gen.) Albert G. Love. It had three subdivisions: Planning, Training, and Hospital Con- struction and Repair. The last of these operated almost independently, its chief, Lt. Col. (later Col.) John R. Hall, having direct access to General Magee.5 This sub- division handled all of The Surgeon Gen- eral’s construction problems, estimating bed requirements and planning hospitals. In this work it collaborated with the War Department’s constructing agencies—the Quartermaster Corps and the Corps of Engineers. This subdivision grew from 2 officers, 3 civilian architects, and 4 clerks in September 1940 to 4 officers, 4 archi- tects, and 7 clerks by the end of 1941.6 The remainder of the Planning and Training Division dealt with medical field units. It 3 (1) Mark S. Watson, Chief of Staff: Prewar Plans and Preparations (Washington, 1950), pp. 57-84, in UNITED STATES ARMY IN WORLD WAR II, has an excellent discussion of the origin and powers of the General Staff. (2) AR 10-15, Gen Staff, Orgn and Gen Duties, 18 Aug 36. (3) EM 101-5, Staff Officers’ Field Manual, 19 Aug 40. 4 (1) Armfield, op. cit. (2) Kent R. Greenfield, Rob- ert R. Palmer and Bell I. Wiley, The Organization of Ground Combat Troops (Washington, 1947), pp. 1-32, in UNITED STATES ARMY IN WORLD WAR II, have a discussion of the development of GHQ. 5 Interv, MD Historian with Col Love, 27 Aug 47. HD: 000.71. 6 Achilles L. Tynes, Data for Preparation of Histori- cal Record of Construction Branch of The Surgeon General’s Office during the Expansion Period of the Army and World War II (1945) (cited hereafter as Tynes, Construction Branch). HD. 304244 0—55 3 10 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR estimated the number that would be re- quired and prepared or revised their tables of organization and equipment. Until GHQ was established in July 1940, this Division also supervised the training and use in the United States of hospital and other medical units. The Finance and Supply Division furnished hospitals with supplies and equipment and allotted them funds for the employment of civilians. The Military Personnel, Dental, Veterinary, and Nursing Divisions handled military personnel and certain professional matters. The Professional Service Division estab- lished policies for medical care and treat- ment and issued technical directives to maintain professional standards.7 In recognition of the growing impor- tance of problems of hospitalization during mobilization, a Hospitalization Subdivi- sion was set up in the Professional Service Division in February 1941. Two months later it was separated and became the Hospitalization Division. Lt. Col. (later Col.) Harry D. Offutt was made its chief and continued in that capacity throughout General Magee’s administration. Estab- lished with one officer and one clerk, this division expanded to three officers and three clerks by the end of June 1941. Al- though it was charged with the develop- ment of plans and policies for hospitaliza- tion and evacuation through liaison with other divisions of the Surgeon General’s Office, it had neither the authority nor the staff to make comprehensive plans and co- ordinate the actions of others in making such plans effective.8 The Surgeon General’s Control Over Hospitals and Hospital Units While all hospitals were under the tech- nical supervision of The Surgeon General, not all were subject to the same control by his Office. The degree varied according to the command structure of the War De- partment. For administrative purposes the United States was divided into nine corps areas, each in charge of a corps area com- mander under the jurisdiction of the Chief of Staff. Overseas possessions were organ- ized into three departments that corre- sponded administratively to corps areas in the United States. All stations in depart- ments and most in corps areas were under the command-control of department and corps area commanders respectively. Lo- cated within corps areas but beyond the jurisdiction of their commanders were field installations of the War Department. They operated directly under the chiefs of various arms and services in Washington and were therefore called “exempted sta- tions.” Hospitals classified as War Department field installations were subject to the great- est amount of control by The Surgeon General because they were under his com- mand. All general hospitals in the United States were in this category. In only one instance was an intermediate commander between The Surgeon General and a gen- eral hospital commander. Walter Reed General Hospital was under the jurisdic- tion of the commandant of the Army Med- ical Center (Washington, D. C.), who was in turn under the command of The Sur- 7 Armfield, op. cit. 8 SG OOs 32, 13 Feb 41; 87, 18 Apr 41. In an inter- view on 15 November 1949 Brig Gen H. D. Offutt stated that he never felt handicapped by a lack of per- sonnel in his division. HD: 000.71. In an interview on 10 November 1950 Maj Gen James C. Magee (Ret) stated that no one division could have exercised authority over all factors involved in hospitalization and that vesting such authority in one division would have subordinated other divisions of the Surgeon General’s Office to a sort of oi'erlordship. HD; 314 (Correspondence on MS) HI. ORGANIZATION AND RESPONSIBILITIES FOR HOSPITALIZATION 11 geon General. Despite this intermediate step, Walter Reed actually received closer supervision from the Surgeon General’s Office than did other general hospitals, largely because of its proximity. Next in line in degree of control were hospitals of exempted stations of all other services and of all arms except the Air Corps. For ex- ample Fort Benning (Georgia), including its station hospital, was under the Chief of Infantry and Fort Belvoir (Virginia) was under the Chief of Engineers. The chiefs of arms and services normally had no sur- geons on their staffs and were therefore prone to refer problems connected with hospitalization to The Surgeon General. He employed corps area surgeons as his own field representatives to supervise hos- pitals of exempted stations. Corps area hospitals, under the command-control of corps area commanders, were supervised by corps area surgeons in their dual capac- ities as local staff officers and technical representatives of The Surgeon General. Hospitals furthest removed from the lat- ter’s influence were those in overseas de- partments, not only because of their dis- tance from Washington but also because department surgeons did not serve as field representatives of The Surgeon General.9 Although hospitals of the Air Corps were theoretically in the same class as those of exempted stations of other arms and services, they were actually in a some- what different category. The Chief of the Air Corps had in his Office a Medical Division, whose head was analogous to a staff surgeon and therefore assumed con- siderable authority over Air Corps station hospitals. During 1940 and 1941, as the Air Corps expanded, the number of such hospitals increased. Soon after a reorgani- zation of the air forces in June 1941, which established the Army Air Forces and gave it control over the Air Corps, the Secretary of War directed a blanket exemption of all Air Corps stations—new as well as old— from corps area control. The following October the head of the Air Corps Medi- cal Division, Col. (later Maj. Gen.) David N. W. Grant, was assigned to AAF head- quarters and designated “Air Surgeon.” This series of events tended to separate Air Corps hospitals from other Army hospitals and to place them more under control of AAF headquarters at the expense of the Surgeon General’s Office.10 A shift of responsibility which affected The Surgeon General’s control over medi- cal units, including those for numbered hospitals, had meanwhile occurred. Until late 1940 certain corps area commanders and surgeons acted also as commanders and surgeons of the four field armies in the United States. Corps area surgeons were therefore responsible, under their com- manders and The Surgeon General, for supervising the training of field medical units. In October 1940, the command of field armies was taken away from corps area commanders and placed in the hands of separate army commanders responsible to GHQJn Washington. GHQand army headquarters were charged with the train- ing and use on maneuvers of all field units. Actually, this transfer of training functions was not so complete as anticipated,11 even though in November 1940 all table-of- 9 (l)'-AR 170-10, CAs and Depts, Admin, 10 Oct 39. (2) AR 350-105, Mil Educ, Gen and Spec Serv Schs—Desig, Loc, and Orgn, 1 Oct 38. (3) Armfield, op. cit. 10 (1) Rad MX-F, TAG to CGs of CAs, 27 Jun 41. (2) Ltr, TAG to GofAAF and ACofS G-4 WDGS, 12 Sep 41, sub: Trf of Gen Staff Functions . . . to AAF. Both in AG: 322.2 (6-18-41)(l) Sec 2. (3) Hubert A. Coleman, Organization and Administration, AAF Medical Services in the Zone of Interior (1948), pp. 45-76. HD. 11 See below, pp. 43-48. 12 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR organization units in the United States, including those of the Medical Depart- ment, were either assigned or attached to armies or corps.12 In the changes just enumerated were seeds that were eventually to grow into bitter weeds for The Surgeon General. Among them were the trend of the Army Air Forces toward separatism and its de- velopment of a separate set of hospitals, the establishment of medical officers in headquarters on a higher level of author- ity than The Surgeon General, and the latter’s partial loss of authority over medi- cal field units. Understanding something of these changes and of responsibilities and relationships of various War Department agencies, one may now turn to a consider- ation of the manner in which the Army provided hospitalization during the emer- gency period. 12 (1) Greenfield et al., op. cit., pp. 3-4, 6-9. (2) Armfield, op. cit. (3) Ltr, TAG to GGs all Armies, Army Corps, CAs, CofS GHQ, etc., 4 Nov 40, sub: Units Asgd and Atchd to GHQ, Armies, and Corps. . . . AG: 320.2 (8-2-40)(4) Sec 3. CHAPTER II Planning for and Expanding Hospitals in the United States Hospital Construction Early Basic Decisions Any large-scale expansion of “hospital facilities”—that is, wards, offices, and clinics normally found in civilian hospi- tals, plus housing for commissioned and enlisted personnel, storage for medical and military supplies and equipment, and administrative space for nonmedical mili- tary activities—demanded a simple method of estimating requirements and authorizing beds. Such expansion also de- manded that additional housing be pro- vided as rapidly and inexpensively as possible. The method prescribed by mobilization regulations for estimating bed require- ments was one that Colonel Love had de- vised from World War I experience. It involved computation of the number of beds needed for successive 15-day periods of mobilization on the basis of average daily admission rates, the rate of accumu- lation of patients in hospitals by 15-day periods, and increases and decreases in troop strengths during these periods. When hospitals were expanded for the Sep- tember 1939 increase in the Army, this method proved too complicated for gen- eral use and The Surgeon General in- cluded in his Protective Mobilization Plan of December 1939 a simpler one, also de- vised by Colonel Love—the multiplication of troop strength by a predetermined per- centage of beds. In August 1940 G-4 adopted the latter, and its simplicity made its ready acceptance by all agencies of the War Department a foregone conclusion.1 Opinion differed on the proper percent- age to use in estimating and authorizing station hospital beds. The Surgeon Gen- eral used 4 percent in calculating require- ments in the fall of 1939, and G-4 began to use this figure in planning for mobiliza- tion in August 1940. Experience of the previous winter made some surgeons be- lieve it provided insufficient beds for “green troops,”2 and on 6 September 1940 General Magee asked the General Staff to consider 5 percent as the probable 1 (1) Albert G. Love, “War Casualties,” Army Med- ical Bulletin, No. 24 (1931), pp, 18, 37, 38, 68. (2) MR 4-3, 2 Apr 34; MR 4-2, 13 Feb 40; and SG PMP, 1939, Annex No 29. (3) Ltr AG 600.12 (8-6-40)M- D-M, TAG to C of Arms and Servs, GGs of CAs, and COs of Exempted Stas, 7 Aug 40, sub: Supp No 2 to WD Cons Policy. SG: 600.12-1. 2 (1) Synopsis Ltr, Surg 4th CA to Surg Ft McClel- lan, 13 Aug 40, sub: Expansion of FIosp Fac, and 8 inds. SG: 632.-1 (Ft McClellan)N. (2) Ltr, Surg 7th CA to SG, 10 Sep 40, sub: Hosp . . . NG. SG: 632.-1 (7th CA)AA. 14 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR requirement for station hospital beds.3 G-4’s Construction Branch verbally ap- proved this ratio, but the Assistant Chief of Staff, G-4, Brig. Gen. Richard C. Moore, later reversed this action, author- izing station hospital beds for only 4 per- cent of the strength served but permitting provisions for expansion to 5 percent if necessary.4 This meant in the case of new hospitals that wards would be constructed with space for beds for 4 percent of a com- mand but that utilities, administrative buildings, and clinical facilities would be constructed to serve a hospital with beds for 5 percent. Thus additional wards could be erected later without overloading the “chassis” of a hospital. The ratio of beds in general hospitals to the total strength of the Army—1 percent—received official sanction at the same time. General Magee did not protest the decision as to station hospitals but observed a policy during the following year of supporting local requests or initiating action for increases in bed ratios in specific instances.5 The manner of providing additional housing was a subject on which The Surgeon General and the General Staff eventually came to marked disagreement. Based on a belief that unnecessary con- struction should be avoided and a fear that sudden attack would require mobi- lization before requisite construction could be completed, War Department policy in 1939 was to use existing housing to the maximum extent possible.6 Mobilization regulations therefore called for the use of existing Army hospitals, with emergency expansions, for the initial beds required. To house additional beds other buildings would be used in the following order: (1) Federal hospitals, (2) civilian hospitals, (3) vacated Army posts, and (4) public and private buildings such as schools and hotels. Finally, as a last resort, new station and general hospitals would be con- structed.7 For all new buildings the War Depart- ment planned to use one-story frame con- struction, called “cantonment-type.” It required The Quartermaster General to keep on file standard plans for such build- ings.8 Those for hospitals had been pre- pared in 1935 in collaboration with The Surgeon General’s Hospital Construction and Repair Subdivision. They consisted of forty-nine drawings: forty-five for admin- istrative offices, clinics, wards, messes, quarters for personnel, and service build- ings, and four for twenty different com- binations of these buildings to make hospi- tals ranging in size from 25 to 2,000 beds. Most of the buildings were of a standard size. To reduce the danger of fire, all were separated by a minimum of fifty feet. For each group of not more than five, this space was increased to 100 feet. Each hos- pital therefore covered a large area, a 500- bed installation spreading over twenty acres. Advantages of this hospital were its relatively low cost, the rapidity with which it could be erected, and the small number :1 Ltr, SG (Magee) to TAG, 6 Sep 40, sub: MD in Mob. AG: 381 (1-1-40) Sec 3. 4 (1) Memo, SG for ACofS G-4 WDGS, 10 Sep 40. (2) D/S, ACofS G-4 WDGS to SG, 13 Sep 40, sub: Hosp . . . Mob. . . . (3) Memo, Cons Br G-4 WDGS for Maj Gen [Eugene] Reybold, 7 Mar 41, sub; Four Percent Hosp. All in HRS; G-4/29135-12. 5 (1) Synopsis Ltr, CG Ft Jackson to TAG, 1 1 Dec 40, sub: Cons Sta Hosp, and 4 inds. SG: 632.-1 (Ft Jackson)N. (2) 5th ind, Surg Ft Sill to CG 8th CA, 12 Mar 41, on cy Ltr, CG Ft Sill to TAG, 10 Dec 40, sub: Add Hosp, Ft Sill. SG: 632.-1 (Ft Sill)N. (3) Ltr SG to TAG, 27 May 41, sub: Add Hosp Fac. . . . SG: 632.-1. (4) Ltr, CG 4th CA to TAG, 1 May 41, sub: Add Hosp Bed Reqmts, and 11 inds. SG: 632.-1 (4th CA)AA. 6 The War Department Mobilization Plan, speech by Lt Col Harry L. Twaddle, GSC, Chief Mob Br G-3 Div WDGS, 30 Sep 39. G-3 Course No 13 and 13A, AWG, 1939-40. 7 MR 4-3, 2 Apr 34; MR 4-3, C-l, 31 Dec 34; and MR 4-2, 13 Feb 40. 8 MR 4-1, Sup; Cons; Trans, 5 Jan 40. PLANNING AND EXPANDING HOSPITALS 15 of highly skilled workmen needed to con- struct it. Its most obvious disadvantages were the danger of fire and the adminis- trative difficulties caused by the wide area covered.9 The hospital construction policy enun- ciated in mobilization regulations was not made the official guide for the provision of hospitals for Regular Army expansions in 1939 and 1940, but certain aspects of it were followed. Thus, although appar- ently no attempt was made to use non- Army buildings, existing Army hospitals were expanded and new construction was authorized only at stations not served by such. For example, essential units of a 350-bed cantonment-type hospital—a mess hall, a clinical building, and several wards—were constructed at Camp Jack- son (South Carolina), a National Guard encampment. Regular Army posts which already possessed hospitals, such as Fort McClellan (Alabama) and Fort Benning (Georgia), expanded them by converting hospital porches, barracks, and other available buildings into hospital wards.10 In such instances results were unsatisfac- tory. At Fort Benning, for example, the surgeon had to enlarge a 230-bed hospi- tal, built for a garrison of 4,000, to serve a strength of 19,000 in January 1940. He did this by adding 334 beds in porches, barracks, and a portable wooden building. The operating rooms, clinics, laboratory, and mess halls of the permanent hospital were then too small for the greater bed capacity. Thus there was created, he ex- plained, “a relative giant with inadequate heart and internal viscera.” 11 Despite this experience, in the spring of 1940 G-4 planned to establish the practice of expanding existing hospitals as official policy for subsequent increases in the Reg- ular Army. Both The Surgeon General and The Quartermaster General opposed this move. Among the many objections they raised, probably the most important from the medical viewpoint was the one Just noted—limits upon expansion of bed capacity imposed by the size of operating rooms and clinical facilities. Of equal im- portance, from the construction viewpoint, was the unsuitability of many barracks for hospital use because of their location or structural characteristics. Moreover, it was improbable that their conversion and eventual reconversion would be cheaper in the long run than the erection of can- tonment-type hospitals. On 24 May 1940, therefore, Colonel Love, Acting The Sur- geon General, recommended that all ad- ditional beds should be housed in new cantonment-type hospitals. G-4 disap- proved this recommendation, perhaps be- cause of shortages of funds and uncer- tainty about the nature of increases in the Regular Army, and on 7 June 1940 issued an official “Policy for Hospitalization during the Emergency.” It authorized cantonment-type hospitals for new stations but required the expansion of existing hospitals on all Regular Army posts.1'2 9 (1) Floyd Kramer, “Mobilization Type Hospi- tals,” Army Medical Bulletin, No. 31 (1935), pp. 1-19. (2) Tynes, Construction Branch, HD. 10 See correspondence in SG; 632.-1 (Cp Jack- son)D. 632.-1 (Ft McClellan)N, and 632.-1 (Ft Ben- ning)N. 11 Ltr, Surg Ft Benning to SG, 19 Jan 40, sub: An Rpt of Sta Hosp. SG: 632.-1 (Ft Benning)N, 12 (1) Memo, Exec Off G-4 for Cons Br G-4 WDGS, 22 May 40, sub; Hosp. (2) Memo QM 600.1 C-C, QMG for ACofS G-4 WDGS, 28 May 40, sub: Util of Bks for Temp Hosp Accommodations. (3) Memo, Act SG for ACofS G-4 WDGS, 24 May 40, sub: Hosp for Increase in the Army above 227,000. (4) Memo, Chief Cons Br G-4 for ACofS G-4 WDGS, 3 Jun 40, sub: Util of Bks for Temp Hosp Accommo- dations. (5) Memo, Chief Cons Br G-4 for ACofS G-4 WDGS, 5 Jun 40, sub: Hosp for Increases of Army. (6) Ltr AG 705 (6-5-40)M-DM, TAG to CGs of all GAs, COs of Exempted Stas, and CofArms and Servs, 7 Tun 40, sub: Policy for Hosp during Emergency. All in HRS: G-4/31757. 16 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR PLAN FOR CANTONMENT-TYPE HOSPITAL The inapplicability of this policy soon became apparent. For example, despite a recommendation by The Surgeon General that a 550-bed cantonment-type hospital be constructd for Camp Ord, G-4 di- rected on 6 June 1940 that the camp con- tinue to use an expanded hospital at the Presidio of Monterey. The Surgeon, the Quartermaster, and G-4 of the Ninth Corps Area opposed this decision. They pointed out that the hospital and barracks at Monterey did not have enough total space to accommodate all the beds needed and that some cantonment-type construc- tion would be necessary. In addition, both the barracks and the hospital were old and in need of repairs, were potential fire- traps, were separated by a public road, and were located six miles from the troops at Ord. In view of these arguments, the General Staff reversed its decision and authorized the construction of a canton- ment-type hospital at Camp Ord.13 As plans were made to receive draftees in the fall of 1940, dissatisfaction with the existing policy increased and The Surgeon General attempted to get it changed. His 13 (1) Ltr, SG to Surg 9th CA, 6 Jun 40, sub; Hosp for Cantonment Garrison, Cp Ord, with 3 inds. SG: 632.-1 (Cp Ord)C. (2) Rad 265 WVY V 50 WD. CG 9th CA to TAG, 15 Jul 40. Same file. (3) Correspondence in SG: 632.-1 (Ft Sill)N. PLANNING AND EXPANDING HOSPITALS 17 LAWSON GENERAL, A CANTONMENT-TYPE HOSPITAL Office supported requests of local sur- geons for exemption from its provisions.14 On 5 September 1940 General Magee conferred with General Moore and the next day sent him a personal note. Refer- ring to the impossibility of providing an adequate hospital at Fort Benning under the established policy, he stated: “There is so much dynamite in this that I think you should know about it.” 15 Nevertheless, the War Department did not immediately revise the policy, and G-4 permitted few exceptions to it.16 As a result the situation became so serious by mid-September that the Chief of Staff asked The Inspector General to investigate the rights and wrongs of interchanges between G-4 and The Surgeon General as well as delays in deciding the type of construction to be used.17 Apparently The Inspector Gen- 14 For example, see: Memo, SG for AGofS G-4 WDGS, 11 Sep 40, sub: Hosp, Ft McClellan. SG; 632.-1 (Ft McClellan)N. 15 Memo, Maj Gen J fames] C. Magee for Brig Gen Rfichard] C. Moore. 6 Sep 40. SG: 632.-1 (Ft Ben- ning)N. 16 (1) Rad AG 600.12 (9-5-40), TAG to CG 9th CA, 10 Sep 40. SG 632.-1 (Ft Lewis)N. (2) Ltr, Surg Ft Benning to SG, 21 Aug 40, sub: Cons of Med Fac, and 3 inds. SG: 632.-1 (Ft Benning)N. (3) Syn- opsis Ltr, CG Ft Bragg to CG 4th CA, 6 Sep 40, and 5 inds. SG: 632.-1 (Ft Bragg)N. 17 Memo, CofSA for IG, 14 Sep 40. HRS: OCS 1 7749-225. The reply to this memorandum has not been located in War Department files. 18 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR eral’s report favored The Surgeon Gen- eral’s position, for soon afterward the Chief of Staff personally approved Gen- eral Magee’s recommendation “that the erection of cantonment hospitals be an- nounced as the normal procedure” for all large posts, whether Regular Army or not.18 The revised policy on hospital construc- tion, issued by the War Department on 26 September 1940, discarded the long- established plan to construct additional buildings for hospitals as a last resort only. Thereafter peacetime hospitals were to be expanded only on small posts where clin- ical facilities were generally sufficient for additional patients. Cantonment-type hospitals were to be constructed else- where.19 Without this change hospitals on Regular Army posts would have consisted of a hodgepodge of small permanent hos- pitals, permanent barracks, and tempo- rary buildings required to supplement them. Delay in making the revision was responsible for much confusion and some delay in the erection of suitable hospital buildings on Regular Army posts,20 but it had no effect on hospitals for new posts because cantonment-type construction had been authorized for them since June 1940. Planning for Construction and Selecting Sites of Hospitals Planning for station hospitals was done on a day-to-day rather than a long-term basis, because their size, number, and lo- cation depended almost entirely upon a constantly changing troop distribution. In the fall of 1940 the Surgeon General’s Of- fice prepared two studies showing the ad- ditional beds that would be required by June 1941 at each post in the United States,"1 but lack of information about ultimate troop distribution and changes in station strengths limited their value. In some instances three or more increases in authorized strengths required the same number of revisions of hospital construc- tion plans for a single post.2'2 As informa- tion about stations and their strengths be- came available, the Construction and Re- pair Subdivision prepared plans for hospital construction for each. Consisting of the number of beds needed, the types and numbers of buildings required, and the layout or arrangement of buildings, these plans amounted only to recommen- dations. Final decisions on hospital con- struction were made by G-4 for ground force stations and by the Chief of the Air Corps for air stations. Because of the day- to-day type of planning and the lack of information about action on his recom- mendations, The Surgeon General found it difficult to keep track of station hospitals authorized for construction.23 Planning for general hospitals was on a more comprehensive basis. Although it 18 (1) Memo, SG for ACofS G-4 WDGS, 20 Sep 40, and note thereon signed G. G. Mfarshall]. (2) D/S, ACofS G-4 WDGS to TAG, sub; Revised Policy for Hosp during Emergency. Both in HRS: G-4/31757. 19 Ltr AG 600.12 (9-25-40) MD, TAG to CofArms and Servs, CGs of CAs, and COs of exempted Stas, 26 Sep 40, sub: Revised Policy for Hosp during Emer- gency. HRS: G-4/31757. 20 SG: 632.-1 (Ft McClellan)N; 632.-1 (Ft Ben- ning)N; 632.-1 (Ft Bragg)N. 21 SG Ltrs, 1 Oct and 7 Nov 40, sub: Bed Reqmt Study. SG; 632.-2. 22 SG: 632.-1 (Ft Jackson)N, 1940; SG; 632.-1 (Ft Ord)C, 1940; SG: 632.-1 (Ft Bragg)N, 1940. 22 (1) Ltr, GofAC to SG, 1 7 Apr 41, sub; Increases in Str for Pilot Tng Sch, and 9 inds. AAF: 632B Hosp and Infirmaries. (2) Ltr AG 600.12 (9-28-40)M-D, TAG to QMG, 3 Oct 40, sub: Temp Cons . . . 5th CA. SG: 632.-1 (5th CA)AA. (3) Memo, SG for QMG, 7 Oct 40, sub; Ft Knox. SG: 632.-1 (Ft Knox)N. (4) Ltr, SG to Fed Bd of Hosp, 5 May 41. SG: 632.-1. PLANNING AND EXPANDING HOSPITALS 19 depended to some extent upon troop dis- tribution, the fact that general hospitals would serve more than one post and would operate directly under The Sur- geon General gave him considerable lati- tude in determining their size, number, and location. On 10 August 1940 G-4 sought information on increases in general hospitals that passage of the Selective Service Act would require.24 In response The Surgeon General proposed the con- struction of ten new general hospitals with a total capacity of 9,500 beds—one each in the First, Second, Fifth, Sixth, and Seventh Corps Areas; three in the Fourth, where the troop concentration would be heaviest; and two in the Ninth, where troops would be spread from Canada to Mexico. In the Eighth Corps Area, he proposed redesignation of the 1,700-bed Fort Sam Houston (Texas) Station Hospi- tal as a general hospital, since it was already performing the functions of both types.20 Plans had already been made to increase the capacity of Walter Reed Gen- eral Hospital, in the Third Corps Area, by relieving it of station-hospital cases which it had previously received from near-by posts.26 With the general hospitals already in operation, this plan would have pro- vided a total of over 15,000 general hos- pital beds in the United States for an ex- pected Army strength of 1,400,000. The expansion of general hospitals dur- ing 1941 followed basically The Surgeon General’s plan. On 25 September 1940 G-4 approved the construction of ten gen- eral hospitals, with a total capacity of 10,000 beds, in locations substantially the same as those recommended by The Sur- geon General.27 Objections of the com- mander of the Eighth Corps Area to re- designation of the Fort Sam Houston Station Hospital caused The Surgeon General to withdraw that proposal.'8 During 1941, therefore, the following gen- eral hospitals were added to the five the Army already had: Lovell at Fort Devens, Mass.; Tilton at Fort Dix, N. J.; Stark at Charleston, S. C.; Lawson at Atlanta, Ga.; LaGarde at New Orleans, La.; Bil- lings at Fort Benjamin Harrison, Ind.; O’Reilly at Springfield, Mo.; Hoff at Santa Barbara, Calif.; and Barnes at Van- couver Barracks, Wash.29 No additional ones were required until September 1941, when an increase in the size of the Army was anticipated. At that time The Surgeon General submitted a proposal for a pro- portionate increase in the number of gen- eral hospital beds,30 but it was later merged with a larger plan to meet the needs of a wartime Army. Selection of proper sites was an essential factor in planning for hospital construc- tion. It was important, for instance, for both station and general hospitals to have sufficient space for future expansion; to be free from objectionable neighbors such as factories, railroad yards, warehouses, utilities areas, and training grounds; and 24 Memo, ACofS G-4 WDGS for SG, 10 Aug 40, sub: Increase in Number of Gen Hosps. HRS: G-4/ 29135-11. 25 1st ind, SG to TAG, 23 Aug 40, on Memo G-4/ 29135-11, ACofS G-4 WDGS for SG, 10 Aug 40, sub: Increase in Number of Gen Hosps. AG: 322.3 Gen Hosp (8-10-40)(l). 28 4th ind SGO 701.-1, SG to TAG, 5 Aug 40, and 7th ind, TAG to SG, 30 Sep 40, on Ltr, SG to TAG, 15 Jul 40, sub: Gen Hosp Beds for Enlarged Army. AG: 322.3 Gen Hosp (7-15-40)(l) Sec 1. 27 D/S, ACofS G-4 WDGS to TAG, 25 Sep 40, sub; Increase in Number of Gen Hosps. HRS; G-4/ 29135-11. 28 Ltr, SG to TAG, 9 Oct 40, sub: New Gen Hosp (Ft Sam Houston, Tex), with 2d ind, CG 8th GA to TAG, 7 Nov 40, and 4th ind, SG to QMG, 9 Dec 40. AG: 322.3 Gen Hosp (8-10-40)(l). 29 SG: 632.-1, 1941, for each hospital named. 30 Memo, SG for ACofS G-4 WDGS, 19 Sep 41, sub: DF G-4/20052-103, Augmented PMP, 1942. SG: 632.-1. 20 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR to be located on terrain that was moder- ately level and properly drained. The ac- cessibility of good highway and railroad nets was especially important for general hospitals, whose function was to receive patients from other hospitals. The avail- ability of good water supplies and of ade- quate utilities connections had also to be considered. The Quartermaster General’s chief interest in hospital sites lay in their suitability from an engineering and con- struction standpoint. During the emergency period The Quartermaster General selected construc- tion sites in collaboration with other in- terested War Department agencies. For hospitals, this meant both The Surgeon General and corps area commanders.31 In the early phases of mobilization the selec- tion of sites for station hospitals was left in many instances to local authorities, for The Surgeon General’s Hospital Con- struction and Repair Subdivision had little personnel to spare for such activities. Sites so selected were generally satisfac- tory but sometimes had undesirable fea- tures, such as promixity to training areas, poor drainage, or inadequate space for expansion. As the press of work abated during 1941, The Surgeon General began to exercise more direct supervision over site selection through visits of his repre- sentatives to stations where hospital con- struction was anticipated.32 The selection of sites for general hospitals was more complicated and time consuming, even though the general areas in which they were to be located were first approved by the General Staff. As a rule, the War De- partment directed corps area commanders to appoint boards, with medical repre- sentatives, to make investigations and recommendations. Their surveys required considerable time and their recommenda- tions in some instances were deemed un- satisfactory. In such cases, the Secretary of War appointed other boards represent- ing The Surgeon General, The Quarter- master General, the General Staff, and corps area surgeons to make further surveys and recommendations.33 Difficulties in Providing Satisfactory Hospital Plants The Surgeon General and The Quar- termaster General disagreed about the manner in which the Medical Depart- ment as the using agency should exercise advisory supervision over hospital con- struction. The Surgeon General insisted that his office should review each building schedule which was sent out and each change in plans proposed by the field. He believed that this procedure was necessary to maintain the proper division of space among various hospital services, an ap- propriate relationship among different buildings of a hospital plant, and the possibility of future expansion. In his opinion experience justified this position. For example, hospital construction at Fort Francis E. Warren (Wyoming) was de- layed from early November 1940 until 31 Memo QM 322.2 C-OT (Gen Hosps), QMG for ACofS G-4 WDGS, 11 Jan 41, sub; Gen Hosps, and D/S G-4/32445, ACofS G-4 WDGS to TAG, 15 Jan 41, sub: Control of Cons Projects. AG: 322.2 Gen Hosp (7-15-40)(l) Sec 1. 32 (1) Tynes, Construction Branch, p. 32. (2) Memos from offs of Hosp Cons and Repair Subdiv dated 18 Jan, 11 Apr, 28 Jul, 20 Aug, 22 Aug, 2 Sep, and 16 Sep 41. HD: 333(Hosp). 33 (1) Memo, ACofS G-4 WDGS for DepCofSA, 14 Nov 40, sub: Gen Hosps. HRS: G-4/29135-1 1. (2) Ltr, TAG to CG 4th CA, 29 Sep 40, sub: Cons of Cantonment Hosps 4th CA (Atlanta, Charleston, New Orleans). AG: 322.3 Gen Hosp (9-27-40) M-D. (3) Rad, TAG to CG 7th CA, 19 Dec 40, and D/S G-4/ 29135-14, ACofS G-4 WDGS to TAG, 14 Jan 41, sub: Convening a WD Board .... AG; 322.3 Gen Hosps (7-15-40) (1) Sec 4. PLANNING AND EXPANDING HOSPITALS 21 January 1941 because The Quartermaster General sent out plans which The Surgeon General had not approved and against which local authorities protested. At Fort Rosecrans (California) local quarter- master and medical officers erected a two- story wooden hospital which The Surgeon General considered unsafe. In other places, such as Camp Wallace (Texas), Camp Custer (Michigan), Camp Roberts (California), and Camp Leonard Wood (Missouri), local changes in approved plans produced hospitals considered un- satisfactory by The Surgeon General.34 Hoping to speed construction, The Quartermaster General proposed stand- ardization and decentralization—the use of standard building schedules (that is, lists of buildings for hospitals ranging in size from 25 to 2,000 beds) approved initially by the Surgeon General’s Office and subject to no further changes by it, and the delegation of authority to make changes in hospital layouts and building plans to medical and quartermaster offi- cers in the field.35 Nevertheless, because of The Surgeon General’s insistence, both the Quartermaster Corps and the Corps of Engineers followed the practice of re- ferring hospital building schedules and layouts to his Office for approval and twice during 1941 The Quartermaster General instructed his field agents not to change hospital construction plans with- out prior approval of the Surgeon Gen- eral’s Office.36 Centralization of the Medical Depart- ment’s advisory supervision over hospital construction did not necessarily assure erection of satisfactory hospital buildings. That depended considerably upon the plans used. Drawn in 1935, they were simply pulled “offthe shelf’ when needed. The medical officer (Col. Floyd Kramer) who had helped prepare them warned the Surgeon General’s Office that they would not be entirely satisfactory, and in Octo- ber 1940 Colonel Hall, of the Hospital Construction and Repair Subdivision, in- dicated that he was “by no means certain” that they would “suit our 1940 ideas.”37 It soon appeared that they did not. Hospi- tals built on such plans had insufficient space for some activities and none at all for others. X-ray clinics and laboratories were too small for use in modern medi- cine. Administration buildings had insuf- ficient space for extensive records required for patients and civilian employees and were cut up into too many small rooms for efficient use. Post dental work required more room than originally expected. Gen- eral hospitals needed more space for quar- termaster activities. Inadequate kitchens and mess storerooms became the source of frequent complaints. Offices for the medi- cal supply officer and the medical detach- ment commander, recreation buildings for patients and for nurses, post exchange 34 (1) Ltr, SG to QMG, 5 Jan 41, sub: Unauth Changes in Cantonment Hosps. . . , with 2d ind, SG to QMG, 14 Feb 41. SG: 632.-1. (2) 1st ind, SG to QMG, 1 7 Jul 41, on Synopsis Ltr, QMG to SG, 17 Jul 41. Same file. (3) SG: 632.-1 (Ft F. E. Warren)N, 1940-41 and (Ft Rosecrans)N, 1940-41. 35 (1) 1st ind QM 632 C-ED, QMG to SG, 8 Feb 41, on Ltr, SG to QMG, 5 Jan 41, sub: Unauth Changes in Cantonment Hosps. . . . (2) Synopsis Ltr, QMG to SG, 17 Jul 41. Both in SG: 632.-1. 36 (1) Ltr QM 632 C-EP Hosp Fac, QMG to SG, 9 Aug 41, sub: Add Hosp Fac. SG: 632.-1. (2) 2d ind, CofAC to CofEngrs, 11 Aug 41, on Ltr, SG to Gof- Engrs, 31 Jul 41, sub: Hosp Insp, AC Sta, 8th CA. Same file. (3) Ltr, QMG to Cons QMs, 8 Feb 41, sub: Hosp Layouts. Same file. (4) Ltr QM 632 C-EP (Zone VII), QMG to Zone Cons QM, Zone VII, 12 Sep 41, sub: Revisions in Hosp Plans and Layouts. Off file, Hosp Cons Div SGO, “Policy File.” 37 (1) Lessons Learned from Planning and Con- structing Army Hospitals, Speech by Col John R. Hall, 16 Sep 43. HD; 632.-1. (2) Ltr, Col J. R. Hall to Col H. C. Coburn, Jr, MG, Sta Hosp Ft Bragg, 16 Oct 40. SG: 632.-1 (Ft Bragg)N. 22 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR buildings, ambulance garages, and strong rooms for safeguarding narcotics as re- quired by Federal law were not included in existing plans. Of equal importance, neuropsychiatric wards for which plans were provided lacked sufficient strength and safety features to prevent patients from attempting escape or suicide.38 The question of whether to revise exist- ing plans completely or to make piece- meal changes arose in the fall of 1940. General Love, Chief of the Planning and Training Division, advocated their com- plete revision, but Colonel Hall demurred on the ground that he would encounter delays and difficulties in securing ap- proval of G-4 and co-operation of The Quartermaster General.39 That his posi- tion had some basis in fact is indicated by a controversy from August through Octo- ber over proposed changes for separate buildings. After The Quartermaster Gen- eral complained that requests of The Sur- geon General for piecemeal changes were delaying construction, their offices hurled charges and countercharges against each other until G-4 forbade further changes in standard designs without Staff approval, and the chief of the G-4 Construction Branch, concluding that further argument was useless, closed the controversy by recommending on 18 October 1940 that all papers pertaining to it be filed.40 Two months later The Quartermaster General proposed a complete revision of canton- ment-type hospital plans, but Colonel Hall maintained his former position, this time for a different reason. “It is the opinion of this office,” he wrote, “that sufficient experience with the plants to be erected according to the present plans has not yet been had to make a complete and satisfactory revision possible at this time.” 41 As soon as hospitals built on the 1935 plans were received from contractors, steps had to be taken to correct their defects and overcome their deficiencies. Several methods were adopted. One was to rear- range the use of space. For example, local commanders converted wards into X-ray clinics and laboratories and used the space vacated in clinical buildings to increase surgical facilities. To replace the bed ca- pacity thus lost, The Surgeon General ob- tained additional wards.42 Another meth- od was to modify the buildings erected. Changes in neuropsychiatric wards, such as the removal of exposed pipes, were made to increase the safety of mentally disturbed patients; and kitchens and mess halls were enlarged by adjacent construc- tion.43 A third method was to construct additional buildings, such as storehouses, 38 (1) An Rpts, 1941, Sta Hosps at Fts Knox and Bragg, Cps Lee, Roberts, Claiborne, and Bowie, and O’Reilly GenHosp. HD. (2) Memo, IG for ACofS G-4 WDGS 22 Apr 41, sub; Cons Defects. HRS: G-4/32900. (3) Tynes, Construction Branch, pp. 16- 18. (4) Rpt, Conf of SG with CA Surgs, 10-12 Mar 41. HD: 337. 39 Interv, MD Historian with Col Albert G. Love, 27 Aug 47. HD: 000.71. 40 (1) Ltr AG 600.12(8-15-40), TAG to SG, 17 Aug 40, sub: Changes in Standard Design, with 3d ind, QMG to TAG, 7 Sep 40, 4th ind, TAG to SG, 20 Sep 40, and 5th ind, SG to TAG, 8 Oct 40. SG: 632.-1. (2) Memo, Lt Col Stephen J. Chamberlin for ACofS G-4 WDGS, 18 Oct 40, same sub. HRS: G-4/ 31741. 41 Memo, SG (Hall) for QMG, 1 7 Dec 40. SG: 632.-1. 42 (1) An Rpts, 1941, Sta Hosps at Ft Bragg and Cp Roberts and O’Reilly Gen Hosp. HD. (2) Ltr, SG to TAG, 7 May 41, sub: Request for Urgent Emer- gency Cons, and 2d ind AG 600.12 (5-7-41), TAG to QMG, 5 Jul 41. SG: 632.-1. (3) Ltr, SG to QMG. 14 Jul 41, same sub. Same file. 43 (1) Memo, Col John R. Hall for SG, 28 Jul 41, sub: Rpt of Insp, 8th GA. HD: 333. (2) 2d ind, SG to Hq AAF, 9 May 42, on Ltr, Surg Southeast AC Tng Ctr to SG, 5 May 42, sub: Hosp Messes. SG: 632.-1. (3) Ltr QM 300.5 C-ED(Gen), QMG to all Cons QMs, 21 May 41, sub: Piping—Detention Wards. SG: 632.-1. PLANNING AND EXPANDING HOSPITALS 23 ambulance garages, post exchanges, and strong rooms.44 Finally, existing plans for a few buildings, such as neuropsychiatric wards, kitchens, and messes, were revised during 1941 for subsequent use, in order to prevent perpetuation of the process of building and changing.45 Development of a New Type of Hospital Plant In the spring of 1941 complaints were made in both military and civilian circles that the hospitals constructed not only lacked space for certain activities but also were unsatisfactory from an administrative and safety viewpoint.46 Wide dispersal of buildings intensified administrative prob- lems without assuring adequate fire pro- tection. As early as January 1941 the offices of The Quartermaster General and The Surgeon General had agreed upon a program of installing draft-stops in closed corridors that connected different build- ings of hospital plants, as a fire-protection measure.47 In May the Chief of the Air Corps secured appropriations for the in- stallation of automatic fire-sprinkler sys- tems in fifty-eight Air Corps hospitals and The Quartermaster General made plans for their installation in all other hospitals with 400 or more beds. By December 1941 the installation of such systems in all the wards, except detention wards, and in the patients’ kitchens of cantonment-type hos- pitals became War Department policy.48 Meanwhile work had begun on the development of a new type of hospital. When complaints about existing plants were first made, Colonel Hall expressed The Surgeon General’s preference for more compact hospitals built of fire-resist- ant materials.49 Soon afterward his Office began to collaborate with the Quarter- master General’s in designing such a plant. It consisted of buildings that were gener- ally two stories high with exterior walls of masonry and interiors of slow-burning materials. Such construction permitted a more compact arrangement of structures than had previously been possible. Ward buildings were placed opposite each other on a central connecting corridor permit- ting one diet kitchen and one ward office and examining room to serve two wards. Two-story corridors connected the build- ings of a hospital group, and ramps were placed at suitable intervals to give access from one story to the other. To allow more 44 (1) Ltr, SG to Off of Budget Off, 26 Dec 40, sub: Supp Est, FY 1941. SG: 632.-1. (2) D/S G-4/29135- 17, ACofS G-4 WDGS to TAG for transmittal to SG, 13 Jan 41, sub: Med Fac. . . . AG; 322.3 Gen Hosp (7-15-40)(l) Sec 1. (3) Ltr, SG to ACofS G-4 WDGS, 15 Mar 41, sub: PXs for Hosps. SG: 632.-1. (4) Ltr AG 600.12 (8-4-41 )MO-D-M, TAG to CGs of all Depts et at., 19 Aug 41, sub: WD Cons Policy. HD: 600.12-1. 45 (1) Ltr, SG to Cons Div OQMG, 4 Jun 41, sub: Plans for Ward 8—NP Bldgs. (2) Ltr, SG to QMG, 7 Aug 41, sub: Modification of M-16 Mess, with 1st ind QM 633 C-ED(Danville GH), QMG to SG, 4 Sep 41. Both in SG: 632.-1. 46 (1) Ltr, Nathaniel O. Gould, Architect and Engr, Detroit, to Sec War, 27 Mar 41. AG: 600.12 (3-27- 41)(1). (2) Ltr, F. A. Arnold to SG USPHS, 4 Apr 41. SG; 632.-1. (3) Ltr, CofEngrs to SG, 9 May 41, sub: Type of Hosp Cons. Same file. (4) Memo, Exec Asst OCE for Engr Div OCE, 3 May 41, and Memo, Head Engr for Exec Asst OCE, 6 May 41, sub: Hosp Lay- outs. CE: 632 Pt I. 47 Memo, SG (Hall) for QMG, 29 Jan 41. SG: 632.-1. 48 (1) Synopsis Ltr, GofAC to CofEngrs, 9 May 41, sub: Fire Prevention in Hosps, with 1st ind, CofEngrs to GofAC, 17 May 41, and three subsequent inds. SG: 671.2. (2) Memo QM 632 C-ED (Gen), Design Sec OQMG for Chief Design Sec OQMG, 13 May 41, sub: Sprinkler and Alarm Systs — Hosps. CE: 671.3 Pt 1. (3) 3d ind AG 671.7 (10-21-41)MO-D, TAG to CofEngrs, 26 Dec 41, on Ltr QM 67 1 C-RU (Gen), QMG to TAG, 21 Oct 41, sub: Fire Protection. Same file. 49 2d ind SGO 600.12-1, SG (Hall) for TAG, 16 Apr 41, on Ltr, Nathaniel O. Gould to SecWar, 27 Mar 41. AG; 600.12 (3-27-41)(l). 24 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR VALLEY FORGE GENERAL, A SEMIPERMANENT-TYPE HOSPITAL space for medical care, the width of all wards, clinics, and other key buildings was increased from twenty-five to thirty-two feet, and facilities that were either lack- ing or inadequate in cantonment-type hospitals were introduced or redesigned in plans for the new type.50 On 6 August 1941 the Staff authorized the construction of two-story, semipermanent, fire-resistant plants for all future hospitals.51 Final drawings were not completed for several months, and before they could be put into general use the United States was at war. Evaluation of Hospital Construction Program Although hospitals constructed during the period of peacetime mobilization did not “even approach the ideal,” in Colonel Hall’s opinion the wonder was “not that so many mistakes were made but rather that we have been able in a somewhat satisfactory manner to meet our obligation to the sick and wounded.” 52 Hospital beds had to be provided on a scale unknown in ordinary times. Between September 1940 and December 1941 the number of nor- mal beds (that is, those for which 100 square feet of space each was provided in ward buildings) in station hospitals in- creased from 7,391 to 58,736 and in gen- eral hospitals, from 4,925 to 15,533. (Chart 1) Only in the fall and winter of 1940-41 was there a shortage of normal beds. At that time the Medical Depart- ment used emergency and expansion beds (that is, those set up on the basis of sev- enty-two square feet each not only in 50 (1) Tynes, Construction Branch, pp. 39-40. (2) Ltr, SG to CofEngrs, 7 Feb 42, sub: Fire-Resistant Type of Hosp. SG; 632.-1. 51 2d ind AG 632 (7-7-4l)MO-D, TAG to QMG and SG in turn, 6 Aug 41, on Ltr, SG to TAG, 7 Jul 41, sub; Fire-Resistant Type of Cons for Hosp. SG: 632.-1. 52 Lessons Learned from Planning and Construct- ing Army Hospitals, speech by Col Hall, 16 Sep 43. HD: 632.-1. Chart 1—Status of Station and General Hospital Beds in Continental United States: August 1940-December 1941 STATION AND GENERAL HOSPITALS - TOTAL STATION HOSPITALS TOTAL BEDS (NORMAL, •— EMERGENCY 8 EXPANSION) .NORMAL BEDS* AUTHORIZED NORMAL BEDS REPORTED BEDS OCCUPIED GENERAL HOSPITALS * Based on War Department determined percentage of troop strength. Source: Figures for total beds, normal beds reported, and beds occupied, as of the last full week of each month, shown in Bed Status Reports, Health Reports Br, Med Statistics Div, SGO. 304244 0—55 4 26 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR wards but also in porches, halls, barracks, and tents) and sent some patients to near- by civilian and Veterans Administration hospitals.53 It also continued a policy, be- gun early in 1940, of reducing the number of Civilian Conservation Corps and Vet- erans Administration patients in Army hospitals and in December secured War Department approval of a policy of limit- ing sharply the hospitalization of depend- ents of military personnel.54 In the spring of 1941 construction began to catch up with needs and after March the number of patients in hospitals at no time exceeded the total number of normal beds. (See Chart 1.) Hospital Administration Internal Organization and Administrative Procedures When mobilization began, the only guide to the organization and administra- tion of Army hospitals was an Army regu- lation published in the mid-1930’s. It gave hospital commanders much discretion in both fields and lacked detailed instructions for inexperienced officers to follow.55 A more specific guide was therefore neces- sary. In October 1940 the Medical De- partment devoted an entire issue of the Army Medical Bulletin to an article prepared by Col. Charles M. Walson, then surgeon of the Second Corps Area, entitled “Sta- tion Hospital Organization Chart, Regu- lations, and Medical Department Ques- tionnaire.” During the first half of 1941 the Training Subdivision of the Surgeon General’s Office revised this article and the War Department issued it in July as a technical manual.56 The manual described hospital organi- zation in considerable detail, advocating the separation of activities into two major categories, administrative and profes- sional, and the grouping of professional activities into services composed of sub- units called sections. For example, the surgical service of a station hospital might contain sections devoted to general sur- gery, orthopedics, obstetrics and gynecol- ogy, urology, eye-ear-nose-and-throat dis- orders, anesthesia, roentgenology, and physiotherapy; the medical service, sec- tions for general medicine, contagious dis- eases, dermatology, neuropsychiatry, and detention. The manual also provided for a headquarters, or commanding officer’s staff, separate from other administrative units of general hospitals. In addition, it described the duties and responsibilities of staff officers, as well as important admin- istrative procedures, and contained check- lists for chiefs of services to use in measur- ing the efficiency of operations. While it was somewhat more specific than the Army regulation governing hospital ad- ministration, this manual also gave local commanders considerable autonomy. (Chart 2) 53 (1) An Rpts, 1941, Sta Hosps at Cps Beauregard, Shelby, Blanding, Custer, and Roberts, and Fts Leon- ard Wood, Sill, and Bragg. HD. (2) AR 40-1080, par 2 n (1), (2), and (3), 31 Dec 34, and C 2, AR 40-1080, par 2 n (1), (2), and (3), 16 Mar 40. (3) Ltr, CO Sta Hosp Ft Snelling to Surg 7th CA, 9 Sep 40, sub: Auth to Reduce Floor Space. . . , and 3 inds. SG: 632.-l(Ft Snelling)N. 54 (1) Rpt, Conf of SG with CA Surgs, 14-16 Oct 40, and 10-12 Mar 41. HD; 337. (2) Memo, ACofS G-4 WDGS for CofSA, 5 Dec 40, sub: Reply of SecWar to VA. HRS: G-4/28901-17. (3) Ltr, SG to TAG, 28 Nov 40, sub: Med Care for Dependents . . . and cy Ltr AG 702 (1 1-28-40) M-A-M, TAG to CGs of CAs and Depts and COs of Exempted Stas, 18 Dec 40, same sub. HD: 701.-1. 55 AR 40-590, 21 Nov 35, The Admin of Hosps, Gen Provisions. 56 (1) Army Medical Bulletin, No. 54, (1940). (2) TM 8-260, Fixed Hosps of the MD (Gen and Sta Hosps), Jul 41. (3) Memo for Record on D/S G-3/44468, ACofS G-3 WDGS to TAG, 17 Apr 41, sub; TM 8-260. AG: 300.7 TM 8-260 (4-15-41)(l). Chart 2—Hospital Organization as Suggested by TM 8-260, July 1941 COMMANDING OFFICER EXECUTIVE OFFICER ADJUTANT MEDICAL SUPPLY OFFICER CHAPLAIN PERSONNEL OFF. ADMINISTRATIVE OFFICER OF THE DAY VETERINARY SERVICE A D M I N I S T R A T I V E p R 0 F E S S I 0 N A L PROFESSIONAL OFFICER OF THE DAY MEDICAL INSPECTOR GENERAL SURGERY ORTHOPEDICS REGISTRAR SURGICAL SERVICE UROLOGY COMMANDING OFFICER DET. PATIENTS SEPTIC ROENTGENOLOGICAL SERVICE EENT GENERAL MEDICINE MESS OFFICER COMMUNICABLE DISEASE COMMANDING OFFICER DET. MED. DEPT. NEUROPSYCHIATRY MEDICAL SERVICE GASTROINTESTINAL CARDIOVASCULAR PRINCIPAL CHIEF NURSE LABORATORY SERVICE OFFICERS SECTION UTILITIES OFFICER DENTAL SERVICE RECEIVING AND DISPOSITION OFFICER DISPENSARY AND OUTPATIENT SERVICE PHARMACY PROPHYLAXIS GEN. EXAM.STREAT. 28 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Lack of a specific directive requiring standard hospital organization resulted in many local variations.57 The one general point of similarity was the separation of administrative from professional activities. In most hospitals the latter were organized as sections that were grouped in services: medical, surgical, dental, and laboratory. Some hospitals looked upon nursing as a separate professional service, although the manual recommended that the nursing unit be considered an administrative one. Others gave activities that might have been included as sections of either the medical or surgical service a higher status. For example, the station hospitals at Fort Lewis (Washington) and Fort Knox (Kentucky) possessed orthopedic services; that at Fort Ord (California) had sepa- rate genitourinary and eye-ear-nose-and- throat services; and that at Fort Bragg (North Carolina), a separate neuropsychi- atric service. On the other hand there were but three professional services at the 1,200-bed station hospital at Camp Bowie (Texas): medical, surgical, and nursing. Administrative units were usually not grouped in services, and their number varied from one hospital to another. For example at Stark General Hospital there were 29, including staff offices; at La- Garde, 14; while the number proposed in the manual was 12. Station hospitals like- wise varied. On some posts they were under the supervision of station surgeons, who supplied certain administrative serv- ices. In one such instance the station sur- geon handled all hospital personnel and supply activities. On other posts, a single officer served both as station surgeon and as hospital commander. The Fort Bragg Station Hospital, which was divided into three sections located from one quarter of a mile to a mile apart, had separate com- manders for each unit, but possessed a central registrar’s office, medical supply section, nursing section, mess and hospital fund, military and civilian personnel divi- sions, and medical detachment. General hospitals not located on Army posts usu- ally had administrative sections not found in station hospitals, such as the finance and provost marshal’s offices. Neither Army regulations nor the man- ual on organization limited the number of officers a hospital commander could super- vise directly. Thus the number of individ- uals reporting to him varied as did the organization of administrative and pro- fessional activities. As a rule, only chiefs of professional services, not of sections under them, reported to the commanding officer, but in most hospitals the chief of each administrative section reported directly to the commander or his executive officer. Thus the officers supervised directly by a hospital commander sometimes reached large numbers. For example, at Stark General Hospital the chiefs of four profes- sional services and twenty-nine different administrative sections reported directly to the commander. In some instances the number of officers actually reporting was smaller than it seemed, because one officer frequently held several positions. (Chart 3) Administrative procedures likewise var- ied from hospital to hospital. Since there was no manual covering hospital opera- tions in detail, hospital commanders were free to supplement general procedures outlined in Army regulations as they saw 57 (1) The following three paragraphs are based on: An Rpts, 1941, Sta Hosps at Fts Knox, Leonard Wood, Lewis, Bragg, Sill, Ord, and G. G. Meade, and Cp Bowie, and Stark, Billings, Hoff, LaGarde, and Lawson Gen Hosps. HD. (2) See also: Edward J. Morgan and Donald O. Wagner, The Organization of the Medical Department in the Zone of the Interior (1946), pp. 102-06. HD. UTILITIES OFFICER REGISTRARS J CO DET. 1 PATIENTS RECORDS TRAINING OFFICER POST OFFICE OFFICERS ENLISTED MEN PRINCIPAL I CHIEF NURSeI NURSES 8 AIDES RECORDS NURSES QUARTERS recreation) OFFICER I ATHLETICS OFFICER ADMINISTRATIVE DIVISION SUMMARY COURT FIRE MARSHAL | ADMINISTRATIVE O.D.| DIRECTOR DIETETICS MESSES DIETITIANS Chart 3—Organization of Lawson General Hospital, 1941 MILITARY POLICE GUARD QUARTER- MASTER SALES OFF TRANS- ' PORTATION DET. Q.M.C. ■JsiGNAL OFF SUPPLIES PX PROVOST MARSHAL med.supplyI OFFICER I STORAGE 8 ISSUES chaplains! RED CROSS) COMMANDING OFFICER REPAIRS LAUNDRY MED. LIBRARY EXECUTIVE OFFICER PERSONNEL ADJUTANT FINANCE OFFICER CO MEDICAL DETACH. ADJUTANT HOSPITAL INSPECTOR INSPECTIONS AUDITS INVESTI- GATIONS RECEIVING aj EVAC. OFF. I THERAPY SECT. POLICE OFFICER NURSING SERVICE OIAG. SECT. INFORMATION OFFICE MESSENGER SERVICE RECRUITING OFFICER X-RAY SERVICE WOMENS SECT. ANES.OPER SECT. PHYSIO- THERAPY UROLOG SECT, [PROFESSIONAL O.D OUTPATIENT! SERVICE I INFIRMARY PHARMACY EMERGENCY MED. SECT. ALLERGY CLINIC SURGICAL SERVICE GEN. SURG. SECT. SEPTIC SURG SECT. ORTHOPED. SECT. OFFICERS SECT. PROFESSIONAL DIVISION DENTAL SERVICE DETENTION WARD OPERATIVE SECTION PROSTHETIC SECT. ORAL SURGERY EMERGENCY DENT. SECT. X-RAY SECTION N.R SERVICE PSYCHI- ATRY NEUROL- OGY OCCUPAT. THERAPY E.E.N.T. SERVICE COMMON. DIS. SECT GASTRO- INT, SECT. GENERAL MED. SECT. EYE SECTION EAR, NOSE 8. THROAT SECT MEDICAL SERVICE LAB. SERVICE OFFICERS SECT. CAROIOVAS. SECT. DERMATOL SECT. WOMENS SECT. PATHOLOGY SECTION CLIN. MICRO. CHEM.SECT. VETERINARY SECT. 30 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR fit. Hospital regulations published in the Army Medical Bulletin in October 1940 and in Technical Manual 8-260 in July 1941 were probably of value to some, but offi- cers opening new hospitals often borrowed copies of regulations and administrative forms of other hospitals to use as guides in establishing their own administrative procedures,58 The Surgeon General supervised and directed the professional work of hospitals through inspections by members of his Office and the issuance of technical in- structions, but he exercised little direct control during this period over their ad- ministrative activities. Rather he de- pended on The Inspector General and corps area authorities to keep hospitals in line with Army procedures and to report administrative problems that arose.59 The question of whether the autonomy given hospital commanders resulted in less efficient operations than might have other- wise been the case was not discussed dur- ing the period under consideration. Argu- ments might have been raised in favor of flexibility which permitted accommoda- tion to local situations. Later on, lack of uniformity in organization and adminis- tration became a subject of much discus- sion and efforts were made to develop standardized organizations and simplified administrative procedures.60 Manning of Hospitals: Manning Guides and Personnel Problems In September 1940 there was no up-to- date guide for manning named hospitals. Since they were then small, few in num- ber, and widely different in construction none was needed, for personnel require- ments of each installation could be deter- mined best on an individual basis. With the opening of large hospitals built on standard plans, corps area surgeons began to need a guide to use in computing re- quirements and distributing personnel. The only available one was a 1929 table of organization for wartime station hospi- tals in the zone of interior.61 Although named hospitals were not being organized under it the General Staff early in 1940 had given the Third Corps Area permis- sion to use this table as a guide, pending the publication of a “table for converting bed requirements into personnel require- ments.” Preparation of the latter in the Surgeon General’s Office was delayed until December 1940, because the revision of tables of organization for field force units had priority.62 As submitted to the General Staff, the new guide called for more personnel, espe- cially officers and enlisted men, than did the old one. For example, a 500-bed sta- tion hospital under the old table was to have 25 officers, 60 nurses, and 200 en- listed men; under the new guide, 37 offi- cers, 60 nurses, and 275 enlisted men. The Surgeon General thought that the old table did not provide sufficient personnel for “a present day hospital.” Although G-l agreed that the amount called for by 58 (1) Interv, MD Historian with Maj Gen Howard McC. Snyder, 25 May 48. HD: 000.71. (2) See also: An Rpt, 1941, Lovell Gen Hosp. HD. 59 (1) Interv, MD Historian with Col Albert G. Love, 27 Aug 47. HD: 000.71. (2) Interv, MD His- torian with Gen Snyder, 25 May 48. HD: 000.71. 60 See below, pp. 121-24, 268-78. 61 T/O 786 W, Sta Hosp, ZI, 1 Jul 29. 62 (1) 2d ind, TAG to GG 3d CA, 28 Mar 40, on Ltr, Surg 3d CA to SG, 22 Jan 40, sub: Civ Employees in Sta Hosps. AG: 381 (1-1-40) Sec 1. (2) 1st ind SGO 370.01-1, SG to TAG, 9 Apr 40, on Ltr, TAG to CGs of CAs, COs of Exempted Stas, C of Arms and Servs, 28 Mar 40, same sub. Same file. (3) Ltr SGO 370.01-1, SG to TAG, 19 Dec 40, sub: Guide for De- termining Pers Reqmts, Sta Hosps, ZI. AG: 381 (11- 3-37) Sec 1-12. PLANNING AND EXPANDING HOSPITALS 31 the new guide was reasonable,63 the Staff delayed its publication because it ex- pressed requirements in terms of military personnel only and called for more en- listed men than the number already al- lotted to hospitals. The first objection was apparently removed in January 1941 when Maj. (later Col.) Arthur B. Welsh, of The Surgeon General’s Planning and Training Division, stated that civilians could be substituted for enlisted men on an approximate man-for-man basis.64 Two months later, incidentally, his superior officer, General Love, informed corps area surgeons that civilians should replace en- listed men on a three-for-two basis.65 In view of continued disagreement among members of the General Staff over the total number of enlisted men involved, the question of publication was submitted in March 1941 to the Chief of Staff. As a result a “Guide for Determination of Med- ical Department Personnel” was pub- lished on 9 April 1941 with the under- standing that it represented requirements, not availabilities.66 Publication of the guide did not mean that hospitals were to have the strength prescribed. The Surgeon General appar- ently had no trouble in getting the Gen- eral Staff to authorize the number of phy- sicians, dentists, and nurses whom he de- sired, but he encountered difficulty in pro- curing the number authorized.67 During the fall and winter of 1940-41 hospitals considered the shortage of physicians and nurses acute. To alleviate it they employed civilian nurses on a temporary basis and used Medical Corps officers from field force units located near by. Medical Ad- ministrative Corps officers filled a few administrative positions, but the Army had few such officers and their substitu- tion for Medical Corps officers in admin- istrative work gained little headway prior to the war years. By the spring of 1941 the procurement situation had apparently im- proved and many hospital commanders reported that the number of officers and nurses assigned to them was adequate.68 The question of the number of enlisted men to be assigned to named hospitals was bound up with the use of civilian em- ployees and the training of medical per- sonnel. The Surgeon General contended that the Medical Department needed pro- portionately as many enlisted men in named hospitals during mobilization as in peacetime in order to train enlisted men in technical duties for use later as cadres and fillers for new units and installations. He insisted, therefore, that hospital staffs should have no higher proportion of civil- ians than 20 percent of the total enlisted 63 (1) Memo, Act SG for ACofS G-l WDGS, 1 Apr 4 1, sub: Approval of T/O for Sta Hosps in the ZI. HD: 322.052-1. (2) Memo G-l/13308-291, ACofS G-l WDGS for ACofS G-4 WDGS, 14 Feb 41, sub: Guide for Determining Pers Reqmts, Sta Hosp, ZI. AG: 381(1 1-3-37) Sec 1-12. 84 D/S G-4/31697, ACofS G-4 WDGS to TAG, 30 Dec 40, sub: Guide for Determining Pers Reqmts, Sta Hosp, ZI, and Memo G-l/13308-291, ACofS G-l WDGS for ACofS G-4 WDGS, 8 Jan 41, same sub. AG; 381(1 1-7-37) Sec 1-12. 65 Rpt, Conf of SG with CA Surgs, 10-12 Mar 41. HD: 337. 68 (1) Memo G-l/13308-291, ACofS G-l WDGS for ACofS G-4 WDGS, 14 Feb 41, sub: Guide for De- termining Pers Reqmts, Sta Hosp, ZI. (2) Memo G-3/42107, ACofS G-3 WDGS for ACofS G-4 WDGS, 28 Feb 41, same sub. (3) Memo G-4/31697, ACofS G-4 WDGS for ACofS G-l WDGS, 1 1 Mar 41, same sub. (4) Memo G-4/31697, ACofS G-4 WDGS for CofSA, 22 Mar 41, same sub. All in AG: 381(1 1-3-37) Sec 1-12. The Chief of Staffs stamp of approval for publication was dated 28 March 1941. (5) MR 4-2, Hospitalization, C-l, 9 Apr 41. 67 John H. McMinn and Max Levin, Personnel (MS for companion vol. in Medical Dept, series), HD. 88An Apts, 1941, Hoff, O’Reilly, and Billings Gen Hosps and Sta Hosps at Cps Livingston and Forrest, Fts Knox and Jackson, and Indiantown Gap Mil Res. HD. 32 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR and civilian staff.69 On the other hand, faced with the problem of dividing a given number of enlisted men among field force units (including numbered hospital units) and zone of interior installations of the various arms and services, the General Staff believed that civilians should consti- tute as much as 50 percent of the staffs of named hospitals. In this connection G-3 suggested that the Medical Department might affiliate (not explaining what it meant by this term) numbered hospital units with named hospitals to provide additional enlisted men for service in the named hospitals and at the same time to give the numbered hospital units the best possible training.70 The Surgeon General planned to train numbered units in named hospitals, but he apparently expected the members of such units to be used not as regular operating personnel but as under- studies of their opposite numbers. Repeat- edly, therefore, he asked for greater allot- ments of enlisted men for fixed installa- tions of the Medical Department, but without success.71 Hence, the enlisted men authorized for assignment to general and station hospitals were fewer than The Surgeon General desired, and those re- ceived by hospitals were fewer than the number authorized. To supplement them hospitals used civilians and men from near-by field medical units, the former sometimes constituting more than half of the total enlisted and civilian staffs.72 In addition to having less military per- sonnel than they considered desirable, hospitals received officers and enlisted men who needed further training. Nurses and Medical Corps Reserve officers were of course qualified by training and experi- ence to care for the sick and injured, but most who entered the Army after Septem- ber 1940 knew little about the administra- tion of Army hospitals. In some instances this resulted in devotion of more time and energy to paper work than was ordinarily thought proper. Recognizing the need for training Reserve officers in administrative procedures before assigning them to hos- pitals, The Surgeon General authorized a program in November 1940 to train fifty Reserve and National Guard officers each month for such positions as registrar, de- tachment commander, receiving and dis- position officer, adjutant, executive officer, medical supply officer, and mess officer. In general, though, the burden of training officers and nurses in administrative work fell upon the commanding officers of the hospitals to which they were assigned.7 3 A majority of enlisted men available for service in hospitals during 1941 lacked a knowledge of both military and technical matters. The number of Medical Depart- ment men in the enlisted Reserves was 69 (1) Ltr, SG to TAG, 3 Sep 40, sub: Employment of Civs. AG: 381(1-1-40) Sec 3. (2) Ltr, SG (init J. C. M[agee]) to TAG, 6 Sep 40, sub: MD in Mob. Same file. (3) Memo, Act SG (Brig Gen A[lbert] G. Love) to ACofS G-l WDGS, 1 Apr 41, sub: Increase in Auth for MD EM for . . . Overhead. HD: 322.052-1. 70 Memo G-l/15081 Med, ACofS G-l WDGS for AGofS G-3 WDGS, 13 Sep 40, sub: Allocation of MD Pers, and Memo G-3/6541 Med 68, ACofS G-3 WDGS for ACofS G-l WDGS, same sub. AG; 381 (1-1-40) Sec 3. 71 (1) For example, see: Memo, Act SG for ACofS G-l WDGS, 1 Apr 41, sub: Increase in Auth for MD EM for CA, SvC, and WD Overhead. HD; 322.052-1. (2) Also see McMinn and Levin, op. cit. 72 For example, see; An Rpts, 1941, Sta Hosps at Cps Blanding, Bowie, and Forrest, Fts Bragg and Knox, Indiantown Gap Mil Res, and Hoff Gen Hosp. HD. 73 (1) Interv, MD Historian with Gen Snyder, 25 May 48. HD: 000.71. (2) An Rpts, 1940, Sta Hosps at Cps Livingston, Blanding, Edwards, Shelby, For- rest, J. T. Robinson, and Claiborne, Fts Jackson, Bragg, and Knox, and O’Reilly, Lawson, Hoff, Bil- lings, and Tilton Gen Hosps. HD. (3) SG Ltrs 79, 7 Nov 40; 14, 26 Feb 41; and 32, 5 Apr 41. PLANNING AND EXPANDING HOSPITALS 33 negligible, and the Medical Department’s replacement training centers and enlisted technicians’ schools did not begin to turn out trained men in large numbers until the summer of 1941.74 Regular Army en- listed men from hospitals already in oper- ation formed the cadres of enlisted detach- ments of new hospitals. The remainder were usually men assigned direct from reception centers. The necessity of giving them basic military training interfered with their performance of technical duties, and hospital commanders generally pre- ferred men from replacement training centers after they became available. To make up for the lack of technical training, hospitals instituted on-the-job training programs which varied in content and value from one installation to another.75 Civilians in Army hospitals were nor- mally used in jobs traditionally held by such enlisted men as medical technicians, ward orderlies, clerks, cooks and cooks’ helpers, repair and maintenance men, and janitors. In some instances civilian nurses were employed, and until the end of the first year of the war all female dieti- tians and physical therapy aides were in civilian status. The chief problem in the use of civilians was procurement. To re- duce difficulties in that connection The Surgeon General in September 1940 de- centralized to corps areas the employment of civilians for station hospitals, including those on exempted stations. He retained in his Office for a time the employment of civilians for named general hospitals.76 Among local conditions that continued to hamper the procurement of sufficient numbers of qualified civilians, the most important were lack of housing near hos- pitals in isolated areas, inadequate trans- portation to such hospitals, absence of labor markets in some places, and com- petition of other government agencies for available civilians.77 Shortages of Supplies and Equipment Another difficulty encountered in open- ing new hospitals was a shortage of suit- able supplies and equipment, and com- plaints of hospital commanders on this score were frequent.78 Depots met earliest needs by issuing reserves stored after World War I. As a result, much that hos- pitals received, such as surgical instru- ments, plaster of paris bandages, and ward furniture, was of 1918 vintage. When reserves proved insufficient, depots supplemented them with local emergency 74 (1) Annual Report of The Secretary of War, 1941 (Washington, 1941), pp. 95, 134. (2) McMinn and Levin, op. cit. (3) [Samuel M. Goodman], A Summary of the Training of Army Service Forces Medical De- partment Personnel, 1 July 1939-31 December 1944 ([1946]), pp. 38, 46-48. 75 (1) An Rpts, 1941, Sta Hosps at Cps Livingston, Blanding, Edwards, Shelby, Forrest, J. T. Robinson, Bowie, and Claiborne, Fts Jackson, Bragg, and Knox, and O’Reilly, Lawson, Hoff, Billings, and Tilton Gen Hosps. HD. 76 Ltr, SG (Fin and Sup Div) to Surgs CAs and Depts, 12 Sep 40, sub: Use of Civ Pers in Army Hosps, and Ltr, TAG to C of Arms and Servs, CGs of Exempted Stas, 31 Oct 40, sub; Provision for Civ Em- ployees in Hosps of Exempted Stas. AG 381 (1-1-40) Sec 3. 77 An Rpts, 1941, Sta Hosps at Cps Livingston, Blanding, Edwards, Shelby, Forrest, J. T. Robinson, Bowie, and Claiborne, Fts Jackson, Bragg, and Knox, and O’Reilly, Lawson, Hoff, Billings, and Tilton Gen Hosps. HD. 78 Unless otherwise indicated, the following para- graphs are based upon annual reports of Barnes, Hoff, Lawson, and O’Reilly General Hospitals, and Camps Beauregard, Blanding, Claiborne, Croft, Forrest, Shelby, and Forts Bragg, Jackson, Lewis, and Leonard Wood Station Hospitals. In a conference on 10 No- vember 1950, General Magee disagreed with the in- terpretation given here, stating that he personally found a high state of satisfaction with supplies when he inspected hospitals. (Notes filed in HD: 314 [Cor- respondence on MS] I.) For a statement about the general shortage of Army supplies in 1940, see Mark S. Watson, Chief of Staff: Prewar Plans and Preparations (Washington, 1950), p. 209, in UNITED STATES ARMY IN WORLD WAR II. 34 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR purchases but even so had to ship many as- semblages 50- to 60-percent complete.79 Hospitals thus failed initially to receive many critical items. Most frequently lack- ing were sterilizers, X-ray equipment, orthopedic equipment, dental operating units, cystoscopic instruments, and cath- eters. To make up for shortages hospitals re- sorted to a variety of expedients. In some instances medical and dental officers sent home for their own instruments. At Camp Claiborne (Louisiana) they personally purchased medical supplies which they considered requisite. The station hospital at Camp Blanding (Florida) made up for its lack of laboratory supplies and equip- ment by borrowing from the University of Florida and the Florida State Board of Health, while the Camp Claiborne Sta- tion Hospital borrowed an X-ray devel- oping tank from a dealer in Shreveport, Louisiana. In other instances Army au- thorities arranged locally to use the facil- ities of neighboring hospitals. For exam- ple, the Camp Beauregard (Louisiana) Station Hospital sent cases requiring X-ray and electrocardiographic work to the Veterans Administration Facility at Pineville, La.; used the diagnostic and clinical facilities of the Central Louisiana State Mental Hospital for neuropsychia- tric patients; and sent fractures requiring reductions or large casts to the Baptist Hospital in Alexandria, La. Where office and ward furniture was lacking, hospitals improvised desks, chairs, and tables from boxes and lumber salvaged from the hos- pital’s construction. Thus the improvisa- tion and ingenuity of local personnel com- pensated to a great extent for shortages of supplies and equipment. The above situation resulted initially from the inadequacy and obsolescence of the war reserve. It continued because con- siderable time was required both for in- dustry to convert to the production of goods on the scale demanded and for the Medical Department to modify its peace- time methods of requirements-computa- tion, purchasing, stock-control, storage, and distribution. Although the quantity of supplies became more adequate by the fall of 1941, the situation was by no means satisfactory at the end of the year and many items were still on “back order.” 80 Development of Procedures Affecting Operation of the Hospital System As new station and general hospitals opened, broad policies and procedures to govern the hospital system in general be- came necessary and The Surgeon Gen- eral’s Hospitalization Division concen- trated its efforts in those fields.81 The need for a new policy to govern the selection of patients for transfer to general hospitals developed in the spring of 1941. Until that time hospital commanders and corps area surgeons decided which cases were suffi- ciently “serious, complicated, or obscure” to require treatment in the five general hospitals then in operation. Few restric- tions were placed upon them: cases of resection and amputation requiring the fitting of prostheses were to be transferred to Walter Reed, Letterman, or Army and Navy General Hospitals; patients with tuberculosis, to Fitzsimons; and “cases of such diseases as the waters of the hot springs of Arkansas have an established reputation for benefiting,” to Army and 79 (1) Memo, Lt Col R. L. Black, Dir Storage and Maintenance Div SGO for HD SGO, 16 Nov 44, sub: Sup [Depot] Hist Highlights. HD: 400.24 (Storage and Distr). (2) Hist and Procedure Manual of the Toledo Med Depot, 1941-45. HD. 80 Richard E. Yates, The Procurement and Distri- bution of Medical Supplies in the Zone of the Interior during World War II (1946), pp. 22-46. HD. 81 Cmtee to Study the MD, 1942, Testimony of Col Harry D. Offutt, pp. 196-98. HD. PLANNING AND EXPANDING HOSPITALS 35 Navy.82 To provide a more exact guide the Hospitalization Division developed a policy that was published on 26 March 1941.83 While it did not relieve local sur- geons of responsibility for selecting pa- tients to be transferred, it provided gen- erally that all requiring more than sixty days of hospitalization as well as those needing specialized treatment not avail- able at station hospitals should be sent to general hospitals. Major elective 84 oper- ations were to be performed at general hospitals only. Station hospitals were to dispose of enlisted neuropsychiatric or psychotic patients locally, but were to send officers, nurses, and warrant officers who were similarly affected or who had other disabilities which made them unfit for further military service to general hos- pitals for observation and disposition. Hospitals previously designated for the care and treatment of special cases were to continue to receive them as in the past. Soon after this policy was established the Hospitalization Division developed a procedure to implement it. Under current Army regulations hospital commanders needed corps area approval for each transfer of a patient from a station to a general hospital.85 As new hospitals opened, this requirement resulted in much paper work for corps area surgeons and in delayed treatment for patients. On 19 May 1941, therefore, The Surgeon Gen- eral requested authority to set aside spe- cific numbers of general hospital beds to which station hospitals might transfer patients without reference to corps area headquarters. The General Staff ap- proved this request and on 21 June 1941 authorized the establishment of a system of bed credits. This permitted the Hospi- talization Division to allot a certain num- ber of beds in general hospitals to each large station hospital and, through corps area surgeons, to small ones. Thereafter post commanders normally transferred patients to general hospitals without refer- ence to higher authority. When stations needed changes in allotments, they ordi- narily requested them through corps area surgeons. In emergencies, they were au- thorized to communicate directly with The Surgeon General.86 The procedure for transferring patients from station to general hospitals was fur- ther simplified in the late summer of 1941. Until then Army regulations required each hospital to make extracts or copies of the clinical records, including case his- tories, of patients being transferred, to be sent along with them. As the number of patients increased, this time-consuming process began to delay their transfer and hence their treatment. The Surgeon Gen- eral then secured approval of a change which permitted station hospital author- ities to transfer to general hospitals, along with patients, the original clinical records of their cases. The transferring hospital kept only clinical-record briefs and cross references indicating the disposition of original records.87 Another problem for the Hospitaliza- tion Division was the disposition of pa- tients. It concerned the Hospital Con- struction and Repair Subdivision also, for prompt disposition of patients reduces total bed requirements by making avail- able for patient care more of the beds al- 82 (1) AR 40-600, Gen Hosp, Gen Provisions, 31 Dec 34. (2) Mins, SGO Conf with CA Surgs, 10-12 Mar 41. SG: 337.-1. 83 (1) SG Ltr 24, 26 Mar 41. (2) Annual Report . . . Surgeon General, 1941 (1941), p. 253. 84 Advantageous to the patient but not necessary to save life. 85 AR 40-600, par 4 a (1), 31 Dec 34. 86 (1) Ltr, SG to TAG, 19 May 41, sub; Trf of Pnts to Gen Hosps. SG: 705.-1. (2) WD Cir 120, 21 Jun 41. 87 (1) Ltr, Brig Gen H. D. Offutt to Gol H. W. Doan, lOJun 48, annex 1. HD: 322. (2) WD Cir 184, 26 Aug 41. (3) SG Ltr 94, 16 Sep 41. 36 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR ready set up. During 1941 there was con- siderable local dissatisfaction with diffi- culties and delays encountered in granting patients disability discharges from the Army. Believing that lack of experience on the part of many medical officers was responsible, one corps area surgeon issued a directive in 1940 to clarify procedures for handling such cases.88 In general, the centralization in corps area headquarters of authority to discharge men on certifi- cates of disability, rather than inefficient hospital procedures, seems to have been considered the most important reason for delays.89 Apparently sharing this view, The Surgeon General secured authority in September 1941 for the commanders of general hospitals to grant disability dis- charges. At the same time, it should be noted, the War Department was further decentralizing such authority to other local commanders, including those of divisions, reception centers, replacement training centers, and exempted stations. The Surgeon General also secured author- ity for general hospital commanders to issue travel orders for men returning to duty or being discharged from the Army.90 In the fall of 1941 the Chief of Staff be- came concerned about delays in the re- tirement of disabled officer-patients. When General Marshall called a case of this kind to his attention, The Surgeon General replied that such delays were “chronic” but that they occurred in large part in Army administrative channels after general hospitals had completed their work and made their recommenda- tions. Soon afterward he directed general hospital commanders to “personally as- sure themselves that the disposition of officer patients is expedited insofar as this can be done without prejudice to the in- terest of the individual or of the Govern- ment.” 91 Further steps to speed the dis- position of officer-patients were not taken at this time. Partial simplification of the procedure for granting disability discharges went some distance, though not as far as pos- sible, toward relieving Army hospitals of patients who were unnecessarily occupy- ing beds. Action was also taken to relieve hospitals of certain other patients—that is, some of those suffering from tuberculosis, psychosis, and other chronic diseases. At the beginning of mobilization the Presi- dent approved a recommendation of the Federal Board of Hospitalization that members of the armed forces who were in- jured or incurred disabilities “in line of duty” and whose physical rehabilitation by the Army or Navy was not feasible should be cared for by the Veterans Ad- ministration. Accordingly the Surgeon General’s Office secured approval in March 1941 for the transfer to the Veter- ans Administration of most enlisted men who were permanently disabled by the development of pulmonary tuberculosis. Two months later this provision was ex- tended to all classes of chronic disability cases. Three classes of tuberculous pa- tients—those nearing retirement after thirty years of service, those in the first three noncommissioned grades whose re- covery was probable within a year, and those whose cases were considered not to have been incurred in line of duty—were to be kept in the Army and transferred to Fitzsimons General Hospital. As soon as 88 An Rpt, 1940, Surg 2d CA. HD. 89 Rpt, Conf of SG with CA Surgs, 10-12 Mar 41. HD: 337. 90 (1) Cmtee to Study the MD, 1942, Testimony of Col Offutt, pp. 196-98. HD. (2) WD Cirs 194, 17 Sep 41; 196, 19 Sep 41; and 187,4 Sep 41. 91 (1) Memo, CofSA for SG, 23 Sep 41. (2) Memo, CG WRGH for SG, 26 Sep 41. (3) Ltr, SG to COs Gen Hosps, n d, sub: Disposition of Off Pnts. (4) Memo, Act SG to CofSA, 6 Oct 41, same sub. All in SG: 705.-1. (5) WD Cir 217, 15 Oct 41. PLANNING AND EXPANDING HOSPITALS 37 patients in the last group were able, they were to be discharged to their own care or that of relatives.92 The removal of psychotic patients from Army hospitals was more complicated. Many could not be transferred to the Vet- erans Administration because their dis- abilities had existed before induction. State institutions were often reluctant to accept those who required care in locked wards. As a result psychotic patients be- gan to accumulate in Army hospitals. Early in the mobilization period a large three-story section of Walter Reed Gen- eral Hospital was converted into closed wards and the Medical Department ar- ranged to use, as an annex to that section, 100 beds in St. Elizabeth’s Hospital in Washington. One or two closed wards more than had been planned were con- structed at each new general hospital erected during 1941. In the summer of that year, after Walter Reed General Hos- pital had demonstrated the rather ele- mentary fact that transfer of psychotic pa- tients to state institutions was expedited by addressing requests to proper state agencies or authorities, The Surgeon Gen- eral issued a circular letter naming those in each state. About the same time his Office arranged to establish a special neu- ropsychiatric center in the just-completed and unused State Hospital at Danville, Ky. Called Darnall General Hospital, it was ready to receive patients a few months after the Japanese attacked Pearl Har- bor.93 Starting almost from scratch in Septem- ber 1939, the Medical Department reached a state of partial preparation for war by December 1941. To provide hospi- tals for a rapidly expanding Army in the United States, a simple method of com- puting requirements was adopted and ratios of beds to troop strength—smaller than The Surgeon General considered de- sirable—were officially established. Ex- perience in expanding hospital facilities showed that it was impracticable to rely upon the use of existing Army hospitals and available non-Army buildings. It also revealed imperfections and shortcomings in cantonment-type hospitals planned in the thirties, with the result that a new type of hospital more compact and fire resist- ant was developed. As new hospitals opened, the Surgeon General’s Office evolved general guides for their organiza- tion and administration but left hospital commanders with much autonomy in this field. Attention was focused not upon in- ternal hospital administration but upon simplifying procedures affecting the hospi- tal system in general. In this connection attempts were made to reduce unneces- sary occupancy of beds by patients no longer needing treatment or of no further use to the Army. There were shortages of personnel, though authorized allotments for hospitals were generous, and it was necessary in many instances to substitute civilians for enlisted men. Shortages of supplies and equipment were alleviated by the ingenuity of hospital commanders and their staffs. Meanwhile, the Surgeon Gen- eral’s Office was also concerned with plans and preparations for overseas hospitaliza- tion, the subject to which the discussion now turns. 92 (1) Annual Report . . . Surgeon General, 1941 (1941), p. 253. (2) Ltr SGO 300.3-1, SG to TAG, 7 Apr 41, sub: Proposed Change in AR 615-360. AG: 220.8 (8-1-34) Case 1. (3) WD Cirs 100, 19 May 41; 44, 17 Mar 41; 226, 27 Oct 41; and 252, 1 1 Dec 41. 93 (1) Ltr, Brig Gen H. D. Offutt to Col H. W. Doan, 10 Jun 48, inch 1. HD: 322. (2) Ltr, SG to QMG, 17 Dec 40, sub: Add Fac for the Care of In- sane, and 1st ind QM 632 C-EP (Gen Hosp), QMG to SG, 31 Jan 41. SG: 632.-1. (3) SG Ltr 64, 24 Jun 41, sub: Disposition of NP Pnts. (4) Annual Report . . . Surgeon General, 1941 (1941), p. 165. CHAPTER III Plans and Preparations for Hospitalization in Overseas Areas Mobilization Planning Planning for field hospitalization in the event of mobilization involved determina- tion of the numbers and types of medical units that would be needed for the force anticipated, provision of up-to-date guides for their organization and equipment, and arrangements for furnishing them with personnel and supplies. Until the fall of 1940 the defensive nature of all War De- partment mobilization planning com- bined with limitations upon available funds to hold Medical Department activ- ities in this sphere largely within the realm of paper work. Determining the Number of Medical Units Needed Determination of the number of mobile medical units that would be needed was governed primarily by the number of combat units authorized. Each combat organization such as a regiment or divi- sion had a standard structure consisting of a specific number of units of the several arms and services, including medical, that were “organic” parts of the larger unit. Thus units designed to provide emergency medical care and transportation for pa- tients in divisional areas of combat zones were automatically required along with the regiments and divisions of which they were a part. The organization of corps and armies, though not strictly governed by tables of organization, was also stand- ardized. On recommendation of The Sur- geon General in the winter of 1939 a “type army” (that is, a standard army) was authorized 3 medical regiments, 10 evacuation hospitals, 8 surgical hospitals, 1 convalescent hospital, 1 medical labora- tory, and 1 medical supply depot. A corps was authorized either a medical regiment or a medical battalion. Other medical units varying in kind and number might be authorized as a General Headquarters (GHQ) reserve force. In July 1940 the War Department Protective Mobilization Plan listed as mobile medical units, for an anticipated force of approximately 1,150,000 men, 8 medical regiments, 5 “reinforcing” medical battalions, 1 horse- drawn ambulance company, 1 medical troop, 17 evacuation hospitals, 13 surgical hospitals, 1 convalescent hospital, 2 medi- HOSPITALIZATION IN OVERSEAS AREAS 39 cal laboratories, 2 medical supply depots, and certain other miscellaneous units.1 There was no standard number of fixed medical units such as station and general hospitals for given combat forces. To esti- mate the number needed the Surgeon General’s Office again turned to Colonel Love’s analysis of World War I battle casualty experience. From this study some members of the Planning and Training Division believed that beds in fixed hospi- tals should equal 15 percent of a theater’s strength. Others believed a lower ratio would suffice.2 The Surgeon General in- dicated in his Protective Mobilization Plan of 1939 that 126,000 fixed beds would be needed by the end of the first year of mobilization.3 The War Depart- ment Plan provided for only 35,000—in 32 general hospitals, 4 station hospitals, and 2 hospital centers. The Surgeon Gen- eral considered this provision “alarmingly inadequate” and attempted during 1940 to secure an increase both in the number of beds authorized and in their scheduled rate of availability. In February he sub- mitted a study showing that a minimum of 115,000 fixed beds would be required, but because G-3 believed that the major- ity of troops to be mobilized should be al- lotted to combat arms, The Surgeon General’s recommendations received only partial approval. On 6 August 1940 the General Staff authorized an increase in the number of 1,000-bed general hospi- tals from 32 to 102. The number of station hospitals and hospital centers remained as originally planned.4 (Table 1) Revision of Tables of Organization and Equipment Lists As a part of its mobilization planning the Surgeon General’s Office undertook a general revision of tables of organization of all medical units and the preparation of up-to-date equipment lists for them. Al- though these projects had been started earlier, only the equipment list for med- ical regiments and the tables of organiza- tion for medical regiments and squadrons had been completed by the fall of 1939. After the President declared an emer- gency this work was pushed to completion by the end of 1940. Changes in the tables of organization of medical units that supplied emergency medical care and transportation for pa- tients in combat zones reflected changes in combat units to increase their mobility and flexibility. When the infantry division was “streamlined” and converted from a “square” to a “triangular” organization, its organic medical unit was reduced from a regiment to a battalion and appropriate tables for the latter were prepared. Like- wise, the medical battalion eventually be- 1 (1) Kent R. Greenfield, Robert R. Palmer, and Bell I. Wiley, The Organization of Ground Combat Troops (Washington, 1947), pp. 263-68, 275-80, in UNITED STATES ARMY IN WORLD WAR IE (2) 1st ind, SG to TAG, 1 1 Oct 39, on Ltr, TAG to C of Arms and Servs, 3 Oct 39, sub: Orgn of Army Troops. AG: 320.2(9-27-39)(l). (3) Ltr 320.3-1, SG to ACofS G-3 WDGS, 13 Jul 40, sub: Corps Med Units and Atchd Med, and Army Med Regts. HD; McKinney files. (4) War Department Protective Mobilization Plan, 1940, Annex No. 7, Pt. I. AG: Budget Div, WDGS files, A-45-7. 2 Memo, GEM [Col Garfield L. McKinney] for Col [Albert G.] Love, 6 Feb 40. HD: McKinney files. 2 SG PMP, 1939, Annex No. 29, Chart No 2. 4 (1) Ltr, SG to TAG, 15 Feb 40, sub: Hosp under WD PMP 1939. AG; 381 (5-10-40) G-4/20052-134. (2) Ltr, SG to TAG, 8 Jul 40, sub: Hosp under WD PMP, 1939, with 1st ind AG 381 (7-8-40)M-C, TAG to SG, 6 Aug 40. HD; 370.01-1. (3) Memo G-3/6541 -Med-64, ACofS G-3 WDGS for Sec Gen Staff, 14 Apr 40, sub: Status of MD for War. AG: 381 (4-6-40) (1). (4) The War Department Mobilization Plan, speech by Lt Col Harry L. Twaddle, GSC, Chief Mob Br G-3 Div WDGS, 30 Sep 39. G-3 Course No 13 and 13A, AWC, 1939-40. 40 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Table 1—Comparison of the War Department’s Plan and The Surgeon General’s Recommendation for Fixed Beds for Theaters of Operations Days of Mobilization War Department Plan The Surgeon General’s Recommendation Gen Hosp Sta Hosp Hosp Ctr Gen Hosp Sta Hosp Hosp Ctr M-Day M+10/11 1,000 8,000 32.000 36.000 43.000 52.000 72.000 84.000 92.000 96.000 99.000 101,000 102,000 M+30/31 M+ 60/61 3.000 3.000 22,000 32.000 32.000 32.000 32.000 32.000 32.000 32.000 32.000 1,000 2,000 3.000 3.000 3.000 3.000 3.000 3.000 3.000 3.000 3.000 2,000 2,000 4.000 5.000 5.000 7.000 9.000 10,000 10,000 10,000 10,000 M+90/91 M+120/121 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,000 M+150/151 M+180/181 M+210/211 M+240/241 M+270/271 M+300 M+330 M-(-360 Source: Study accompanying Ur, SG to TAG, 14 Feb 40, sub: Hosp under WD PMP 1939. AG: 381 (S-10-40) G—4/20052-134. came the organic unit of a corps. Plans for the organization of armored divisions required the preparation of tables of or- ganization for medical units of that type of combat organization. In 1940 the tables of medical regiments and squadrons were again revised. Generally there was a tend- ency to increase the personnel in medical units of all sizes and to replace animal- drawn with motor vehicles. Basically, none of the changes made altered the Medical Department’s long-established doctrine of hospitalization and evacuation in combat zones.5 Changes in tables of organization of hospital units reflected a growth in spe- cialized medicine. New tables published during 1940 listed for the first time the specialists required as ward officers and chiefs of sections of professional services. They also allotted to hospitals more en- listed men having specialists’ ratings and correspondingly fewer having only basic military training. For the first time, they provided for civilian dietitians, physical- therapy aides, and dental hygienists. In many cases the total number of officers and enlisted men was increased. For ex- ample, in a 1,000-bed general hospital the number of officers rose from 42, of whom 30 were physicians, to 73, of whom 55 were physicians, and of enlisted men from 400 to 500. These changes, the Surgeon General’s Office believed, would enable military hospital units “to perform the necessary additional specialized medical 5 (1) Documents on the revisions are in SG: 320.3-1, 1939 and 1940. (2) History of Organization and Equipment Allowance Branch [SGO], 1939-44. HD. (3) Ltr, Surg 4th CA to Corps and Div Surgs, 26 Mar 40, sub: Third Army Maneuvers. HD: McKinney files. (4) Memo, Capt Thomas N. Page for [Brig.] Gen [Albert G.] Love, 28 Dec 40, sub: Activities of the Planning Subdiv [SGO]. HD: McKinney files. HOSPITALIZATION IN OVERSEAS AREAS 41 and surgical work required, in order to approach the standards of medicine and surgery as practiced in first class civilian hospitals. . . .”6 Although no new hospital unit was de- veloped during the emergency period, a change in the surgical hospital indicated the Medical Department’s awareness of the problem of developing a highly mobile unit to care for seriously wounded casual- ties near the front lines. The single-unit 250-bed surgical hospital developed after World War I was replaced by a new 400- bed surgical hospital to be organized under a table of organization issued on 1 December 1940.7 Similar in some re- spects to the “mobile hospital” adapted from the French auto-chir during World War I,8 the new hospital comprised a headquarters and three subordinate ele- ments: a mobile surgical unit and two 200-bed hospitalization units. Each of the latter had its own headquarters. Since each subordinate unit was capable of in- dependent operation, the surgical unit would be free to move forward, as soon as one hospitalization unit was immobilized with patients, to operate for the other hos- pitalization unit or to supplement the fa- cilities of other medical stations. Some of the surgical units, the Surgeon General’s Office anticipated, would have complete operating, sterilizing, X-ray, and medical supply rooms permanently installed on bus-type or van-type motor vehicles.9 Along with revised tables of organiza- tion, new equipment lists were prepared. At the beginning of 1939 the only ones available were shipping lists used during World War I. Like the medical supply catalog, they contained many articles that were obsolete and lacked others that had been developed in intervening years. To enable medical units to give modern med- ical and surgical treatmet, it was neces- sary to find out from manufacturers what articles were available and to analyze the functions and activities of each unit, from reveille to taps, to determine which were needed. Another factor, the transporta- tion of units to theaters of operations, had to be considered. To conserve shipping tonnage an attempt was made to include only indispensable articles in equipment lists. This work was done by Colonel Off- utt, assigned to the Army Medical Center in January 1939 and later transferred to the Surgeon General’s Office. He collab- orated with the Medical Field Service School (Carlisle Barracks, Pennsylvania), Walter Reed General Hospital, and The Surgeon General’s Supply Division and Planning and Training Division. The first list completed (in June 1939) was for the medical regiment. Others—including those for hospitals—followed during the remainder of 1939 and the first ten months of 1940. As rapidly as they were approved by the Surgeon General’s Office they were mimeographed and sent to the various medical supply depots. Concurrently, the table of basic allowances for the Medical Department was revised by The Surgeon 6 (1) The above paragraph is based largely on a comparison of the following T/Os: Gen Hosps, T/O 683 W (6 Jun 32) with T/O 8-507 (25 Jul 40); Sta Hosp, T/O 684W (1 Jul 29) with T/O 8-508 (25 Jul 40) and Evac Hosp, T/O 283 W (1 Jul 29) with T/O 8-232 (1 Oct 40). (2) See also Ltr, SG to TAG, 11 Jul 40, sub: Publication of T/O 8-508 and T/O 8-507. AG; 320.6 (Med) (4-18-40) (1). 7 T/O 8-231 (1 Dec 40) superseded T/O 284W (1 Jul 29). 8 The Medical Department ... in the World War (1925), vol. VIII, pp. 184-91. 9 (1) Ltr, Maj Frank B. Wakeman, SGO to Lt Col Guy B. Denit, MG, C&GS Sch, Ft Leavenworth, 11 Feb 41. SG: 322.3-1. (2) For documents on the experi- mental development of these vehicles see SG: 322.15- 17. 304244 0—55 5 42 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR General’s Planning and Training Division and was published on 1 November 1940.10 Efforts to Assure Availability of Equipment and Personnel for Units Planned Revision of equipment lists emphasized the importance of modernizing World War I unit assemblages in storage. After the war in Europe began, Surgeon Gen- eral Magee requested funds for this pur- pose. In April and again in May 1940 he informed the General Staff of the Medical Department’s unpreparedness for war, stating; “I have not at the War Depart- ment’s disposal for any emergency one complete, modern 1,000-bed general hos- pital for instant dispatch.” 11 Funds which the General Staff could secure were limited.12 Moreover, believing that The Surgeon General failed to recognize that increases in industrial capacity since World War I would make procurement easier and faster, G-4 opposed “piecemeal action” which favored the Medical De- partment alone. Hence the Staff only promised “consideration” of Medical De- partment requirements along with those of other services, and it was not until the month before the passage of the Selective Service Act that substantial funds for Medical Department equipment were in- cluded in the War Department’s budget requests.13 To provide professional staffs for hospi- tals included in the Protective Mobiliza- tion Plan, The Surgeon General early in 1940 began to arrange with civilian medi- cal institutions for the organization of authorized affiliated units. By June 1940 he requested an increase in their number, stating that the response of sponsoring in- stitutions was more enthusiastic than he had expected. The next month the Gen- eral Staff raised the numbers authorized to 68 general, 30 evacuation, and 23 surgical hospital units. About a year later the Sur- geon General’s Office reported success in the organization of affiliated units for 41 general, 11 evacuation, and 4 surgical hos- pitals—approximately the number origi- nally authorized in 1939.14 Attempts to secure enlisted men for training in hospital units were only par- tially successful. Although draftees could be used to fill units scheduled for activa- tion during mobilization, trained cadres would be required for each one and some units would have to be ready for action on M Day. Therefore some men needed to be trained in units before mobilization. In- creases in the authorized enlisted strength of the Army during 1939 and 1940 and in the authorized strength of the Medical Department in May 1940 from 5 to 7 per- cent of Army’s strength afforded some additional men. Since most of them were needed for organic medical units of divi- sions or for expanding named hospitals, 10 (1) Hist of Basic Equip Lists for Med T/O Orgns, incl 2, to Ltr, Brig Gen Harry D. Offutt to Col H. W. Doan, 10 Jun 48. HD: 322. (2) Memo, Capt Thomas N. Page for Gen Love, 28 Dec 40, sub: Activities of the Planning Subdiv [SGO]. HD: McKinney files. 11 Ltrs, SG to TAG, 6 Apr and 10 May 40, sub: Status of the MD for War. AG: 381 (4-6-40) (1). 12 Mark S. Watson, Chief of Staff: Prewar Plans and Preparations (Washington, 1950), pp. 156-66, in UNITED STATES ARMY IN WORLD WAR II. 13 (1) Memo G-4/20052-134, ACofS G-4 WDGS for CofSA, 20 Apr 40, sub: Status of MD for War. AG: 381(4-6-40) (1). (2) Ltr, TAG to SG, 23 May 40, same sub. Same file. (3) Memo G-4/20052-134, Act ACofS G-4 WDGS for CofSA, 19 Aug 40, same sub. (Marked “not used.”) AG: 381(5-10-40). 14 (1) Ltr, SG to Each Affiliating Inst, 16 May 40, sub; Affiliated Units, MD, USA. HD: 326.01-1. (2) Ltr, SG to TAG, 26 Jun 40, same sub, with 1st ind AG 381 (6-26-40)M-A, TAG to SG, 22 Jul 40. Same file. (3) Annual Report . . . Surgeon General, 1941 (1941), p. 145. (4) John H. McMinn and Max Levin, Personnel (MS for companion vol. in Medical Dept, series), HD. HOSPITALIZATION IN OVERSEAS AREAS 43 the General Staff at first allotted none at all to nonorganic medical units and num- bered hospitals. Insisting upon the neces- sity of training men in such units, The Surgeon General secured authority in June 1940 for the organization, along with one medical laboratory and one medical supply depot, of two evacuation and two surgical hospital units at half their table- of-organization enlisted strength, but it was not until 1 August 1940 that the first of these was activated.15 Preparing Hospitalization for Overseas Areas During a Peacetime Mobilization Mobilization of the Army for a year of peacetime training reversed the situation which had been anticipated in mobiliza- tion plans. Instead of field medical units such as regimental medical detachments, medical battalions, medical regiments, and numbered hospitals to support combat forces engaged in defensive operations, the greatest need was for named hospitals in the United States. Hence, they had first call upon medical personnel and equip- ment. Moreover, since the United States was not at war, additional hospitalization required in bases and possessions outside its continental limits was provided on a peacetime basis—that is, in named hospi- tals. Nevertheless, medical units had to be organized and trained along with the combat forces they were designed to sup- port. Activation of Field Medical Units When mobilization began in September 1940 the Army had, aside from the medi- cal units that were organic parts of exist- ing divisions, only the following field med- ical units: 2 surgical hospitals, 2 evacua- tion hospitals, 2 medical regiments, 1 med- ical supply depot, and 1 medical labora- tory.16 Additional organic medical units would be activated and trained along with their parent units, such as infantry divi- sions. Their number depended upon the number of parent units that would be called into being by the General Staff. The number of nonorganic units—those serv- ing with armies, corps, and General Head- quarters—that would be activated for training might differ from the number needed for combat operations. In anticipa- tion of the passage of the Selective Service Act, The Surgeon General had recom- mended in July 1940 the activation at half strength of all such units in the Protective Mobilization Plan except hospital centers, hospital trains, the auxiliary surgical group, and the general dispensary.17 The General Staff partially adopted this rec- ommendation in preparing the 1941 troop basis. In December 1940, it authorized the following corps, army, and GHQ medical units: 8 medical battalions, 8 medical regiments, 1 medical supply depot, 1 medical laboratory, 1 general dispensary, 15 evacuation hospitals, 6 surgical hospi- tals, 22 general hospitals, and 22 station hospitals.18 Approximately half of these 15 (1) Memo, ACofS G-l WDGS for TAG, 6 Nov 39, sub: Enl Pers, MD. G-1: 15081-Med. (2) Ltr AG 320.2 (5-13-40)M-D, TAG to SG, 14 May 40, sub: Adequacy of Serv Units as Contained in Proposed Trp Basis, with 1st ind, SG to TAG, 20 May 40. SG: 320.2-1. (3) Memo, SG for ACofS G-3 WDGS, 26 Jun 40, sub: Sta Lists. HD: McKinney files. (4) McMinn and Levin, op. cit. 16 (1) Annual Report . . . Surgeon General, 1940 (1941), p. 175, and 1941 (1941), p. 153. (2) Unit cards of the 1st and 3d Evac Hosps, 6th and 7 th Surg Hosps, 2d Med Lab, and 4th Med Sup Depot. HD. 17 Ltr SGO 370.01-1, SG to TAG, 17 Jul 40, sub: Mob of MD Units in President’s Tng Mob, PMP. AG: 381(1-1-40) Sec 3. 18 Ltr AG 320.2 (1 l-15-40)M(Ret) M-C, to CGs of all Armies et al., 16 Dec 40, sub: Constitution and Activation of Units. AG: 320.2(11-15-40)(1) Sec 1. 44 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR units were to be activated in February 1941 and the rest in June. Early in 1941 the Staff revised the troop basis, and authorized an additional medical bat- talion and two additional medical regi- ments. By the end of June 1941 all of the units authorized had been activated. The next month two additional station hospi- tal units were provided when two provi- sional hospitals, organized but not needed for a task force, were redesignated as numbered hospitals. Although plans were made later in the year for additional units, no more were authorized until after war came.19 Role of Hospital Units; Their Personnel and Equipment Confusion existed about the purpose of the hospital units activated during this period. The character of the mobilization and the nature of the international situa- tion were perhaps responsible for this. Under the Selective Service Act, Reserv- ists and draftees could not legally be made to serve outside the United States except in its territories and possessions. Neverthe- less, the Army being mobilized had to be prepared for action anywhere in the event of a threat to the security of the country. The Surgeon General seems to have re- garded authorized hospital units as pri- marily if not exclusively schools for tactical training that would furnish cadres for other similar units or would provide trained enlisted men as fillers for the hos- pitals that would be called up in case of war—that is, the affiliated units. Along with shortages of personnel and equip- ment and demands of named hospitals for both, this view undoubtedly influenced his recommendations and plans for supply- ing hospital units with these elements. As tactical training units, numbered hospitals would need—in The Surgeon General’s opinion—officers and equipment for unit administration and field training only. Their enlisted members would be given technical training in named hospitals or in enlisted technicians’ schools. Moreover, full assemblages of equipment and com- plete officer staffs were not available for numbered hospitals. Therefore, The Sur- geon General planned to issue only field training equipment to numbered hospital units and he recommended that few officers, from two to five, should be as- signed to each.20 The General Staff considered the 1941 hospital units not as training schools but as true hospitals which could operate in the United States (presumably on maneu- vers) or in theaters of operations “in the event of an emergency.” On 3 January 1941 it issued a letter to that effect.21 Despite this view, the Staff adopted The Surgeon General’s recommendation that hospital units be given only part of their personnel—perhaps because of the short- age of men and officers to meet various needs and demands.22 Those formed dur- 19 (1) Annual Report . . . Surgeon General, 1941 (1941), pp. 153-54. (2) An Rpt, 1941, Surg GHQ. HD. (3) Ltr AG TAG to GofS GHQ; CGs of all Armies, CAs, and Depts; C of Arms and Servs, etc, 22 Nov 41, sub: Revision of Trp Unit Basis, FY 1942. SG: 320.2-1. (4) An Rpts, 1941, 267th and 168th Sta Hosps. HD. 20 (1) Ltr cited n. 17. (2) Annual Report . . . Surgeon General, 1941 (1941), p. 154. (3) Istind SGO 322.15-17. (Ft Knox)N, SG to Surg Ft Knox, 10 Sep 40, on Ltr, CO 6th Surg Hosp to SG, 5 Sep 40, sub: T/O&E. HD; McKinney files. (4) Ltr, SG to TAG, 25 Feb 41, sub: Unit Assemblages, with 3 inds. SG: 475.5-1. 21 Ltr AG 322.2(12-6-40)M-C-M, TAG to CofS GHQ CGs of Armies, et al., 3 Jan 41, sub: Purpose and Tng of Certain MG Units to be Activated with Sel Serv Men. SG: 322.3-1. 22 Ltr AG 11 1 (12-23-40)M-C-M, TAG to CofS GHQ; CGs Armies, CAs, and Depts, 31 Dec 40, sub: Trp Basis, PMP, 1941. AWC: 160-93. HOSPITALIZATION IN OVERSEAS AREAS 45 ing 1941 received initially, in addition to cadres of Regular Army enlisted men, from two to five officers each and only enough selectees—either from reception centers or from replacement training centers—to provide them with about half of their table-of-organization enlisted strength.23 The position of the Staff on equipment differed from The Surgeon General’s. In December 1940 it announced a supply policy for all Army units—they would ob- tain complete issues of authorized equip- ment, except controlled items (that is, those in short supply and issued only on special instructions by the War Depart- ment), by submitting requisitions to corps area headquarters. Two weeks later it issued another directive making this policy applicable specifically to Medical Depart- ment units,24 but a shortage of supplies and equipment made compliance with this directive impossible when hospital units were first activated in 1941.25 Toward the middle of 1941 the views of The Surgeon General on the purpose of hospital units began to coincide with those of the General Staff. By that time he had been required to provide medical com- plements for hospitals being established in new overseas commands and to prepare medical support for task forces being formed to occupy the French West Indies when it was feared that area might fall into German hands.26 For these purposes he drew personnel from named hospitals in the United States. In May 1941 he in- formed G-3 that he was having consider- able difficulty in providing hospitals for “task forces destined for early dispatch.” Explaining that he had to collect medical personnel from many scattered sources for this purpose, he pointed out that this was not only a disorderly process but also a threat to the medical service of the hospi- tals from which personnel was drawn. He therefore asked G-3 to authorize full com- plements of officers, nurses, and enlisted men for seventeen of the hospitals acti- vated earlier in 1941. This would simplify the problem, he thought, of converting training units into functional units. At the same time he requested authority to with- hold from such units all supplies and equipment, except training equipment, individual equipment, motor transporta- tion, and controlled items, until their as- signment to missions involving medical care.27 Early in July the Staff approved sufficient increases in the personnel of eleven—but not seventeen—units to bring their number of enlisted men up to almost full table-of-organization strength and of officers and nurses up to 50 and 75 percent respectively. The Staff also approved The Surgeon General’s proposal to withold the issuance of full hospital equipment to these 23 An Rpts, 1941, 4th, 6th, 10th, 11th, 15th, 19th, 23d, and 27th Evac Hosps; 28th, 33d, 48th, 61st, 62d, and 74th Surg Hosps; 1st, 5th, 7th, 10th, 11th, 12th, 22d, 47th, and 109th Sta Hosps; and 53d, 56th, 63d, 66th, 148th, 208th, 209th, 210th, 212th, 213th, and 214th Gen Hosps. HD. 24 (1) Ltr, TAG to CofS GHQ; CGs Armies, CAs, et al., 30 Dec 40, sub: Current Sup Policies and Pro- cedure. AG: 475 (8-12-40) (1) Sec 1. (2) Ltr AG 320.2(1 1-16-40)M-D-M, TAG to same, 14 Jan 41, sub; Orgn, Tng, and Admin of Med Units. SG: 322.3-1. 25 (1) Equipment for only three hospital units was available in medical supply depots in June 1941. Memo for Record on Memo, Act ACofS G-4 WDGS for TAG, 13 Oct 41, sub: Equip forMed Units. . . . HRS: G-4/33344. (2) See An Rpts of numbered hosps cited above. HD. 26 (1) See below, pp. 48 and 49. (2) An Rpts, 1943, 167th and 168th Sta Hosps. HD. These hospitals were originally organized as provisional hospitals, Station Hospitals A and B, for service with a task force being organized for the occupation of the French West Indies. 27 Memo, SG for ACofS G-3 WDGS, 27 May 41, sub: Med Units, Task Forces. . . . AG: 320.2(5-27- 41)(6). 46 HOSPITALIZATION AND EVACUATION, ZONE’OF INTERIOR eleven units, thus sanctioning, at least for this group, the practice already followed. The next month, G-4 refused to grant The Surgeon General’s request to approve this practice as policy for all other numbered hospital units. Accordingly, when a “War Department Pool of Task Force Units” was formed in August 1941, raising the total number of hospital units earmarked for actual operations from eleven to thirty- one, different supply procedures prevailed for the two groups.28 In the fall of 1941 the difference of opinion about issuing hospital assemblages reached a crucial point when G-4 noted that only four assemblages had been com- pleted by October, that demands of the Philippine Army and lend-lease aid might seriously interfere with the completion of others, and that, according to its observers, hospital units participating in maneuvers needed full issues of equipment. Accord- ingly G-4 asked The Surgeon General for recommendations on speeding up the equipment of units in the task force pool.29 In reply The Surgeon General pointed to progress, stating on 5 November 1941 that five hospital assemblages had been issued, that twenty others were ready for issuance, and that still others were being packed. He attributed delays to slow deliveries by manufacturers and again requested per- mission to hold assemblages in depots un- til hospital units were assigned to missions involving the actual care of patients. In support of this request he argued that units in training did not need full equip- ment, storage for it in the field was inade- quate, careless handling by unit members would cause breakage and deterioration, and units would be unable to repack assemblages for shipment.30 Maintaining its position but recognizing the possibility of warehousing shortages, G-4 began a survey of corps area storage facilities on 6 December 1941 and directed The Sur- geon General to earmark and hold all available equipment for specific units until further notified.31 Training and Use of Hospital Units In accord with The Surgeon General’s plan—that members of hospital units would receive tactical training in units but technical training in named hospitals— numbered hospital units were generally stationed near named hospitals, but con- fusion existed about the command that was responsible for their training and use. With the separation of field forces from 28 (1) Ltr, TAG to GGs 2d, 3d, 4th, 7th, 8th, and 9th CAs, and SG, 7 Jul 41, sub: Orgn of Med Units. AG: 320.2 (5-27-41) (6). (2) Ltr, SG to TAG, 17 Jul 41, sub: Sup of Med Units, and 1st ind, TAG to SG, 6 Aug 41. SG: 475.5-1. (3) Ltr, AG 381 (7-28-41) MC-E-M, TAG to CofS GHQ, GGs of Armies et at., 20 Aug 41, sub: Units for Emergency Expeditionary Forces. SG: 322.3-1. 29 (1) Memo, Act AGofS G-4 WDGS for TAG, 13 Oct 41, sub: Equip of Med Units for WD Pool of Task Forces, with Memo for Record. HRS: G-4/33344. (2) 1st ind, SG to TAG, 16 Oct 41, and 2d ind, TAG to SG, 27 Oct 41, on Ltr, TAG to SG, 14 Oct 41, sub: Equip of Med Units for WD Pool of Task Forces. AG: 320.2(5-27-41)(6). (3) Memo G-4/33344, Lt Col Clarence P. Townsley, GSC, Chief Planning Sec [G-4] (init WLW[ilson]) for Col [Albert W] Waldron, [25 Nov 41], sub; Equip for Med Units for WD Pool of Task Forces. HD: Wilson files, “Vol. I, 15 May 41- 20 Jan 42.” (4) D/S, Act AGofS G-4 WDGS for TAG, 25 Oct 41, sub: Equip for Med Units for WD Pool of Task Forces, with Memo for Record. HRS: G-4/33344. 30 (1) Ltr, SG to TAG, 5 Nov 41, sub: Equip for Med Units in WD Pool of Task Forces. SG; 475.5-1. (2) Memo, SG for AGofS G-4 WDGS, 19 Nov 41, sub: Comments on Draft of Ltr “Current policies and Procedures for Classification, Storage, and Issue of Sup.” Same file. 31 (1) Memo, Act AGofS G-4 WDGS for TAG, 27 Nov 41, sub: Equip forMed Units for WD Pool of Task Forces, with Memo for Record. HRS: G-4/ 33344. (2) 1st ind, TAG to SG, 6 Dec 41, on Ltr, SG to TAG, 5 Nov 41, same sub. AG: 320.2 (5-27-41) (6). (3) Ltr, TAG to GGs of CAs, 6 Dec 41, same sub. Same file. HOSPITALIZATION IN OVERSEAS AREAS 47 corps areas late in 1940, the General Staff, it will be recalled, either assigned or at- tached to the four field armies all num- bered medical units, including station and general hospitals that did not normally serve under the jurisdiction of field armies. At the same time, the Staff directed corps area commanders to make their medical facilities available for the training of hos- pital units, and it forbade army com- manders to assume control over such units without the approval of corps area com- manders. Furthermore, while one direc- tive stated that the personnel and units of field forces on duty with corps areas would be controlled entirely by corps area com- manders, another forbade the same com- manders to assume jurisdiction over field force units undergoing training in corps area installations.32 As a result, neither GHQ nor the Surgeon General’s Office exercised any very direct control over numbered hospital units, and the units themselves were sometimes confused as to whether they were subject to army or corps area command.33 Without close supervision from higher authorities the training which hospital units received depended primarily upon the attitudes of local surgeons and unit commanders. In some instances, well- planned on-the-job training programs were established in named hospitals and were co-ordinated with unit field training. In others, the commanders of named hos- pitals assigned men from numbered units to vacant jobs regardless of their training value. In such cases technical training suf- fered because many men did only menial work, and controversies developed be- tween hospital commanders responsible for post medical care and unit com- manders responsible for the technical as well as the field training of their men.34 Confusion about the control of hospital units also affected their use on maneuvers. Explaining his lack of authority over hos- pital units, The Surgeon General sug- gested that the personnel of some should be used to augment the staffs of named hospitals and to assist medical detach- ments, battalions, and regiments engaged in maneuvers. He proposed that other units should be employed in giving medi- cal care as they would in theaters of oper- ations.35 Their use in this manner was lim- ited by incomplete staffs and lack of equipment. In some instances evacuation hospitals borrowed enough personnel and equipment from other medical units and from corps areas to enable them to provide limited hospitalization for troops in the field. After they were set up, such hospitals tended to become stationary. Army com- manders then had to improvise mobile hospitals by using personnel and equip- ment of medical regiments. Generally armies had to rely upon corps areas for 3- (1) Ltr AG 3 20.2 (9-2 7-40) M-C, TAG to C of Arms and Servs, CGs of Armies, Army Corps, Divs, CAs and Depts, etc., 3 Oct 40, sub: Orgn, Tng, and Admin of Army. SG: 320.3-1. (2) Ltr, TAG to same, 4 Nov 40, sub: Units Asgd and Atchd to GHQ, Armies, Corps. . . . AG: 320.2(8-2-40) (4) Sec 3. (3) Ltr AG 320.2(11-16-40)M-D-M, TAG to same, 14 Jan 41, sub; Orgn, Tng, and Admin of Med Units. SG; 322.3-1. (4) Ltr, TAG to same, 8 Apr 41, sub; Asgmt and Atchmt of Fid Force Units to GHQ, Armies, Army Corps. . . . AG: 320.2(8-2-40)(4) Sec 3 A, Pt 1. 33 (1) Memo 2, incl to Ltr, Col Daniel J. Sheehan, MG, to Col Roger G. Prentiss, Jr, MG, 10 May 51. HD: 314 (Correspondence on MS) HI. (2) An Rpts, 1940 and 41, 222d, 213th, 215th, and 183d Gen Hosps. HD. 34 (1) Memo, Lt Gol T. E. Huber for Historian, Tng Div SGO, 4 Jun 45, sub: Unit Tng, ASF, World War II. HD: 353. (2) Memo 2, incl to Ltr, Col Daniel J. Sheehan, MG, to Col Roger G. Prentiss, Jr, MG, 10 May 51. HD: 314 (Correspondence on MS) HI. 35 Rpt, Conf of SG with CA Surgs, 10-12 Mar 41. HD: 337. 48 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR hospitalization of troops on maneuvers. To assist corps area hospitals and at the same time to give members of numbered units some experience in the actual opera- tion of hospitals, station, general, evacua- tion, and surgical hospital units were at- tached to named hospitals in maneuver areas. Because their members were usually integrated with the staffs of corps area hospitals, such units not only tended to lose their identities but also failed to acquire experience as functioning organi- zations.36 Furnishing Hospitalization for Overseas Areas Even before war actually began, addi- tional hospitalization had to be supplied for troops in garrisons in territorial posses- sions of the United States and on island bases leased from the British in September 1940. In the Hawaiian and Philippine Islands, the Panama Canal Zone, Puerto Rico, and Alaska, hospitals were ex- panded as in the United States and addi- tional increments of supplies and person- nel were sent to care for the expansion.37 According to War Department plans, the Atlantic bases were to be garrisoned and operated on a peacetime basis. The Sur- geon General’s Office therefore planned hospitalization for them in the same way as for posts in the United States. After computing bed requirements on a 5 per- cent ratio, the Hospital Construction and Repair Subdivision collaborated with the Chief of Engineers (who was charged with the construction of those bases) in drawing plans for permanent or semipermanent hospital buildings of appropriate sizes. Meanwhile, other groups in the Office planned shipments of supplies and equip- merit and earmarked personnel to be drawn from existing installations for new hospitals.38 Implementation of the plans to garrison the Atlantic bases got under way early in 1941 before construction was completed. In January a few medical officers and a small detachment of enlisted men sailed with troops being sent to St.John’s, New- foundland. They operated a 40-bed hospi- tal aboard the transport Edmund B. Alexan- der until it was ready to return to the United States about the middle of June. Then they moved into a rented estate at Northbank.39 In April, a second group of medical personnel, consisting of 21 medi- cal officers and 164 enlisted men, accom- panied the garrisons bound for Trinidad and Bermuda. The detachment which accompanied the Trinidad base force es- tablished a hospital in a temporary, single- building structure. The one which went to Bermuda set itself up, along with base headquarters and other activities, in a hotel building. In other bases medical offi- cers with small staffs operated dispensaries and arranged for the hospitalization of patients needing further treatment either 36 An Rpts, 1941, Surg GHQ, First Army, Second Army, Third Army, Fourth Army, and 1st, 4th, 6th, 10th, 1 1th, and 23d Evac Hosps, 166th Sta Hosp, and Ft Bragg Sta Hosp. HD. 37 (1) An Rpts, 1941, Surg Hawaiian, Puerto Rican, and Panama Canal Depts. HD. (2) HD: 322, Welsh file. 38 (1) Memo, Lt Col H. D. Offutt for Maj Welsh, 8 Feb 41. HD; Atlantic Bases file folder. (2) Ltr, SC to CofEngrs, 25 Feb 41, sub: Floor Plans for MD Fac at Antigua, Bahama, British Guiana, and Saint Lucia. SC: 632.-1. (3) Memo, SC for Maj [Henry I.] Hodes, G-3, 28 Nov 40, sub: MD Pers for Atlantic Bases. HD: Atlantic Bases file folder. (4) Ltr, SC to CofEngrs, 10 Mar 41, sub: Med Sups and Equip . . . , and 1st ind, CofEngrs to SC, 31 Mar 41. Same file. 39 An Rpt, 1941, Sta Hosp. Newfoundland Base Comd. HD. HOSPITALIZATION IN OVERSEAS AREAS 49 in hospitals established by the Engineers for civilians working on Army construc- tion or in hospitals operated by the British.40 In the fall of 1941 the first numbered hospital units were sent overseas. Under an agreement with the Icelandic Govern- ment, the United States established a force in Iceland as an outpost of defense. On 5 September 1941 the second echelon of this force, “the first United States expedi- tion to depart with a complete plan and all means necessary to implement it,” 41 sailed from New York. The 11th, 167th, and 168th Station Hospitals accompanied it. The last two were composed of Regular Army men drawn from named hospitals in the United States and organized in mid-1941 as provisional Station Hospitals A and B for service with an expedition (later canceled) to the French West Indies. The other was made up primarily of drafted men who converted themselves into Regular Army soldiers by volunteer- ing for three-year enlistments before sail- ing. Upon arriving in Iceland only one of these units actually operated a hospital in 1941. On 24 September the 168th opened in a permanent three-story frame building at Camp Laugarnes. The 11th and 167th were attached to the 168th and served as maintenance and construction forces on roads, utilities, and buildings.42 Plans and preparations for hospitaliza- tion in overseas areas were limited during the emergency period by meager funds and the uncertain nature of the peacetime mobilization. For this reason the Medical Department encountered difficulty—as it would later for other causes—in securing authority from the War Department Gen- eral Staff to plan for and activate as many hospital units as it considered desirable. For estimating requirements the Surgeon General’s Office had only World War I experience to rely upon, and there were differences of opinion as to how many fixed beds would be really needed. In order to enable units to give modern med- ical care, the tables governing their organ- ization and equipment were revised. Al- though personnel authorized by such re- visions was often increased, the General Staff began a practice—to be carried to greater lengths later—of requiring reduc- tions in both personnel and equipment for table-of-organization units. Affiliated units were organized and some regular units were activated. The role of the latter was uncertain, but The Surgeon General gradually tended to agree with the Gen- eral Staff that some of them at least would be used to give actual medical care. The rest would continue to train fillers for affiliated units. While The Surgeon Gen- eral and the General Staff agreed upon the policy of providing hospital units with less than full quotas of officers and enlisted men, they disagreed upon the question of whether or not units in training should receive full issues of supplies and equip- ment. This dispute was to continue un- abated during the first half of the war. 40 (1) Memo, Maj A. B. Welsh for Brig Gen A. G. Love, 7 Apr 41, and Ltr AG 320.2(4-8-41)M-D-M, TAG to C of Arms and Servs, 8 Apr 41, sub: Immed garrison for Bermuda and Trinidad. . . . HD: At- lantic Base file folder. (2) A History of Medical De- partment Activities in the Caribbean Defense Com- mand in World War II, vol I, pp. 245-46, 281-82, 311, 314, and 320. HD. (3) An Rpt, 1941, Surg Ber- muda Base Gomd. HD. 41 Greenfield et al., op. cit., pp. 22-23. For a full discussion of the agreement with Iceland and the force sent for its defense, see Stetson Conn and Byron Fairchild, Defense of the Americas, Vol. II, a forth- coming volume in the series UNITED STATES ARMY IN WORLD WAR II. 42 An Rpts, 1941, 1943, 168th Sta Hosp; 1941, 1942, 167th Sta Hosp; 1941, 11th Sta Hosp; 1942, Surg Iceland Base Gomd. HD. PART TWO HOSPITALIZATION IN THE EARLY WAR YEARS 7 DECEMBER 1941—MID-1943 Introduction Despite its year of peacetime mobiliza- tion the United States was not prepared for the offensive when war came on 7 De- cember 1941. An immediate necessity was the deployment of troops to protect the country and its overseas bases. At the same time the Nation’s power had to be mo- bilized and co-ordinated with that of its Allies. The Army’s total strength increased from 1,686,403 in December 1941 to 6,993,102 in June 1943. Although most troops were of necessity in training in the United States, enough were overseas by the latter part of 1942 to permit a transi- tion from the defensive to the offensive with assaults upon the Japanese in the Solomons and the invasion of North Africa. By June 1943 the peak of the prep- aration phase was reached. The next month saw the beginning of a steady decline in the strength of the Army at home as more and more troops moved overseas. In the latter half of 1943 the invasion of Sicily and Italy occurred and the Pacific island-hopping, which was to culminate in the defeat of Japan, began. The Medical Department, like the rest of the country, was unprepared to support offensive operations at the outbreak of the war. This lack of preparation is most evi- dent in the field of hospitalization. Few hospital units were in training and equip- ment in the war reserve was inadequate and in part obsolete. Although hospitals in the United States were sufficient for the Army that had thus far been mobilized, additional beds had to be provided rap- idly as the Army’s numerical strength shot upward. The first year and a half of the war was therefore a period of “growing pains” for the Medical Department, dur- ing which it adjusted itself to the demands of global warfare and with some difficulty discarded or modified peacetime practices and procedures in favor of those required by far-flung offensives. It was a time of finding out what was wrong with prewar planning and of correcting errors; of meet- ing immediate needs in the quickest possi- ble fashion and of preparing at the same time for future operations. Under General Magee’s leadership, the Department ex- hibited certain conservative tendencies in hospital expansion and administration which sometimes irked those in higher positions of authority. Nevertheless many developments considered progressive in the later war years had their origins during this period. At this time also a reorganization of the War Department shifted The Surgeon General to a new position in the official hierarchy. Affecting his responsibility and authority for hospitalization, it required major adjustments in the relationships of his Office with other War Department agencies. The main features of that reor- ganization and its effects, along with changes in units in the Surgeon General’s Office concerned with hospitalization, need to be discussed before details of the expansion and administration of hospitals are considered. CHAPTER IV Changes in Organization and Responsibilities for Hospitalization Since most changes occurring early in the war in the responsibilities of various agencies for hospitalization resulted from the reorganization of the War Department in March 1942, major outlines of the new organization must be described briefly here.1 In this connection one should un- derstand that difficulties in hospitalization and evacuation resulting from the reor- ganization were aspects of a larger prob- lem involving activities of the Medical Department in general and that similar problems were often encountered by other technical and supply services. Reorganization of the War Department Under the new setup the General Staff was relieved of some of its administrative and operative functions in the zone of in- terior by the creation of three major com- mands—Army Air Forces, Army Ground Forces, and Services of Supply (called Army Service Forces after March 1943). The divisions of the General Staff were to devote themselves to planning, to the gen- eral supervision of matters for which they were traditionally responsible, and to the strategic direction of forces in theaters of operations. The three major commands were all subject to the supervision and control of the General Staff, under the Chief of Staff, General George C. Mar- shall. War Department charts placed them all on the same level, but differences of opinion subsequently developed over whether or not they were actually coequal in authority. The Army Air Forces, which had been established in June 1941 and had attained a great deal of practical autonomy, had taken the lead and supplied the drive for the reorganization as a means of protect- ing and regularizing its current position. Colonel Grant continued as the Air Sur- geon. The Army Ground Forces com- prised the arms (such as Infantry, Caval- ry, and Artillery) and was responsible for 1 Fuller discussions may be found in other volumes: (1) John D. Millett, The Organization and Role of the Army Service Forces (Washington, 1954), pp. 23-42, 93-97, 132-37, 148, 298-309, Ray S. Cline, Washing- ton Command Post: The Operations Division (Washing- ton, 1951), pp. 61-74, 90-95, 11 1-19, and Kent R. Greenfield, Robert R. Palmer, and Bell I. Wiley, The Organization of Ground Combat Troops (Washington, 1947), pp. 142-45, 268-71, all in UNITED STATES ARMY IN WORLD WAR II. (2) Wesley Frank Craven and James Lea Cate, eds., The Army Air Forces in World War II (Chicago, 1948), Vol. I, pp. 257-67. (3) Blanche B. Armfield, Organization and Adminis- tration (MS for companion vol. in Medical Dept, series). HD. CHANGES IN ORGANIZATION AND RESPONSIBILITIES 55 preparing the ground army for combat. General Headquarters was now liqui- dated and much of its personnel was transferred to AGF headquarters. Colonel Blesse then became Chief Surgeon of the Army Ground Forces (or the Ground Sur- geon). He remained in that position until December 1942, when he was succeeded by Col. William E. Shambora, and re- turned to it again in May 1944 for the rest of the war. To the Services of Supply were assigned the corps areas, the technical and supply services such as the Medical Department and the Quartermaster Corps, certain War Department administrative services, and some of the functions and personnel of G-4. Lt. Gen. (later General) Brehon B. Somervell, Assistant Chief of Staff, G-4, of the War Department General Staff since 25 November 1941, became Com- manding General, Services of Supply. Under his jurisdiction was The Surgeon General, the head of the Medical Depart- ment. The Surgeon General’s New Position Uncertainty developed about the effect the reorganization had or should have on responsibilities and authority for hospital- ization and other medical activities. While General Magee recognized that there were “changes in the flow of control from the Secretary of War to the Medical De- partment,” he did not believe that the re- organization had altered the responsibility of The Surgeon General for the health and medical care of the entire Army.2 Ap- parently he did not comprehend at the outset the full impact on his office of the interposition of an intermediate head- quarters between himself and the General Staff. According to SOS doctrine General Somervell was responsible for all activities, including hospitalization, within the Serv- ices of Supply and was at the same time staff adviser to—and in some instances spokesman for—the Chief of Staff on sup- plies and services, including medical, for the entire Army.3 In his new position, The Surgeon General was an adviser to Gen- eral Somervell. In this capacity the extent to which General Magee could discharge what he considered to be his responsibil- ities depended primarily upon the degree to which General Somervell accepted his recommendations (1) regarding SOS medical matters as the basis of command decisions and (2) regarding Army-wide medical matters as a basis for action or advice to the Chief of Staff. So far as hos- pitalization and evacuation in particular were concerned, it depended—partially, at least—upon the role of a medical sec- tion in SOS headquarters. When SOS headquarters was estab- lished in March 1942 a medical officer, Lt. Col. William L. Wilson,4 was trans- ferred from G-4 along with General Somervell, Brig. Gen. (later Lt. Gen.) LeRoy Lutes, and others. For several months he served in the Miscellaneous Branch of the SOS Operations Division under General Lutes. In July 1942, when SOS headquarters was reorganized, a 2 (1) Ltr, SG to CG SOS, 25 Mar 42, sub: Med Serv of Army. HD: 321.6-1. (2) Cmtee to Study the MD, 1942, Testimony, p. 2055. HD. 3 (1) Ltr, Gen Brehon B. Somervell to Col R[oger] G. Prentiss, Jr, ed, Hist of the MD in World War II, 13 Nov 50. HD: 314 (Correspondence on MS) III. (2) Ltr, Lt Gen LeRoy Lutes to same, 8 Nov 50. Same file. (3) The SOS viewpoint is explained in Millett, op. cit., pp. 143-47. 4 Colonel Wilson received his promotion from major to lieutenant colonel on 18 April 1942 but it was retroactive to 1 February 1942. This accounts for the fact that documents signed by him and cited in the footnotes show him as a major until the middle of April. 56 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Hospitalization and Evacuation Branch was established in General Lutes’ office and Colonel Wilson was made its chief. This Branch gained additional medical officers and by October 1942 it had, in addition to its chief, one Medical Admin- istrative Corps and three Medical Corps officers. Lt. Col. William C. Keller, a physician formerly with the Pennsylvania Railroad, was in charge of a railway evacuation section. Maj. (later Col.) John C. Fitzpatrick, who had had experience as a transport surgeon, was in charge of a sea evacuation section. Maj. (later Lt. Col.) Henry McC. Greenleaf devoted his atten- tion to hospitalization. The administrative officer, Maj. (later Col.) Harry J. Nelson, was in charge of office administration.5 The SOS statement of the functions of this Branch—to review plans for, co-ordi- nate activities related to, and insure the means for hospitalization and evacua- tion—was subject to different interpreta- tions. General Magee believed that his Office was best equipped to decide upon medical matters and that his advice should be given preponderant weight. Ac- cordingly, in his opinion any medical of- ficer in a staff position of a higher head- quarters should be a representative of The Surgeon General and should receive his instructions and advice from the Surgeon General’s Office. He interpreted estab- lishment of the Hospitalization and Evac- uation Branch as representing a desire in SOS headquarters for a section to co- ordinate activities of various Army agen- cies in the transportation (or evacuation) of patients.6 The SOS viewpoint was different. In July 1942 General Lutes informed corps area commanders that the “Hospitaliza- tion and Evacuation Branch lays down the policies to the Surgeon General on Hospitalization and Evacuation,” and that it then visited their areas to see if “policies and plans as laid down to the Surgeon General” were satisfactory and were being followed.7 Colonel Wilson took the position that hospitalization and evac- uation required supervision by a higher headquarters than the Surgeon General’s Office. In explaining his position as chief of the SOS Hospitalization and Evac- uation Branch, he emphasized that he had no authority as a staff officer to make decisions or to issue orders concerning hospitalization and evacuation (that could be done only by General Somervell or General Lutes) but that it was his respon- sibility to gather and evaluate information on such matters and to present it, along with recommendations for action, to Gen- erals Lutes and Somervell. If his advice differed from The Surgeon General’s, he stated, he gave the latter’s opinion as well as his own.8 In view of different concep- tions of their respective responsibilities, it was perhaps inevitable that conflicts would develop between the SOS Hospi- talization and Evacuation Branch and the Surgeon General’s Office.9 5 (1) WD Cir 59, Orgn Chart, SOS Orgn, 2 Mar 42. (2) Cmtee to Study the MD, 1942, Testimony, pp. 1274-76. HD. (3) History of Planning Division, ASF, Vol. 1, p. 77. HRS. 6 (1) Cmtee to Study the MD, 1942, Testimony, pp. 1973-2022. HD. (2) Verbatim transcription of notes employed by Maj Gen James G. Magee in conf in HD AML, 10 Nov 50. HD: 314 (Correspondence on MS) HI. 7 Rpt, Conf of CGs, SOS, 2d sess, 30 Jul 42, pp. 52-53. HD: 337. 8 (1) Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, sub: Hosp and Evac Oprs, SOS. HD: Wilson files, “No 472, Hosp and Evac, 1941-42.” (2) Cmtee to Study the MD, 1942, Testimony, pp. 1910-11, 1956-57. HD. See also pp. 1869-1964, 1271-1339. (3) Memo, Col W. L. Wilson for Col R. G. Prentiss, Jr. HD: 314 (Correspondence on MS) HI. 9 See below, pp. 63-67, 151-60. CHANGES IN ORGANIZATION AND RESPONSIBILITIES 57 The extent to which The Surgeon Gen- eral could discharge his responsibility for the health and medical care of the Army depended also upon willingness of com- manders of the Ground and Air Forces to admit that the Commanding General, Services of Supply, or one of his subordi- nates, had any authority—even technical and professional—over matters for which they were responsible and upon which their own surgeons could advise them. So far as hospitalization in the United States was concerned, this involved mainly the Air Forces. Since the Ground Forces were to occupy and use stations operated by the Services of Supply, AGF headquar- ters readily accepted the dictum that the “Medical Department under the com- mand of the Commanding General, Serv- ices of Supply,” would furnish all of its hospitalization and evacuation in the United States except that provided by field medical units operating under tac- tical control. On the other hand, it will be recalled that the Air Forces already had a separate set of hospitals and the reorgan- ization placed them, along with stations they served, under command of the Com- manding General, Army Air Forces. Several documents issued after the re- organization purported to clarify the re- spective responsibilities of the commanders of the Air and Service Forces and the re- lationships of the Air Surgeon and The Surgeon General. A General Staff direc- tive charged all commanders with “com- mand responsibility for the operation of all medical facilities under their control and for future planning in connection therewith.” It also charged the Com- manding General, Army Air Forces, “with development and operation of air evacuation,” and the Commanding Gen- eral, Services of Supply, with providing “for the evacuation of sick and wounded delivered to his control,” and with “ad- ministrative responsibility for the coordi- nation of the plans of all commands for evacuation of the sick and wounded to be delivered to his control, and for coordina- tion of plans for hospitalization within the continental United States.” An SOS direc- tive on 18 June 1942 charged The Surgeon General with “the initial preparation and the maintenance of basic plans for mili- tary hospitalization and evacuation oper- ations, and the coordination of the plans therefor of all commands concerned.” An announcement of an agreement between the Air Surgeon and The Surgeon Gen- eral, approved by G-3, had stated earlier that the “routine conduct of medical activities with the Army Air Forces” was a “responsibility of each local surgeon acting under the Air Surgeon, who is responsible to The Surgeon General for the efficient operation of Medical Department tech- nical activities with the Air Forces.” It had also stated that the Air Surgeon would not duplicate activities of the Sur- geon General’s Office, “with the exception of those procedures necessary for the proper control of Medical Department personnel and activities under the juris- diction of the Army Air Forces.” 10 None of these documents specifically stated that the Services of Supply was to 10 (1) Ltr, SG to CG SOS, 25 Mar 42, sub: Med Serv of Army. HD: 321.6-1. (2) Memo, CG SOS for AGofS G-3 WDGS, 26 Mar 42, sub: Med Activities under WD Cir 59, 1942, with Memo for Record. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” (3) Ltr, CG SOS to all CA Comdrs and SG, 26 May 42, sub: Med Activities under WD Cir 59, 1942. SG: 020.-1. (4) Ltr AG 704 (6-17-42)MB-D-TS-M, TAG to CGs AGF, AAF, SOS, All Def Comds, All Depts, All Theaters, and All Sep Bases, 18 Jun 42, sub; WD Hosp and Evac Policy. HD: 705.-1. (5) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub; Opr Plans for Mil Hosp and Evac, with inch SG: 705.-1. 304244 0—55 6 58 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR exercise authority over AAF hospitaliza- tion and all of them were sufficiently vague to permit a variety of interpreta- tions. Difficulties that arose from Air Forces’ resistance to SOS claims of au- thority and from the Air Surgeon’s striv- ings for completely separate AAF hospi- talization will be discussed later.11 The division of responsibility for hospi- tal units being prepared in the United States for overseas service was clearer. This problem involved mainly the Army Ground Forces, for the Air Forces at that time had no such units and made no bid for them.12 Moreover, in February 1942 General Magee had secured Staff ap- proval of a policy of “providing over-all hospitalization for task forces, instead of attempting to provide separate hospital- ization for the air and ground components thereof. . . 13 While it was clear that the reorganization placed medical units that were organic elements of air and ground combat forces under AAF and AGF headquarters respectively, respon- sibility for nonorganic service units, such as hospitals, was left to be “directed by the War Department.” 14 The Ground Surgeon believed that medical units normally used in combat zones in close support of ground troops should be assigned to the Ground Forces and those normally used in communica- tions zones, to the Services of Supply.15 Mindful of his position as chief medical officer of the Army, The Surgeon General wanted all hospital units—those that served in combat as well as in communi- cations zones—and certain other medical units that normally served as parts of field armies, such as medical laboratories and depots, to be under the jurisdiction of the Services of Supply.lfi On the recommen- dation of its Hospitalization and Evacua- tion Branch, SOS headquarters first requested that only general and station hospital units be placed under SOS con- trol but later adopted The Surgeon Gen- eral’s position.17 After considerable investigation and study of the larger problem of jurisdiction over service units in general, G-3 took a view that coincided with the Ground Sur- geon’s. On 30 May 1942 it announced that the three major commands would, in general, train the nondivisional service units which they used.18 On 8 July 1942 this principle was extended to cover acti- 11 See below, pp. 106-09, 117-20, 173-76, 182-88. 12 In March 1942 AAF Headquarters concurred in the SOS proposal that SOS have jurisdiction over general and station hospital units and AGF over all other field medical units. Memo, CG SOS for ACofS G-3 WDGS, 26 Mar 42, sub: Med Activities under WD Cir 59, 1942. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” 13 1st ind SGO 322.4-1, SG to TAG, 5 Feb 42, and 2d ind AG 320.2 (1-29-42) MSG-C, TAG to SG, 18 Feb 42, on Memo, C of Air Staff for SG, 29 Jan 42, sub; Expansion Program of AAF for Calendar Year 1942. HD: 320.3 (Trp Basis). 14 WD Cir 59, 2 Mar 42. 15 Cmtee to Study the MD, 1942, Testimony, pp. 409-13. HD. 16 (1) Memo, SG for CG SOS, 16 Mar 42. SG: 020.-1. (2) Memo, Act SG for Tng Div SOS, 31 Mar 42. SG: 322.3-1. (3) Ltr, SG to CG SOS, 28 Oct 42, sub: Recomds in Regard to Activation, Control, and Tng of Med Units, with 1 inch SG: 320.3-1. 17 (1) Memo for Record on Draft Memo, CG SOS for ACofS G-3 WDGS, 26 Mar 42, sub: Med Activi- ties under WD Cir 59, 1942. HD; Wilson files, “Book I, 26 Mar 42-26 Sep 42.” (2) Memo SP 020 (3-28-42), CG SOS (init WLW[ilson]) for ACofS G-3 WDGS, 17 Apr 42, same sub. Same file. (3) Memo, CG SOS for ACofS G-3 WDGS, 14 May 42, sub: Responsibility for Tng. HRS: G-3/353 (Only) vol. II. (4) For a discussion of the general problem, see Rob- ert R. Palmer, Bell I. Wiley, and William R. Keast, The Procurement and Training of Ground Combat Troops (Washington, 1948), pp. 499-51 1, in UNITED STATES ARMY IN WORLD WAR II. 18 Memo WDGCT 353 (5-30-42), ACofS G-3 WDGS for CGs AGF, AAF, and SOS, 30 May 42, sub: Responsibility for Tng. HRS: G-3/320.2 “Acti- vation, vol. I.” CHANGES IN ORGANIZATION AND RESPONSIBILITIES 59 vations also.19 As a result, for the rest of the war the Services of Supply was re- sponsible for activating and training com- munications zone units. Among them were fixed hospitals, such as general, station, and hospital center units, and certain evacuation units, such as hospital trains and hospital ship companies. The Army Ground Forces was similarly responsible for combat zone units, including surgical and evacuation hospitals as well as such units as medical regiments, medical bat- talions, medical detachments, and medi- cal supply depots. With division of responsibility for acti- vating and training service units, AGF headquarters assumed responsibility for recommending the number of mobile units to be included in tl>e troop basis, while The Surgeon General and SOS headquarters concentrated on units for fixed hospitals. Subsequently, responsi- bility for preparing tables governing the organization and equipment of hospital units was also divided. Since mobile hos- pitals were designed for use in combat zones, AGF headquarters felt that it should be free to make such changes in person- nel and equipment of these hospitals as it found desirable for tactical reasons. In September 1942 G-4 proposed that AGF headquarters should be given re- sponsibility for the preparation of tables for all AGF service units.20 General Som- ervell feared that the chiefs of technical services, including The Surgeon General, might be bypassed if this proposal were adopted. On his recommendation, G-4 amended its original proposal to require AGF to consult with SOS when prepar- ing tables for service units.21 Thereafter, responsibility for the preparation of tables of organization, tables of equipment, and tables of basic allowances for numbered hospital units was divided, as that for their activation and training had been earlier, between AGF and SOS headquarters.22 Even so, The Surgeon General retained considerable authority over the medical equipment and supplies furnished all hos- pital units, mobile as well as fixed, for one item in each table of equipment was the unit assemblage. It contained all items of medical equipment required for a hospi- tal, was packed according to Medical Department equipment lists, and was issued by Medical Department depots as a single item. While he customarily con- sulted with the Ground Surgeon when revising equipment lists, The Surgeon General alone was responsible for their preparation and for the packing of unit assemblages.23 Further changes affecting the manner in which The Surgeon General could dis- charge his responsibility for the medical care of the Army occurred as a result of the reorganization of the Services of Sup- ply in the summer of 1942. At that time corps areas were renamed service com- mands and authority formerly concen- 19 Memo WDGCT 320.2 (Activation) (7-1-42), ACofS G-3 WDGS for CGs AAF, AGF, and SOS, 8 Jul 42, sub: Responsibility for Activation of Units. FIRS: G-3/320.3 “Activation, vol. I.” 20 Memo WDGDS 809, ACofS G-4 WDGS for CG SOS, 21 Sep 42, sub; Prep of T/Os and T/Es. AG: 320.3(3-13-42)(5). 21 (1) 1st ind SPOPU 320.3(9-21-42), CG SOS to ACofS G-4 WDGS, 25 Sep 42, on Memo WDGDS 809, ACofS G-4 WDGS for CG SOS, 21 Sep 42, sub: Prep of T/Os and T/Es. AG: 320.3(3-13-42) (5). (2) DF WDGDS 867, ACofS G-4 WDGS to ACofS G-3 WDGS, 29 Sep 42, same sub. Same file. 22(1)AR 310-60, pars 8 and 16, 12 Oct 42. (2) WD Memo W310-9-43, 22 Mar 43, sub: Policies Govern- ing T/Os and T/Es. FID. 23 (1) Memo, SG for CG SOS, 5 Nov 42, sub: Make-up of Hosp Unit Assemblies. SG: 475.5-1. (2) Rpt of [SGO] Bd for Determining Possibilities of De- leting Certain Items in a 400-bed Evac Hosp [13 Nov 42]. SG: 475.5-1. 60 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR trated in Washington was decentralized to them Thus the control of all general hos- pitals, except Walter Reed, was trans- ferred from The Surgeon General to com- manding generals of service commands. For a while the former retained authority to determine staff allotments for general hospitals, subject to SOS approval; but in April 1943, on the recommendation of the SOS Control Division, that function was also decentralized to commanding gen- erals of service commands.24 The reor- ganization also diminished the authority of service command surgeons and altered the Surgeon General’s relationship with them. They no longer occupied the posi- tion of staff advisers to their commanders but were now subordinated as chiefs of medical branches to the chiefs of per- sonnel or supply divisions of service com- mand headquarters. Moreover, since com- mand responsibilities were emphasized in the field, as in Washington, they could no longer be considered as field representa- tives of The Surgeon General and could therefore exercise no authority over hospi- tals not under service command control. Finally, The Surgeon General could—in theory at least—communicate with service command surgeons and hospital com- manders only through command chan- nels—that is, through General Somervell and the commanding generals of service commands. This indirect method of in- tercourse was somewhat offset by the practice of permitting informal direct communication between the Surgeon General’s Office and service command surgeons.25 Changes in responsibilities for hospital construction and maintenance also oc- curred, but resulted only partially from the reorganizations discussed above. In December 1941, in conformity with an act of Congress, all of The Quartermaster General’s construction and maintenance activities were transferred to the Chief of Engineers.26 About five months later the War Department concentrated in the latter responsibility which he had previ- ously shared with The Surgeon General for the maintenance of hospital plants.27 After the War Department reorganization, rec- ommendations of The Surgeon General for construction of new plants and for major alterations of existing plants were subject to review by both the Hospitaliza- tion and Evacuation Branch and the Con- struction Planning Branch of SOS head- quarters. The former considered them from the viewpoint of medical needs; the latter, of Army-wide requirements. Both branches were guided by decisions and policies of the General Staff and by direc- tives of the War Production Board. The selection of sites and the internal arrange- ments of new hospitals, as well as altera- tions of existing plants, continued to be a joint function of The Surgeon General and the Chief of Engineers. Insistence of the 24 (1) SvC Orgn Manual, 22 Jul 42, sec 403.02, in WD Hq SOS SvC (formerly CA) Reorgn, 22 Jul 42. HRS. (2) Memo, SG for Dir Control Div SOS, 1 Aug 42. SG: 020.-1. (3) Cmtee to Study the MD, 1942, Testimony, Statement of Col H. D. Offutt, pp. 214- 15. HD. (4) AR 170-10, par 6a(l)(p), 10 Aug and 24 Dec 42. (5) Memo, Dir Control Div ASF for CofS ASF, 6 Apr 43, sub: Clarification of Prov of AR 170- 10. . . . AG: 600.12(10 Mar42) (1). (6) AR 170-10, C 2, 14 Apr 43. 25 (1) Edward J. Morgan and Donald O. Wagner, The Organization of the Medical Department in the Zone of the Interior (1946), HD, pp. 97-99. (2) Ltr, SG to CG SOS, 9 May 42, sub: Med Activities under WD Cir 59, 1942. SG; 020.-1. (3) Memo, Chief Pro- fessional Servs [SGO] for Mr. Corrington Gill, 2 Oct 42, sub: Supervision and Coord of Professional Care in Mil Hosps in Continental US. SG; 701.-1. (4) SOS Orgn Manual, 10 Aug 42, sec 403.02. (5) For a fuller discussion, see Armfield, op. cit. 26 WD Cir 248, 4 Dec 41. 27 (1) WD Cir 157, 23 May 42. (2) AR 100-80, 9 Jun 42. (3) See below, pp. 94-96. CHANGES IN ORGANIZATION AND RESPONSIBILITIES 61 latter and of SOS headquarters upon de- centralization to the field of as much con- struction authority and activity as possible, in order to speed construction, resulted by the end of 1942 (as will be seen later) in The Surgeon General’s loss of some au- thority he had previously exercised over the erection and alteration of hospital plants.28 The Wadhams Committee Late in 1942 responsibilities and organ- ization for hospitalization, along with many other aspects of Medical Depart- ment work, were the subject of review and comment by a civilian committee ap- pointed by the Secretary of War. This group, which called itself the “Committee to Study the Medical Department” but which will be referred to hereafter for the sake of brevity as the Wadhams Commit- tee (from the name of its chairman, Col. Sanford Wadhams, a retired medical offi- cer), was constituted to “make a thorough survey of professional, administrative, and supply practices of the Medical Depart- ment.” 29 It probed the relation between the Surgeon General’s Office and the SOS Hospitalization and Evacuation Branch, and testimony presented in that connec- tion placed on record information sum- marized above which might not otherwise have been available.30 While some of the Committee’s recommendations dealt with the position of The Surgeon General in the War Department, they appear to have had little influence on the authority and re- sponsibility of either the Surgeon General’s Office or major commands for hospitaliza- tion. This subject, along with an account of the Committee’s background and inves- tigation as a whole, is discussed fully else- where.31 Recommendations of the Com- mittee on policies and procedures for hospitalization had significant effects and will be discussed at appropriate places in following chapters.32 Changes in the Surgeon General’s Office During the early war years changes occurred in the organization of the Sur- geon General’s Office as well as in higher headquarters, but they affected the divi- sions most concerned with hospitalization less than others.33 On 21 February 1942 the Hospital Construction Subdivision was raised in status to a division, reflecting the rapid expansion of construction activities.34 The next month it was placed, along with the Hospitalization, Planning, and Train- ing Divisions, in a newly formed Opera- tions Service. In August, to describe its functions more accurately, the Hospitali- zation Division’s name was changed to Hospitalization and Evacuation.35 The Hospital Construction Division continued to exercise The Surgeon Gen- eral’s advisory supervision over the con- struction, leasing, and maintenance of all establishments for the care and treatment of the sick and wounded. Colonel Hall re- mained at its head. To handle wartime 28 (1) Army Hosp Program in Continental US, ex- tract from sec 6, Analysis, Monthly Progress Rpt, data as of 31 Mar 43. SG: 632.-1. (2) See below, pp. 92-93. 29 Sec War Memo, 10 Sep 42. AG: 020 SGO (3-30- 43)(1). 30 See above, p. 56, and also Cmtee to Study the MD, 1942, Testimony, pp. 1271-1339, 1690-94, 1869-1964, 1973-2022, 2039-49. HD. 31 Armfield, op. cit. 32 See below, pp. 93-94, 99, 118, 122-23, 127, 129, for example. 33 Morgan and Wagner, op. cit., pp. 9-25. These changes will be considered in detail in Armfield, op. cit. 34 (1) See above, pp. 24-26. (2) Memo, unsigned and unaddressed, 1 Dec 42, sub: Rpt on Admin Devs, SGO. HD; 024.-1. 35 An Rpt, 1943, Oprs Serv SGO. HD. 62 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR workloads the number of officers in this Division was increased between December 1941 and December 1942 from 4 to 8; of civilian architects, from 4 to 7; and of civil- ian clerks, from 7 to 10. During 1943, 1 officer, 1 civilian, and 2 clerks were dropped from the rolls, but a civilian real estate consultant was added, as the hospi- tal construction program neared comple- tion.36 Changes in the Division’s branches reflected shifts in construction policies and problems. In February 1942 there were three branches: Planning and Estimates, Construction and Conversion, and Main- tenance and Repairs. In March, when increasing emphasis was placed upon the use of existing buildings, the Construction and Conversion subdivision was separated into two equal branches. Subsequently, the Conversion Branch was likewise sub- divided, becoming the Ground Troop Fa- cilities and Air Corps Facilities Branches. This move was perhaps accounted for by the expansion and growing independence of the Air Forces. In the late summer of 1942 the Planning and Estimates Branch was dropped from the Division, foreshad- owing the transfer of its activity to the Hospitalization and Evacuation Division. By August, then, the Hospital Construc- tion Division consisted of the Maintenance and Repair, Civilian Facilities Conversion, Ground Troop Facilities, and Air Corps Facilities Branches. This organization con- tinued until July 1943.37 The Hospitalization Division, under Col. Harry D. Offutt, limited its activities largely to the development of hospitaliza- tion policies, the control of bed credits in general hospitals, and the maintenance of liaison with other divisions of the Office whose activities affected the functioning of hospitals.38 The names of its subdivisions reflect this fact. In February 1942, they were the following: Hospital Inspection, Bed Credits, and Liaison. In March, the inactive Inspection subdivision was dropped. In August, the two remaining subdivisions became the Bed Credits and Evacuation Branch and the Miscellaneous Branch.39 During 1942 this Division grad- ually took on another function, the peri- odic revision required by SOS headquar- ters of a basic directive for hospitalization and evacuation operations.40 In Septem- ber 1942 it also took over the job of esti- mating and planning for general hospital beds that would be required in the future.41 Except for short periods, in December 1942 and again in April 1943, the Divi- sion’s staff was limited to four officers and four clerks until the latter half of 1943.42 At that time, the Division was enlarged and reorganized, under a new chief, to enable it to carry out the functions and activities which the war placed upon it.43 The Planning and Training Divisions continued to be responsible for numbered hospital units. Col. Howard T. Wickert was chief of the former. It made recom- mendations for the troop basis, for activa- tion schedules, and for medical support for task forces and overseas theaters. It also prepared and revised tables of organi- 36 (1) Tynes, Construction Branch, pp. 11-12. (2) Memo, Lt Col Seth O. Craft for Col R.W. Bliss, 8 Jul 43. HD: 319.1-2. 37 Morgan and Wagner, op. cit., Orgn Charts VI, VII, IX, X, and XI. 38 An Rpt, FY 1943, Hosp and Evac Div SCO. HD. 39 Morgan and Wagner, op. cit., Orgn Charts VI, VII, and IX. 40 An Rpt, FY 1943, Hosp and Evac Div SCO. HD. For this directive, see below, pp. 63-67. 41 For example, the Hospitalization and Evacuation Division prepared the following document: Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps. SG: 632.-2. 42 Memo, Col H. D, Offutt for Chief Oprs Serv SGO, 8 Jul 43. HD: 319.1-2. 43 See below, pp. 176-78. CHANGES IN ORGANIZATION AND RESPONSIBILITIES 63 zation, tables of equipment, and equip- ment lists. After separation of responsibil- ity for nonorganic service units between AGF and SOS headquarters, this Division limited itself primarily to SOS medical units but occasionally extended its activi- ties to others when called upon to partici- pate in conferences with the Operations Division of the General Staff on the forma- tion of task forces or the deployment of additional troops to established theaters. After SOS headquarters was given respon- sibility for training SOS service units, the Training Division (separated from the Operations Service in August 1942) estab- lished a Unit Training Branch to discharge its responsibilities in connection with the training of hospital and other medical units.44 A Dispute About General Planning for Hospitalization and Evacuation Closely connected with the War Depart- ment reorganization and arising partly from differences of opinion between the Surgeon General’s Office and the SOS Hospitalization and Evacuation Branch about their respective responsibilities was a controversy over hospitalization and evacuation planning which developed early in 1942. Within three days after the establishment of the Services of Supply, Colonel Wilson reported to General Lutes on the results of a transcontinental inspec- tion trip which he had undertaken while assigned to G-4 and which he had initi- ated with a view to having G-4 exercise greater supervision over hospitalization and evacuation. He stated that he had found no definite basic plan for hospitali- zation and evacuation within the United States, no plan or system of operations for evacuation from theaters, and no basic directive or system for activating, training, equipping, and using numbered hospital units in the United States. He recom- mended that SOS headquarters give fur- ther attention to the problem of numbered hospital units and overseas evacuation and that The Surgeon General be directed to submit basic plans for hospitalization and evacuation operations for the approval of SOS headquarters and subsequent publi- cation “for the guidance of all con- cerned.” 45 General Lutes approved the proposal, and on 14 March 1942 directed The Surgeon General to submit such plans.46 The Surgeon General’s Hospitali- zation Division conferred with the Office of the Chief of Transportation and on 31 March 1942 submitted a plan for hos- pitalization and evacuation operations.47 Considering it unacceptable, Colonel Wil- son prepared another which he presented to General Lutes on 18 April 1942 with the statement that its preparation had been necessary “because of the incomplete 44 (1) An Rpts, SGO, FY 1942 and 1943, and An Rpt, Oprs Serv SGO, FY 1943. HD. (2) Morgan and Wagner, op. cit., pp. 9-23. 45 (1) Memo G-4/24499-1 78, Col W. M. Good- man, GSC, Chief Planning Br G-4 (init WLW[ilson]) for Gen Somervell, 20 Jan 42, sub: Current Status of Hosp and Evac. HD; Wilson files, “Vol. I, 15 May 41-20 Jan 42.” (2) Memo Old G-4/24499-178, Maj W. L. Wilson for Gen [LeRoy] Lutes, 12 Mar 42, sub: Basic Plans for Hosp and Evac. HD: Wilson files, “No 472, Hosp and Evac, 1941-42.” (3) For an earlier interim report see: Memo, same for same, 8 Feb 42, sub: Recent Trip for Study of Hosp and Evac. Same file. 46 (1) Memo, CG SOS (signed Brig Gen LeRoy Lutes) for SG, 14 Mar 42, sub: Basic Plan for Hosp Oprs. SG: 704.-1. (2) Memo, same for same, 14 Mar 42, sub: Basic Plan for Evac of Sick and Wounded. Same file. 47 Memo, SG for CG SOS, 3 1 Mar 42, sub; Basic Plan for Hosp Oprs and Evac of Sick and Wounded, with inch SG: 704.-1. The first three drafts of this document, as well as proposals submitted by the Chief of Transportation, are on file HD; 705 (Hosp and Evac Planning). 64 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR nature and less understandable form of various plans submitted by The Surgeon General.” 48 This draft was discussed with the Surgeon General’s Office and then was sent to G-4 on 8 May 1942.49 On the same day General Lutes charged The Surgeon General with having failed to prepare hospitalization and evacuation plans either before or after he was so directed.50 This charge, transmitted to The Surgeon General with a statement by General Somervell that it was “of course inexcusable not to have fully matured basic hospitalization plans,” 51 began a controversy which lasted for many months. General Magee defended himself both in writing and in a personal conference with General Somervell. He took the position that all contingencies to be covered by the plan called for, except enemy raids and local disasters, had already arisen and had been actually handled under existing plans. He believed, furthermore, that the document prepared by his Office was not only adequate but also preferable in some respects to the SOS draft.52 Later, when documents of the SOS Hospitalization and Evacuation Branch emphasizing the lack of plans for hospitalization and evacuation were presented to the Wadhams Commit- tee, General Magee again defended his position, stating that if the allegations were true “it would indeed appear that chaotic conditions prevailed, but these assertions are not supported by facts.” Although Colonel Wilson insisted that “there wasn’t any planning” early in 1942 he now stated that The Surgeon General had not been “any more negligent than all the rest of the Army,” including G-4.53 In its final report, the Committee implied approval of The Surgeon General’s position, but it made no definite statement clearing him of charges of lack of adequate planning.54 The real picture was neither as black as SOS headquarters painted it nor as white as the Surgeon General’s Office main- tained. Plans for meeting normal hospital requirements for the zone of interior and theaters of operations were being made continuously by the Surgeon General’s Office. In view of the generous basis on which normal beds were authorized in the United States, together with the possibili- ties of expansion by setting up wards in barracks (a method that was almost tradi- tional with the Medical Department), it would seem that emergency needs also were being sufficiently provided for. Since 48 Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, stib; Hosp and Evac Oprs, SOS. HD: Wilson files, “No 472, Hosp and Evac, 1941-42.” 49 (1) Memo, Col H. T. Wickert, SGO for Col [W. L.] Wilson, SOS, 30 Apr 42, with incl Memo, SG for Dir Oprs SOS, 30 Apr 42. HRS: ASF Hosp and Evac Sec file, “Misc Classified Corresp from Off CG ASF to AGO.” (2) Memo, CG SOS for ACofS G-4 WDGS, 8 May 42, sub: Hosp and Evac Oprs SOS. HRS: G-4 files, “Hosp and Evac Policy.” 50 Memo, Brig Gen LeRoy Lutes for Gen Somer- vell, 8 May 42, sub: Activities of SG. SG; 704.-1. 51 Memo, Gen Somervell for Gen Magee, 8 May 42. SG: 704.-1. 52 1st ind, SG to CG SOS, 12 May 42, on Memo, Gen Somervell for Gen Magee, 8 May 42. SG: 704.-1. The following note appears on this indorsement: “Personally delivered by Gen Magee, 12 May 42.” General Lutes prepared a reply to General Magee, pointing out errors in the latter’s defense and con- tending that there were no plans. ([2d ind SPOPG 370.05 (Policy), CG ASF (init LL[utes]) to SG, 19 May 42, on Memo, Gen Somervell for Gen Magee, 8 May 42. HRS: ASF Hosp and Evac Sec file, “Misc Classified Corresp from Off CG ASF to AGO.”]) Whether or not this reply was sent to General Magee is uncertain. No copy of it has been found in SGO files. An ink note attached to the copy cited states: “This is in reply to a formal indorsement written by Surg. Gen. in which he took exception to criticism of his lack of a suitable plan. He visited Gen Somer- vell on the subject. Gen S may want to know of this reply. Lutes.” In pencil on this copy is the following notation: “Suspend for Jun 3.” 53 Cmtee to Study the MD, Testimony, pp. 1988- 89, 1995-98, 1919-23. HD. 54 Cmtee to Study the MD, Rpt, p. 15, HD. CHANGES IN ORGANIZATION AND RESPONSIBILITIES 65 no enemy attack or severe epidemic oc- curred, the latter statement can be made with less certainty than the former. More- over, the Surgeon General’s Office was collaborating with the Chief of Transpor- tation in planning facilities, personnel, and equipment for the evacuation of patients from theaters of operations. But the Medi- cal Department had not prepared a basic directive for hospitalization and evacua- tion such as SOS headquarters required, nor was any one division in the Surgeon General’s Office charged with the prep- aration of comprehensive Army-wide plans for hospitalization and evacuation. Certainly confusion existed as to responsi- bilities under the new War Department organization, but one may question whether, under the circumstances, it was any more incumbent on The Surgeon General than on higher headquarters to define those responsibilities and to require subordinate commanders to submit plans for hospitalization and evacuation. The “plan” which Colonel Wilson drafted differed considerably from the one prepared by The Surgeon General’s Hos- pitalization Division.55 Perhaps this was caused as much by ambiguity of the SOS directive requiring the preparation of a “plan” as by The Surgeon General’s lack of officers trained in planning, which SOS headquarters charged. A comparison of the two drafts shows that Colonel Wilson accepted and incorporated most of the in- formation, pertaining chiefly to established policies and procedures, which The Sur- geon General’s draft contained. Greatest change was the addition of statements out- lining the responsibilities of various com- manders for hospitalization and evacua- tion and requiring them to submit plans, in specified forms at specific times, to The Surgeon General, who in turn was to re- view and co-ordinate them and then sub- mit them along with his own “plan” to SOS headquarters. Reviewing the SOS draft, G-4 called it “an ‘omnibus docu- ment’ which undertakes to do a number of things,” and suggested that two documents should be issued in its place: one, a state- ment of basic policies and procedures for hospitalization and evacuation; the other, a directive calling for “data and sub-plans from the field.” 56 Subsequently, after col- laboration between G-4 and SOS head- quarters, two documents were issued on 18 June 1942. One was a General Staff directive stating in general terms the re- sponsibilities of major commanders for hospitalization and evacuation. This re- mained unchanged for the balance of the war. The other, revised later on, was an SOS letter with the SOS “plan” as an inclosure.57 Only the plans which these documents required of subordinate agen- cies need to be considered here. Responsi- bilities which they delineated and policies and procedures which the SOS “plan” an- nounced will be discussed elsewhere in this volume.58 Subordinate agencies had to include in hospitalization plans tabulations of beds for normal use, along with statements of 55 (1) Memo, SG for CG SOS, 31 Mar 42, sub: Basic Plan for Hosp Oprs and Evac of Sick and Wounded, with incl 1. SG: 704.-1. (2) Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr 42, sub: Hosp and Evac Oprs SOS, with Tab A, same sub. HD: Wilson files, “No 472, Hosp and Evac, 1941-42.” 56 Memo, ACofS G-4 WDGS for CG SOS attn Oprs Div, 11 May 42, sub; Hosp and Evac Oprs, SOS. HRS: G-4 files, “Hosp and Evac Policy.” 57 (1) Ltr AG 704 (6-17-42) MB-D-TS-M, Sec War to CGs AGE, AAF, SOS, et al., 18 Jun 42, sub: WD Hosp and Evac Policy. HD: 705.-1. (2) Ltr SPOPM 322.15, CG SOS to CGs and GOs of CAs, PEs, and Gen Hosps and to SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac. Same file. 58 See below, pp. 57-58, 81, 88-90, 114, 319-20, for example. 66 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR shortages; reports of provisions made to double hospital capacities in emergencies by the use of existing buildings such as apartments, hotels, schools, and dormi- tories; and reports of relations established with other agencies, such as the Office of Civilian Defense, “under which unilateral or mutual hospitalization support may be planned.” Evacuation plans were to in- clude estimates of persons of all types to be evacuated, both normally and in emer- gencies, along with statements about the status of personnel and equipment re- quired for the transportation and care en route of patients being evacuated. Hospital, port, and corps area com- manders complied with this directive, and on 30 August 1942 The Surgeon General transmitted their plans, along with his own “comprehensive plan,” to SOS headquar- ters.59 The Surgeon General’s “plan” was twofold. It contained a consolidation of the tables presented by corps areas and a draft of a “plan” based largely upon the SOS directive issued on 18 June 1942. The SOS Hospitalization and Evacuation Branch considered this draft acceptable, but revised it before publication, adding statements to bring the compilation of policies and procedures governing hospi- talization and evacuation up to date and changing the wording to require The Sur- geon General to submit a directive, rather than a “plan,” thus making the terminol- ogy conform more closely with the fact. The revised edition of the hospitalization- and-evacuation-operations-planning di- rective was issued by SOS headquarters in November 1942, although it was dated 15 September 1942.60 To make subsequent revisions as required, The Surgeon Gen- eral on 7 November 1942 appointed a board of officers, with Colonel Offutt as chairman.01 Although it submitted a re- vised version on 12 February 1943, none was published until the end of 1943.62 That version appeared in the form of a War Department circular. An evaluation of the importance of the “plan” or directive, as issued in its various versions, is difficult because of the contro- versial atmosphere in which it was pre- pared. In April 1943 the director of the ASF Planning Division stated that the 15 September 1942 version was “the first world-wide system for operations in the history of the War Department, under which the sick and wounded might be re- ceived from overseas commands and cared for and transported ultimately to a gen- eral hospital in the United States.” 63 Con- sidered objectively this was undoubtedly an overstatement, but the directive did have certain values which stand out with considerable clarity. In its initial form the directive helped, at a time when other efforts were being made to achieve the same end, to clarify hospitalization and evacuation responsi- bilities. It was not strictly applicable to Ground and Air Forces commanders, however, for it was issued in the first two versions as an SOS directive only. When published in later versions as a War De- partment circular, it became binding upon Ground, Air, and Service Forces alike. In 59 Memo, SG for CG SOS, 30 Aug 42, sub: Opr Plans for Hosp and Evac. SG: 704.-1. 60 (1) Memo SPOPH 322.15, CG SOS for CGs and COs of SvCs and PEs and for SG, 15 Sep 42, sub; Mil Hosp and Evac Oprs, with incl 1, same sub. SG: 704.-1. (2) Memo, SG for Chief Oprs SOS, 27 Jan 43. SG: 705.-1. 61 SG OO 456, 7 Nov 42. 62 (1) Memo, SG for CG SOS, 12 Feb 43, sub: Opr Plans for Hosp and Evac. SG: 705.-1. (2) WD Gir 316, 6 Dec 43. 63 Memo SPOPI 370.05, Dir Planning Div ASF for ACofS for Oprs ASF, 23 Apr 43, sub: Hosp and Evac Plans. HD; Wilson files, “Book IV, 16 Mar 43-17 Jan 43.” CHANGES IN ORGANIZATION AND RESPONSIBILITIES 67 each version, the directive served as a val- uable reference document, for it assem- bled in one place statements of several pol- icies and procedures that existed only in separate letters, circulars, and regulations. It was not comprehensive in this respect, nor was it always up to date, for many additional policies and procedures had to be established and old ones changed dur- ing the periods between revisions. In Sep- tember 1942 Colonel Offutt stated that his Division could operate effectively under the current version.64 The following Feb- ruary, when Colonel Wilson visited field installations to evaluate operations under the directive, he found that each head- quarters visited, with one exception, thought it clear, understandable, practi- cable, and of definite benefit.65 The value of the subordinate plans sub- mitted in compliance with the basic direc- tive is less clear. Each came to be what The Surgeon General’s executive officer, Col. John A. Rogers, called one of them in September 1942—“just a plan to be tucked away.” 66 Each was reviewed by the hospitalization and evacuation sec- tions of both the Surgeon General’s Office and SOS headquarters. They were then filed for future reference.67 That no emer- gency developed to require their use need not detract from the foresightedness of having emergency expansion plans on hand, but whether those on file would have been adequate for a major disaster seems to have been doubted in the fall of 1942.68 Tabulations of shortages of person- nel, equipment, hospital beds, and trans- portation usually arrived too late to have any appreciable effect upon the supply of those elements, for problems of shortages were handled when they appeared and could not await the submission at periodic intervals of subordinate plans for hospital- ization and evacuation. This requirement was dropped from subsequent versions of the directive early in 1944.69 In conclusion, one may question whether the benefits derived from the di- rective counterbalanced the friction and bad feeling which its issuance engendered between SOS headquarters and the Sur- geon General’s Office. Similar results might have been achieved more harmo- niously if the principals in both agencies had been more considerate and under- standing in dealing with each other or if relationships and responsibilities of the SOS Hospitalization and Evacuation Branch and the Surgeon General’s Office had been more clearly delineated. Such was not the case, however, and the con- troversy that developed in this instance illustrated dangers and difficulties inher- ent in the new structure of the War De- partment and the new position of The Surgeon General. 64 Diary, Hosp and Evac Br SOS, 22 Sep 42. HD; Wilson files, “Diary.” 85 (1) Resume of Conf, SvCs and Ports, Feb-Mar 43, incl 1 to Memo SPOPI 337, GG ASF for SG and CofT, 30 Apr 43, same sub. HD: Wilson files, “Book IV, 16 Mar 43-17 Jun 43.” (2) Memo, Col W. L. Wilson for Chief Hosp and Evac Br ASF, 17 Feb 43, sub: Visit to 8th SvC and Southern Def Comd. HD; Wilson files, “Book HI, 1 Jan 43-15 Mar 43.” (Col Robert C. McDonald succeeded Colonel Wilson as Chief, Hospital and Evacuation Branch on 6 Febru- ary 1943.) 66 Notes on tel conv between Col E. G. Jones, Surg 5th SvC and Col Rogers, 1 Sep 42. HD: Oprs Div files. 67 (1) Memo SPOPH 322.15, Chief Hosp and Evac Br SOS for Chief Oprs SOS, 16 Nov 42, sub: SvC and Port Plans for Hosp and Evac Oprs. HD: Wilson files, “Book 2, 26 Sep 42-3 1 Dec 42.” (2) Memo, SG for CG SOS, 30 Aug 42, sub: Oprs Plans for Hosp and Evac. SG: 704.-1. (3) Copies of the subordinate plans are in Wilson files, HD. 68 See below, pp. 80-84. 89 (1) For example, see 1st ind SPOPH 322.15 (8- 30-42), GG SOS to SG, 26 Sep 42, on Memo, SG for CG SOS, 30 Aug 42, sub: Oprs Plans for Hosp and Evac. CE: 632. (2) WD Gir 140, 11 Apr 44. CHAPTER V Hospital Plants in the United States In December 1941 the Army had a total of approximately 74,250 beds in about 200 station hospitals and 14 general hospitals in the United States.1 During the next eighteen months it was to build enough additional hospitals to house more than three times the number provided during the fifteen-month period of peacetime mobilization.2 In addition, it was to have enough hospitals under construction in June 1943 to house over 65,000 more beds.3 Concurrently, improvements would have to be made in the cantonment-type hospitals already in operation.4 Types of Construction Emphasis on Simplicity With the country at war, speed in con- struction and conservation of building materials became factors of paramount consideration. Accordingly the General Staff insisted upon the simplest type of construction. On 29 December 1941 G-4 revoked the authority it had previously granted to construct hospitals on the two- story semipermanent plan,5 and about a month later revised the War Department construction policy. After 6 February 1942 all construction at new stations, except that already in the advanced planning stage, was to be a modified form of the type designed for theaters of operations.6 The Engineers interpreted this policy to mean that in station hospitals all ware- houses and utility shops, and all buildings used for housing, feeding, and entertain- ing male members of the hospital staff would be of theater-of-operations-type construction, while those used in the care, treatment, feeding, and recreation of pa- tients and as quarters, messes, and recre- ation rooms for nurses were to be of cantonment-type construction.7 General 1 Bed Status Rpts, end of last week in Dec 41. Off files, Health Rpts Br Med Statistics Div SGO. A few beds were reported in Darnall General Hospital, but they are not included in the number given above be- cause this hospital did not open until March 1942. 2 Gen Hosp Sta Hasp Beds Available Sep 40 4,925 7,391 Beds Added Sep 40-Dec 41 10,608 51,345 Beds Added Dec 41-Jun 43 38,226 161,279 Source: Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO. ! An Rpt, 1943, Hosp Cons Div SGO. HD. 4 The even larger program of construction of all types of housing for the Army, of which the hospital expansion program was a part, is discussed in Jesse A. Remington and Lenore Fine, The Corps of Engi- neers: Construction in the United States, a forthcom- ing volume in the series UNITED STATES ARMY IN WORLD WAR II. 5 (1) See above, pp. 23-24. (2) Ltr AG 632(12-27- 41) TAG to SG and CofEngrs, 29 Dec 41, sub: Fire- Resistant Type of Cons in Hosps. SG: 632.-1. 6 Ltr AG 600.12(2-5-42)MO-D-M, TAG to CGs all Depts, CAs, et at., 6 Feb 42, sub: WD Cons Policy. SG; 600.12. 7 Ltr, CofEngrs to TAG, 14 Feb 42, sub: Hosp in T/O Cantonments, with 1st ind AG 600.12 (2-14- 42) MO-D, TAG to CofEngrs, 25 Feb 42. CE: 632 Pt 2. HOSPITAL PLANTS IN THE UNITED STATES 69 hospitals, previously expected to be of semipermanent construction, were now to be entirely of cantonment type. This low- ering of standards brought quick protests from The Surgeon General. The decision to abandon two-story semi- permanent construction for general hospi- tals was modified on 31 December 1941. At The Surgeon General’s request, G-4 approved its use if neither a loss of time nor a material increase in costs was in- volved.8 During the next two months, the Engineers and The Surgeon General’s construction officers disagreed on whether semipermanent hospitals could be shown to cost no more than cantonment-type hospitals.9 In some instances dual bids for the erection of a hospital on either plan were called for, and ten hospitals, includ- ing those already begun before the war, were constructed on the semipermanent plan.10 Subsequently the Engineers found that the initial cost of semipermanent hos- pitals was “considerably greater,” and on 16 April 1942 G-4 returned to its position that only cantonment-type construction be used for general hospitals.11 The decision to use theater-of-opera- tions-type construction for buildings in station hospitals remained unchanged. Buildings of this type were of the lightest possible frame construction, with exteriors usually of heavy treated paper or fiber- board. Plumbing was omitted from bar- racks and placed in separate lavatory buildings. Heat was generally furnished by stoves in each building rather than by a central heating plant.12 The Surgeon General based his protests against the use of theater-of-operations-type construction for hospitals in the United States on its lower quality. He stated that barracks and quarters of that type were unsuitable for conversion to wards to meet emergency needs for additional beds, that messes lacked comforts desired for officer-pa- tients, and that kitchens had inadequate refrigeration and dishwashing facilities.13 The Chief of Engineers admitted that it would be difficult to use theater-of-opera- tions-type barracks for emergency wards, but believed it unwise to provide better housing for Medical Department men than for other troops. The General Staff agreed, and on 24 February 1942 reiter- ated the policy announced earlier that month.14 Later in the year, as the shortage of building materials increased, the General Staff proposed an even lower quality of construction for some hospitals. In May 8 Memo, SG for ACofS G-4 WDGS, 31 Dec 41, with 1st ind, ACofS G-4 WDGS to SG, 31 Dec 41. SG: 632.-1. 9 (1) Ltr, SG [Col John R. Hall] to TAG 19 Jan 42, sub: Fire-Resistant Type of Hosp Cons. (2) Memo, [Mr] Hfarvey] J. H[all] for Col Hall, 5 Feb 42, sub; Comparison Data of the Cantonment-type Cons and the Semipermanent, Fire-Resistant Type, by Bldgs. (3) Ltr, SG (JRFI) to CofEngrs, 7 Feb 42, sub: Fire- resistant Type of Hosp. Comparison with Cantonment Types. All in SG: 632.-1. 10 (1) D/S G-4/33956, ACofS G-4 WDGS to TAG for CofEngrs, 8 Mar 42, sub: Gen Hosp Cons. AG: 322.3 “Gen Hosp.” (2) Ltr AG 322.3 Gen FIosp (3- 8-42) MO-D, TAG to CofEngrs, 10 Mar 42, same sub. SG: 632.-1. General hospitals of this type were Bushnell, McCloskey, Kennedy, Valley Forge, and Schick; there were also five station hospitals of the same type, located at Camps Atterbury (Indiana), Butner (North Carolina), Carson (Colorado), Camp- bell (Kentucky), and White (Oregon). 11 (1) 2nd ind, CofEngrs to TAG, 14 Apr 42, sub: Cons of Hosp, on unknown basic Ltr. CE: 632 Vol. 3. (2) Ltr AG 600.12 (4-15-42) MO-DM, TAG to CGs of AGE, AAF, SOS, et al, 16 Apr 42, sub: WD Cons Policy, ZI. SG; 600.12. 12 Engineering Manual, OCE, Oct 43, Ch. IX, Pt I, par 10-03c. 13 Memo, SG for CofEngrs, 9 Feb 42, sub: Proposed Hosp at Centerville and Grenada, Miss. SG; 632.-1. 14 (1) Ltr, CofEngrs to TAG, 14 Feb 42, sub: Hosp in T/O Cantonments, with 1st ind, 25 Feb 42. CE: 632 Pt 2. (2) Ltr AG 600.12 MO-D-M, TAG to CGs, COs, and C of Arms and Servs, 24 Feb 42 sub; WD Cons Policy, ZI. SG: 600.12. 70 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR 1942 the Secretaries of War and Navy and the Chairman of the War Production Board agreed upon a directive which re- quired construction to be reduced to the minimum in both quantity and quality.15 In conformity with this directive the Gen- eral Staff decided to move units in ad- vanced states of training to field tent camps and to use existing cantonments for the training of new units. They proposed to provide hospitalization for field camps in screened and floored tents.16 The Sur- geon General objected and suggested limiting hospitalization in tents to one third of that required for field camps and providing the rest in cantonment-type buildings, erected either in field camps or as additions to near-by station hospitals.17 The General Staff approved the limitation of hospitalization in tentage but directed the use of theater-of-operations-type buildings for the remainder.18 This meant that in some places buildings used for the care and treatment of patients, as well as those for housing personnel and storing supplies, were to be of low quality con- struction. Again The Surgeon General protested the use of “a hospital of a lower grade than the cantonment type unit.” 19 While the policy was not changed, the practice of using tentage and theater-of- operations-type construction for entire hospital plants seems to have been limited chiefly to AGF maneuver areas.20 Conversion of Existing Buildings Another method of achieving speed and conservation was to convert existing civil- ian buildings into Army hospitals. In mobilization plans this method had had high priority and in the fall of 1940 The Surgeon General had considered its use.21 Soon after war began his construction of- ficers again started looking for civilian buildings suitable for conversion.22 On 19 March 1942, about the time the decision was being made to construct no more semipermanent hospitals, SOS headquar- ters suggested the acquisition of civilian buildings to house additional general hos- pital beds.23 A little over a month later the Chief of Staff considered the possibility of abandoning entirely the construction of new general hospitals in favor of the civil- ian-facilities-conversion method. He gave up that idea after The Surgeon General’s Construction Division and SOS head- quarters pointed out difficulties involved.24 15 Directive for Wartime Cons, 20 May 42, incl to Ltr AG 600.12 (5-20-42) MO-SPAD-M, TAG to CGs AAF, Depts, CAs, and C of Tec Servs, 1 Jun 42, same sub. SG: 632.-1. 16 Draft Memo WDGCT 600.12, ACofS G-4 WDGS for CofS, n d, sub: Housing for 1943 Trp Basis. SG: 632.-1. 17 Memo SG for Col [Lester D.] Flory, Oprs SOS, 17 Jul 42, sub: Comments on Housing for the 1943 Trp Basis. SG: 632.-1. 18 (1) WD Gir 278, 21 Aug 42. (2) Mil Hosp and Evac Oprs, 15 Sep 42, par 136 (1), incl 1 to Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs, PEs, and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs. HD: 322 (Hosp and Evac). 19 1st ind, SG to CofEngrs thru CG SOS, 8 Sep 42, on Memo CE 354 SPEOT, CofEngrs for SG, 27 Aug 42, sub: Hosp Fac for Fid Cp. SG: 632.-1. 20 (1) See below, pp. 104-06. (2) Tynes, Construc- tion Branch, p. 36. 21 Memo, Act AGofS G-4 WDGS for CofS, 12 Nov 40, sub; Gen Hosp Program. HRS: G-4/29135-1 1. 22 (1) Ltr, Col John R. Hall, SGO to Dr. Morris Fishbein, AMA, 4 Feb 42. SG: 601.-1. (2) Memo, Maj Achilles L. Tynes, SGO for SG, 26 Feb 42, sub: Rpt of Insp Trip to Monroe and Charlotte, NC. SG: 632.-1. 23 Memo SP 632 (3-19-42), CG SOS for CofEngrs, 19 Mar 42, sub: Add Gen Hosps. SG: 632.-1. 24 (1) Memo SPEX 632 (5-1-42), [Maj Gen Wil- helm D.] Styer for [Lt Gen Joseph T.] McNarney, 1 May 42, sub: Acquisition of Existing Hosps, ... in lieu of Cons of New Gen Hosps. (2) Memo, CG SOS for GofSA, 3 May 42. (3) Memo, JTM[cNarney] for CofSA, 5 May 42. (4) D/S 632 (5-3-42), Dep- CofSA for SG, n d. All in SG: 632.-1. (5) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1. NURSES QUARTERS PLAN FOR THEATER-OF-OPERATIONS-TYPE HOSPITAL OFFICERS QUARTERS 72 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR OLIVER GENERAL HOSPITAL converted from the Forest Hills Hotel. A “Directive for Wartime Construction,” issued two weeks later, confirmed as policy the practice of converting existing build- ings into hospitals whenever practicable and of constructing new buildings other- wise.25 Difficulties involved in the civilian-fa- cilities-conversion method restricted its use. Of hundreds of buildings which civil- ians offered to the Medical Department, not over 3 percent were suitable for use as hospitals.26 Many were too small. Some had corridors, stairways, and doors that were too narrow to permit the passage of patients on litters. Others that were several stories high lacked adequate ele- vator service. Still others were in undesir- able locations.27 In some instances, where both the buildings and locations were suit- able, local politicians and owners tried to get higher prices than the War Depart- ment was willing to pay. In others, local citizens banded together to prevent Army acquisition because they feared a depre- ciation in neighboring property values.28 Finally, even after suitable buildings were found and all arrangements for acquisition completed, additions and alterations had to be made before the Medical Depart- 25 Directive for Wartime Cons, 20 May 42, incl to Ltr AG 600.12 (5-20-42) MO-SPAD-M, TAG to GGs AAF, Depts, CAs, and C of Tec Servs, 1 Jun 42, same sub. SG: 632.-1. 26 Ltr, Maj Lawrence G. King, SGO to Lt Col Albert Pierson, Off ACofS G-4 WDGS, 18 Jun 42, sub: Util of Existing Bldgs as Hosps. SG: 601.-1. 27 (1) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1. (2) Memo, SG for CofSA thru GG SOS, 19 May 42, sub: Preliminary Surv of Atlantic City Hotels for Hosp. HD: Hosp Insp Rpts, p. 680. 28 (1) Pers Ltr, Col Harry D. Offutt to Gol Don [G.] Hilldrup, 21 Apr 42. SG: 632.-2 (3d SvC)AA. (2) Notes on Conf, Hosp Cons Div SGO, 26 Mar 42, sub: Gen Hosp Program. HD: 632.-1. HOSPITAL PLANTS IN THE UNITED STATES 73 Table 2—Army Hospitals Established in Converted Civilian Buildings by End of 1943 Hospital Civilian Buildings AAF Regional Sta Hosp Miami Biltmore, Floridian, Gulf Stream, King Cole, Nautilus, Pancoast, and Tower Hotels Army & Navy Gen Hosp Annex Eastman Hotel Ashford Gen Hosp Greenbrier Hotel Bronx Area Sta Hosp Lebanon Hosp Camp Shanks Sta Hosp Rockland State Hosp Charlotte, N. C., Sta Hosp Charlotte Sanatorium Dante Sta Hosp, San Francisco, Calif. (Later part of Letterman Gen Hosp) Dante Hosp Darnall Gen Hosp Kentucky State Hosp Deshon Gen Hosp Butler Hosp England Gen Hosp (Formerly AAF Sta Hosp, Atlantic City, N. J.). . . Haddon Hall, Cedarcraft, Colton-Manor, Dennis, Keystone, New England, Rydal, Traymore, Warwick, and Chalfonte Hotels Gardiner Gen Hosp (Formerly AAF Sta Hosp, Chicago, 111.) Chicago Beach Hotel Halloran Gen Hosp Willowbrook School Hoff Gen Hosp Annex Jefferson School, Calif. Los Angeles, Calif., Sta Hosp Villa Riviera Hotel Mason Gen Hosp Pilgrim State Hosp New Haven, Conn., Sta Hosp Wm. Wirt Winchester Hosp Oakland Area Sta Hosp Oakland Hotel Oliver Gen Hosp Forest Hills Hotel Pasadena Area Sta Hosp Vista Del Arroyo Hotel Percy Jones Gen Hosp Battle Creek Sanitarium Percy Jones Gen Hosp Annex Kellogg Estate, Battle Creek, Mich. Ream Gen Hosp (Formerly AAF Sta Hosp, Palm Beach, Fla.) Breakers Hotel Rhodes Gen Hosp Annex Marcy NYA Facility, N. Y. St. Petersburg, Fla., Sta Hosp Don-Ce-Sar Hotel Seattle Area Sta Hosp New Richmond Hotel Staten Island Area Sta Hosp Seaside Hosp Torney Gen Hosp El Mirador Hotel Walter Reed Gen Hosp Annex National Park College Sources: (1) Ltr, SG to Sec War thru CG ASF, 18 May 43, sub: Gen Hosp Progra m. Use of converted hotels (Air Forces), with 7 nds. HD: 632.-1 (Hosp Expansion). (2) Incl, Record of Expansion and Contraction, Hosp ZI, and Hosp Ships, to Memo, Chief Cons Br SGO for HD SGO, 1 Nov 46, same sub. Same file. (3) Diary Hosp Cons Br SGO, 15 and 20 Jul 44. HD: 024.7-3. (4) An Rpt, 1943, England Gen Hosp, p. 3. HD. (S) An Rpt, 27 Nov 44, Hq AAF Reg Sta Hosp No. 1, pp. 1-6. HD. ment could move in and set up function- ing hospitals. Despite these difficulties and problems, the Army acquired enough civilian buildings by the end of 1943 to house twenty-three hospitals and expand five others. (Table 2) Development of One-Story Semipermanent Type Hospital Concurrently with increasing emphasis on conservation of building materials, forces were at work during 1942 which 304244 0—55 7 74 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR PLAN FOR TYPE A HOSPITAL were to cause the War Department to turn again to the construction of semiperma- nent hospitals. As early as February 1942 the Clay Products Association of the Southwest began a campaign for the use of its materials by the Army, at least in hospital construction.29 In April the Ad- ministrator of Veterans Affairs protested against the repetition of a World War I 29 (!) Ltrs, Norman W. Kelch, Engr-Mgr, Clay Products Assn of the Southwest to UnderSecWar, 13 Feb and 3 Mar 42, sub: Fire-resistive Cons for Can- tonment Type FIosps. (2) Ltr, UnderSecWar to Kelch, 19 Mar 42. (3) Ltr, CofEngrs to Kelch, 6 Mar 42. All in CE: 632 Pt I. HOSPITAL PLANTS IN THE UNITED STATES 75 BIRMINGHAM GENERAL, A TYPE A HOSPITAL mistake—the construction of hospitals that could not be converted to postwar use.30 By June shortages of lumber had begun to develop in some areas, while sur- pluses of brick and tile had begun to accu- mulate. In some places, therefore, the Engineers began to build cantonment- type hospitals of tile and brick instead of lumber.31 Then, on 10 August 1942, the War Production Board informed The Sur- geon General of the availability of tile and brick and urged their use in hospital con- struction. The Surgeon General replied that he had always preferred noninflam- mable materials for hospital construc- tion.32 Soon afterward, his representatives joined the Engineers in work on plans for a new type of hospital. The chief obstacle to development of plans for a one-story semipermanent hos- pital, which the Chief of Engineers pro- posed on 26 August 1942, was a difference of opinion between his Office and The Surgeon General’s over the internal char- acteristics of various buildings. Feeling it necessary to hold the cost of construction as near as possible to that of cantonment- type buildings, the Engineers were prone to limit improvements and refinements to the absolute minimum. On the other hand, Colonel Hall of The Surgeon General’s Construction Division saw no reason to 30 Ltrs, Admin of Vet Affairs to GG SOS and to SecWar, 1 Apr 42. SG: 632.-1. 31 (1) Ltr, CofEngrs to SG, 11 Jun 42, sub: Use of Structural-Tile Exterior Walls at Ft Des Moines and Cp Dodge Hosps, with 1st ind, SG to CofEngrs, 15 June 42. SG: 632.-1. (2) Exhibit A to Memo, Gol John R. Hall for SG, 13 Jun 42, sub: Rpt of Fid Trip covering Insp of 1411-bed Hosp at Cp Atterbury and of the French Lick Hotel Property. HD: Hosp Insp Rpts, p. 726. 32 (1) Ltr, Chief Bldg Materials Br Oprs WPB to SG, 10 Aug 42. (2) Ltr, SG to WPB, 14 Aug 42, sub: Hosp Cons. Both in SG: 632.-1. 76 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR design a third type of hospital if it was not materially better than the cantonment type and equal, in most respects, to the two-story semipermanent type. For ex- ample, he wanted larger and more effi- ciently arranged clinical buildings, strong- er and safer neuropsychiatric wards, increased administrative space, and bet- ter-equipped messes. After numerous con- ferences and what must have seemed to the Engineers an uncompromising attitude on the part of the Surgeon General’s Of- fice, they composed their differences and during the winter of 1942-43 a civilian architectural firm employed by the Engi- neers completed drawings for the new type of hospital.33 The Type A hospital, as plants con- structed according to the new design were called, came to be considered by the Sur- geon General’s Office as the best for emer- gency construction in the zone of interior. Basically, it was the two-story semiper- manent hospital reduced to one-story form. Being only one story high it was safer for patients and did not require ex- pensive and unhandy two-story ramps. Its clinical facilities were more adequate and more efficiently arranged than those of the two-story hospital. It also cost less to build. Because wards were placed on both sides of corridors and were lengthened from 262 to 287 feet, the Type A hospital covered a smaller area than other one- story plants. Its chief disadvantage was that it was designed on the dispersed- pavilion principle. Before the war’s end, twelve hospitals were constructed on this plan.34 (Table3) Modification of the Type A Hospital for Postwar Use by the Veterans Administration In the spring of 1943 plans for the Type A hospital were modified as a result of at- tempts to co-ordinate wartime hospital construction with postwar needs. On 31 March 1943 the President directed the Federal Board of Hospitalization to re- view plans for hospital construction of all federal agencies, including the War and Navy Departments.35 The next month the Board proposed that the Army build some of its hospitals according to standard plans of the Veterans Administration, for use after the war. SOS headquarters raised no objection, but disclaimed any responsibil- ity for justifying and defending this pro- posal.36 Anticipating its approval, The Surgeon General’s construction officers and the Engineers, in collaboration with the Veterans Administration, prepared layouts for Type A hospitals which sub- stituted five two-story VA-type ward buildings for ordinary wards. In May the President approved the Federal Board’s recommendation that two Army general hospitals—McGuire at Richmond, Va., and Vaughan at Hines, 111.—be con- structed on that plan.37 Many factors thus shaped the kinds of hospital plants which the Army acquired 33 (1) Ltr, GofEngrs to SG, sub: One-Story Mason- ry Wall Gen Hosp, 26 Aug 42, with 3 inds. (2) Ltr, SG to GofEngrs, 12 Nov 42, sub: One-Story Masonry Cons Hosp, 1100 Series, Drawings by York and Sawyer, with 4 inds. All in SG: 632.-1. 34 (1) Tynes, Construction Branch, pp. 37, 40-41. (2) The Type A hospitals were Battey, Birmingham, Crile, Cushing, DeWitt, Dibble, Glennan, Madigan, Mayo, Baker, and Northington General Hospitals, and Waltham Regional Hospital. 3:> Lir, President of US to Sec War, 3 1 Mar 43. SG; 632.-1. 36 Memo, CG SOS for SG 17 Apr 43, sub: Comple- tion of Gen Hosp Program in U.S. SG: 632.-1. 37 (1) Memo, SG for GofEngrs, 3 May 43. SG: 632.-1. (2) Ltr, GofEngrs to CG ASF, 10 May 43, sub: VA Type Ward Bldgs, with 1st ind SPRMC 600.12 (5-10-43), CG ASF to GofEngrs, n d. CE; 632 Vol 4. (3) Ltr, Dir Cons VA to Col John R. Hall, SGO, 19 May 43, with 1st ind, SG to GofEngrs, 1 Jun 43, sub: Hosp Cons. SG: 632.-1. (4) Ltr, SG to GofEngrs, 7 Jun 43, sub: 1785-bed Gen Hosp, Richmond, Va., Area. SG; 632.-1 (McGuire Gen Hosp)K. HOSPITAL PLANTS IN THE UNITED STATES 77 Table 3—Building Schedule for Type-A Hospital General Hospital Plan Building Type Title Number Required For 1727 Beds For ISIS Beds ADM E-H Administration Building 1 1 1 1 1 1 10 1 1 1 1 1 1 1 uired. ANIM A-H Animal House BKS D-H Med. Det. Adm. & Unit Stores BKS D-H Med. Det. Barracks 11 1 CHAP A-H Chapel CLIN CLIN R-H Q-H X-H Clinic, Dental, EEN&T Clinic, Lab. & Prof. Services 1 1 CLIN Clinic, X-ray, G. U. & Physiotherapy 1 FIRE B-H Fire Station 1 GUAR B-H Guard House 1 CUES A-H Guest House 1 HEAT G-H Heating Plant, H. P As rec HEAT E-H Heating Plant, L. P HEAT F-H Heating Plant, H. P. Annex to L. P INC A-M Incinerator—3-ton i 1 1 1 LDY D-H Laundry i LDYSP A-H Laundry Steam Plant i MESS Z-H Enl. Patients & Med. Det. Mess i 1 MESS AA-H Officers’ & Nurses’ Mess i 1 3 NQ OQ POPX A-H Nurses’ Qtrs 4 E-H Officers’ Qtrs 2 2 A-H Post Office & Post Exchange 1 1 REC H-H Med. Det. Recreation 1 1 REC G-H Officers’ & Nurses’ Recreation 1 1 REC F-H Patient’s Recreation 1 1 RECG A-H Receiving & Evacuation Bldg 1 1 SHGA A-H Shops & Garage 1 1 SHMO A-H Hospital Shop & Morgue 1 1 STOR I-H Med. Storehouse 1 1 STOR H-H Med. Storehouse & Offices 1 1 STOR J-H B-H Storehouse 2 1 SURG Clinic, Surgery 1 1 WARD K-H Ward, Combination 9 6 WARD S-H Ward, Detention 4 3 WARD J-H Ward, Standard IS IS Covered walks and exit ramps are included in the plan. A number of supplementary buildings may also be added to hospital construction. The basic plan is shown on the opposite page. Source: Tynes, Construction Branch, p. 49. HD:314.7-2 (Hosp. Const. Br.). this type of 78 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR or constructed during World War II. Such forces as necessity for speed in construc- tion, availability of building materials, pressure of civilian groups, and co-ordina- tion of Army wartime construction with postwar needs of other Federal agencies often seemed stronger than medical con- siderations. The Surgeon General’s Office therefore frequently found itself in con- flict with higher authorities in attempting to get what it considered to be suitable and satisfactory hospital plants. While undesirable cantonment-type plans drawn before the war were used for most hospi- tals, better plants were designed and the Army erected 10 two-story and 12 one- story semipermanent hospitals on new plans as well as 2 designed specifically for postwar use by the Veterans Administra- tion. Estimates of Hospital Capacity Needed Speed in construction and conservation of materials also affected planning for the expansion of hospitals. During most of 1942 speed was so necessary to keep hos- pital capacities abreast of the Army’s growth that there was little time for re- examining the basis already established for estimating requirements. Hence, con- servation of building materials was at first achieved by lowering the quality rather than the quantity of construction. More- over the need for speed, along with uncer- tainty about the eventual size of the Army and the rate of its movement overseas, perhaps accounted partially for the fact that until the end of 1942 little attention was given to the co-ordination of station with general hospital requirements, of Army with Navy requirements, and of wartime with postwar requirements. Even disregarding these matters, planning for a rapid and unprecedented expansion was a complicated process. In the first part of 1942 plans had to be made to meet imme- diate normal requirements. In addition, plans for emergencies were needed be- cause it was feared that sneak attacks, sabotage, or severe epidemics might re- quire hospital beds far in excess of the number normally provided. Later, when emphasis was placed upon reduction in quantity as well as quality of construction, a tendency developed to make long-range plans. All three types of planning—nor- mal, emergency, and long-range—were inevitably interrelated. Early Plans To Meet Normal Requirements Plans for station hospitals to house the number of beds authorized by the existing bed ratio were automatically included by the Engineers in general construction plans for each camp, but planning for the expansion of general hospitals was differ- ent. Although general hospital beds were authorized for 1 percent of the total strength of the Army, construction of plants to accommodate that number did not automatically follow. Instead The Surgeon General had to request period- ically the approval of construction to house specific numbers of general hospital beds. He usually received approval for less than the 1 percent asked for. As a stopgap measure The Surgeon General on 18 De- cember 1941 recommended the construc- tion of four new general hospitals and annexes to two existing hospitals to pro- vide 6,000 additional beds. The next day G-4 approved this recommendation.38 38 (1) Ltr, SG to TAG, 18 Dec 41, sub: Location of 6,000 Add Gen Hosp Beds. SG: 632.-1. (2) Memo, ACofS G-4 WDGS for TAG. 19 Dec 41, sub: Gen Hosps. HRS: G-4/29135-11. HOSPITAL PLANTS IN THE UNITED STATES 79 McGuire general, a va-type hospital The following February, after the troop basis for 1942 was published, The Surgeon General recommended enough additional beds (18,600) to make a total by the end of 1942 of 39,600, 1 percent of the planned strength of the Army.39 Of these, G-4 au- thorized only 14,000, to be completed by 30 September 1942, advising The Surgeon General informally to include further re- quirements in longer-range planning.40 By June 1942 it was possible to project re- quirements to the end of 1943. Informed that the strength of the Army by that time would be 6,600,000 men The Surgeon General recommended 30,026 beds in ad- dition to those already available or au- thorized, to make a total of 66,000.41 Although the SOS Hospitalization and Evacuation Branch agreed to this number for planning purposes, the SOS Construc- tion Planning Branch directed the Engi- neers a few weeks later to construct only 23,500.42 When The Surgeon General estimated total general hospital bed requirements, he planned also their distribution among different hospitals. Before the war all new 39 Ltr, SG to CofEngrs, 3 Feb 42, sub: Add Gen Hosp Beds. SG: 632.-1. 40 Memo for Record, on Memo, ACofS WDGS G-4 for TAG, 9 Feb 42, sub: Add Gen Hosp Beds. HRS: G-4/29135-1 1. 41 Ltr, SG to CG SOS, 6 Jun 42, sub: Add Gen Hosp Beds. SG: 632.-2. 42 Memo SPOPM 632, Dir Oprs Div SOS (init WLWfilson]) for Dir Reqmts Div SOS, 17 Jun 42, sub: Add Gen Hosp Beds. HD: Wilson files, “Book I, 26 May 42-26 Sep 42.” (2) Memos SPRMC 601.1, GG SOS for CofEngrs, 4 and 7 Jul 42, same sub. HD: 632.-1. 80 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR general hospitals had been constructed on a 1,000-bed plan. Larger hospitals could be operated with a lower ratio of person- nel to beds, and after Pearl Harbor he be- gan to recommend the construction of 1,500-bed hospitals.43 During 1942 hospi- tals of this size gradually superseded those of 1,000-bed capacity.44 With this begin- ning, the tendency to enlarge general hos- pital capacities was to grow until some of them would reach 6,000 by 1945. When the Army began to emphasize reductions in quantity as well as quality of construction, attention centered momen- tarily on the authorized bed ratio. The Inspector General and the director of the SOS Requirements Division believed that it was too high.45 In June 1942 there were 96,291 beds in general and station hospi- tals, but only about 73,285 were occu- pied.46 According to the authorized ratio, there should have been 129,640 beds.47 Referring to reports on the occupancy of beds and to directives limiting construc- tion to the essential minimum, SOS head- quarters called upon The Surgeon General for an analytical study of bed require- ments based on the experience of the previous ten years, rather than World War I, with a view to a possible reduction in authorized ratios.48 Although tables he submitted showed the ratio of occupied beds to Army strength from 1932 to 1941 to have been nearer 3.5 percent than the authorized ratio, The Surgeon General urged that the latter not be reduced. He pointed out that only 80 percent of the beds provided should be considered avail- able, since approximately 20 percent of the total was lost through “dispersion”— the separation of patients into wards ac- cording to disease, rank, and sex. He believed that a higher proportion of men would require beds during war than dur- ing peacetime, because battle casualties would need extended periods of hospital care, recruits would have higher sick rates than seasoned soldiers, and accidents would occur more frequently under stren- uous training programs.49 By the time of this reply higher authorities were consid- ering double bunking in barracks and this was to lead to a temporary increase, rather than a reduction, in the authorized bed ratios. Planning for Emergencies Hospital construction for normal use was so urgent in the first hectic months of the war that planning for emergencies was left largely to local commanders. The Sur- geon General expected them to meet needs that might arise by setting up beds in the solaria of hospital buildings, by placing more beds in wards than were usually considered desirable, and by using as wards the barracks of enlisted hospital- complements and, if necessary, of other troops. These methods were prescribed in 43 (1) Ltr, SG to TAG, 18 Dec 41, sub: Location of 6,000 Add Gen Hosp Beds. SG: 632.-1. 44 Ltr, SG to CG SOS, 6 Jun 42, sub: Add Gen Hosp Beds. SG: 632.-2. 45 Memo for Record, on Memo SPOPM 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub; Reqmts and Distr of Hosp Beds. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” 4,i Bed Status Rpts, end of last week in Jun 42. Off file, Health Rpts Br Med Statistics Div SGO. 47 This figure was arrived at by multiplying the strength of the Army in the United States by 4 per- cent and the total strength of the Army by 1 percent and adding the results. Of a total strength in June 1942 of 3,074,184, there were in the United States 2,472,407 officers and men. Figures furnished by Strength Accounting Branch AGO, 25 Oct 47. 48 Memo SPOPM 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub: Reqmts and Distr of Hosp Beds. SG; 632.-2. 49 1st ind, SG to Dir of Oprs SOS, 25 Jul 42, on Memo 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub; Reqmts and Distr of Hosp Beds. SG: 632.-2. HOSPITAL PLANTS IN THE UNITED STATES 81 Army regulations and, upon The Surgeon General’s recommendation, the use of barracks to expand hospital capacities was required by the SOS directive on hospital- ization and evacuation issued on 18 June 1942. Included in the same directive by the SOS Hospitalization and Evacuation Branch was another provision which The Surgeon General considered unneces- sary—the requirement that subordinate commanders plan to double hospital ca- pacities in emergencies by using civilian buildings such as apartments, hotels, schools, and dormitories.50 In the late summer and fall of 1942 a combination of circumstances focused attention upon the question of emergency hospitalization. Plans were being made for the North African invasion and for the reception in the United States of large numbers of casualties. Concurrently, as a means of reducing general construction requirements, the Chief of Staff and the commanding general, Services of Supply, decided to require the double bunking of troops in existing barracks. The Surgeon General warned them that the resultant reduction in per capita air space might lead to severe epidemics of respiratory dis- eases.51 General Marshall believed that this risk had to be taken, but feared that existing beds might be insufficient if an epidemic should occur at the same time casualties began to flow back from North Africa. On 10 August 1942 he verbally directed The Surgeon General, through the latter’s executive officer, to plan to take over hotels in an emergency for use as Army hospitals and to arrange with local physicians for civilian groups to man them. The next day General Marshall’s deputy referred to this directive in a meeting of the General Council (a group of represen- tatives of the General Staff, and of AGE, AAF, and SOS headquarters) and the SOS Chief of Staff afterward directed The Surgeon General “to take immediate” steps to enlarge hospital capacities in the event of an emergency.52 The Office of Civilian Defense was making plans for the emergency hospitali- zation of civilians, earmarking hotels and organizing “affiliated units” of civilian physicians and nurses to staff them if needed.53 Realizing the possibility of con- flict between OCD plans and General Marshall’s directive, General Magee dis- cussed the problem with General Lutes and with Dr. George Baehr, who was in charge of OCD medical activities. He then presented it to the Office of Defense Health and Welfare Services’ Health and Medical Committee, whose function was to co-ordinate all health and medical activities relating to national defense. Meanwhile, on 27 and 28 August 1942, General Magee transmitted General Mar- shall’s directive to service commands. They were already listing hotels that could 50 (1) AR 40-1080, C 2, 16 Mar 40. (2) The Sur- geon General’s Plan for Hosp (ZI) and Evac, incl to Memo, SG for CG SOS, 31 Mar 42, sub; Basic Plan for Hosp Oprs and Evac of Sick and Wounded. HRS: ASF Hosp and Evac Sec file, “Misc Classified Corresp from Off CG ASF to AGO.” (3) Memo, Col H. T. Wickert, SGO, for Col [W. L.] Wilson, SOS, 30 Apr 42, with incl Memo, SG for Dir Oprs SOS, 30 Apr 42. Same file. (4) See above, pp. 65-66. 51 (1) 1st ind, SG to CG SOS, 11 Jul 42, on Memo, CG SOS for SG, 9 Jul 42, sub: Capacity of Bks. (2) Memo, SG for CG SOS, 25 Aug 42, sub: Double Bunking. All in SG: 632.-1. 52 (1) Extract from Mins of Gen Council, 11 Aug 42. HD: Wilson files, 600.13 “Hosp Policy and Plans.” (2) Memo, CofSA for President of US, 21 Sep 42, sub: Reply to your Memo of Sep 14th Cone Util of Hotels as Mil Hosps. WDCofSA: 632 (14 Aug 42). (3) Memo, Brig Gen Larry B. McAfee for SG, 31 Oct 42. HD: 632.-1 “Hosp Expansion.” (4) State- ments of SG and his Exec Off, Cmtee to Study the MD, Testimony, pp. 1309ff and 1669ff. HD. 53 Cmtee to Study the MD, 1942, Testimony, pp. 984ff. HD. 82 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR be taken over in emergencies, in accord- ance with the SOS directive of 18 June 1942. To comply with the new directive, they had merely to review those lists, item- ize the medical property that would be required, and arrange with a local physi- cian to build up a staff for each emergency hospital.54 The Office of Civilian Defense and the Health and Medical Committee objected to this action because it threatened to interfere with plans for emergency hospi- talization for civilians and posed the danger of transferring epidemics from Army camps into cities. The Office of De- fense Health and Welfare Services then informed the President of the Army’s plan, suggesting that the War Department re- scind its directive and plan to provide emergency hospitalization for military personnel entirely within the confines of Army camps and with military profes- sional staffs only. Meanwhile the plan called for by the Chief of Staff was misinterpreted by the President, who understood that the Army intended to take over hotels and develop them into stand-by hospitals in advance of an emergency. When asked for an ex- planation, General Marshall assured him that this was not so, but assumed full responsibility for having directed the ear- marking of hotels and the organization of civilian staffs for emergency use. The President apparently considered this ex- planation satisfactory, for he passed Gen- eral Marshall’s letter on to the Office of Defense Health and Welfare Services with the single comment, “for your informa- tion.”55 After General Marshall’s explanation to the President it was still necessary to solve the problem of simultaneous planning by the Army and the Office of Civilian De- fense to use civilian staffs in emergency hospitals. At first SOS headquarters took the position that “any plan to utilize civil- ian medical personnel for military hospi- talization is entirely a planning matter to establish a potential means to meet major emergencies. . . .” 56 When this assur- ance failed to satisfy the Office of Civilian Defense, SOS headquarters changed its position and, strangely enough, required The Surgeon General to inform the Health and Medical Committee that it had never been War Department policy to use civilian staffs to care for military patients.57 Meanwhile General Magee had conferred with General Marshall and with Dr. Baehr. He then proposed a compro- 54 (1) Memo, SG for Brig Gen LeRoy Lutes, 21 Aug 42, sub: Over-All Plan for Emergency Med Care, Civ and Mil. HD; 632.-1 “Hosp Expansion.” (2) Statements by Baehr and Magee, Cmtee to Study the MD, 1942, Testimony, pp. 984ff and 1669ff. HD. (3) Ltrs, CG SOS per SG to CGs of SvCs, 27 and 28 Aug 42, sub: Hosp Expansion. HD: 632.-1. 33 (1) Ltr, Exec Sec, Health and Med Cmtee to Dir Off of Def Health and Welfare Servs, 5 Sep 42. HD: 632.-1 “Hosp Expansion.” (2) Ltr, Dir Off of Civ Def to same, 12 Sep 42. Same file. (3) Ltr, Dir Off of Def Health and Welfare Servs to the President, 10 Sep 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3. (4) Memo, FDR[oose- velt] for Gen Marshall, 14 Sep 42. WDCofSA: 632 (1‘4 Aug 42). (5) Memo, CofSA for the President, 21 Sep 42, sub; Reply to your Memo. . . . Same file. (6) Memo, FDRjoosevelt] for Hon Paul McNutt, [Dir Off of Def Health and Welfare Servs], 3 Oct 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3. 58 (1) Memo SPOPH 701, Lt Col W. L. Wilson, Chief Hosp and Evac Br SOS for Gen Lutes, 17 Sep 42, sub: Current Program for Mil Hosp, with 2 incls. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” (2) Ltr SPAAC 601, Chief Admin Serv SOS for Dir OCD, 9 Oct 42. Natl Archives; Record Group 215, Off of Community War Servs, 922.3. 57 (1) Memo, SG for CG SOS, 8 Oct 42, sub: Plan- ning for Expansion, Army Med Fac. HD: 632.-1 “Hosp Expansion.” (2) Ltr, Dir OCD to Maj Gen George Grunert, Chief Admin Serv SOS, 23 Oct 42. Natl Archives: Record Group 215, Off of Community War Servs, 922.3. (3) Memo SPAAC 632 (10-20-42), CG SOS for SG, 26 Oct 42, same sub, with 4 inds. SG: 632.-1. (4) Memo SPOPH 632 (10-10-42), Dep for AGofS for Oprs SOS (init WLW[ilson]) for Chief HOSPITAL PLANTS IN THE UNITED STATES 83 mise which in his opinion embodied the wishes of General Marshall and met the approval of Dr. Baehr. According to its terms the Army would plan to use in an emergency only those hotels which it could reasonably expect to staff with mili- tary personnel. If civilian doctors and nurses should be needed temporarily the Army would borrow staffs organized by the Office of Civilian Defense and the United States Public Health Service. Al- though SOS headquarters had disavowed the use of civilian staffs shortly before, it now approved a letter to service com- mands on 11 January 1943 explaining the compromise just mentioned.58 On 22 Feb- ruary Dr. Baehr sent a similar explanation to regional medical officers of OCD.59 Since the contemplated emergency never developed, the Army had no occasion either to take over the hotels earmarked or to call upon the Office of Civilian Defense for emergency staffs. SOS planning for the emergency ex- pansion of Army hospitals went on con- currently with that directed by General Marshall. On 25 August 1942 the Chief of the Hospitalization and Evacuation Branch informed General Lutes that no plan existed for assuring the availability of beds in case of an epidemic and requested authority to prepare one.60 Given the go- ahead signal, he proposed on 9 September 1942 that the station hospital bed ratio be raised from 4 percent to 5 percent for the winter of 1942-43 and that housing for additional beds thus authorized should be provided either by converting cantonment- type hospital barracks into wards and con- structing theater-of-operations-type bar- racks for the displaced enlisted personnel or by constructing additional cantonment- type wards wherever a medical detach- ment already lived in theater-of-opera- tions-type barracks.61 This plan was approved, and on 19 September 1942 the commanding general, Services of Supply, ordered the Chief of Engineers to put it into effect.62 As further provision for an emergency, the SOS Hospitalization and Evacuation Branch inserted in the revised version of the hospitalization and evacu- ation directive dated 15 September 1942 a requirement that each hospital plan to provide additional beds in barracks for 10 percent of the troops served.63 Thus each hospital would be prepared to care for 15 percent of its station’s strength. The 5 per- cent authorization proved sufficient for the winter’s needs. In the course of the Army’s controversy with the Office of Civilian Defense, Gen- eral Marshall directed General Snyder, the medical officer on The Inspector Gen- eral’s staff, to investigate means of meeting requirements that might develop in an emergency. General Snyder reported that enough beds existed, on the 4 percent 58 (1) 3d ind, Act SG to Chief of Admin Serv SOS, 14 Dec 42, on Memo SPAAC 632 (10-20-42), CG SOS for SG, 26 Oct 42, sub: Planning for Expansion, Army Med Fac. SG: 632.-1. (2) Ltr SPX 632 (1-8- 43) OB-S-SPOPH-M, CG SOS to CGs all SvCs, 11 Jan 43, same sub. HD: 632.-1. 59 Ltr, Chief Med Off OCD to Regional Med Offs OCD, 22 Feb 43, sub: Cooperation with the Army in the Care of Mil Casualties. HD: 632.-1. 60 Memo SPOPH 620 (7-4-42) Bks, Col Wilson for Gen Lutes, 25 Aug 42, sub: Capacity of Bks. HD; Wilson files, “Book I, 26 Mar-26 Sep 42.” 61 Memo SPOPH 322.15, ACofS for Oprs SOS (init WLW[ilson]) for Cons Br Reqmts Div SOS, 9 Sep 42, sub: Opr Plans for Hosp and Evac. HD: Wil- son files, “Book I, 26 Mar-26 Sep 42.” 62 Memo SPRMC 632 (9-9-42), CG SOS for GofEngrs, 19 Sep 42, sub: Add Hosps. SG: 632.-1. 63 Mil Hosp and Evac Oprs, sec I, par 3b (3), incl 1 to Ltr SPOPH 322.15, CG SOS to CGs of SvCs and PEs and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs. HD: 322. Admin Serv SOS, 20 Oct 42, same sub. HD; Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” (5) Memo SPOPH 632 (1 1-17-42), ACofS for Oprs SOS (init WLW[ilson]) for same, 22 Nov 42, same sub. Same file. (6) Ltr, Act SG to Exec Sec, Health and Med Cmtee, 14 Dec 42. SG: 632.-1. 84 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR basis, to meet ordinary requirements plus those of a minor epidemic. He estimated that 7,500 additional beds could be made available by treating minor cases in quar- ters; 6,000, by treating uncomplicated cases of venereal disease on a duty status; 97,000, by caring for convalescent patients in barracks; 25,000, by reducing the floor area per bed in existing wards; and a sub- stantial number, by improving adminis- trative procedures and limiting the per- formance of elective operations. In case of an unusually severe epidemic, all bar- racks, he believed, could be converted into hospitals and troops could be moved into warehouses, regimental recreation build- ings, and chapels.64 Under an SOS direc- tive, The Surgeon General attempted later to carry out some of General Snyder’s recommendations for more effective bed utilization.65 His recommendations for meeting the needs of an epidemic never had to be put into effect. Long-Range Planning Late in 1942 the Army began to try to co-ordinate hospital construction with other requirements and with postwar needs. To this end SOS headquarters in- sisted that each service forecast its normal needs as far ahead as possible.66 The Sur- gion General found it difficult to antici- pate station hospital requirements be- cause they depended, as always, upon troop distributions unknown by him. In addition, records of existing station hospi- tals were unreliable, those of the divisions of the Surgeon General’s Office differing among themselves and with records of the Engineers.67 But projection into the future of general hospital bed requirements was less difficult. In forecasting the need for general hos- pital beds in the fall of 1942, The Surgeon General adopted a new basis for estimates. Plans for the invasion of North Africa were being made and it was expected that large numbers of combat casualties would be returned to the United States. From World War I experience it appeared that beds would be needed in general hospitals in the United States for 1.7 percent of all overseas forces if patients requiring 120 or more days of hospitalization were evacu- ated from theaters of operations.68 The Surgeon General therefore added .7 per- cent of the strength of overseas forces to the 1 percent of the total strength of the Army already established as the basis for estimating general hospital bed require- ments. On 26 September 1942 he recom- mended that a total of 96,000 general hos- pital beds be provided by the end of 1943 and of 124,800 by the middle of 1944. About two months later, when the pro- jected Army strength was changed, he proposed that the mid-1944 figure be cut to 103,500. SOS headquarters approved his recommendations, and until the early part of 1943 this figure stood as the num- ber of beds authorized for planning pur- poses, but not for construction.69 (Chart 4) 84 Ltr, IG per Brig Gen Howard McC. Snyder to CofSA, 10 Nov 42, sub: Surv of Hosp Fac and their Util. HRS: WDCSA 632. 85 See below, pp. 127, 130-31. 66 (1) Memo, CofEngrs for SG, 10 Oct 42, sub: Prep of Sec V of Army Sup Program. SG: 632.-1. (2) Memo for Record, on 3d ind SPOPH 632 (9-26-42), CG SOS to SG, 29 Oct 42, on Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps. HD: Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” 67 (1) Cmtee to Study the MD, 1942, Rpt, p. 8. HD. (2) Memo, Dir Control Div SGO for SG, 8 Feb 43, sub; Statistics on Hosp Beds. SG; 632.-2. 68 Statistics of World War I were analyzed in Army Medical Bulletin, No. 24 (1931). 69 (1) Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps, with 4 inds. SG: 632.-2. (2) Memo, Chief Hosp Cons Div SGO for Asst Dir Fiscal Div SGO, 19 Jan 43, sub: Bed Reqmts for FY 1944. Same file. (3) Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5. HOSPITAL PLANTS IN THE UNITED STATES 85 Chart 4—The Surgeon General’s Estimates in 1941—4:2 of Bed Requirements in General Hospitals in Continental United States and Actual Beds Reported January 1942-July 1944 JFMAMJJASONDJFMAMJJASOND JFMAMJ 1942 1943 1944 Source: (1) Documents referred to in Chap V, sec “Estimates of Hospital Capacity Needed.” (2) Bed Status Reports, Health Reports Br, Med Statistics Div, SGO. Early in 1943 a combination of circum- stances pointed toward intensified efforts by the General Staff and SOS headquar- ters to limit construction. In January a study of hospital bed occupancy, prepared by the Surgeon General’s Office for inclu- sion in the SOS Monthly Progress Report, showed that estimated requirements had been higher than actual needs. While there was a close correlation between esti- mated requirements and occupied beds in station hospitals, a discrepancy between estimated requirements and occupied beds in general hospitals had grown from 11,000 to 45,000 during 1942. The Sur- geon General explained that this resulted from better health and fewer combat casualties than anticipated.70 In March 1943 certain members of Congress threat- ened to investigate the use of all hospital beds, both civilian and military, in the United States.71 Soon afterward the Sec- retary of the Navy proposed that the Army and Navy consider the possibility of making joint use of their hospitals.72 Furthermore, the Surgeon General of the 70 (1) SOS Monthly Progress Rpt, Sec 5, Pt IV, Health, pp. 44-45, 31 Jan 43. 71 Establishing a Select Committee to Investigate Hospi- tal Facilities Within the United States of America, 78th Cong, 1st sess on H. Res. 146, 3 March 1943. 72 Memo WDGDS 2857, ACofS G-4 WDGS for CofSA, 15 Mar 43, sub: Joint Army-Navy Use of Available Hosp Accommodations. HRS; G-4 files, “Hosp and Evac Policy.” 86 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR United States Public Health Service, call- ing attention to the interest of Congress and of the War Production Board in the matter, suggested to Brig. Gen. Frank T. Hines, Administrator of Veterans Affairs and Chairman of the Federal Board of Hospitalization, the desirability of co-or- dinating the hospital construction plan- ning of all Government agencies.73 As a result, the President on 31 March 1943 ordered the War and Navy Departments, the Federal Security Administration, and the Veterans Administration to submit all plans for additional hospital construction to the Federal Board of Hospitalization for co-ordination and submission to him, through the Bureau of the Budget, for ap- proval.74 Meanwhile, despite a discrepancy be- tween estimated and actual requirements in 1942 and in the face of growing interest in limiting hospital construction, The Sur- geon General again raised his estimates. On the basis of new troop strength figures from the Bureau of the Budget, he asked SOS headquarters on 11 March 1943 to approve an increase in authorized general hospital beds from 96,000 to 102,882 for December 1943 and from 103,500 to 110,- 693 for July 1944. He also asked approval of the higher bed ratio which he had been using since September 1942.75 Apparently the Services of Supply, renamed Army Service Forces on 12 March 1943, was in no mood to approve either additional beds or a higher ratio. Instead, its Require- ments Division directed The Surgeon General to review the proposed ratio in the light of recent war experience and to consider a reduction of construction re- quirements by the joint use of Army and Navy facilities, the expansion of existing general hospitals, and the conversion of station to general hospitals.76 Methods which ASF headquarters sug- gested for reducing hospital construction proved practicable only in part. A study of the possibilities of joint Army-Navy hospitalization promised little in the way of additional beds for Army use.77 The proposal to reduce the bed ratio got no- where. The director of the ASF Control Division agreed with The Surgeon Gen- eral that information on World War II casualty rates was insufficient to warrant a reduction, and the ASF Hospitalization and Evacuation Branch interpreted the 15 September 1942 directive on hospital- ization and evacuation as giving The Sur- geon General alone the authority to esti- mate bed requirements for overseas casualties.78 Hence, the ASF Require- ments Division accepted The Surgeon General’s estimate of requirements and turned to the remaining means of reduc- ing general hospital construction—the use of station hospital beds and the expansion of existing general hospitals. In a conference attended by representa- tives of the Surgeon General’s Office on 8 April 1943, the ASF Requirements Divi- 73 Ltr, SG USPHS to Brig Gen Frank T. Hines, 18 Mar 43. SG: 632.-1. 74 (1) Ltrs, Franklin D. Roosevelt to SecWar and to Dir Bu of Budget, 31 Mar 43. SG: 632.-1. (2) Ltr, Dir Bu of Budget to Chm Fed Board of Hosp, 2 Apr 43. Same file. 75 Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps. SG; 323.7-5. 76 1st ind, CG ASF to SG, n d, on Ltr, SG to CG SOS, 11 Mar43, sub: Hosp, Gen Hosps. SG: 323.7-5. 77 (1) 2d ind, SG to CG ASF, 31 Mar 43, on Ltr, SG to GG SOS, 1 1 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5. (2) 1st ind, SG to CG ASF, 12 Jun 43, on Memo, GG ASF for SG, 19 Mar 43, sub: Joint Army-Navy Use of Available Hosp Accommodations. SG: 705.-1. 78 (1) Memo SPOPH 632 (5 Apr 43), ACofS for Oprs ASF (init WLW[ilson]) for ACofS for Mat ASF, 7 Apr 43, sub: Hosp, Gen Hosps. HD: Wilson files, “Book IV, 16 Mar 43-17 Jun 43.” (2) Memo, Dir Control Div ASF for CG ASF, 2 Apr 43, sub: Situ- ation with Respect to Army Hosps. SG: 322.15. HOSPITAL PLANTS IN THE UNITED STATES 87 sion pointed out that the construction or acquisition of general hospitals to provide a total of 83,000 beds had already been approved. To provide approximately 103.500 beds by December 1943, about 20.500 additional beds would be required. On the basis of projected overseas move- ments, 5,400 station hospital beds would be surplus by that time. If they should be converted to general hospital use, housing for only 15,100 additional general hospi- tal beds would need to be constructed. Additional general hospital requirements during 1944 could be met by using in- creasingly large numbers of surplus sta- tion hospitals for that purpose. ASF head- quarters therefore approved the expan- sion of thirteen existing general hospitals by 250 beds each, the construction of seven new general hospitals, and the acquisition of Pilgrim State Hospital, Brentwood (Long Island), New York, in order to pro- vide the total number of beds required by December 1943.79 Reviewing this plan as the President had directed, the Federal Board approved the construction of the thirteen 250-bed annexes, the acquisition of Pilgrim State Hospital, and the construction of two new general hospitals.80 Before it acted on the five other general hospitals, the Air Forces gave up certain buildings it had been using, including the Chicago Beach Hotel at Chicago and the Haddon Hall Hotel at Atlantic City. Furthermore, ASF head- quarters decided that adjustments in the military program would make possible a reducion in authorized beds by approxi- mately 7,000. Accordingly on 22 June 1943 the commanding general, Army Service Forces, directed The Surgeon General to withdraw from the Federal Board requests for approval of 8,750 ad- ditional beds and to provide, instead, 1,810 beds in the two hotels being vacated by the Air Forces. In the opinion of ASF, this would complete the general hospital building program in the United States.81 The events just described reveal a pat- tern that was to be repeated later in the war—increases in estimated bed require- ments by The Surgeon General, publica- tion of statistics showing relatively low oc- cupancy of beds already provided, and subsequent efforts by higher headquarters to limit or reduce the number authorized. In this instance, such efforts resulted from attempts to reduce construction costs and save building materials but later from a need to conserve personnel. Earlier, as already noted, the urgent necessity for ad- ditional hospitals precluded doubts about estimated requirements as well as co- ordination of hospital construction pro- grams of various federal agencies, both military and civilian. When such co- ordination was finally undertaken, the Army program had been virtually com- pleted. Experiences encountered in plan- ning for emergency hospitalization re- vealed the difficulties involved in co-or- dinating plans of the Army with those of other agencies and in permitting several War Department agencies to work inde- pendently on a single problem. 79 (1) Memo, “Basis used by Gen Wood at Conf on Hosp, ZI, SOS, 8 Apr 43, attended by Hall, Offutt, Wickert, Welsh,” undated and unsigned. HD: SGO Oprs Div files. (2) Memo, CG ASF for SG, 9 Apr 43, sub: Completion of Gen Hosp Program in US. HRS: Hq ASF Somervell files, “SG 1943.” (3) Memo, CG ASF for SG, 10 Apr 43, same sub. SG: 632.-1. 80 Photostat copy, Res adopted by Fed Bd Hosp, 21 May 43. SG: 632.-1 (McGuire Gen Hosp)K. See also pp. 000, above. 81 (1) Ltr, SG to SecWar thru CG ASF, 18 May 43, sub: Gen Hosp Program, Use of Converted Hotels (AF), and 6 inds. SG: 632.-1. (2) Memo, CG ASF for SG, 22 Jun 43, sub: Completion of Gen Hosp Pro- gram. Same file. 88 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Location, Siting, and Internal Arrangement of Hospital Plants In the hospital construction program attention had to be given not only to types of construction and estimates of the capac- ity needed but also to the location, siting, and internal arrangements of hospital buildings. After war was declared the se- lection of locations and sites, especially for general hospitals, became more compli- cated, while the need for speed in con- struction raised again the question of control over the internal arrangements of hospitals. Selection of Locations and Sites Station hospitals had to be located at camps whose situation was chosen by higher authority than the Surgeon Gen- eral’s Office, but selection of sites within those camps was a joint enterprise of The Surgeon General and the Chief of Engi- neers. In selecting locations for general hospitals The Surgeon General had more authority but not a free hand. He set up criteria of his own but was also subject to policies established by higher authority, to review of ASF headquarters, and to the Engineers’ opinion of the suitability of available sites within general areas. After war began The Surgeon General continued to regard as important such factors as climate, terrain, utilities con- nections, transportation systems, and com- munications networks. Moreover the growth of war industries and military in- stallations necessitated more careful in- vestigation than before of available labor, housing, and commodity markets. Fur- thermore there was the well-established policy of locating general hospitals in areas near large training camps, in order to simplify the transfer of patients from station to general hospitals. Occasionally these factors conflicted with each other. For example, cities with adequate hous- ing, labor, and commodity markets were scarce in the South and Southwest, where most troops were concentrated.82 A policy of hospitalizing war casualties near their homes was not established until the gen- eral hospital construction program had been virtually completed.83 It therefore had little effect upon hospital locations. If it had been established earlier, more general hospitals might have been located in centers of population rather than in centers of troop density and the problem of finding areas with adequate markets might have been less difficult. Early in 1942 G-4 ordered all new gen- eral hospitals to be located between the Atlantic and Pacific coast ranges as a safety masure.84 It was immediately evi- dent that this policy conflicted with the necessity of placing hospitals near ports of debarkation where they could readily re- ceive patients returning from overseas theaters.85 In June 1942, therefore, SOS headquarters permitted the construction of some general hospitals near the coasts to support ports of debarkation, but it made even more restrictive the area for the location of others by moving its boundaries inland to a line running from 82 The above information was taken from numer- ous reports of inspection of areas for hospital locations. They are filed in SG: 632.-1 and in HD: Hosp Insp Rpts. 83 See below, pp. 116-17. 84 (1) Rpt on SGO Staff Conf, 17 Feb 42, in Diary of SGO Hist Subdiv. HD. (2) Info furnished by Col John R. Hall (Ret), 2 Dec 50. HD: 314 (Correspond- ence on MS) III. 85 Ltr, SG to TAG, 14 Feb 42, sub: Add Gen Hosp Beds. SG; 632.-1. LOCATION OF GENERAL, CONVALESCENT, AND REGIONAL HOSPITALS DURING WORLD WAR II HOSPITAL CENTERS GENERAL HOSPITALS AAF REGIONAL HOSPITALS ASF REGIONAL HOSPITALS AAF CONVALESCENT HOSPITALS ASF CONVALESCENT HOSPITALS to _1 < CL to 0 1 z- IS |z —I LU QCu- O' LU CO X T 304244 0—55 8 90 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Spokane to Phoenix to El Paso to Temple (Texas) to Atlanta to Cleveland.86 This limitation was not strictly observed and toward the end of 1942 General Marshall in a conference with General Magee ver- bally abrogated both the G-4 and SOS restrictions.87 Of the 51 general hospitals authorized, acquired, or constructed be- tween the beginning and end of the war, 28 were outside the area prescribed by SOS headquarters, 4 were on its edge and 19 were within it.88 Of the 28 outside the area, 9 were in the populous northeastern section of the country and 7 were in the Pacific Coast area. Increasing emphasis during 1942 upon the use of existing civilian buildings for Army hospitals complicated the process of site selection and sometimes interfered with proper location. In some instances several buildings, such as hotels or civilian hospitals, had to be surveyed for engineer- ing features and potential bed capacities before a decision could be made either to use one of them or to erect a new Army plant in the same general area. In the lat- ter case a satisfactory site still had to be selected. Existing buildings were some- times chosen simply because they were suitable for conversion into Army hospi- tals, even though they were in towns that were smaller than The Surgeon General considered desirable or were outside the area prescribed by SOS headquarters.89 The Surgeon General’s selection of lo- cations for general hospitals had to be re- viewed by SOS headquarters before the Engineers could investigate specific sites for their construction. Of eighteen loca- tions which The Surgeon General pro- posed in June 1942, the SOS Hospital- ization and Evacuation Branch changed almost a third because its chief considered them too near the coast or other general hospitals and too far from adequate rail facilities and large towns.90 During the winter of 1942 that Branch urged The Surgeon General rather unsuccessfully to locate more hospitals in the West, to care for possible increases in troop concentra- tions and evacuee loads in that area.91 About the same time, the SOS Require- ments Division became involved, insisting upon the speedy selection of locations for all hospitals to be constructed by June 1944. This made selection more difficult, according to both The Surgeon General and the Chief of Engineers, and in some instances The Surgeon General found it expedient to agree to sites which, although 86 Opr Plans for Hosp and Evac, sec I, par 5 c, incl 1 to Ltr SPOPM 322.15, CG SOS to GGs and COs of CAs, PEs and Gen Hosps, and to SG, 18 Jun 42, same sub. HD: 705.-1. 87 1st ind, SG to CG SOS, 15 Jan 43, on Memo SPRMC 632, CG SOS for SG, 18 Dec 42, sub: Hosp, Gen Hosps. SG: 632.-1. 88 General Hospitals established outside the area were: Ashford, Newton D. Baker, Birmingham, Brooke, Butner, Cushing, Dibble, Deshon, DeWitt, Edwards, England, Finney, Fletcher, Foster, Ham- mond, Halloran, Madigan, Mason, McCaw, McGuire, Moore, Oliver, Pickett, Ream, Rhoads, Torney, Valley Forge, and Woodrow Wilson; those inside the area were: Ashburn, Battey, Borden, Bruns, Bushnell, Carson, Gardiner, Glennan, Harmon, Ken- nedy, Mayo, Nichols, Percy Jones, Prisoner-of-War General Hospital No. 2, Schick, Thayer, Vaughan, Wakeman, and Winter; those on the edge were Bax- ter, Crile, McCloskey, and Northington. 89 (1) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1. (2) Memo CE 632 (Hosps) SPEOT, GofEngrs for CG SOS, 19 Dec 42, sub: Adv Planning for Add Gen Hosp Fac. SG: 632.-1. 90 Memo SPOPM 632, ACofS for Oprs SOS (init WLW[ilson]) for Dir Reqmts Div SOS, 17 Jun 42, sub: Add Gen Hosps. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” 91 (1) 3d ind SPOPH 632 (9-26-42), CG SOS (Oprs SOS) to SG, 29 Oct 42, with n. for record, on Memo, SG for CG SOS, 26 Sep 42, sub: Hosp, Gen Hosps. HD: Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” (2) 5th ind SPOPH 632 (9-26-42), ACofS Oprs SOS for ACofS Mat SOS, 5 Dec 42, on same memo. Same file. HOSPITAL PLANTS IN THE UNITED STATES 91 less desirable in his opinion, were superior for construction purposes.92 Throughout the early war years, local pressure on the War Department some- times complicated the process of select- ing hospital locations and sites but appar- ently did not often sway the judgment of those responsible for making the choice. In their attempts to lure additional war- time activities, many communities and cities made attractive offers, including the presentation of lands for general hospitals and the extension of utilities lines to the edges of those areas. In some instances there seemed to be a buyers’ market. For example, after The Surgeon General planned to establish a general hospital in the Fort Worth-Waco (Texas) area, six cities offered valuable inducements. From the sites offered, The Surgeon General se- lected the one which, in the opinion of his representative and that of the Chief of Engineers, seemed best suited for hospital purposes.93 In other instances local au- thorities banded together to prevent the establishment of hospitals in their areas.94 Sometimes United States Senators and Representatives also attempted to influ- ence the selection of certain locations. Gen- erally they seem to have met with little success. For example, Sens. Charles L. McNary and Rufus C. Holman and Rep. Walter M. Pierce were particularly insist- ent upon the establishment of hospitals near LeGrande and Hot Lake, Oreg., rather than at Spokane and Walla Walla, Wash., but after appropriate investiga- tions the latter locations were approved.95 Likewise, Sen. John H. Bankhead and Rep. Carter Manasco sought a hospital for Jaspar, Ala., a mining town suffering from a lack of war projects, but The Sur- geon General’s representative recom- mended that Jaspar not be selected, and the place finally chosen for the one hospi- tal in Alabama was Tuscaloosa.96 On the other hand, a hospital was located at Mar- tinsburg, W. Va., a city commended for that purpose by Rep. Jennings Ran- dolph;97 and, as a rule, after The Surgeon General’s Construction Division made tentative selections of locations and sites, it discussed them with appropriate Sen- ators and Representatives and secured their co-operation and help in dealing with local authorities.98 In view of the many factors involved, it is not surprising that the process of site se- lection was slow and gave rise to consider- able criticism later in the war. Much of this criticism sprang from the fact that there were too few hospitals in densely populated areas to enable all patients 92 (1) Memo, CG SOS (Dir Reqmts Div) for SG, 18 Dec 42, sub: Hosp, Gen Hosps, with 1st ind, SG to CG SOS, 15 Jan 43. SG: 632.-1. (2) Memo CE 632 (Hospitals) SPEOT, CofEngrs for CG SOS, 19 Dec 42, sub: Adv Planning for Add Gen Hosp Fac. Same file. (3) Ltr, Col John R. Hall to Lt Col Don J. Leehey, Off Div Engr, Portland, Oreg, 23 Mar 42. SG: 601.-1. 93 (1) Memo, Col John R. Hall for SG, 3 1 Dec 41, sub: Rpt of Insp Trip Made for the Purpose of Locat- ing Add Gen Hosp . . . in North Texas Area, with 12 incls. SG; 632.-1. (2) D/S, ACofS G-4 WDGS to TAG, SG, and CG 8th GA, 19 Jan 42, sub: Site for Gen Hosp, Temple, Tex. HRS; G-4/29135-1 1. 94 Notes on Conf, 26 Mar 42, Hosp Cons Div SGO, atchd to Ltr, SG to TAG, 14 Feb 42, sub: Add Gen Hosp Beds. HD: 632.-1. 95 (1) Ltr, SG to Hon Rufus C. Holman, US Sen, 21 Apr 42. SG: 601.-1. (2) Memo, Col John R. Hall for SG, 3 Jun 42, sub: Insp Trip to Oreg, Wash, and Calif. Same file. 96 (1) Memo, Maj Lee C. Gammill for Col John R. Hall, 6 Jul 42, sub: Jaspar, Ala, Hosp Sites. HD: Hosp Insp Rpts. (2) Memo, Lt Gol Achilles L. Tynes for SG, 22 Aug 42, sub: Rpt on Site Bd Surv for Loca- tion of Gen Hosp at Greeneville (sic), SC and Jaspar, Ala. SG: 601.-1. 97 Memo, Col John R. Hall for SG, 15 Jun 42, sub: Insp of Proposed Sites Offered by City of Martins- burg, W. Va. HD: Hosp Insp Rpts. 98 Info furnished by Gol Hall (Ret), 2 Dec 50. HD: 314 (Correspondence on MS) HI. 92 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR evacuated from overseas theaters to be cared for near their homes. It was gener- ally forgotten—or ignored—that most of the general hospitals were located to fa- cilitate the transfer of patients from station hospitals in training camps and that the War Department did not establish a pol- icy of hospitalizing overseas evacuees near their homes until most of the general hos- pitals had been established. Control over Internal Arrangement of Hospitals The Surgeon General continued to in- sist that building schedules, hospital lay- outs, and floor plans of all new hospitals, plans for all “major” alterations to exist- ing buildings, and all subsequent changes in such plans should be referred to his Office for approval." On the other hand, the Chief of Engineers attempted, as did The Quartermaster General before him, to decentralize as much authority as pos- sible in order to save time. Beginning in February 1942, he again raised the ques- tion of having The Surgeon General ap- prove standard building schedules and layouts for use in the field, without further reference to the latter’s Office, but appar- ently neither the Chief of Engineers nor SOS headquarters wished to challenge The Surgeon General’s position. While official construction policy letters did not require the reference of layouts and plans to his Office, the Engineers generally fol- lowed that practice.100 The extent of The Surgeon General’s authority over hospital construction was discussed but not defined after reorgan- ization of the Services of Supply in the late summer of 1942. On 5 August General Magee requested that certain functions be “retained” in his Office, not decentralized to the field. Among them were the ap- proval of hospital floor plans and layouts, plans for the conversion of civilian build- ings into Army hospitals, and all major alterations to existing hospital build- ings.101 General Somervell’s reply was in- conclusive. He stated that the approval of floor plans and layouts had been and was at that time a responsibility of the Chief of Engineers, but that it was the practice to secure concurrence of the Surgeon Gen- eral’s Office in them. Plans for the conver- sion of civilian buildings, he stated, fell in a “twilight zone” that was not well defined either before or after the reorganization. As for alterations to existing hospitals, General Somervell stated that there was no clear definition of the word “major.” He implied that The Surgeon General should agree with the Chief of Engineers to decentralize authority for alterations to service commands. If The Surgeon Gen- eral could not trust service command sur- geons to supervise alterations properly, General Somervell concluded, he should replace the surgeons.102 99 (1) Ltr, SG to CofEngrs, 9 Feb 42, sub: Hosp Bldg Schedules. (2) 1st ind, SG to CofEngrs, 1 May 43, on Ltr 600.92 (Gen) SPEEG, CofEngrs to SG, 25 Apr 42, sub: Typical Hosp Layouts. (3) 1st ind, SG to CofEngrs, 2 Aug 42, on Synopsis Ltr, CofEngrs to SG, 28 Jul 42, sub: Auth of Div Engr to Auth Cons. All in SG: 632.-1. 100 (1) Ltr, SG to CofEngrs, 9 Feb 42, sub: Hosp Bldg Schedules. SG: 632.-1. (2) Ltr 600.92 (Gen) SPEEG, CofEngrs to SG, 25 Apr 42, sub: Typical Hosp Layouts. Same file. (3) Ltr AG 600.12 (2-19-42) MO-D-M, TAG to CGs of all Depts and CAs, COs of Exempted Stas, and C of Arms and Servs, 24 Feb 42, sub: WD Cons Policy, ZI. HRS; G-4/31751. (4) 1st ind, CofEngrs to CG AAF, 25 Aug 42, on Ltr, CG AAF to CofEngrs, 19 Aug 42, sub: Hosp Cons. AAF; 632 “B Hosp and Infirmaries.” 101 Ltr, SG to CG SOS, 5 Aug 42, sub: Liaison in Reorgn of SvCs. SG: 020.-1. 102 1st ind, CG SOS to SG, 15 Aug 42, on Ltr, SG to CG SOS, 5 Aug 42, sub: Liaison in Reorgn of SvCs. SG: 020.-1. HOSPITAL PLANTS IN THE UNITED STATES 93 Within the same month it became ap- parent that local changes in approved plans for converting civilian buildings into hospitals needed to be more strictly con- trolled. Aware of the difficulties of such conversions, The Surgeon General asked authority on 2 August 1942 to commission five civilian architects to serve as advisers on the spot in the alterations required. The commanding general, Services of Supply, disapproved this request because the Chief of Engineers considered it an encroachment upon his responsibility.103 Meanwhile word reached Washington that local engineer and medical officers had made unnecessary and expensive changes in plans for one of the conver- sions. After a conference on this problem on 14 August 1942 among representatives of the Services of Supply, the Chief of Engineers, The Surgeon General, and the War Production Board, General Somer- vell directed that no changes should be made in approved plans for altering hotels or other buildings without the written consent of both The Surgeon General and the Chief of Engineers.104 In following months The Surgeon Gen- eral and the Chief of Engineers agreed upon a partial decentralization of author- ity to approve alterations of existing hos- pitals. On 5 October 1942 the War Department delegated to service com- manders the authority to approve alter- ations costing up to $10,000 on any build- ing, at any one time and place.105 On 13 November 1942 The Surgeon General suggested, as he had before, that all “major” alterations to hospital buildings, regardless of cost, be sent to his Office for approval. He defined “major” alterations as those requiring structural changes to convert sections of buildings or entire buildings from one use to another, to con- vert ward to office space or vice versa, or to extend buildings into areas expected to be kept vacant. The Chief of Engineers insisted that the term “major” changes would be misleading and suggested that the phrase “changes involving more than $10,000” be used instead. Undoubtedly aware of the War Department’s action of 5 October 1942, The Surgeon General re- luctantly agreed and on 3 December 1942 the Chief of Engineers issued a letter au- thorizing local alterations costing up to $10,000 on hospital buildings, without prior approval of The Surgeon General.106 In November 1942 the Wadhams Com- mittee attributed what it considered to be shortcomings in hospital construction par- tially to the limited extent of The Surgeon General’s authority but also to the inade- quacy of his own construction staff. Stat- ing that the division of responsibility between the Chief of Engineers and The Surgeon General had permitted “passing the buck,” it recommended that the latter be given more authority over construc- tion. At the same time the committee pro- posed that The Surgeon General strength- en his construction staff by adding to it out- standing civilian hospital architects and by placing at its head a nonmedical man 103 (1) Memo for Record, on DF, CG SOS to SG, 1 7 Sep 42, sub: Increase in Procurement Objective, AUS. AG: SPGA 210.1 Med 1-20. 104 (1) Memo 323.7 Hosp SPPDX, Mr. L. G. Woodford for Gen Harrison, 14 Aug 42, sub: Conver- sion of Hotels to Army Hosps. SG: 632.-2. (2) SOS Memo S100-2-42, 27 Aug 42, sub: Limitation on Alterations to Hosps. CE: 632, Pt 2. 105 AR 100-80, C 3, 5 Oct 42. 106 (1) Memo, SG for CofEngrs, 13 Nov 42, sub: Routing of Project Ests Affecting Hosp Bldgs, with 1st ind CE 600.94 (Surg Gen) SPEUU, CofEngrs to SG, n d; 2d ind, SG to CofEngrs, 25 Nov 42, and 3d ind CE 600.94 (Surg Gen) SPEUU, CofEngrs to SG, 7 Dec 42. SG: 632.-1. (2) Ltr, CofEngrs to CGs of SvCs, 3 Dec 42, sub: Nonrecurrent Project Ests Involving Hosp Bldgs. CE: 632, Pt 2. 94 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR experienced in hospital planning. The Surgeon General naturally agreed that he should have more authority, but he concurred with the chief of his Hospital Construction Division in defending the practice of placing a doctor at its head and ascribed the division’s shortage of trained architects to the disapproval of his request to commission five to assist in the conversion program.107 Maintenance of Hospital Plants Responsibility for Maintenance Even before The Surgeon General lost control over hospital alterations costing less than $10,000, he had also lost author- ity over the expenditure of funds for hospital repair and maintenance. At the beginning of 1942 funds from three appro- priations were used for hospital mainte- nance. Two of them, the Barracks and Quarters (B&Q) appropriation and the Construction and Repair of Hospitals (C&RofH) appropriation, were Engineer appropriations; the third, the Medical and Hospital Department (M&HD) ap- propriation, was made to the Medical De- partment. Funds from the B&Q appro- priation and from the M&HD appropria- tion were controlled exclusively by the Engineers and the Medical Department respectively. Those from the C&RofH ap- propriation were controlled jointly by the Chief of Engineers and The Surgeon Gen- eral. B&Qfunds paid for such things as firing boiler plants of hospitals and repair- ing certain buildings occupied and used by operational personnel. C&RofH funds provided for the maintenance of buildings occupied and used by patients and for the upkeep of installed equipment. M&HD funds were used to maintain noninstalled Medical Department equipment and to meet expenses connected with the pur- chase of medical supplies.108 The use of three funds for hospital maintenance produced complications. One was confusion about the fund to which various expenditures should be charged. In January and February 1942 questions arose over whether repairs to hospital barracks should be charged to B&Q or to C&RofH funds.109 Fine dis- tinctions sometimes had to be made in applying the C&RofH fund rather than the M&HD fund and vice versa. For ex- ample, carpenters were employed from both. Those paid with M&HD funds could repair hospital furniture and non- installed equipment, but not buildings and installed equipment; those paid with C&RofH funds had to do that.110 Another problem arose in the joint administration of C&RofH funds. Although they were Engineer funds, their appropriation was based on estimates prepared by The Sur- geon General and they were allotted to hospitals on his recommendation. Corps area and post surgeons controlled their expenditure and reported on it to The Surgeon General, but post engineer offi- cers performed the work.111 107 (1) Cmtee to Study the MD, 1942, Rpt. HD. (2) Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 31. HD. (3) Memo, Col John R. Hall for Exec Off SCO, 3 Dec 42. SG: 632.-1. i°8 Tynes, Construction Branch, p. 54. Also see the language of the appropriations acts. 109 (1) Ltr CE 121.2 (Funds) CU, CofEngrs to SG, 7 Jan 42, sub: Policy for Div of B&QA Funds and G&RofHA Funds, with 1st ind, SG to CofEngrs, 1 Mar 42. (2) Ltr CE 121.2 (Funds) GUC, CofEngrs to SG, 25 Feb 42, sub: Policy for Div of B&QA, C&RofHA and Air Corps Tec Funds, and 1st ind, SG to CofEngrs, 1 Mar 42. Both in SG: 632.-1. 110 Memo, Col Ffrancis] C. Tyng for Budget Off WD, 22 Mar 42, sub: Trf of Approp C&RofH from a Sep Approp to M&HD, A. SG: 632.-1. 111 (1) Memo, Col F. C. Tyng for Budget Off WD, 22 Mar 42, sub: Trf of Approp C&RofH from a Sep Approp to M&HD, A. SG: 632.-1. (2) AR 40-585, par 3 and 4, 16 Jul 31. HOSPITAL PLANTS IN THE UNITED STATES 95 Early in 1942 the Chief of Engineers began to simplify the administration of the C&RofH fund. In order to reduce book- keeping, he proposed on 31 January 1942 the abandonment of a practice of sub- dividing the fund into several smaller project-funds.112 He also began to make allotments directly to district engineers, without securing The Surgeon General’s and corps area surgeons’ recommenda- tions.113 Then he directed district engi- neers to prepare estimates of C&RofH funds in the same way they did those of B&Qfunds.114 The Surgeon General went along with these changes, but insisted that corps area surgeons be informed of allot- ments made to hospitals and that they continue to report to him on all expendi- tures made from such allotments.115 The next month the merger of the C&RofH appropriation with either the B&Qor the M&HD appropriation came up for consideration. The Chief of Engi- neers wanted the C&RofH fund merged with the B&Q fund under his control. Hearing of pending legislation to that effect, The Surgeon General recommend- ed to the Budget Officer of the War De- partment on 22 March 1942 that the C&RofH and the M&HD appropriations be combined into one, under Medical De- partment control. In support of this recommendation he pointed out unsatis- factory features of having a fund con- trolled jointly by the Engineers and the Medical Department.116 This action came too late, because the merger of C&RofH with B&Q funds under a single appro- priation called Engineer Service, Army, had already occurred on 5 March 1942.11 7 The Surgeon General protested against this “radical departure” from accepted practices, maintaining now that joint con- trol of the C&RofH fund had been satis- factory, that only doctors could determine the maintenance required for hospitals, and that Congress had always been, and might be expected to continue to be, more liberal in appropriating funds for hospital maintenance than for the routine mainte- nance of Army posts.118 He failed, how- ever, to keep control over funds expended for hospital maintenance, for on 23 May 1942 the War Department charged the Chief of Engineers with responsibility for repairs and utilities at general hospitals and on 9 June 1942 rescinded the Army regulation which had outlined The Sur- geon General’s former authority over hos- pital maintenance.119 With the reorgan- ization of the Services of Supply, the Chief of Engineers requested The Surgeon Gen- eral on 17 August 1942 to close out all fis- cal transactions pertaining to hospital 112 Memo CE 121.2 (Projects) CUC, CofEngrs for SG, 31 Jan 42, sub; Project Revision. SG: 632.-1. 113 Ltr, Surg 4th CA to SG, 19 Jan 42, sub: C&RofH Funds, with 2d ind, CofEngrs to SG, 13 Feb 42. SG: 632.-1 (4th CA) AA. 114 Ltr CE 315 (Forms) GUC, CofEngrs to SG, 27 Jan 42, sub: Application of OCE Forms No 395 and 395-A to An Est of Funds Req of C&RofH, A. SG: 632.-1. 115 (1) 1st ind, SG to CofEngrs, 23 Jan 42, on Ltr, Surg 4th CA to SG, 19 Jan 42, sub; C&RofH Funds. SG: 632.-1 (4th CA)AA. (2) Ltr, Maj Seth [O.] Craft to Surg 2d CA, 7 Mar 42. SG: 632.-1 (2d CA)AA. (3) Ltr, same to Capt Joe [E.] McKnight, MAC, Off of Surg 1st CA, 4 Feb 42. SG: 632.-1 (1st GA)AA. 116 (1) Ltr, SG to CofEngrs, 25 Feb 42, sub: C&RofH Funds, as Affected by Pending Legislation, H. Res. 6611. SG: 632.-1. (2) Memo, SG for Budget Off WD, 22 Mar 42, sub: Trf of Approp C&RofH . . . toM&HD, A, for FY 1943. SG; 632.-1. 117 (1) 5th Supp Nat Def Approp Act, 1942, Public Law 474, apvd 5 Mar 42. (2) GAO Acts and Proce- dures Ltr 4236, 7 Mar 42. HD: 121.2. 118 (1) Ltr CE 121.2 (Funds) CUC, CofEngrs to SG, 24 Mar 42, sub: Maintenance of Hosp Structures. (2) Memo, SG for Maj Gen Tfhomas] M. Robins, Asst CofEngrs, 26 Mar 42, sub: Maintenance and Repair of Hosps. (3) Memo CE 600.3 (Gen)-CU, CofEngrs for SG, 10 Apr 42, sub: Repairs and Util Functions at MD Fac, with 1st ind, SG to CofEngrs, 23 Apr 42. All in SG: 632.-1. 119 (1) WD Cir 157, 23 May 42. (2) AR 100-80, 9 Jun 42. 96 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR maintenance and to plan to transfer the funds, personnel, and equipment used in that work to the Engineers as of the close of business on 31 August 1942.120 After responsibility was concentrated in the Chief of Engineers, the maintenance and repair of hospitals failed to suffer as the Surgeon General’s Office had antici- pated. The surgeons of several service commands reported favorably on the per- formance of maintenance work under the new system.121 As late as 1945, Col. Achilles L. Tynes, of the Hospital Con- struction Division, pointed out that hospi- tals had experienced no difficulty in get- ting repairs during the war and that it could not be proved that retention of con- trol of funds by theMedical Department would have been more satisfactory than control by the Engineers.122 Reflooring and Rerooflng Throughout the war, maintenance pro- grams of magnitude had to be carried on concurrently with new construction pro- grams, largely as the result of the use of cantonment-type construction in the ma- jority of hospitals built both before and after the war began. Green pine lumber, the only type available in many cases, was frequently used for both flooring and roof- ing. As it dried and warped, it pulled the nails through tar-paper roofing, tearing it and producing leaks, and caused floors to shrink and splinter, leaving them un- sightly, insanitary, and dangerous. Be- ginning late in 1941 and continuing through 1942, The Surgeon General and the Chief of Engineers initiated and car- ried through extensive programs of reroof- ing and reflooring. Asphalt strip shingles gradually replaced tar-paper roofs, and old floors were covered with layers, first of plywood and then of linoleum or similar material. In corridors, imitation-rubber strip-runners were laid to protect floors, to reduce noise, and to increase patients’ safety. These costly programs might have been avoided had better materials been available and authorized for initial hospi- tal construction.123 Efforts to Increase the Safety and Comfort of Patients Despite the War Department’s policy of “Spartan simplicity” in construction and maintenance during 1942 and 1943, the Engineers and the Medical Depart- ment tried to increase the safety and com- fort of patients in hospitals. The practice of installing automatic sprinkler systems as protection against fire in cantonment- type wards was continued and extended to include recreation, mess, post exchange, and clinic buildings as well.124 Numerous requests from separate hospitals for heat in corridors, to protect patients as well as the pipes of sprinkler systems from extreme cold, had prompted The Surgeon General 120 Ltr, Asst CofEngrs to SG, 17 Aug 42, sub: Trfof Repairs and Util Functions. SG: 632.-1. 121 An Rpts, 1942, Surg 5th, 7th, and 9th SvCs. HD. 122 Tynes, Construction Branch, p. 64. 123 Correspondence among The Surgeon General, The Quartermaster General, and the Chief of Engi- neers on these programs is on file in SG: 632.-1; SG; 632.-1 (1st thru 9th CAs)AA; and CE: 632 Vol. 3. Also see Speech, Lessons Learned from Planning and Con- structing Army Hospitals, by Col Hall, 16 Sep 43 (HD: 632.-1), and Tynes, Construction Branch, pp. 65-67. 124 (1) 2d ind, SG to TAG, 19 Jan 42, and 3d ind AG 671.7 (31 Dec 42) MO-D, TAG to CofEngrs, 26 Jan 42, on Synopsis Ltr, Div Engr Carib Div to CofEngrs, 31 Dec 41, sub: Automatic Sprinkler Systs. SG; 671.-2. (2) OCE Cir Ltr 1665, 2 Jun 42, sub: Automatic Sprinkler and Fire Alarm Systs in Small Hosps. CE: 671.3, Pt 1. (3) SOS Memo S30-2-42, sub: Policy Governing Instl of Automatic Sprinkler Systs and Fire Alarm Systs. SG: 671.2. HOSPITAL PLANTS IN THE UNITED STATES 97 in October 1941 to reverse an earlier de- cision and request the installation of heat- ing facilities.125 On 4 February 1942 the Secretary of War authorized their installa- tion in the corridors of all cantonment- type hospitals then under construction or planned.126 Getting approval for the in- stallation of air-cooling systems in hospi- tals in hot southern areas was consider- ably more complicated. During the first summer that the Army began to use cantonment-type hospitals on a wide scale, hospital commanders and corps area surgeons, especially in areas with high temperatures, had complained that patients suffered from heat in wards and that the temperature in operating rooms and clinics was frequently unbear- able.127 The attic space above the low- ceilinged cantonment-type buildings col- lected and held heated air, raising the temperature in the buildings higher than on the outside. Dust in new camps often made it necessary to close all windows, and use of sterilizers and developing tanks in clinics and dark rooms increased hu- midity in those sections of hospitals.128 Colonel Offutt, Chief of The Surgeon General’s Hospitalization Division, prom- ised in September 1941 that attempts would be made to correct this situation by the summer of 1942.129 During the next spring the Surgeon General’s Office collaborated with local surgeons and representatives from manu- facturing concerns in working out systems employing mechanical air conditioners, evaporative coolers, and forced-air ventila- tion. The mechanical air conditioners were self-contained package-type coolers, like those used in restaurants and offices. Outside air was drawn into buildings over coils containing a refrigerating gas, and air-duct installation was not required. Evaporative coolers were useful in dry areas of the Southwest, where the hu- midity was extremely low. These devices drew hot outside air into buildings through wet, porous substances; as the moisture evaporated, the air cooled. In the hot and humid climate of the South and South- east, where evaporative cooling was not practicable, forced ventilation was used. Exhaust fans in attics blew out hot air, producing a condition in the wards below similar to that found outside in the shade with a light breeze.130 Using C&RofH funds allocated by The Surgeon General, local hospital commanders and utilities officers began to install such systems dur- ing the spring of 1942.131 Before this program had gotten very far it encountered a directive, on 20 May 123 Ltr, SG to QMG, 29 Oct 41, sub: Heating of Enclosed Corridors. CE: 632, Pt I. 128 Ltr SGO 674.-1, SG to GofEngrs, 7 Jan 42, sub: Instl of Heating Fac in Corridors of Cantonment-type Hosps, with 1st ind, GofEngrs to TAG, 27 Jan 42, and 2d ind, TAG to GofEngrs, 4 Feb 42. CE: 632, Pt I. 127 For example, see: (1) Synopsis Ltr, AF Combat Comd Hq to CofAG, 5 Jul 41. SG: 632.-1. (2) 1st wrapper ind, Surg 9th CA to SG, 3 Jul 41. SG: 673.-4 (9th CA)AA. (3) Ltr, Surg 4th CA to SG, 6 Sep 41, sub: Comfort and Welfare of Pnts in Cantonment Hosps. SG: 632.-1 (4th CA)AA. 128 Speech, Lessons Learned from Planning and Constructing Army Hospitals, by Col Hall, 16 Sep 43. HD: 632.-L 129 Ltr, SG (per Col H. D. Offutt) to Surg 4th CA, 10 Sep 41, sub: Comfort and Welfare of Pnts in Can- tonment Hosps. SG: 632.-1 (4th GA)AA. 130 (1) Speech, Lessons Learned from Planning and Constructing Army Hospitals, by Col Hall, 16 Sep 43. HD: 632.-1. (2) Memo, Col John R. Hall for SG, 16 Jun 43, sub; Resume of Procurement of Air-Condi- tioning and Ventilative Equip for Cantonment-Type Hosps. SG: 673.-4. 131 (1) 1st ind, SG to GofEngrs, 14 Feb 42, on Ltr, Carrier Corp to SG, 12 Feb 42. (2) Ltr, SG to GofEngrs, 6 Apr 42, sub: Special Features for Ventila- tion of Hosps. (3) Ltr, SG to Various Sta and Gen Hosps, 3d, 4th, 5th, 6th, 7th, and 8th CAs, 6 May 42, sub: Air Conditioning of Operating Rms, X-ray Rms, and Recovery Rms. All in SG: 673.-4. 98 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR 1942, severely restricting the use of me- chanical and electrical equipment in Army construction.132 The Chief of Engi- neers, who by now controlled funds for the purchase of cooling equipment and was responsible for its installation, sought ap- proval of the War Production Board for installing the apparatus recommended by The Surgeon General.133 The Board ap- proved the use of air conditioners in oper- ating rooms, X-ray clinics, and recovery wards, but failed to deal with The Sur- geon General’s proposal to install exhaust fans or evaporative coolers in other hospi- tal buildings.134 The supply of fans and coolers already on hand was believed to be limited, but no Government agency actually knew its extent.135 Consequently the SOS Resources Division wanted to limit installation to cases of greatest need and in August 1942 approved only a lim- ited program.139 Early in 1943 a practice of transferring equipment from nonessen- tial to military uses developed and the War Production Board ascertained that dealers had considerable stocks of air- conditioning and mechanical-ventilating equipment on hand.137 When The Surgeon General resubmitted his proposal in Janu- ary and February,138 therefore, the War Department issued a policy letter on the subject. Under the new policy the installation of cooling equipment from existing inven- tories or from recaptured stocks was per- mitted in areas where the average July temperature exceeded 75° Fahrenheit. Depending upon humidity of the area in which a hospital was located, either evap- orative coolers or exhaust fans were per- mitted in operating rooms, wards, X-ray rooms, clinics, dispensaries where minor operations were performed, and patients’ mess halls. Where neither of these types served the purpose, air conditioners might be installed in operating rooms, X-ray rooms, flight surgeons’ clinics, and re- covery wards. In desert areas, evaporative coolers might also be used in quarters oc- cupied by personnel on night duty.139 Installation of the long-desired equip- ment now began. Since authority to ap- prove jobs amounting to $10,000 or less had been decentralized to service com- mands, the installation of air-conditioning and mechanical-ventilating systems was a responsibility of local engineers. The Chief of Engineers and The Surgeon General developed guides for their use, and on 15 April 1943 the Chief of Engineers in- formed service command engineers of procedures to follow in processing requests 132 Directive for Wartime Cons, 20 May 42, incl to Ltr AG 600.12 (5-20-42) MO-SPAD-M, TAG to CGs of AAF, Depts, and CAs and to C of Tec Servs, 1 Jun 42, same sub. SG: 632.-1. 133 (1) Ltr, GofEngrs to Refrigeration Sec and Fan and Blower Sec WPB, 20 Jun 42. CE: 673, Pt 3. (2) Ltr, SG to GofEngrs, sub: Ventilation and Air Condi- tioning for Cantonment-type Hosp Bldgs, 13 Jun 42. SG; 673.-4. 134 Ltr, WPB to GofEngrs, 23 Jun 42. CE: 673, Pt 3. 135 (1) Memo, 1st Lt James J. Souder for Col John R. Hall, 2 Aug 42, sub: Conf on Evaporative Cooling for Hosp Bldgs. SG: 673.-4. (2) Notes on tel conv be- tween Lt Col Norris G. Kenny and Col John R. Hall, 29 Jun 42. Same file. 136 (1) Memo, Dir Resources Div SOS for SG, 30 Jun 42, sub: Exception from ‘List of Prohibited Items for Cons Work’ of Ventilation Fans for Hosps. SG: 673.-4. (2) Memo SPRMC 674.4(8-11-42), CG SOS for GofEngrs, 16 Aug 42, sub: Policy Determining Instl of Humidifying Coolers. CE: 673, Pt 3. 137 Memo, Capt James J. Souder for Col John R. Hall, 15 Feb 43, sub: Conf on Air Conditioning and Ventilation for Hosps. SG: 673.-4. 138 (1) Memo, SG for Maj Frank Seeter, Resources Div SOS, 23 Jan 42, sub: Ventilative Treatment in Cantonment-Type Hosps. SG: 673.-4. (2) Memo, SG for Production Div SOS, 22 Feb 43, same sub. Same file. 139 WD Memo W100-4-43, 24 Mar 43, sub: Policy for Air-Conditioning, Cooling, and Ventilation of Army Instls, Continental US. SG: 673.-4. HOSPITAL PLANTS IN THE UNITED STATES 99 for that work.140 Although delivery of units was delayed in some cases until the fall of 1943, many hospitals had air-cool- ing systems in time for both patients and operational personnel to benefit from re- duced temperatures during the summer of that year.141 Correction of Errors in Cantonment-Type Hospitals While improvements already men- tioned were being made, the Engineers and the Medical Department worked to correct inadequacies of space for various functions, especially in cantonment-type hospitals. The prewar practice of provid- ing more room for administrative and service activities, X-ray work, storage, and recreation was continued.142 Action was also taken to furnish ear, eye, nose, and throat (EENT) clinics with more space than that originally planned. This occurred after the War Department estab- lished a policy of giving eye examinations and spectacles to all soldiers who required them. Existing EENT clinics were en- larged or w,ere abandoned in favor of new ones set up in ward buildings.143 In the fall of 1942 the Wadhams Com- mittee found fault particularly with short- age of occupational therapy facilities, in- adequacy of space for post exchange and recreational activities, and lack of safety features in neuropsychiatric wards.144 The chief of The Surgeon General’s Hospital Construction Division, Colonel Hall, agreed that post exchanges and recrea- tional facilities were too small but stated that War Department construction poli- cies were responsible for that fault. He believed that it was unnecessary and im- practical to have occupational therapy facilities in station hospitals, because in his opinion all patients needing occupa- tional therapy should be sent to general hospitals.145 Nevertheless, in compliance with an SOS directive, The Surgeon Gen- eral submitted a comprehensive program on 17 January 1943 for the construction of additional occupational therapy build- ings, recreation buildings, detachment dayrooms, post exchanges, libraries, chapels, officers’ and nurses’ recreation buildings, and theaters in all hospitals of two hundred or more beds.140 SOS head- quarters apparently considered this pro- gram as one going beyond the bounds of War Department construction policies, and returned it for reconsideration. After 140 (1) Memo, SG for CofEngrs, 27 Apr 43, sub: Instl Plans for Air Conditioning, Evaporative Cooling, and Mechanical Ventilation. SG: 673.-4. (2) Ltr, CofEngrs to CG 2d SvC attn Dir of Real Estate, Re- pairs, and Utils, 15 Apr 43, same sub. Same file. 141 For example, see: An Rpts, 1943, of Kennedy and Ashburn Gen Hosps and of Sta Hosps at Scott Eld and Cps Bowie, Beale, and Maxey. HD. 142 (1) Ltr, SG to CofEngrs, 27 Jan 42, sub: Request for Urgent Emergency Cons. SG: 632.-1. (2) Ltr, SG to CofEngrs, 6 Jul 42, sub; Request for Working Drawings for Admin Bldg, Type HA-1 and HA-2, with 4 inds. Same file. (3) An Rpts, 1942, Sta Hosps at Cps Dodge and Forrest and 1943, Sta Hosps at Cps Beale, Hale, and Hood. HD. 143 (1) Memo, Col John R. Hall for Chief Profes- sional Serv SCO, 30 Jul 42, sub: Conversion of Ward Bldg into an Enlarged EENT Clinic. SG: 632.-1. (2) Ltr, SG to CofEngrs, 7 Aug 42, sub: Plans for Conver- sion of a Ward Bldg into an EENT Clinic. Same file. (3) An Rpt, 1942, Sta Hosp at Cp Forrest and 1943, Sta Hosps at Cps Beale, Ellis, Hale, and Hood. HD. 144 (1) Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd Nos 10, 15, and 47. HD. (2) Cmtee to Study the MD, 1942, Rpt, pp. 6, 7, 12, and 24. HD. 145 (1) Memo, Col John R. Hall for Exec Off SCO, 3 Dec 42. SG: 632.-1. (2) Extract from 1st ind, SG to CG SOS, 15 Dec 42, on extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd Nos 10 and 15. HD. 146 Extracts from Ltr, SG to CG SOS, 1 7 Jan 43, sub: Recreational Fac in Army Hosps, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 10. HD. 100 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR that, it seems to have passed for some months among the offices of The Sur- geon General, the Chief of Engineers, and the SOS Requirements Division,147 and improvements of the kind asked for were not approved until the latter half of the war. With regard to neuropsychiatric wards, Colonel Hall pointed out that plans for their construction had been completely re- vised during 1941. Faults that continued to exist, he said, resulted either from fail- ure of construction officers to follow speci- fications closely or from the difficulty of constructing wards in wooden buildings so that patients could not escape or com- mit suicide yet at the same time could be easily removed in case of fire.148 On his advice, The Surgeon General recom- mended on 31 December 1942 that the Engineers be instructed to provide all neuropsychiatric wards, including those already constructed, with the features called for in revised plans.149 During the first half of 1943 the Engineers undertook a program of improving neuropsychiatric wards in compliance with this recom- mendation.150 In the spring of 1943, in order to elimi- nate the need for alterations and additions to hospitals after completion, plans for some cantonment-type buildings were re- drawn. This may have resulted from a report made by the Seventh Service Com- mand’s Inspector General. Investigating construction projects at hospitals in his area, he concluded on 9 March 1943 that similar alterations could be avoided in the future by a revision of construction plans.151 Soon after his report reached Washington, the Engineers began to col- laborate with the Surgeon General’s Office in revising plans for cantonment- type administration buildings, clinics, and messes. By the middle of 1943 this project had apparently been completed,152 but this was too late to effect significant sav- ings in hospital alterations, for the major portion of the hospital construction pro- gram had already been completed. Conformity of Hospital Construction to Needs As hospitals were constructed to meet wartime needs experiences encountered in the period of peacetime mobilization were repeated in individual instances. With the Army growing by leaps and bounds troops sometimes moved into new camps before hospitals were completed, and old camps were expanded before existing hospitals could be enlarged. In some areas there were unexpected delays in construction. For these there were numerous causes. Among them were unfavorable weather conditions; shortages of equipment such as electric cables, pumps, motors, and espe- cially high pressure boilers; and labor troubles, including scarcity of laborers and disputes between employers and em- 147 Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 10. HD. 148 (1) Memo, Col John R. Hall for Exec Off SCO, 3 Dec 42. SG: 632.-1. (2) Extract from 1st ind SG to CG SOS, 14 Dec 42, on Memo, GG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 47. HD. 149 Ltr SPMCC 632.-1, SG (init JRH[allj) to CG SOS, 31 Dec 42, sub; NP Wards. CE: 632, Vol. 3. 150 Ink note, “All items referred to have been taken care of by revised drawings and specifications and by circular letter and informal conference with SGO, 7/29/43,” on Ltr, SG to GG SOS, 31 Dec 42, sub; NP Wards. CE: 632, Vol. 3. 151 Ltr, IG 7th SvC to IG, 9 Mar 43, sub: Cons Plans, Gen Hosps, with 2 inds. SG: 333.1-1 (7th SvG)AA. 152 (1) Memo, CofEngrs for SG, 24 Mar 43, sub: Hosp Bldg Plans, with 1st ind, SG to CofEngrs, 2 Apr 43. SG: 632.-1. (2) Ltr CE 600.13 (Hosp) SPEEW, CofEngrs to SG, 31 Mar 43, sub: Proposed Hosp Messes, with 3 inds. Same file. HOSPITAL PLANTS IN THE UNITED STATES 101 ployees. For posts where actual needs out- stripped hospital construction, The Sur- geon General set aside additional beds in general hospitals and local medical offi- cers resorted to expedients used before the war to provide adequate hospital care.153 As a whole, construction kept up with actual needs even though it lagged consid- erably behind estimated requirements. During the first year and a half of the war the number of station hospitals increased from about 200 to more than 425; and the number of normal beds (that is, those for which 100 square feet of space each was provided in ward buildings) rose from about 58,725 to over 220,000. During the entire period the total number of station hospital beds that were occupied through- out the United States was continuously lower than the total number of normal beds provided. From December 1942 to March 1943, when the incidence of respir- atory diseases increased and the transfer of patients from station to general hospitals was restricted to save places for antici- pated casualties, the number of patients in station hospitals exceeded the number of normal beds available but not of normal beds provided. (Only 80 percent of the beds provided were considered available, because the necessity of segregating pa- tients into separate wards according to disease, sex, and grade meant that empty beds in “wrong” wards, amounting as a rule to 20 percent of the total, could not be used.) During the entire period, how- ever, emergency and expansion beds (that is, those set up on the basis of 72 square feet each not only in wards but also in porches, solaria, halls, etc.) made the number of all beds available greater than the number of beds occupied.154 The number of general hospitals in operation increased from 14 in December 1941 to 40 byjune 1943; of beds in them, from about 15,500 to more than 53,750. The total number of occupied beds never reached the total of normal beds provided, but from April through September 1942 in general hospitals the number of oc- cupied beds exceeded the number of nor- mal beds available. This overcrowding resulted largely from the policy of giving the station hospital program priority over that for general hospitals because of the more immediate need for station hospital beds. General hospitals, as did station hos- pitals, set up emergency and expansion beds when they were needed. Older and better-established hospitals, such as Walter Reed and the Army and Navy General Hospital, tended to be more crowded than newer ones, because the latter had to await the presence of supplies and equip- ment as well as full complements of per- sonnel before patients could be trans- ferred to them in large numbers. Byjune 1943, as more new general hospitals opened, the number of available normal beds outnumbered by a comfortable mar- gin the number of occupied beds.155 (Chart 5) 153 (1) An Rpts, 1942, Surg 1st, 3d, and 4th SvCs. HD. (2) An Rpts, 1942, Sta Hosps at Cps McCoy and Adair and Borden Gen Hosp. HD. (3) Memo CE 600.914 (WWGH) SPEOT, CofEngrs for SG, 15 Dec 42, sub: Progress at Woodrow Wilson Gen Hosp. SG: 632.-1 (WWGH)K. (4) Ltr, GO Valley Forge Gen Hosp to SG, 17 Oct 42, sub: Completion Date. SG: 632.-1 (VFGH)K. (5) Ltr, Col E[rnest] R. Gentry to Col H. D. Offutt, 24 Oct 42. SG: 323.7-5 (Borden GH)K. (6) Rpts on Status of Hosp in US, 1 and 6 Feb 43. SG: 632.-1. (7) Memo, SG for CG ASF, 3 1 Mar 43. HD: 632.-2. 154 The above is based on: (1) Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO. (2) ASF Monthly Progress Rpt, Sec 7, Health, pp. 13-16, 28 Feb 43. 155 The above is based on; (1) Bed Status Rpts. Off file, Health Rpts Br Med Statistics Div SGO. (2) ASF Monthly Progress Rpts, Sec 7, Health, 28 Feb and 31 May 43. Chart 5—Status of Station and General Hospital Beds in Continental United States: December 1941-June 1943 STATION AND GENERAL HOSPITALS-TOTAL THOUSAND STATION HOSPITALS GENERAL HOSPITALS * Based on War Department determined percentage of troop strength. Sourer: Figures for normal beds reported, beds available, and beds occupied, as of the end of the last full week of the month (except Nov 1941, the figure for which is as of 14 Nov), shown in Bed Status Reports, Health Reports Br, Med Statistics Div, SGO. CHAPTER VI Early Adjustments in the Zone of Interior Hospital System As the number of hospitals in the United States increased, changes occurred in the hospital system—that is, the combi- nation of hospitals of different types oper- ating under and serving different major commands. It will be recalled that there were only two types of zone-of-interior hospitals at the beginning of the war— station and general hospitals. As the Army’s needs changed with its wartime expansion and combat experience, some of these installations developed character- istics or were given functions which made them differ from the normal. For example, special hospitals were required for prison- ers of war and others had to be prepared to receive combat casualties from theaters of operations. Moreover the desirability of establishing a new type of hospital to care for convalescent patients was con- sidered. Expansion of the Army, along with reorganization of the War Depart- ment, also raised questions as to which commands should be served by and should operate hospitals of different types. Therefore, before discussing the develop- ment of special characteristics and func- tions of some hospitals, an explanation of the command relationships of station and general hospitals with higher headquar- ters is in order. Command Relationships of Hospitals Station Hospitals Classified according to major com- mands under which they operated, station hospitals with few exceptions were either Army Service Forces (called Services of Supply until March 1943) or Army Air Forces hospitals. ASF station hospitals fur- nished hospitalization not only for men and women of the Service Forces but also for those of the Army Ground Forces. Hence, large camps such as Fort Bragg (North Carolina) and Fort Jackson (South Carolina), with several infantry divisions each, were served by ASF station hospi- tals. By August 1942 there were 133 ASF station hospitals; by February 1943, 166. In February they ranged in size from 18 to 3,017 beds and had an average capac- ity of 643 beds each. AAF station hospitals were as numerous as ASF station hospi- tals, but were generally smaller. Located at AAF bases and fields and normally serving only AAF personnel, they num- 104 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR bered 103 in August 1942 and 169 in Feb- ruary 1943. On the latter date they ranged in size from 19 to 1,471 beds and had an average capacity of 233 beds each.1 Since troops of the Ground Forces and of defense commands were usually hospitalized in ASF hospitals, these com- mands had no “named” station hospitals under their jurisdiction, but in a few cases they established what amounted to hospi- tals of that type in the United States. Defense command troops were gener- ally dispersed over extensive areas to guard the coasts of the United States. Re- ceiving only emergency medical care in their own installations, they were ordinar- ily treated in ASF hospitals, or in near-by Air Forces, Navy, and civilian hospitals. In general, this system seems to have worked well,2 but in the Western Defense Command where troops were concen- trated to ward off a sneak Japanese attack, difficulties arose. Delays in the Defense Command’s decision on troop distribu- tions, as well as overlapping jurisdictions of the Defense Command, the Ninth Serv- ice Command, and the Army Air Forces, impeded attempts of The Surgeon Gen- eral, the Service Command, and SOS headquarters to provide adequate facil- ities.3 In April 1942, to meet an immediate need for beds in the Los Angeles area, the Western Defense Command arranged with the Veterans Administration to take over its buildings at Sawtelle, Los Angeles, Calif., from which neuropsychiatric pa- tients were being evacuated inland. The 73d Evacuation Hospital, a Western De- fense Command unit, then moved in and established a 750-bed hospital, which be- came the station hospital for all troops, Service Forces as well as Defense Com- mand, in the area. In the fall of 1942, at the request of the Western Defense Com- mand, the Ninth Service Command took over the operation of this hospital. Al- though a Defense Command unit, it had actually served as a named station hospi- tal for approximately six months.4 The hospitalization of AGF troops on maneuvers continued to be provided dur- ing the early war years essentially as be- fore the war. Ground Forces units, such as evacuation hospitals, furnished immediate care for patients with minor illnesses and injuries, but transferred those requiring major surgery and long-term treatment to near-by ASF hospitals. This sufficed for a situation in which maneuvers shifted from place to place and lasted for a compara- tively short time, but The Surgeon Gen- eral considered different arrangements necessary when in the fall of 1942 the Ground Forces began almost year-round use of two areas, the A. P. Hill Military Reservation in Virginia and the Desert Training Center in California and Arizona. 1 Annex B to Memos, SG for CG SOS, 30 Aug 42 and 12 Feb 43, sub: Opr Plan for Hosp and Evac. SG: 705.-1. 2(1) An Rpt, 1943, Surg, Northwestern Sector WDC. HD. (2) An Rpt, 1943, Surg WDC. HD. (3) Incl 1 to Ltr, CG WDC to SG, 21 Dec 43, sub: Opr Plans for Mil Hosp and Evac. HD: Wilson files, “Hosp and Evac Plans.” (4) Ltr, CG SDC to SG, 30 Mar 44, sub: Plans for Mil Hosp and Evac. Same file. 3 (1) Memo, Chief Misc Br Oprs SOS for Chief Oprs SOS, 14 Apr 42, sub: Add Hosp Cons, WDC. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” (2) 1st ind, CG WDC to TAG, 9 Oct 42, on basic Ltr not located. HD: Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” (3) SG: 632,-l(Cp Haan)C and 632.-1 (Cp Cal- lan)C. (4) See also Memo SPOPH 632, ACofS for Oprs SOS for ACofS OPD WDGS, 26 Sep 42, sub: Hosp Fac for Eastern and Western Def Comds. HD: Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” 4 (1) Ltr, Surg HI Corps to SG thru Mil Channels, 3 Feb 43, sub: An Rpt Med Activities III Corps, 1942. Ground Med files; 319.1-2. (2) Ltr, CG WDC to TAG thru CG 9th SvC, 2 Sep 42, sub: Hosp at Saw- telle, Calif, and 4 inds. SG: 632.-1 (Sawtelle, Calif)F. (3) An Rpt, 1942, 73d Evac Hosp. HD. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 105 Although the Ground Forces operated a numbered evacuation hospital on the A. P. Hill Military Reservation for a short time, the Third Service Command was re- sponsible for providing fixed hospitaliza- tion for troops in that area. AGF head- quarters maintained that the reservation was being used only temporarily. The Ground Surgeon believed that it was satis- factory to give emergency care in a temporary hospital, operated by person- nel of numbered units under service com- mand control, and to evacuate patients with serious illnesses and injuries to the Fort Belvoir Station Flospital fifty miles away. Supporting the Service Command Surgeon, The Surgeon General main- tained that adequate hospitals should be provided in the immediate area in which troops were quartered, in order to avoid long ambulance hauls, and that any facil- ities less than those provided in canton- ment-type buildings were unsatisfactory for the hospitalization of troops in the United States. The War Department Gen- eral Staff supported the position of the Ground Forces, while SOS headquarters gave wavering support to the Medical De- partment, alternately approving and dis- approving recommendations of The Sur- geon General. The upshot of the whole matter was that the Third Service Com- mand, failing to secure War Department approval of its plans, continued for a period of almost two years to operate in this area a temporary hospital located in winterized tents and manned by num- bered station hospital units without nurses.5 When the War Department decided to operate the Desert Training Center (later called the California-Arizona Maneuver Area) as a simulated theater of operations under the jurisdiction of the Army Ground Forces, the Ground Surgeon agreed with other officers from AGE and ASF head- quarters that hospitalization should be provided for it in the same manner as for an actual theater. As a result, engineer units of the communications zone erected theater-of-operations-type buildings for hospitals, and beginning in February 1943, communications zone headquarters moved in numbered station and general hospital units to relieve the Ninth Service Command of all responsibility for hospi- talization within the area. By June 1943 the communications zone had either in operation or in the planning stage eight 250-bed and one 150-bed station hospitals and three 1,000-bed general hospitals. Until these were all in operation, the Desert Training Center continued to send large numbers of patients to neighboring ASF hospitals. Later, as communications zone general hospitals began to offer definitive medical care, the number of pa- tients evacuated to ASF hospitals de- creased. Supplied with equipment author- ized by tables of basic allowances and manned by numbered hospital units which had their own nurses with them, these communications zone hospitals con- t; med to provide station and general hos- pital types of care until the California- Arizona Maneuver Area closed in the spring of 1944. This plan of hospitaliza- tion not only gave participating units in- valuable practical experience but also demonstrated the possibility of using num- 5 Documents dealing with this extended controversy may be found in the following files: SG; 701.-1 (Gp A. P. Hill)C; SG: 632.-1 (Cp A. P. Hill)C; AG: 632(9-18-42) (1); HRS: MID files 600-659, “Vol. I, Jan 42-Jul 44,” and HD: Wilson files, 354.1 “Cp A. P. Hill.” See also An Rpts, 1943, 66th, 108th, 222d, and 230th Sta Hosps (HD) and Comment by Brig Gen Frederick A. Blesse, 5 Dec 50. (HD: 314 [Correspond- ence on MS] III.) 304244 0—55 9 106 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR bered hospital units in the zone of interior medical service.6 General Hospitals All general hospitals in the United States were operated by the Army Service Forces but were planned to care for pa- tients from the Ground, Air, and Service Forces alike. This arrangement was seri- ously threatened in the fall of 1942 by an attempt of the Air Forces to establish its own general hospitals. Although unsuc- cessful at the time, this attempt was a fore- runner of others which later in the war had significant effects upon the hospital system. It deserves consideration here not only for that reason but also because it illustrates difficulties created by the War Department reorganization of 1942. Until the fall of that year only fifteen general hospitals were in operation but beginning in September this number grew until it reached thirty-one by January 1943.7 While new general hospitals were opening, the Air Forces began to establish in effect—though not in name—separate general hospitals for AAF personnel. Hav- ing received authority to recruit its own physicians, the Air Forces manned some of its station hospitals with specialists nor- mally assigned only to general hospitals. In the winter of 1942-43 smaller AAF sta- tion hospitals began to transfer patients to these instead of general hospitals. The Air Forces also began to transfer to AAF station hospitals patients returned from theaters by airplane. With the develop- ment of such practices certain AAF sta- tion hospitals requested the Surgeon Gen- eral’s Office to reduce drastically—if not eliminate altogether—the number of beds in general hospitals set aside for AAF patients. Later the Air Surgeon’s Office asked for specialized equipment with which to establish fifty-four specialty cen- ters in neurosurgery, orthopedic surgery, thoracic surgery, and deep X-ray therapy in AAF station hospitals.8 The Air Surgeon found legal justifica- tion for such actions in the reorganization of the War Department, which in his opinion established the Air Forces as a “command of equal authority” with the Service Forces, as well as in the indefinite terms of current directives governing the transfer of patients to general hospitals. His attempt to set up separate general hos- pitals for the Air Forces was prompted in part by a desire to establish a separate medical department, but it also sprang from professional considerations. The Air Surgeon contended that Air Forces men, especially combat crew members, re- quired specialized care which only AAF hospitals could give. He believed that fliers were often lost to further combat duty because general hospitals unneces- sarily reclassified them for limited service. Furthermore, he insisted that Air Forces hospitals were more efficiently operated 8 (1) History of Medical Section, C-AMA. HD. (2) Draft Memo for Record, undated and unsigned. HRS: ASF Planning Div files, 353 DTC 1942-43. (3) Memo, Col William E. Shambora for ACofS G-3 AGF, 1 1 Mar 43, sub: Insp of La and DTC Maneu- vers. Ground Med files: 354.2 “Maneuvers.” (4) Interv, MD Historian with Col Shambora, 18 Apr 49. HD: 000.71. (5) An Rpts, 1943, 13th, 22d, 34th, and 297th Gen Hosps, and 37th, 59th, 94th, 107th, 127th, and 181st Sta Hosps. HD. (6) Sidney L. Meller, The Desert Training Center and C-AMA, Study No 15 (1946). AG. 7 See below, Table 15, pp. 304-13. 8 (1) See Tabs F, G, I, K, and L of Memo SPOPI 020, CG ASF for CofSA, 30 Apr 43, sub: Unification of Med Serv of Army by SG. AG; 020 SGO (3-30- 43)(1). (2) Memo, Brig Gen C[harles] C. Hillman for SG, 15 Mar 43, sub: Rpt of Observation Trip. HD: 333. (3) Memo, Chief Professional Serv Br Air Surg Off for Chief Sup Div Air Surg Off, 5 May 43. SG: 323.7-5. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 107 than Service Forces hospitals and should therefore, in the interest of economy, give the highest type of medical care for which they were equipped and staffed.9 The Surgeon General disapproved the Air Forces’ establishment of separate gen- eral hospitals under any guise, for he wished to maintain a unified medical serv- ice under his direction as chief medical officer of the Army. Stating that men of the Air Forces were not different from those of other arms and services, who also suffered from occupational diseases and hazards, he insisted that general hospitals were adequately staffed and equipped to care for them as well as for the sick and wounded of the rest of the Army. Permit- ting AAF hospitals to perform the func- tions of general hospitals would make it more difficult, he stated, to supervise and co-ordinate professional practices and procedures. It would also result in dupli- cation of hospital buildings (since general hospitals were already planned to care for the patients of all major commands) and in an uneconomical use of personnel and equipment. Finally, he argued, having separate sets of hospitals for patients evacuated from theaters of operations would complicate the evacuation process and would cause confusion in the submis- sion of medical reports.10 The question of whether the Air Forces would be permitted to establish separate general hospitals came to a head early in 1943 in connection with a movement ini- tiated by the ASF Chief of Staff to re- affirm The Surgeon General’s authority as chief medical officer of the Army.11 It reached the General Staff first, and finally the Secretary of War. G-4 tended to favor the Air Forces, and while conceding that opposing contentions of The Surgeon General and the Air Surgeon were both just, he accepted the latter’s view that AAF hospitals were more efficient than those of the Service Forces. He recom- mended, therefore, that the Air Forces be granted “additional authority” to treat all of their own combat personnel, including evacuees, in AAF hospitals.12 The Office of the Deputy Chief of Staff went a step further, publishing a directive on 20 June 1943 which gave the Air Forces authority not only to treat its own combat personnel but also to operate whatever general hos- pitals were necessary for that purpose.13 Within a week the Air Surgeon’s Office recommended the establishment of five AAF general hospitals; three by the con- version of AAF station hospitals and two 9 (1) Memo, Air Surg for CG AAF, n d, sub: [Com- ments on Gen Somervell’s Memo of 30 Apr 43 for CofSA], with 2 incls. Asst SecWar for Air: 632(AAF Hosp). (2) Brief and Discussion, Tab B, to Memo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 “Rest Ctrs and Gonv Homes.” (3) Hubert A. Cole- man, Organization and Administration, AAF Medi- cal Services in the Zone of the Interior (1948), pp. 93-94. HD. 10 (1) Memo SPMCB 701.-1, SC for GG SOS, 13 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.-1 “Rest Ctrs and Gonv Homes”(l). (2) 1st ind, SG to CG ASF, 12 Apr 43, on Memo SPOPH 020(3-30-43), CG ASF for SG, 30 Mar 43, sub; Relationship between SG and Air Surg. SG: 024.-1. 11 For more details on this movement, see John D. Millett, The Organization and Role of the Army Service Forces (Washington, 1954), pp. 132-37, in UNITED STATES ARMY IN WORLD WAR II; Blanche B. Armfield, Organization and Administration (MS for companion vol. in Medical Dept, series), HD., and Coleman, op. cit., pp. 93-107. Documents concerning it are on file as follows: AG; 020 SGO (3-30-42) (1); HRS: G-4 file, “Hosp and Evac Policy”; SG: 024.-1; and HRS: Hq ASF, Gen Styer’s files, “Med Dept.” 12 Memo WDGDS 4440, ACofS G-4 WDGS for CofSA, 15 Jun 43, sub: Med Serv of Army, with inch HRS: G-4 file, “Hosp and Evac Policy.” 13 Memo WDCSA/320(5-26-43), DepGofSA for CGs AAF, AGF, ASF, 20 Jun 43, sub: Med Serv of Army. HRS: G-4 file, “Hosp and Evac Policy.” The Deputy Chief of Staff, Lt. Gen. Joseph T. McNarney, was an AAF officer. 108 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR by the transfer of the Borden (Oklahoma) and Torney (California) General Hospi- tals to Air Forces’jurisdiction.14 By this time a new Surgeon General, Maj. Gen. Norman T. Kirk, was in office.15 He at- tacked the problem vigorously, and the entire matter reached the Secretary of War, who called representatives of the General Staff, the commanding generals of the Air and Service Forces, and others into conference. General Kirk then pro- posed a compromise which the command- ers of both the Air and Service Forces accepted.16 General Kirk admitted that Air Forces combat crews needed special treatment and consideration and offered to place flight surgeons in his Office and in general hospitals to serve as advisers in that field. He agreed also to the Air Forces’ estab- lishment of convalescent centers. The Air Forces for its part agreed that all general hospitals would continue to operate under The Surgeon General and the command- ing general, Army Service Forces, and that patients evacuated from theaters of operations would be sent to general hos- pitals. The only exception to the latter point was that combat crew members suf- fering from operational fatigue alone would be sent directly to AAF convales- cent centers. These centers were to be equipped and staffed as station hospitals, but one of them, located at Coral Gables, Fla., was authorized to perform a function of general hospitals—the reclassification of officers for limited service and the rec- ommendation for their appearance before retiring boards. These terms of agreement were issued on 9 July 1943, with a state- ment that they had been personally ap- proved by the Secretary of War.17 On the same day, the authority which had been granted to the Air Forces to establish sep- arate general hospitals was revoked.18 This agreement did not dispose of the question of whether or not AAF station hospitals would give general-hospital-type treatment to zone of interior patients. At the time General Kirk drafted its terms, he had also drafted a statement of policy on the transfer of patients to general hos- pitals, defining more specifically the types of cases to be transferred. He had intended to have it included in the 9 July 1943 agreement,19 but instead, on 14 July 1943, he requested its publication as a War De- partment circular.20 While maintaining the traditional responsibility of station hospital commanders for the selection of patients for transfer to general hospitals, 14 Memo [Air Surg] (init R[ichard] L. M[eiling[) for CofSA, 26 Jun 43, sub: Med Serv of AAF. Asst SecWar for Air: 632 (AAF). 15 Gen Kirk assumed office on 1 June 1943. 16 (1) Draft memo, prepared by SG, dated 3 Jul 43, sub: Hosp, with pencil note, “7/3/43 Personally de- livered by Gen Kirk to Gen Somervell.” SG: 705.-1 and SecWar; SP 632 (3 Jul 43). (2) Memo, CG AAF for DepCofSA, 5 Jul 43, sub: FIosp. Same files. (3) Memo, [Col] F. M. S[mith] for Gen Somervell, 5 Jul 43. HRS: Hq ASF Gen Styer’s files, “Med Dept.” How the matter reached the Secretary of War is not clear. On 19 November 1950 General Kirk wrote: “A conference was called in his [Secretary of War’s] office one morning. I was called in ahead of time and Mr. Stimson told me that Secretary of Air, Mr. Lovett, had been to him that morning and told him about the memorandum. That the Air Force couldn’t blame me for bringing it to his attention.” Ltr, Maj Gen Norman T. Kirk to Col Roger G. Prentiss, Jr, 19 Nov 50, with inch HD: 314 (Correspondence on MS) I. 17 (1) Memo WDCSA/632 (9 Jul 43), DepCofSA for CGs AAF, ASF, AGF, 9 Jul 43, sub: Hosps. HRS; G-4 file, “Hosp and Evac Policy.” (2) Memo, GG AAF for CG ASF, 5 Jul 43, sub: Hosps. AAF; 354.-1 “Rest Gtrs and Conv Homes.” (3) Memo, CG ASF for GG AAF, 5 Jul 43. HRS; Hq ASF Gen Styer’s files, “Med Dept.” 18 (1) Memo, DepCofSA for CG AAF, ASF, AGF, 9 Jul 43, sub: Med Serv of the Army. HRS: G-4 file, “Hosp and Evac Policy.” 19 Draft memo prepared by SG, 3 Jul 43, sub: Hosps, with incl 1, sub: Policy regarding Trf of Pnts to Named Gen Hosps. SG: 705.-1. 20 Memo SPMCM 300.5-5, SG for Publications Div AGO, 14 Jul 43. AG: 704.11 (14 Jul 43)(1). EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 109 the revised policy left them less discretion in the matter than they had previously exercised. Its language was directive rather than advisory. The following categories of patients must be transferred to general hospitals: those needing specialized treat- ment of the types for which general hos- pitals had been designated; those who would be hospitalized for ninety days or more; those upon whom elective surgery of a formidable type would be performed; those with specific types of fractures, and, with one exception, those evacuated from overseas theaters. Only Air Forces patients on a flying status, evacuated because of operational fatigue alone, were to bypass general hospitals and go direct to Air Forces convalescent centers.21 This direc- tive combined with the agreement already discussed to resolve for a time in The Sur- geon General’s favor the question of the Air Forces’ establishment of separate gen- eral hospitals. Special Types of ASF Station Hospitals Although all ASF station hospitals were essentially alike in the work they did and the way they operated, a few established in the early war years differed in some re- spects from the normal. Among them were WAAC hospitals, all-Negro hospitals, and hospitals for civilians and prisoners of war. Hospitals for Waacs Formation of the Women’s Army Auxil- iary Corps in May 1942 emphasized cer- tain problems such as the segregation of women from men in hospitals, the estab- lishment of services not ordinarily found in Army hospitals, and the procurement of nonstandard drugs (that is, those not formally standardized for Army use) for the treatment of women. The law estab- fishing the WAAC directed the Secretary of War to provide hospitalization for its members ‘‘to conform as nearly as prac- ticable to similar services rendered to the personnel of the Army” and permitted the use of “facilities and personnel of the Army” for this purpose.22 The Surgeon General approved of this policy. He be- lieved that additional wards should be constructed at established hospitals to supply enough beds to permit the segrega- tion of men from women and of women according to disease and rank. Because he expected women to have a higher sick rate, he recommended the provision of beds for 5 percent of the strength of the WAAC, rather than for 4 percent, as was the case with men. He proposed the pro- curement of a limited number of female physicians, first as contract surgeons and later as commissioned members of the Medical Corps, to serve in hospitals where the WAAC patient load was high. Other- wise, he planned to give Waacs the same medical care as men. As experience with the hospitalization of Waacs accumulated and statistics showed their noneffective rate to be only slightly higher than that for men, the Army provided hospital beds for them in the same ratio as for men and sent them to the same hospitals, though to segregated wards. Nevertheless, three Army hospitals were occupied chiefly by female patients.23 21 WD Cir 165, 19 Jul 43. 22 Public Law 554, 77th Cong., 2d sess., sec 10. 23 (1) Rpt, SGs Conf with CA and Army Surgs, 25-28 May 42. HD: 337. (2) Memo, SG to CofEngrs, 6 May 43, sub: Med Fac for WAAC. SG; 632.-1. (3) AG Memo W 100-9-43, 3 Jul 43, sub; Housing for WAAC Pers. HD: 322.5-1 (WAG). (4) Memo, Maj Margaret D. Craighill, MG, Liaison Off for WAG for Col [Raymond W.] Bliss, 25 Aug 43, sub: Hosp for WAAC. Same file. (5) Memo, SG for CG SOS, 4 Jan 43, sub: Util of Women Doctors. HRS: Hq ASF Gen Styer’s files, “Med Dept 1943.” 110 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR At the WAAC training centers—Fort Des Moines (Iowa), Daytona Beach (Florida), and Fort Oglethorpe (Geor- gia)—the station hospitals became pre- dominantly WAAC hospitals, staffed largely by women and caring mainly for women. This was especially true at Day- tona Beach. By the end of 1943 its 601-bed hospital had an enlisted complement made up almost entirely of women, only fifty men being assigned for duty in and around the hospital. At Fort Des Moines, female doctors engaged as contract sur- geons were assigned for duty with the Waacs. At first the development and supervision of special professional services for women were left largely to local hos- pital commanders. Station hospitals at training centers developed gynecologic and obstetric services and procured locally special drugs required for the medical care of women. In May 1943, approxi- mately a year after the WAAC was estab- lished and a month after Congress authorized the commissioning of women physicians in the Army, The Surgeon General assigned a female Medical Corps officer to his Office to supervise the han- dling of medical problems peculiar to fe- male personnel.24 All-Negro Hospitals The establishment of two all-Negro sta- tion hospitals in the United States came not as a result of any policy of The Sur- geon General to segregate patients racially for medical care and treatment, but rather as a result of The Surgeon Gen- eral’s opposition to the integration of Negro doctors and nurses with white pro- fessional personnel in the operation of hos- pitals caring for white patients.25 This consideration had already resulted in the establishment in May 1941 of groups of all-Negro wards in the hospitals at Fort Bragg (North Carolina) and Camp Liv- ingston (Louisiana). Perhaps because of unencouraging reports from these experi- ments, the Army had not extended the practice to other hospitals. After war started, The Surgeon General revived a recommendation, previously disapproved by the General Staff, that all-Negro hospi- tals be established to employ additional Negro doctors and nurses. The Staff re- versed its earlier decision, and during 1942 an all-Negro station hospital was organ- ized at Fort Ffuachuca (Arizona), a post at which Negro troops were being trained. A separate hospital, manned by white doc- tors and nurses, continued in operation to care for white patients. The year before, the Army Air Forces had established an all-Negro hospital at Tuskegee, Ala. Establishment of all-Negro hospitals and wards did not signify a general abandon- ment of the Army’s long-established policy of nonsegregated treatment. Other hospi- tals manned by white doctors and nurses continued to treat patients of both races on a nonsegregated basis throughout the war.26 Nor did it mean that the Medical 24 (1) An Rpts, 1943, Sta Hosps, Daytona Beach and Ft Oglethorpe. HD. (2) Memos, Dr Paul Titus, Consultant, to SG, [27 Sep 43] and 1 Nov 43, sub: Rpts on Surg (Obstetrics-Gynecology) as an Army Serv. HD: 210.01. (3) Memo, SG for GG SOS, 4 Jan 43, sub; Util of Women Doctors. HRS: Hq ASF Gen Styer’s files, “Med Dept 1943.” (4) Mattie E. Tread- well, The Women’s Army Corps (Washington, 1954), Ch. XXXI, in UNITED STATES ARMY IN WORLD WAR II. (5) Margaret D. Craighill, His- tory of Women’s Medical Unit (1946). HD. 25 For a full discussion of the question of the use of Negro professional personnel by the Medical Depart- ment, see John H. McMinn and Max Levin, Person- nel (MS for companion Vol. in Medical Department series). HD. Also see Ulysses Lee, The Employment of Negro Troops, a forthcoming volume in the series UNITED STATES ARMY IN WORLD WAR II. 26 (1) Ltr, SG to TAG, 25 Oct 40, sub; Plan for Util of Negro Offs, Nurses, and EM in MD, and 3 inds. (2) Memo, SG for ACofS G-l WDGS, 7 Jul 41, sub: Rpts on Util of Negro Med Pers. (3) Memo, Maj EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 111 Department would fail to use Negro en- listed personnel and civilians in other hospitals. As early as December 1941, for example, Negro enlisted men were assigned to the medical detachment of at least one station hospital—that at Chanute Field (Illinois).27 Later Negro enlisted men and women were assigned to other Army hos- pitals. While many were employed in housekeeping and maintenance opera- tions, some were assigned to technical and administrative duties.28 Before leaving this subject one needs to look ahead to the later war years. At that time the practice of using Negro doctors and nurses on a segregated basis was modified. Such civilian groups as the Na- tional Association of Colored Graduate Nurses, certain segments of the press, some members of Congress, the Negro civilian aide to the Secretary of War, and the President’s wife (Mrs. Franklin D. Roose- velt) urged The Surgeon General, ASF headquarters, and the Secretary of War to use more Negro nurses and to use them on a nonsegregated basis.29 In December 1943 and again in May 1944 ASF head- quarters directed The Surgeon General to procure and use additional Negro nurses.30 Accordingly, Negro nurses on duty with the Army increased from 218 in Decem- ber 1943 to 512 by July 1945. Although some continued to serve with all-Negro hospitals in this country and in theaters of operations, others were used on a non- segregated basis in 4 general hospitals, 3 regional hospitals, and at least 9 station Arthur B. Welsh for [Brig] Gen [Larry B.] McAfee, 17 Jan 42. (4) Memo, SG for ACofS G-3 WDGS, 30 Jan 42. (5) Memo, SG for TAG, 16 Mar 42, sub: SecWar’s Press Conf on Use of Negro Doctors. All in HD: 291.2. (6) Memo, ACofS G-l WDGS for GofSA, 4 Aug 41, sub: Almt of Negro MD Res Offs and Female Nurses. HRS: G-l/15640-46. (7) Memo, P. W. Clarkson, Off ACofS G-l WDGS for Record, 8 Aug 41. Same file. (8) An Rpt, 1942, Post Surg Ft Huachuca. HD. hospitals in the United States.31 During 1945 nonsegregated use of Negro doctors occurred in at least one instance. When the troop strength of Fort Huachuca de- clined, the patient load decreased and professional staffs of the two station hospi- tals at that post were reduced accord- ingly. Services of the two then gradually merged and both doctors and nurses of the two races served together to care for white as well as Negro personnel.32 Thus the primary reason for the establishment of separate all-Negro wards and hospi- 27 An Rpt, 1941, Sta Hosp, Chanute Field. HD. 28 (1) An Rpts, 1942, Sta Hosps, Cps Shelby and Forrest, and An Rpts, 1942, 702d, 720th, 721st, and 730th Med Sanitary Cos. HD. (2) McMinn and Levin, op. cit. 29 Letters to this effect may be found in the follow- ing files: SG: 211 “Nurses, Negro”; OSW: Civ Aide to Sec War, “Nurses”; and AG: 211 “Nurses, Negro.” See also Florence A. Blanchfield and Mary W. Stand- lee, The Army Nurse Corps in World War II (1950), pp. 161-205. HD. 30 (1) Memo, CG ASF for SG, 14 Dec 43, sub: Uti- lization of Negro Nurses. SG; 291.2-1. (2) Memo, CofS ASF for SG, 6 May 44, same sub. ASF: 210.31. 31 (1) Memo, Col Florence A. Blanchfield (SGO) for Col Arthur B. Welsh (SGO), 17 Dec 43, sub: Distr of Colored Nurses. SG: 291.2-1. (2) Memo, SG for Civ Aide to SecWar, 26 Jul 45. SG: 2 11 “Nurses, Negro.” (3) Facts about Negro Nurses and the War, prepared jointly by the National Association of Col- ored Graduate Nurses and the National Nursing Council for War Service, ca. Jan 45. OSW: Civ Aide to SecWar, “Nurses.” 32 (1) Memo, Asst Aide to SecWar for SG, 29 Mar 45, sub: Staff of Sta Hosp No 1, Ft Huachuca, Ariz. (2) Memo, Dep Chief [of Oprs Serv] for Hosp and Domestic Oprs [SGO] for SG, 8 Jun 45, sub: Rpt of Visit to Sta Hosp, Ft Huachuca, Ariz. (3) Ltr, CO Sta Hosp Ft Huachuca to Maj Gen G[eorge] F. Lull, SGO, 16 Aug 45. All in OSW: Civ Aide to SecWar, “Huachuca.” There was some question during the war whether the two hospitals at Huachuca were ever in fact two separate hospitals or merely two sections of one hospital. This arose apparently from the fact that the post surgeon, a white Medical Corps officer, served in addition as commander of the white hospi- tal and exercised at the same time considerable authority over the commanding officer of the all- Negro hospital. Failure to settle this question resulted in dissatisfaction on the part of the latter. See letters in the file just cited and in SG: 323.3 (Ft Huachuca)N. 112 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR tals—opposition to the integrated use of Negro and white professional personnel in the care of both white and Negro pa- tients—had begun to lose some of its force by the end of the war. Army Hospitals for Civilians By the end of 1942 a situation de- veloped which required the establishment in the United States of several hospitals for civilian employees and their families. During 1941 the Army had initiated in- dustrial hygiene programs in Army-owned plants and depots. Under Medical De- partment supervision, these programs ex- panded rapidly during 1942 to keep pace with wartime industrial growth. Designed to give only emergency medical care, in- dustrial hygiene facilities were adequate in areas where civilian hospitals were available. Toward the end of 1942, when the Ordnance Department established storage depots for explosives in isolated regions, lack of hospitals retarded em- ployee procurement and increased ab- senteeism. Workers were reluctant to move with their families to such areas and failure to receive prompt medical care often resulted in prolonged illnesses. To help maintain depot production levels, The Surgeon General proposed in Decem- ber 1942 that the Army construct and operate hospitals in remote areas which lacked adequate medical facilities. In February 1943 the Secretary of War authorized the construction of hospitals at the Sierra (California), Umatilla (Ore- gon), Black Hills (South Dakota), Tooele (Utah), Sioux (Nebraska), and Navajo (Arizona) Ordnance Depots. Constructed during 1943, these hospitals operated under service command supervision until after the end of the war. They differed from other Army station hospitals in hav- ing a minimum of military personnel as- signed to them, in providing family medi- cal care, including gynecologic and ob- stetric services, and in requiring payment for services rendered. Despite recom- mendations of The Surgeon General, simi- lar hospitals were not established in other places. In one instance, permission was granted to establish an Army hospital but was withdrawn partly on account of polit- ical pressure and partly because the com- munity itself, after an extended period of time, provided additional hospital ac- commodations. In another, authority was granted to hospitalize civilian employees and their families in a near-by Army station hospital.33 Hospitals for Prisoners of War Early in 1942, when prospective com- bat operations demanded preparation for the internment of prisoners of war, The Provost Marshal General and The Sur- geon General agreed upon basic policies for their hospitalization. In compliance with the Geneva Convention,34 hospital accommodations and medical care for prisoners of war were to be equal to those for United States troops, and prisoners 33 (1) Ltr, SG to SecWar thru CG SOS, 11 Dec 42, sub: Med Care for Civ Employees of Army-Oper- ated Plants, and their Families, with 4 inds. (2) Ltr, SG to CofS SOS, 21 Jan 43, same sub. (3) Memo WDGDS-2172, SecWar for CG SOS, 9 Feb 43, same sub. All in AG; 701(9-1 7-41)(l). (4) W. L. Cooke, Jr, Organization and Administration of Preventive Medicine Program, pp. 53-59. HD. (5) An Rpts, 1943, Sta Hosp Black Hills and Tooele Ord Depots. HD. (6) An Rpts, 1942 and 43, Surg, 1st thru 9th SvC. HD. (7) Memo, Capt J[ames] J. Souder for Col J[ohn] R. Hall, 8 Apr 43, sub; Conf on Prov of Hosp Fac for Instls in Ogden, Utah, Area. SG: 632.-1. 34 Article I, Chapter I, Conventions of 1906 and 1929. See Army Medical Bulletin, No. 62 (1942), pp. 88 and 105. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 113 were to assist in the care of their com- patriots. Promulgated in tentative regula- tions published in April 1942 and re- iterated in September 1943, these policies governed the hospitalization of prisoners throughout the war. For separate pris- oner-of-war camps, the Army constructed hospitals with beds for 4 percent of the inmates. For prisoners at Army posts, wards surrounded by wire fences were added to existing station hospitals. Whether in separate camps or on Army posts, such hospitals operated under serv- ice command supervision and, except for the use of captured enemy personnel and civilian registered nurses, were similar to other service command hospitals. Pris- oners requiring more specialized care than offered in station hospitals were transferred to general hospitals.35 Port and Debarkation Hospitals Hospitals were needed near ports for large numbers of transients—troops await- ing shipment overseas as well as patients being returned to general hospitals in the United States. In accord with SOS direc- tives, hospitals for ports and staging areas were exempt from service command juris- diction and operated directly under port commanders who in turn were subject to control by the Chief of Transportation.36 For most of 1942, many ports lacked ade- quate staging area hospitals and therefore sent patients to others located near by. At Los Angeles, for example, patients from the port were cared for in the Western Defense Command’s 73d Evacuation Hos- pital at Sawtelle. The ports at Charleston, New Orleans, and San Francisco used Stark, LaGarde, and Letterman General Hospitals, respectively, while those at Boston and Hampton Roads sent patients to near-by service command station hospi- tals. During 1942 and 1943 special port and staging area hospitals were con- structed and opened to care for port per- sonnel and transient troops. They differed from other station hospitals primarily in that their surgical services were consider- ably smaller and less important than their medical services, because they normally performed only emergency surgery for the thousands of troops who passed through ports.37 The kind of hospitals that would be used to receive transient patients return- ing from theaters of operations remained uncertain until the latter part of 1942. Special debarkation hospitals under port control might be established in existing buildings with only the personnel and equipment needed to “process” returning patients—that is, replace their missing records, make partial payments of the 35 (1) Memo, Gapt Charles M. Huey, Mil Intel Aliens Div OPMG for Chief Aliens Div OPMG, 26 Dec 41, sub; Conf Regarding the Estab of Hosp . . . in PW Cps. SG: 255.-1. (2) Tentative Regulations: Interned Alien Enemies and Prisoners of War. AG: 383.6(8-9-42)(l). (3) PW Gir 1, 24 Sep 43. PW Off OPMG. (4) Memo, CofS ASF for SG and QMG, 26 May 43, sub: Hosp Fac for PW Cps, and 1st ind. SG: 632.-1. (5) An Rpts, 1943, Surg, 7th and 8th SvCs. HD. (6) An Rpts, 1943, Sta Hosp PW Cps at Flor- ence, Ariz; Cp Clark, Mo; and Como, Miss. HD. (7) See also; Rene H. Juchli, Record of Events in the Treatment of Prisoners of War, World War II (1945). HD. 36 Mil Hosp and Evac Oprs, incl 1 to Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs and PEs and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs. HD; 322(Hosp and Evac). 37 (1) An Rpts, 1942 and 43, Surg, Boston, New York, Hampton Roads, Charleston, New Orleans, Seattle, and Portland PEs, and An Rpts, 1943, Surg, Cps Myles Standish, Kilmer, and Plauche. HD. (2) Opr Plan for Mil Hosp and Evac, Boston, 30 Nov 42; New York, 10 Dec 42; Hampton Roads, 15 Dec 42; Charleston, 24 Nov 42; New Orleans, 12 Dec 42; San Francisco, 9 Jul and 1 Dec 42; and Seattle, 27 Nov 42. HD: Wilson files. (3) SG; 632.-2, 1942 and 43, (La- Garde GH)K, (Letterman GH)K, and (Stark GH)K. 114 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR money due them, classify them according to disease or injury, and prepare them for further travel to general hospitals. Such hospitals had been used during World War I,38 and for a while in 1942 it seemed as if SOS headquarters and certain port commanders expected their revival. One SOS directive implied that ports might establish special debarkation hospitals,39 and Charleston, Seattle, and San Fran- cisco expressed a desire for them.40 The Surgeon General had other plans. During the emergency period he had used general hospitals near ports—Tilton for New York, Stark for Charleston, LaGarde for New Orleans, and Letterman for San Francisco—to receive and care for pa- tients brought in on ships. After war began he continued this system, granting unlimited bed credits in near-by general hospitals to ports receiving overseas casu- alties.41 He also located some of the gen- eral hospitals planned early in 1942 in coastal areas, though not in close prox- imity to ports,42 with the expectation that they would process patients arriving from theaters. A final decision to this effect came in the fall of 1942 in connection with plans for the reception of casualties from the North African invasion. At that time whole trainloads of patients with a variety of ills could be sent to a single general hos- pital, because hospitals had not yet been designated for the specialized treatment of certain types of cases nor had the policy of hospitalizing casualties near their homes been established.43 Two alternatives there- fore presented themselves, namely, ship- to-train movements, in which patients would be transferred directly from ships to trains for transfer to distant general hos- pitals, and ship-to-hospital movements, in which they would be moved from ships to near-by hospitals before undertaking fur- ther travel.44 The possibility of using ship- to-train movements exclusively, thereby eliminating the need for a debarkation hospital at or near the port, arose at Hampton Roads. Piers at that port had ample trackage to accommodate hospital trains, making it possible to move patients under cover directly from ships to trains. The port commander preferred this pro- cedure, his surgeon explaining that it would maintain the port as an agency of movement, its primary purpose.45 While The Surgeon General and the chief of the SOS Hospitalization and Evacuation Branch recognized the merits of this posi- tion, both felt that some ship-to-hospital movement would be unavoidable. Some patients would require immediate hospi- tal care before further travel; in some instances ship-to-train evacuation might 38 The Medical Department ... in the World War (1923), vol. V, pp. 426-33, 786, 791, 800. 39 Mil Hosp and Evac Oprs, par 5 d (3) (d), incl 1, to Ltr SPOPM 322.15, CG SOS to CGs and COs, CAs, PEs, GHs and SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac. HD: 705.-1. 40 Opr Plans for Mil Hosp and Evac, Jul 42, Charleston, Seattle, San Francisco, New Orleans, and Boston. HD: Wilson files. 41 For example, see: (1) Ltr, SG to CG NYPE, 18 Feb 42, sub: Bed Almts in Gen Hosps. Same file. (2) Ltr, SG to CG 9th CA, 5 Jan 42, sub: Bed Almts in Barnes Gen Hosp. SG: 632.2 (Barnes GH)K. (3) 2d ind, SG to CG NYPE, 9 Mar 42, on Ltr, Port Surg Sub-Port of Boston to Port Surg NYPE, 5 Mar 42, sub: Bed Credits. SG: 632.-2 (NYPE)N. (4) 1st ind, GG SOS (SG) to CO CPE, 29 Aug 42, on Ltr, CO CPE to CG SOS, 21 Aug 42, sub: Bed Credits. SG: 632.-2 (Stark GH)K. 42 For example, Valley Forge, Woodrow Wilson, Moore, Torney, Hammond, Baxter, and McCaw General Hospitals. Also see above, pp. 88-90. 43 See below, pp. 116-17. 44 Rpt, Conf, CofT, SG, SOS, NYPE, and HRPE, 23 Oct 42. TC: 370.05 (Plans, Policies, Procedures). 49 (1) Ltr, CG HRPE to SG, 10 Nov 42. SG: 705.-1 (HRPE)N. (2) Ltr, Port Surg HRPE to SG, 15 Dec 42, sub: Opr Plans for Mil Hosp and Evac. HD; Wil- son files. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 115 interfere with troop movements; in others, casualties might arrive unexpectedly when trains were unavailable.46 For these rea- sons they overruled the port commander. Since the housing shortage in Norfolk made impracticable a proposal to take over a hotel for hospital use, arrangements were made to use the station hospital at Fort Monroe and five hundred beds in the Veterans Administration hospital at Ke- coughtan, Va., for debarkation purposes.47 This action made it clear that some hospi- tal, whatever its kind, would be estab- lished to receive casualties at every port of debarkation. Unlike his counterpart at Hampton Roads, the port commander at New York wanted Halloran General Hospital, being opened on Staten Island, to serve solely as a debarkation hospital under port con- trol.48 The Chief of Transportation, on the other hand, wished to keep ports free of the burden of administering large hospi- tals and on 9 November 1942 announced that SOS directives authorized ports to operate hospitals for assigned personnel and transient troops only, not for patients being returned from theaters.49 Concur- rence of the SOS Hospitalization and Evacuation Branch in this interpretation placed an official stamp of approval on The Surgeon General’s plan to use gen- eral hospitals under service command control, rather than special hospitals under port control, for debarkation ac- tivities. Most general hospitals located near ports performed dual functions—provid- ing definitive treatment for some patients and processing others for further travel— until late in the war. This created com- plications. Ports were granted unlimited bed credits in such hospitals, but near-by station hospitals also continued to receive bed credits in them. This overlapping caused some concern in SOS headquar- ters.50 Investigation showed that Halloran General Hospital kept a list of patients earmarked for transfer to other general hospitals when the evacuation load re- quired it.51 Stark, LaGarde, and Barnes General Hospitals simply waited until the necessity arose and then transferred pa- tients receiving definitive care to other general hospitals located farther away from ports. Others, notably Letterman and Lovell, kept beds vacant while await- ing the arrival of evacuated casualties. This system occasionally caused the trans- fer of patients needing general hospital care to station hospitals. In the opinion of some hospital commanders, it was also wasteful of both professional personnel and highly specialized equipment.52 Later, when the evacuation load reached its peak, The Surgeon General partially shared their view, for in 1945, as will be seen later, he proposed the conversion of 46 (1) 1st ind, Chief Hosp and Evac Br SOS to CofT, 18 Nov 42, sub: Evac, on unknown basic Ltr. TC: 370.05(Plans, Policies, Procedures). (2) Ltr, GG HRPE to SG, 10 Nov 42. SG; 705.-1 (HRPE)N. 47 (1) Off memo, signed by Col H. D. Offutt, 9 Nov 42. HD: 370.05 “Spec Oprs.” (2) Ltr, Act SG to GG HRPE, 14 Nov 42. SG: 705.-1 (HRPE)N. 48 (1) Diary, Chief Hosp and Evac Br SOS, 2 Nov 42. HD: Wilson files, “Diary.” (2) Ltr, Port Surg NYPE to Gol H. D. Offutt, 12 Nov 42. SG: 705(NYPE)N. (3) An Rpt, 1942, Halloran Gen Hosp. HD. 49 (1) Diary, Chief Hosp and Evac Br SOS, 3 Nov 42. HD: Wilson files, “Diary.” (2) Ltr, CofT to CGs of PEs, 9 Nov 42, sub: Mil Hosp and Evac. TC: 370.05 (Plans, Policies, Procedures). 50 Diary, Chief Hosp and Evac Br SOS, 14 Dec 42. HD: Wilson files, “Diary.” 51 Memo SPOPH 701, Chief Hosp and Evac Br SOS for ACofS for Oprs SOS, 27 Dec 42, sub; Avail- ability of Hosp Beds for Port of NY. HD: Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” 52 An Rpts, 1942 and 43, Halloran, Stark, LaGarde, Barnes, Letterman, and Lovell Gen Hosps. HD. 116 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR staging area station hospitals into de- barkation hospitals.53 Designation of General Hospitals for Specialized Treatment Early in 1943 The Surgeon General initiated a formal program of specializa- tion in general hospitals. During World War I the Medical Department had manned and equipped certain hospitals for the care of particular types of cases.54 In the interval between wars specializa- tion had continued on a limited scale. By January 1942, for example, deep X-ray therapy had been established as a spe- cialty in the Army and Navy, Fitzsimons, Lawson, Letterman, Walter Reed, and William Beaumont General Hospitals.55 In March 1942 Darnall General Hospital opened to receive psychotic patients who needed closed ward treatment.56 Other specialty centers gradually developed at hospitals where eminent specialists were assigned,57 and toward the end of 1942 The Surgeon General made it known that he intended to formalize and extend exist- ing specialization. Apparently he awaited only the development of circumstances warranting such action.58 In the winter of 1942 that development occurred. Beginning in September new general hospitals opened in increasing numbers.59 It was soon evident that a lim- ited supply of specialists would prohibit the staffing of each one for all kinds of surgical and medical work. Referring to this problem, the surgeon of the Fourth Service Command suggested in January 1943 that certain general hospitals in his area be equipped and manned to give spe- cialized care in different branches of sur- gery.60 Simultaneously with the opening of the new general hospitals, a transition from defensive to offensive warfare pre- saged the arrival oflarge numbers of com- bat casualties requiring complicated sur- gery. Moreover, public insistence upon hospitalization of casualties near their homes grew until The Adjutant General in December 1942 proposed establishment of a policy to conform with the demand.61 If adopted and applied too rigidly, such a policy would conflict with The Surgeon General’s unpublished plan to transfer casualties to hospitals specializing in par- ticular diseases or injuries. He therefore made a counterproposal: patients needing specialized treatment would be sent to general hospitals designated for such, while those requiring prolonged but not specialized treatment would be transferred to hospitals in the vicinity of their homes.62 53 See below, p. 192. 54 The Medical Department ... in the World War (1923), vol. V, pp. 171-73. 55 SG Ltr 44, 15 May 41, and SG Ltr 1, 2 Jan 42. 56 An Rpt, 1942, Darnall Gen Hosp. HD. 57 An example of this development was found in Tilton General Hospital which established a special neurosurgical section during 1942 and was designated a neurosurgical center in March 1943. An Rpts, 1942 and 43, Tilton Gen Hosp. HD. 58 (1) Memo, SG for Dir Control Div SOS, 1 Aug 42. SG: 020.-1. (2) Memo, Chief Pers Serv SGO for Dir Mil Pers SOS, 2 Dec 42. SG: 323.7-5. 59 Number of General Hospitals Reporting Month Patients Weekly August 1942 15 September 1942, . 17 October 1942 19 November 1942 22 December 1942 26 January 1943 31 60 Ltr, CG 4th SvC (Chief Med Br) to SG, 23 Jan 43, sub: Surg Serv, Gen Hosps, with 1st ind, CG SOS (SG) to CG 4th SvC attn Chief Med Br, 8 Feb 43. SG: 323.7-5 (4th SvG)AA. 61 (1) Draft memo, TAG for GofS SOS, 29 Dec 42, sub: Hosp of Casuals Returned to the US as Battle Casualties. AG: 701 (12-29-42)( 1). (2) IAS, TAG to SG, 29 Dec 42, same sub. Same file. 62 (1) 1st memo ind, SG to TAG, 7 Jan 43, on IAS, TAG to SG, 29 Dec 42, sub: Hosp of Casualties. AG: 701(12-29-42)(l). (2) Memo SPOPH 701(1-16-43), ACofS for Oprs SOS for TAG, 19 Jan 43, same sub. Same file. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 117 Approval and publication of this policy on 1 February 1943 63 required the formal designation of specialty centers. For sev- eral weeks afterward The Surgeon Gen- eral’s Hospitalization and Evacuation Division worked on this problem,64 and on 6 March 1943 the War Department desig- nated nineteen general hospitals for the following specialties: chest surgery, maxil- lofacial and plastic surgery, ophthalmic surgery and the treatment of the blind, neurosurgery, and the performance of amputations.65 About two months later, two additional specialties—vascular sur- gery and the treatment of the deaf—were announced and another general hospital was placed on the list.66 Further extension of specialization occurred during the later war years. The Question of Establishing Convalescent Hospitals During the latter part of 1942 the opinion gained favor both in civilian and military circles that special accommoda- tions for convalescent patients should be provided either as separate hospitals or as annexes to existing hospitals. Among civil- ians it developed apparently from a desire either to “do something for the boys” or, in some instances, to dispose of large estates with questionable market values.67 In the Army it arose from the need to save both manpower and hospital beds. The idea was not new, for during World War I the Medical Department had conducted “re- construction” programs in general hospi- tals and convalescent centers both in the United States and France.68 In the latter half of 1942 several widely separated hos- pitals—the Fort Bliss Station Hospital in Texas, the Jefferson Barracks Station Hos- pital in Missouri, and the Lovell General Hospital in Massachusetts—established programs to harden patients for return to duty, to reduce the period of their conva- lescence, and to salvage for full field duty those who might otherwise be either dis- charged from the Army or placed in the limited service category.69 In January 1943 the surgeon of the Eighth Service Com- mand recommended the organization of casual detachments to recondition conva- lescent patients and salvage psychoneu- rotic soldiers for full duty.70 The surgeon of the Ninth Service Command proposed the establishment of “overflow installa- tions” to free hospital beds of patients no longer needing hospital care but not yet ready for full military duty.71 In this con- nection, General Snyder, a medical officer on the staff of The Inspector General, found in a survey in November 1942 that approximately 67 percent of the patients 63 WD Cir 34, 1 Feb 43. 64 (1) Memo, SG for TAG, 24 Feb 43, sub: Cir Ltr 50, Spec Hosps. AG: 705(2-24-43)( 1). (2) Ltr, Col Arden Freer, SGO to Col S[anford] W. French, Hq 4th SvC, 8 Feb 43. SG: 323.7-5 (4th SvC)AA. 85 WD Memo W40-9-43, 6 Mar 43, sub; Gen Hosps for Spec Surg Treatment. AG: 705(2-24- 43)(1). 66 WD Memo W40-14-43, 28 May 43, sub: Gen Hosp, Specialized Treatment. AG: 323.7-5(W40-9- 43)(3-6-43). 67 The Surgeon General received numerous offers. For some of the replies he made, see; (1) Ltr SPMCC, SG to Mr. W. K. Kellogg, 4 Aug 42. (2) Ltr, Act SG to Hon Joseph F. Guffey, US Sen, 20 Nov 42. (3) Ltr, Act SG to Hon Lex Green, H. R., 12 Dec 42. All in HD: 601.-1. 68 (1) The Medical Department . . . in the World War (1927), vol. XIII, pp. 79-222. (2) Charles E. Remy, The History of a Convalescent Camp of the American Expeditionary Forces in France (1942). HD. 69 An Rpts, 1942, Sta Hosps at Ft Bliss and Jeffer- son Bks, and Lovell Gen Hosp. HD. Similar action was being taken in the European Theater of Opera- tions at the same time. See Memo, Consultant in Surg ETO to Dir Professional Serv ETO, 28 Sep 42, sub: Rpt on Visit to Med Instls in Northern Ireland. HD: ETO file, “Col Elliott C. Cutler, Rpts Jul 42-Dec 42.” 70 An Rpt, 1942, Chief Med Br 8th SvC. HD. 71 An Rpt, 1942, Chief Med Br 9th SvC. HD. 118 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR in Army hospitals were convalescent and could be cared for in barracks, if neces- sary, to release hospital beds for patients requiring close medical supervision.7" While medical officers in the field were becoming aware of the convalescent prob- lem, it was also receiving attention in Washington. In September 1942 it came up in the hearings of the Wadhams Com- mittee.73 A month later the Air Forces requested authority “to establish and op- erate specialized hospital and recuperative centers for individualized treatment, re- habilitation, and classification of Air Forces personnel.”74 The Air Surgeon believed that special hospitals should be established under Air Forces’ control to treat and rehabilitate Air Forces patients suffering from such conditions as staleness, anoxia, operational fatigue, aeroneurosis, and aero-embolism.75 Surgeon General Magee, on the other hand, strongly dis- approved the establishment by the Air Forces not only of general hospitals, as discussed earlier, but also of any hospitals other than the station hospitals which they already operated. Moreover, he preferred to carry on reconditioning programs in existing hospitals. He argued that conva- lescent patients often needed observation and sometimes “active therapeutic man- agement” by doctors fully acquainted with their cases and should therefore not be moved far from hospitals where they received definitive care. He contended furthermore that the establishment of con- valescent hospitals would lead to duplica- tion of buildings and a waste of personnel and equipment. Hence, he refused to con- cur in the Air Forces’ proposal, but gave his approval instead to the establishment of nonmedical AAF rest camps. To the Wadhams Committee’s recommendation for the establishment of separate convales- cent accommodations free of the hospital atmosphere, The Surgeon General replied on 15 December 1942: “It is the opinion of this office that convalescent sections may be more advantageously operated as integral parts of military hospitals. . . .” 76 Before final action was taken on the Air Forces’ request, both the Air Surgeon and The Surgeon General began to initiate reconditioning programs in existing hospi- tals. In November 1942 the Wadhams Committee recommended this step as well as the establishment of convalescent hos- pitals.77 The next month, the command- ing general, Army Air Forces, published a directive, prepared by the Air Surgeon, requiring all Air Forces hospitals “to insti- tute recreation and reconditioning pro- grams for convalescent patients.”78 In January 1943 The Surgeon General pro- 72 Ltr, Asst to IG (Brig Gen Howard McC. Snyder) to IG, 10 Nov 42, sub; Surv of Hosp Fac and their Util. IG: 705-Hosp(A). 73 Cmtee to Study the MD, 1942, Testimony, pp. 205, 383-84, 441-42, and 460. HD. 74 Memo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 “Rest Ctrs and Gonv Homes.” 75 (1) Cmtee to Study the MD, 1942, Testimony of Brig Gen David N. W. Grant, pp. 383-84. HD. (2) Brief and Consideration of Non-Concurrence [of SG], Tab B and par IV of Memo, C of Air Staff for CofSA, 7 Oct 42, sub: Specialized Hosp and Recuperative Fac for AAF Pers. AAF: 354.1 “Rest Ctrs and Gonv Homes.” 76 (1) Cmtee to Study the MD, 1942, Testimony of Offs of SGO, pp. 163-66, 441-42, 460, HD. (2) Memo SPMCB 701.-1, SG for CG SOS, 13 Oct 42, sub: Spe- cialized Hosp and Recuperative Fac for AAF Pers. AAF; 354.1 “Rest Ctrs and Gonv Homes” (1). (3) Ex- tract from 1st ind, SG to CG SOS, 15 Dec 42, on extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 24. HD. 77 Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 14. HD. 78 (1) AAF Memo 25-9, 14 Dec 42, sub: Recrea- tion and Reconditioning for Gonv Pnts in AAF Hosps. AAF: 300.6. (2) Howard A. Rusk, “Convales- cence and Rehabilitation,” Doctors at War, Morris Fishbein, ed. (New York, 1945), pp. 303-04. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 119 posed a War Department circular to require all fixed hospitals, overseas as well as in the United States, to inaugurate re- conditioning programs. Fearing that such programs would require additional per- sonnel and construction and doubting its own authority to order their establish- ment, SOS headquarters delayed publica- tion of this directive until 11 February 1943.79 Both the Air Forces and War De- partment directives provided for programs of recreation, graded exercises, and drills; the former, for a program of education as well. Until late 1943 only a few hospitals, among them the station hospitals at Camp Crowder (Missouri), Fort Benning (Geor- gia), Jefferson Barracks (Missouri), and the O’Reilly General Hospital, developed effective programs.80 Meanwhile the Air Forces’ persistence in demanding separate convalescent facil- ities led the General Staff to consider that problem. At first G-4 was reluctant to permit the Air Forces to establish even rest centers, proposing instead that they “farm out” convalescents in civilian resort hotels. G-4 felt that the convalescent problem was one for the future, since the immedi- ate needs of combat zones could be met by the organization of rest camps in theaters and patients returned to the United States either would be ready for sick leaves at home or would need definitive care in general hospitals.81 Both the Ground and Service Forces agreed with this viewpoint8J but the Air Surgeon was striving for authority to establish “specialized hospital and recuperative centers.” 83 Tending to agree with the Air Forces on the need, G-l on 16 March 1943 recommended the provision of such facilities not only for the Air Forces but for the Ground and Service Forces as well.84 Because of conflicting opinions, G-4 called the commanding generals of the Ground, Service, and Air Forces into conference with the General Staff on 7 May 194 3.85 The viewpoint of G-l prevailed and on 14 June 1943 G-4 directed ASF headquarters to investigate the proposal to establish convalescent fa- cilities, to determine the requirements of the Army as a whole, and to take what- ever action appeared desirable.86 Two days before this directive was issued Surgeon General Kirk had instructed his Hospital Construction Division to prepare a program for the establishment of con- valescent annexes at general hospitals. On 79 (1) Ltr SPMCB 300.5-1, SG to TAG, 7 Jan 43, sub: WD Gir, with atchd corresp from various offs in SOS. AG: 701(l-7-43)(l). (2) AG Memo W40-6-43, 1 1 Feb 43, sub: Conv and Reconditioning in Hosps. Same file. 80 An Rpts, 1942 and 43, Sta Hosps at Jefferson Bks, and 1943-44, Reconditioning Div SGO. HD. 81 Memo WDGDS 2317, ACofS G-4 WDGS for ACofS G-l WDGS, 6 Feb 43, sub: Rest and Recu- peration of Mil Pers. AAF: 354.1 “Rest Ctrs and Conv Homes.” 82 (1) Memo 720 GNGAP-A, GG AGF for ACofS G-l WDGS, 25 Feb 43, sub; Rest Gps for AGF Pers. AAF: 354.1 “Rest Ctrs and Conv Homes.” (2) DF SPGAM/720/Gen(2-8-43)-l 6, CG SOS for ACofS G-l WDGS, 27 Feb 43, sub: Rest and Recuperation of Mil Pers. HRS; G-l/354.7(2-8-43). 83 (1) Comment No 2, Air Surg to Dir Base Serv AAF, 10 Feb 43, on R&R Sheet, Dir Base Serv AAF to Air Surg, 2 Feb 43, sub: Renaming of Pers Rest Ctr Projects. AAF: 354.1 “Rest Ctrs and Conv Homes.” (2) R&R Sheet, Dep C of Air Staff to Air Surg, 18 Feb 43, sub; Specialized Hosp and Recuper- ative Fac for AAF Pers, with atchd draft Memo, CG AAF for AsstSecWar for Air, 10 Feb 43, and draft Memo, AsstSecWar for Air for SecWar, 15 Feb 43. Same file. 84 Memo, ACofS G-l WDGS for CofSA, 24 May 43, sub; Specialized Treatment for Aircraft Combat Crew Pers. HRS; G-l/354.7(2-8-43). 85 Coleman, op. cit., pp. 384-86, citing Memo, ACofS G-4 WDGS for ACofS G-l, G-3, OPD WDGS, and CGs AGF, AAF, ASF, n d, and Memo WDGAP/354.7(3-8-43), ACofS G-l WDGS for CofSA, 25 May 43. 86 Memo WDGDS 4588, ACofS G-4 WDGS for CG ASF, 14 Jun 43, sub: Recuperation Ctrs for Conv Pnts. Filed as incl to ind dated 29 Jul 43. HD: Wilson files, “Day File, Jul 43.” 120 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR 21 June 1943 ASF headquarters approved the program The Surgeon General pre- sented.87 Neither mentioned separate facil- ities for the Air Forces, hoping apparently to keep the convalescent care of all pa- tients under their own control. The day before, however, a short-lived memoran- dum (already discussed) had granted the Air Forces authority to hospitalize combat crew members returned from theaters of operations and to operate whatever general hospitals were necessary for that purpose.88 As a part of the compromise settlement of this question, it will be recalled, Surgeon General Kirk agreed to the Air Forces’ establishment of convalescent centers for the care of both combat crew members suffering solely from operational fatigue and other Air Forces patients whose medi- cal care had been completed in general hospitals, while the Air Surgeon agreed to the continued operation of all general hospitals by the Service Forces. The Air Forces therefore activated eight convales- cent centers in the latter half of 1943,89 while the Service Forces established con- valescent annexes at each general hospital. Convalescent hospitals as such were not authorized until the spring of 1944.90 87 (1) Memo, Col John R. Hall for SG, 12 Jun 43. (2) 1st ind SPRMC 322 (18 Jun 43), CG SOS to SG, 22 Jun 43, on unknown basic Ltr. Both in SG; 632.-1. 88 See above, pp. 107-08. 89 AAF Memo 20-12, 18 Sep 43. 90 See below, pp. 188-90. CHAPTER VII Minor Changes in Hospital Administration The outbreak of war and expansion of the hospital system produced few changes of consequence in hospital administration. In fact, as in prewar mobilization plan- ning, greatest attention seemed to be de- voted to physical plants, while the internal organization and administration of hospi- tals remained largely under peacetime policies and procedures. The Surgeon General’s Office continued to consider such matters as belonging properly within the province of hospital commanders and concerned itself, as before the war, with attempts to modify administrative proce- dures outside Army hospitals that affected the length of time patients occupied hospi- tal beds. In some instances it seemed loath to break with the past, opposing altogether or accepting reluctantly suggestions for changes in the organization of hospitals and in the manner in which they were staffed. Although it took constructive steps to eliminate problems involved in supply- ing and equipping new and expanded hos- pitals, a shortage of many items continued to plague hospital commanders until early in 1943. Question of Simplified Organization and Internal Administrative Procedures The practice of leaving the organization and administration of hospitals largely, within broad limits already established by Army regulations and technical manuals, to the discretion of local hospital com- manders continued to result in variations as numerous as the hospitals themselves, both in the number of services supplied and in the relation of such services to one another and to the commanding officer.1 In some instances hospital commanders took advantage of the freedom permitted them and increased the efficiency of their installations by organizing services not ordinarily found in military hospitals. For example, the Camp Maxey (Texas) and Fort Bliss (Texas) Station Flospitals, adopting a practice of civilian medicine, established diagnostic clinics to expedite the “work-up” of cases and weed out those not requiring immediate hospitalization. The clinic at Camp Maxey, the hospital commander estimated, saved at least 600 hospital admissions during 1942.2 Other commanding officers showed less initia- tive, organizing and arranging customary services in numbers and relations which they considered desirable. Thus, in the absence of specific organizational direc- tives and standard administrative proce- 1 An Rpts, 1942, Sta Hosps at Cps Butner, Maxey, Howze, Cooke, Bowie, and Ft Bliss, and An Rpts, 1943, Sta Hosps at Cps Carson, Beale, Lee, Maxey, and Ft Bliss. HD. 2 An Rpt, 1942, Sta Hosp at Cp Maxey, and An Rpts, 1942 and 1943, Sta Hosp at Ft Bliss. HD. 304244 0—55 10 122 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR dures, efficient organization and smooth functioning depended largely upon the ad- ministrative capabilities of hospital com- manders and their staffs and upon the supervision and advice they received from higher authorities.3 In the fall of 1942 the Wadhams Com- mittee had stated that Army hospital organization and administration needed improvement. It recommended the pro- curement of trained hospital administra- tors for assignment to key positions on the staffs of hospital commanders and as con- sultants to The Surgeon General and serv- ice command surgeons. It also recom- mended that hospital organization be simplified. Citing a hospital in which thirty-three sections or services operated directly under the commanding officer as proof of need for such action, the Commit- tee suggested a “model organization” in which all functions of a hospital would be grouped under the chiefs of three divisions: the Medical, Administrative, and Service Divisions.4 The Surgeon General took issue with these recommendations. He expressed doubt that any hospital commander had thirty-three section or division chiefs re- porting directly to him and asserted that the hospital organization outlined in Tech- nical Manual 8-260 was the result of many years of medico-military hospital administration and represented the opin- ion of able officers of the Medical Depart- ment. “No advantage would appear to accrue,” he stated, “for [from?] any major change at this time.” He was equally op- posed to the proposal to assign special hos- pital administrators to key positions in station and general hospitals. “Lay” ad- ministrators were used in civilian hospi- tals, he stated, only because doctors did not have time for administrative duties. He asserted that Medical Corps officers could administer Army hospitals best, since some functions found in civilian hos- pitals either were lacking in military hos- pitals or were handled by other Army agencies, such as the Corps of Engineers. He admitted that specialists in hospital administration were useful in some posi- tions, pointing out that approximately one hundred had already been commissioned in the Medical Administrative Corps for administrative work in hospitals. As to the assignment of hospital administrators to his own Office or to those of service com- mand surgeons, he made no comment.5 Later, after the commanding general, Services of Supply, directed him to take immediate action on the Committee’s recommendation, The Surgeon General modified his position. On 16 January 1943 he informed General Somervell that he was negotiating with Dr. Basil G. Mac- Lean, Superintendent of Strong Memorial Hospital, Rochester, N. Y., regarding a commission and assignment to his Office to make a comprehensive survey of mili- tary hospital organization and adminis- tration and to advise him on the procure- ment and assignment of additional hospi- tal administrators from civilian life.6 Dr. MacLean was unable to accept a commis- sion immediately, but on 23 April 1943 he was made a lieutenant colonel and as- signed to The Surgeon General’s Hospi- talization and Evacuation Division. 3 See An Rpt, 1942, Chief Med Br 8th SvC. HD. 4 (1) Cmtee to Study the MD, 1942, Rpt, HD. (2) Extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to study the MD, 1942-43. Actions on Recomd, Recomd Nos 26 and 27. HD. 5 Extract from 1st ind, SG to CG SOS, 15 Dec 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 27. HD. 6 Extracts from 3d ind, SG to CG SOS, 16 Jan 43, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd Nos 26 and 27. HD. MINOR CHANGES IN HOSPITAL ADMINISTRATION 123 The Surgeon General’s reaction to an- other of the Wadhams Committee’s rec- ommendations further exemplified his reluctance to interfere with the internal administration of hospitals. Finding that some diagnostic procedures which re- quired only forty-eight hours in civilian hospitals sometimes took as much as ten days in Army hospitals, the Committee recommended that “a centralized system of control of the length of patients’ stay be instituted to record currently the length of stay by major professional classifications for each hospital, to study the causes of abnormal occupancy, and to institute action to correct undesirable conditions.” 7 Such a system was already operating ef- fectively in the Second Service Command and The Surgeon General agreed that information on the time patients stayed in hospitals would be “highly desirable from a statistical point of view.” Nevertheless, he believed it “impracticable” to establish such a system for all Army hospitals be- cause of the paper work involved, and indicated that he preferred to depend upon professional consultants “inquiring into unnecessarily long periods of hospi- talization with a view to corrective ac- tion.” 8 To supplement their efforts The Surgeon General issued a circular letter on 9 November 1942, urging hospital com- manders to prevent the padding of records by “repetition, verbosity, and inclusion of extraneous historical material and forms” and to reduce “irrelevant, routine, and repetitive requests” for laboratory exami- nations.9 Certain changes in the organization of general hospitals did occur as a result of their transfer from control of The Surgeon General to that of service commands in the fall of 1942. Since few were located on Army posts, most had post as well as hos- pital functions, and their commanding officers were both post and hospital com- manders. Duties of such officers as post commanders were relatively unimportant compared with their duties as hospital commanders, for post functions of a gen- eral hospital existed only to serve the hos- pital. Nevertheless, after general hospitals became service command installations the organization of their post function was expected to conform with the standard post organization outlined in the SOS Or- ganization Manual, 30 September 1942. It grouped post activities functionally in seven divisions: Administrative, Personnel, Operations and Training, Supply, Repairs and Utilities, Internal Security and Intel- ligence, and Medical. The result was that relatively minor post functions, previously organized as administrative sections or services, were raised to division status, equal on paper at least to the Medical Division. The latter usually comprised all hospital functions, administrative—such as medical supply, the registrar’s office, and the enlisted complement—as well as professional. The commanding officer’s double role meant that while only some seven division chiefs reported to him directly as post commander, in most in- stances the original number of section or branch chiefs of the Medical Division also reported to him directly as chief of that 7 (1) Extract from Memo, GG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 25. HD. (2) Cmtee to Study the MD, Rpt, pp. 5, 7, 10, 13. HD. 8 (I) Extract from 1st ind, SG to CG SOS, 15 Dec 42, on extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 25. HD. (2) History, Office of the Surgeon, Second Corps Area and Second Service Command from 9 September 1940 to 2 September 1945, pp. 8 and 102. HD. 9 SG Ltr 148, 9 Nov 42, sub: Hosp Admin and Professional Servs. 124 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR division—that is, as commander of the hospital.10 (ChartG) Efforts To Shorten the Average Period of Hospitalization As the number of hospitals increased and the patient load became heavier, the Surgeon General’s Office along with other agencies of the War Department devoted attention to administrative procedures outside Army hospitals which affected the occupancy of hospital beds. For the most part such procedures were those that gov- erned the disposition of patients after com- pletion of treatment—either by return to duty or separation from the Army—and were hence essentially personnel proce- dures. Attempts To Speed the Disposition of Officer-Patients Two problems arose during the early war years in the disposition of officer-pa- tients after hospitalization. The first re- sulted from keeping on active duty, rather than retiring, officers qualified for limited service only; the other, from loss of touch with units and organizations to which of- ficers qualified for full duty should return.11 The procedure for the assignment of of- ficers qualified for limited service only, in effect in January 1942, required hospital commanders to hold officers after com- pletion of treatment while reports of their cases were sent through military channels to The Adjutant General in Washington for instructions on assignments.12 On 21 March 1942 a revision of this procedure cut out some of the correspondence and time involved by permitting post and corps area commanders to assign all limited service officers except those under the jurisdiction of the Army Air Forces. The latter still had to be reported to the commanding general, Army Air Forces, for assignment.13 The normal procedure for returning general service officers to their “proper” stations also needed modification. In many cases organizations to which they belonged either had left for overseas serv- ice or had moved to some other location in the United States, without informing the hospital or officer concerned. New assignments had to be made in such cases. On 6 October 1942 the War Department issued instructions permitting corps area commanders to make assignments of all officers in this category except those be- longing to the Air Forces. The latter, like AAF limited service officers, could be as- signed only by the commanding general, Army Air Forces.14 These changes re- duced but did not eliminate entirely diffi- culties of hospital commanders in procur- ing assignments for officer-patients.15 A further revision of directives govern- ing the disposition of officers was issued the last day of 1942. It tended to expedite the process. Under the new procedure, all officers needing hospitalization who be- longed to troop units in the United States, 10 (1) SOS Orgn Manual, 1942, sec 402.02 and 406.01. HD. (2) Rpt, Conf of CGs SvCs [SOS], 2d sess, 17 Dec 42, p. 41. HD: 337. (3) An Rpts of the following Gen Hosps: Hoff, Baxter, Billings, Tilton (1942), and Ashburn, Baxter, Percy Jones, Kennedy, and Hoff (1943). HD. 11 (1) Ltr, TAG to CGs Armies, Army Corps, Divs, CAs, and Depts; CofS GHQ; C of Arms and Servs; CG AF Combat Comd; C of Armored Force; COs of Exempted Stas, 21 Jan 42, sub: Physical Fitness of Offs. AG; 201.6 (l-17-42)(3). (2) AR 40-600, par 5 a, 31 Dec 34. (3) WD Cir 24, sec III, 27 Jan 42. 12 (1) AR 40-600, par 5 a, 3 1 Dec 34. (2) WD Cir 24, sec III, 27 Jan 42. 13 WD Cir 83, 21 Mar 42. 14 AR 40-600, par 5 a, 6 Oct 42. 15 For example, see An Rpt, 1942, Tilton Gen Hosp. HD. MINOR CHANGES IN HOSPITAL ADMINISTRATION 125 Chart 6—Organization of Baxter General Hospital Compared With Standard Plan for SOS Post Organization, 1942Md COMMANDING OFFICER FISCAL BRANCH CONTROLBRANCH EXECUTIVE OFFICER PUBLIC RELATIONS ADMINISTRATIVE DIVISION PERSONNEL DIVISION TRAINING DIVISION SUPPLY DIVISION INTERNAL SECURITY intelligence! DIVISION ENGINEER SURGEON REPAIRS a -UJjyjJES. MEDICAL DIVISION ADJUTANT CIVILIAN PERSONNEL TRAINING QUARTER- MASTER BRANCHES OF THESE DIVISIONS NOT SHOWN. SURGICAL SERVICE BRANCH TRANSPOR- TATION MEDICAL SERVICE BRANCH JUDGE ADVOCATE MILITARY PERSONNEL OPERATIONS FINANCE SPECIAL SERVICES SIGNAL DENTAL SERVICE BRANCH X-RAY SERVICE BRANCH MEDICAL INSPECTOR CHAPLAIN ORDNANCE REGISTRAR CHEMICAL WARFARE SERVICE I LABORATORY] | SERVICE ) i BRANCH i DIETETICS ARMY EXCHANGE EENT SERVICE BRANCH ADMINISTRATIVE NURSING SERVICE BRANCH STANDARD ORGANIZATION FOR ASF SERVICE COMMANDS AND POSTS. 1942 DISTRIBUTION SUBSISTENCE 1 MEDICAL ' RETAINED IN ORGANIZATION OF BAXTER GENERAL HOSPITAL, 15 NOVEMBER 1943 MAINTENANCE HOSPITAL ] POLICE AND | personnel' ADDED IN ORGANIZATION OF BAXTER GENERAL HOSPITAL AMERICAN RED CROSS who had returned from theaters, or who were en route to overseas destinations, were transferred at the time they entered general hospitals to replacement pools of their respective arms and services. Upon completion of hospital treatment, whether qualified for general or limited service, they could be returned to pools to await permanent reassignment. Other officers, for example those of station complements, were not assigned to such pools and had to be returned to their proper stations. In either case, hospitals might dispose of pa- tients as soon as their medical treatment 126 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR had been completed, without waiting for higher headquarters to make assign- ments.16 Nevertheless, some hospital com- manders continued to hold officer-patients until higher headquarters had acted upon the recommendations of hospital disposi- tion boards.17 Attempts To Speed the Disposition of Enlisted Men Delays in the disposition of enlisted men, both those being discharged from the Army on certificates of disability and those being returned to duty for limited service, also caused the Medical Department concern. As in the case of officers, such delays re- sulted in part from administrative actions required of headquarters outside hospitals. Attempts were made to remove this cause of delay during the early war years. Later, emphasis was to be placed upon simplify- ing procedures within the hospitals them- selves. Failure to receive service records and al- lied papers, such as individual clothing and equipment records, of enlisted pa- tients transferred to general hospitals was one cause of delay. Without such records hospitals could not release men entitled to discharge from the Army. As early as December 1941 some hospitals com- plained about this situation.18 To correct it The Surgeon General secured the issu- ance of a War Department letter requiring “the immediate transfer of such papers to a general hospital when a member of the command is transferred thereto.” 19 This of course did not solve the problem of pa- tients whose records had been lost or de- stroyed. Several officers, including the commanding general of Lovell General Hospital, the director of training of the Services of Supply, the finance officer of the New York Port of Embarkation, and representatives of the Surgeon General’s Office, became interested in it almost simultaneously.20 On 6 June 1942, there- fore, the War Department published a di- rective permitting hospital personnel of- ficers to prepare payrolls, final pay state- ments, and new service records on the basis of affidavits of men whose records had been lost in disasters either at sea or on land.21 Within a month, both SOS headquarters and the Chief of Finance de- cided that this policy should be broadened to include all lost records, whether or not they had disappeared as a result of mili- tary action.22 This was done by a new War Department directive published on 24 July 1942.23 Its provisions helped to speed 16 WD Gir 424, 31 Dec 42. 17 (1) An Rpts, 1943, Tilton, LaGarde, Ashburn, and O’Reilly Gen Hosps. HD. (2) Memo, Lt Col Basil C. MacLean, MG for [Brig] Gen [Raymond W.] Bliss thru Gol [Albert H.] Schwichtenberg, 6 Nov 43, sub: Observations Based on Recent Visits of Varying Periods to 9 Gen Hosps. SG: Gen Bliss’s Off files, “Util of MCs in ZI” (19) # 1. In this letter, Colonel MacLean stated: “The wastage in days and dollars is scandalous and can be attributed directly to the stu- pidities of a cumbersome and complex procedure which is not easily adaptable to a war time load.” 18 (1) Statement of CO Lawson Gen Hosp, Agenda of SGO Conf with COs Gen Hosps, 15 Dec 41. HD: 337.-1. (2) Inf memo, SG for TAG [Dec 41], sub: Trf of Pnts. AG; 201.3 (l-23-42)(8). 19 Ltr, TAG to CGs Armies, Army Corps, et at., 29 Jan 42, sub; Delay in Trf of S/R. AG: 201.3 (l-23-42)(8). 20 (1) Ltr, CG Lovell Gen Hosp to TAG, 21 May 42, sub: Lost S/R. HRS: G-l/10381. '(2) Memo SPTRU 333.1 (5-12-42), Dep Dir Tng SOS for Dir MPD SOS, 12 May 42; sub: EM. Same file. 21 (1) 2d ind, CofF to TAG, 2 Jun 42, on Ltr, Fin Off, Brooklyn, NY to CofF, thru Fin Off 2d CA, 24 May 42, sub; Pay of EM without S/R. AG: 240 (5-24-42)(l). (2) WD Gir 177, sec I, 6 Jun 42. 22 (1) Memo, CG SOS for CofSA, 27 Jul 42, sub: Prompt Discharge of EM on CDD from Gen Hosp. HRS: G-l/10381. (2) Memo SPFDR 300.3/360354 (WD Cir), CofF for C of Admin Servs SOS, 21 Jul 42, sub; Proposed WD Cir. AG: 240 (l-3-42)(l). 23 WD Cir 244, 24 Jul 42. MINOR CHANGES IN HOSPITAL ADMINISTRATION 127 the discharge of enlisted men on certifi- cates of disability by making it unneces- sary to hold patients in hospitals while missing records were located or until new ones were issued by The Adjutant Gen- eral.24 At station hospitals a serious cause for delay in discharging patients for disability was that officials outside hospitals had both to initiate and to consummate the action. Under existing regulations an en- listed man’s immediate commanding officer had to initiate the certificate re- quired for this purpose (WD AGO Form 40), and an authority higher than the sta- tion hospital commander, either the post commander or the service commander, had to approve the certificate and the rec- ommendations of the medical board who examined the man.25 When members of the Wadhams Committee visited Army hospitals in the fall of 1942, they found that complaints on this score were gen- eral.26 The Committee recommended that authority to approve disability discharges be vested in all commanders of camps having a strength of 20,000 or more.27 About the same time, General Snyder found in a survey which he was making that approximately 12 percent of all pa- tients were awaiting disability discharges. To free beds for other patients, he recom- mended that measures be taken to require organization commanders to initiate dis- ability certificates promptly and to permit commanders of all posts having a strength of 5,000 or more to approve disability dis- charges.28 Accordingly, The Surgeon General prepared a memorandum, pub- lished by the War Department on 30 November 1942, requiring “all con- cerned” to insure prompt action by unit commanders in initiating disability cer- tificates. In December he also secured a modification of Army regulations to per- mit commanders of all stations with hous- ing capacities of 5,000 or more to grant disability discharges.29 These actions, par- ticularly the latter, simplified the disposi- tion of such patients and in at least one hospital reduced the average period of their stay by almost two thirds, from fifty- eight to twenty-one days.30 Causes for de- lay still existed for papers still had to be transmitted between unit and hospital commanders and between hospital and post commanders. Early in 1943 G-l directed SOS to make a study of War Department regula- tions governing disability discharges “with a view to their clarification and the speedy consummation of discharges under this authority.” 31 The revision of regulations which SOS headquarters subsequently proposed seemed to The Surgeon General 24 (1) Ltr, CO Tilton Gen Hosp to TAG, 31 Jul 42, sub: Discharge of EM, with 1st ind, TAG to CG Til- ton Gen Hosp, 25 Aug 42. AG: 220.8 (8-l-34)(l). (2) An Rpts, 1942, Torney Gen Hosp, and 1943, LaGarde Gen Hosp. HD. 25 AR 615-360, sec II, par 5, 8, 9, 11, 14, and 16, 4 Apr 35 and 26 Nov 42. 26 (1) Memo by Dr J. H. Musser, n d, sub: Visit to Louisiana Hosp Instls. Pers files of Dr Lewis H. Weed, Mem of the Wadhams Cmtee. (2) Memo by Dr Arthur H. Ruggles, n d, sub: Visit with Mr. James Hamilton to Cp Devens, Mass. Same file. 27 (1) Extract from Memo, GG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 12. HD. (2) Cmtee to Study the MD, 1942, Rpt, p. 5. HD. 28 Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG: 705-Hosp (A). 29 (1) 3d ind, SG to GG SOS, 24 Nov 42, on Ltr, Asst IG to IG, 10 Nov 42, sub; Surv of Hosp Fac and their Util. IG: 705-Hosp (A). (2) WD Memo W40- 9-42, 30 Nov 42, sub: Delays in Processing WD AGO Form 40. Same file. (3) WD Gir 404, sec HI, 14 Dec 42. 30 An Rpts, 1942, Sta Hosp at Sheppard Fid, and Surg 7th SvC. HD. 31 Memo, ACofS G-l WDGS for Dir MPD SOS, 9 Feb 43, sub: Discharge of EM on CDD. AG;220.8 (2 Jun 42)(2) Sec 1. 128 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR likely to retard rather than to speed dis- charges. He therefore requested a confer- ence of representatives of his own Office and of The Adjutant General, The Judge Advocate General, the commanding gen- eral of Services of Supply, and the Vet- erans Administration, to consider the en- tire question.32 As a result a revision was worked out which eliminated some chan- nels of communication and placed time limits upon the transfer of papers required for disability discharges.33 Under the new procedure, published on 16 April 1943, patients were to be trans- ferred (on paper) from their own units to the station complement of the post on which the hospital treating them was lo- cated within forty-eight hours after hospi- tals decided to discharge them. Thus, all steps leading up to discharges for disability were to be under the control of post com- manders, independent of any action by unit commanders. Station complement commanders were required to forward disability certificates to station hospitals within twenty-four hours after they were requested, and hospital commanders had to forward all papers, with recommenda- tions, to post commanders within forty- eight hours after action by medical boards examining patients. In addition, discharge of patients was not to be delayed until all records of previous medical examinations had been received. Furthermore, hospital commanders were charged with the re- sponsibility, under post commanders, for processing all records within the time limits allowed.34 Under the revised regulation the amount of time needed to process the papers required for disability discharges was reduced appreciably. In the station hospital at Camp Chaffee (Arkansas) for example, the time was cut from approxi- mately eighteen to five days.35 Here, as in other instances, the post commander elim- inated even the transmission of records from station complement headquarters to hospitals and from hospitals to post head- quarters. He accomplished this by plac- ing detachments to which patients were transferred to await discharge under the command of members of the hospital staff and by permitting hospital commanders to exercise the authority of post com- manders to approve disability discharges. In this way, the entire process of granting discharges on certificates of disability was centralized under station hospital com- manders.36 Such was already the case in general hospitals, because enlisted men treated in them belonged to detachments of patients, rather than to the units to which they had been assigned previously, and general hospital commanders had had authority since September 1941 to grant discharges on certificates of dis- ability. Further simplification of proce- dures within hospitals themselves re- mained to be done during the later war years. The disposition of psychotic patients in- volved problems not ordinarily encoun- tered in other disability discharges. Until the spring of 1943 patients who became mentally deranged within six months after induction and required institutional care after discharge from the Army had to be 32 Memo SPMCH 300.3-1, SG for TAG, 7 Mar 43. AG: 220.8 (2 Jun 42)(2) Sec I. 33 Memo, CG SOS for ACofS G-l WDGS, 17 Mar 43, sub: Discharge of EM on CDD. AG:220.8 (2 Jun 42)(2) Sec I. 34 AR 615-360, C 4, 16 Apr 43. 35 An Rpt, 1943, Sta Hosp at Cp Chaffee. HD. 36 (1) Comments of Surg, 1st, 2d, and 7th SvCs, Rpt, SGs Confwith Chiefs Med Br SvCs, 14-17 Jun 43, pp. 56-58. HD: 337. (2) An Rpts, 1943, Sta Hosps at Cp Chaffee, and Fts Custer, Bragg, and Riley. HD. MINOR CHANGES IN HOSPITAL ADMINISTRATION 129 sent to State mental institutions or to St. Elizabeth’s Hospital in Washington, D. C. Only patients with more than six months’ service were “line-of-duty” cases and therefore eligible for care by the Veterans Administration. To arrange for State care of mental patients frequently required several weeks or else turned out to be im- possible altogether.37 To relieve other hos- pitals of the accumulation of such patients awaiting discharge, The Surgeon General opened Darnall General Hospital on 1 March 1942, established additional closed ward facilities at Valley Forge and Bush- nell (Utah) General Hospitals in the fall of 1942, and on 12 June 1943 activated Mason General Hospital in buildings ac- quired from the State of New York.38 In March 1943 Congress authorized the Veterans Administration to care for patients regardless of their “line-of-duty” status.39 Thereafter, Army hospitals en- countered less difficulty in disposing of psychotic patients, since they could trans- fer any of them to the Veterans Adminis- tration. More than a year before this Congress had taken action which might have re- sulted in delaying the disposition of pa- tients. On 12 December 1941 Congress authorized the Army to retain in its hospi- tals, rather than transfer to the Veterans Administration, patients whose terms of service had expired but who needed con- tinuing hospitalization.40 The extension of all terms of service, on the following day, for “the duration plus six months,” reduced the importance of this authorization con- siderably.41 The question remained of how long the Army would keep patients who could not be returned eventually to active duty. Wishing to free as many beds as possi- ble, The Surgeon General appealed to a policy which the Federal Board of Hospi- talization had established in 1940: the early transfer to the Veterans Administra- tion of patients who could not be salvaged for further service.42 The Wadhams Com- mittee, on the other hand, responsive per- haps to a feeling among the public that the Army should do everything possible for its sick and wounded men, recom- mended that the Army keep all patients, except those who were neuropsychiatric, until they had received maximum thera- peutic benefits.43 This might have proved embarrassing for The Surgeon General had not the Federal Board ruled, in Feb- ruary 1943, that under its 1940 resolution the decision as to when patients should be transferred to the Veterans Administration rested with The Surgeon General.44 This ruling left him free either to transfer pa- tients as soon as it was determined that they could not be returned to duty, thus saving beds for other Army patients, or to keep them for extended periods of Army hospitalization as increasing emphasis 37 (1) SG Ltrs 99, 4 Sep 42; 1, 1 Jan 43; and 6, 2 Jan 43. (2) An Rpts, 1942, Darnall, Stark, and Tilton Gen Hosps, and Sta Hosp at Cp Roberts. HD. 38 An Rpts, Hosps named above, 1942 and 1943. HD. (2) Rpt, SGs Gonf with CA and Army Surgs, 25-28 May 42. HD: 337. (3) Memo, Col H. D. Offutt for Col J. R. Hall, 22 Sep 42. SG: 632.-2. (4) Extract from 1st ind, SG to CG SOS, 15 Dec 42, on extract from Memo, CG SOS for SG, 26 Nov 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No. 22. HD. 39 (1) Public Law 10, 78th Cong, 17 Mar 43, 57 Stat 10. (2) AR 615-360, C 4, 16 Apr 43. 40 (1) Public Law 333, 77th Cong., 12 Dec 41, 55 Stat 333. (2) Ltr, Franklin D. Roosevelt to SecWar, 12 Dec 41. AG: 322.8 (9-1-34) Case 1. 41 Public Law 338, 13 Dec 41,55 Stat 338. 42 2d ind, SG to TAG, 19 Mar 42, on Ltr 220.811-1, SG to TAG, 31 Jan 42, sub: Policy Gone Discharge of Disabled EM. AG: 200.8 (8-1-34) Case 1. 43 Cmtee to Study the MD, 1942, Rpt, p. 12. HD. 44 Ltr, Chm Fed Board of Hosp to SG, 4 Feb 43, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 29. HD. 130 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR came to be placed on Army recondition- ing and rehabilitation during the later war years. Delays in the disposition of enlisted pa- tients occurred also, as in the case of offi- cers, when their organizations had moved to undisclosed destinations or when men were physically fit for only limited service at the end of treatment. Such patients were found less in station than in general hospitals, since the latter treated those who had the more serious illnesses or in- juries and required longer periods of med- ical care. Both the men whose organiza- tions had moved and those qualified for only limited service required new assign- ments. To prevent their being held in hos- pitals awaiting assignment by higher headquarters, meanwhile occupying beds needed for other patients, The Surgeon General’s Hospitalization Division recom- mended on 22 January 1942 that casual detachments be set up near all general hospitals for the immediate assignment, on a temporary basis, of all enlisted pa- tients whose hospitalization had been completed.45 Instead of approving this recommendation, the Secretary of War, on the advice of the General Staff, directed that Air Corps (after March 1942, Air Forces) enlisted patients be reassigned by the chief of the Air Corps; others, by corps area commanders.46 Two days later, after Colonel Offutt protested that this failed to solve the problem, the War Department suggested that corps area commanders furnish hospitals with blocks of available assignments or that they designate stations to which enlisted men might be sent tem- porarily, pending permanent assign- ments.47 This procedure worked well in some corps areas. In others, where corps area commanders failed to establish casual detachments under such “permis- sive regulation,” it was less successful in enabling hospitals to speed the disposition of patients.48 Other Efforts To Shorten the Period of Hospitalization The speed-up of dispositions was not the only way by which beds could be saved for patients who really needed them. The same result could be accomplished by limiting the treatment given in hospitals. During the winter of 1942-43 The Sur- geon General instituted measures of that type. Among them were the treatment of patients with uncomplicated cases of gon- orrhea on a duty status and the curtail- ment of elective operations. Although the majority of patients with gonorrhea in civilian life were treated on an out-patient basis, the Army had cus- tomarily hospitalized soldiers with that disease.49 In the fall of 1942 such patients often remained in hospitals for more than a month and, according to General Sny- der, occupied approximately 6,000 beds. During 1942, some posts in the Fourth Service Command had begun to use sul- fonamide compounds to treat patients with gonorrhea on a duty status, thus avoiding long periods of hospitalization. On 10 November 1942 General Snyder recommended the immediate considera- 45 Ltr, SG to TAG, 22 Jan 42, sub: Disposition of Pnts. SG: 705.-1. 46 (1) 1st ind AG 220.31 (l-22-42)EA, TAG to SG, 30 Jan 42, on Ltr, SG to TAG, 22 Jan 42, sub; Dispo- sition of Pnts. SG; 705.-1. (2) WD Cir 24, 27 Jan 42. 47 Ltr, TAG to CGs of all CAs, 29 Jan 42, sub: Dis- position of Pnts in Gen Hosps. AG; 322.3 Gen Hosp (l-28-42)(l). 48 (1) Ltr, Col Harry D. Offutt to Col W. H. Smith, 9 Mar 42. SG: 323.7-5 (LaGarde GH)K. (2) Rpt, SGs Conf with GA and Army Surgs, 25-28 May 42, p. 2. HD: 337. 49 Paul Padgett, The Diagnosis and Treatment of the Venereal Diseases (1948). HD. MINOR CHANGES IN HOSPITAL ADMINISTRATION 131 tion of standardizing this practice through- out the Army.50 The Surgeon General then requested the appointment of a board of medical officers to review accu- mulated experience to determine the wis- dom of extending on-duty treatment of gonorrhea patients.51 By January 1943 the board had completed its work. It recom- mended that the policy of treating patients with uncomplicated cases of gonorrhea on a duty status be encouraged, but not re- quired.52 Adoption of this policy reduced the number of patients in hospitals and thereby lessened both construction and personnel requirements.53 At the same time, to achieve the same end, General Snyder also recommended the curtailment of elective operations, such as the repair of hernias, the removal of pilonidal cysts, and the correction of internal derangements of knee joints and other preinduction disabilities.54 In con- formity with this recommendation, The Surgeon General directed hospitals to con- sider for elective operations only men who might be of definite value to the Army afterwards.55 Although this directive did not require a curtailing of elective opera- tions, some hospitals reduced the number performed.56 Later during 1943, when the manpower shortage demanded maximum use of available men, it was necessary to relax this policy.57 Early Changes in the Size and Composition of Hospital Staffs With the war making increasingly heavy demands upon the Nation’s avail- able manpower, zone of interior hospitals faced the prospect of having to function with staffs that had progressively lower proportions of Medical Corps officers and able-bodied enlisted men. Although re- ductions were carried to greater lengths during the latter part of the war, they started during its early years and the practice of replacing physicians and able- bodied enlisted men by personnel in other categories began at that time. Throughout 1942 the personnel guide that had been issued in April 1941 re- mained effective for station hospitals, and the Surgeon General’s Office instructed general hospitals to use tables of organiza- tion of corresponding numbered units as their guide.58 During the year, his Office not only revised such tables but in Decem- ber presented for Staff approval new guides for manning both station and gen- eral hospitals in the zone of interior.59 Made partly at the instance of the Gen- eral Staff as a means of reducing the Army’s requirements for physicians,60 50 Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG; 705-Hosp (A). 51 (1) 3d ind, SG to CG SOS, 24 Nov 42, on Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of Hosp Fac and their Util. IG; 705-Hosp (A). (2) Ltr, SG to CG SOS, 19 Nov 42, sub: Apmt of Bd for Investigation of Treat- ment of VD on Duty Status. Same file. 52 WD AGO Memo W40-2-43, 19 Jan 43, sub: Treatment of Individuals with Uncomplicated Gon- orrhea on a Duty Status. HD: 726.1-1. 53 An Rpts, 1942, Sta Hosps at Cp Butner and Ft Bragg. HD. 54 Ltr, Asst IG to IG, 10 Nov 42, sub; Surv of Hosp Fac and their Util. IG; 705-Hosp (A). 55 SG Ltr 167, 30 Nov 42, sub: Performance of Elective Oprs for Pre-Induction Disabilities. 56 An Rpts, 1943, Fletcher Gen Hosp and Sta Hosp at Cp Chaffee. HD. 57 SG Ltr 190, 17 Nov 43, sub: Sel of Cases for Elective Opr for Pre-Induction Disability. 58 Ltr, Col H. D. Offutt to Col E. R. Gentry, Borden Gen Hosp, 4 Nov 42. SG: 323.7-5 (Borden GH)K. 59 Incl 1, Annexes A and B, to Memo, Act SG for DepGofS WDGS thru Mil Pers Div SOS, 14 Dec 42, sub: Availability of Physicians. SG: 322.051-1. 60 Memo, ACofS G-l WDGS for SG thru Pers Div SOS, 1 Apr 42, sub; Availability of Physicians. HRS: G-l/16331-16335. For a full treatment of the question of the Army’s requirements and the availability of physicians, see John H. McMinn and Max Levin, Personnel (MS for companion vol. in Medical Dept, series), HD. 132 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Table 4—Positions and Ranks in Zone of Interior Hospitals Permitted but not Required to be Filled by Medical Administrative Corps Officers, 9 April 1941 Size of Hospital Adjutant Medical Supply Officer CO En- listed De- tachment Mess Officer Assistant Registrar ® Assistant Adjutant Assistant Medical Supply Officer Assistant CO En- listed De- tachment Assistant Mess Officer 50 & 75 Beds 2d Lt 2d Lt 1st Lt Capt Capt Capt Capt Capt 100 150 & 200 Beds 1st Lt 1st Lt 1st Lt Capt Capt Capt Capt 1st Lt 1st Lt 1st Lt Capt Capt Capt Capt 250, 300, 350, & 400 Beds. Capt Capt Capt Capt (*) (6) 500, 600, & 700 Beds 750, 800, & 900 Beds 1,000 Beds 1,500 & 2,000 Beds 1st Lt 2d Lt 2d Lt 2d Lt 2d Lt 2d Lt 1st Lt 1st Lt 1st Lt 2d Lt 2d Lt 2d Lt 2d Lt “ The registrar was required in all hospitals to be a Medical Corps officer. b The mess officer of hospitals with 1,000 or more beds was required to be a Major, Medical Corps. Source: Guide for Determination of Medical Department Personnel, C 1, MR 4-2, Hospitals, 9 April 1941. these changes were expected to lower the number of Medical Corps officers author- ized for hospitals of various sizes and to increase the use of Medical Administra- tive Corps officers in administrative posi- tions. Throughout 1942 allowances of Medi- cal Corps officers for zone of interior hospitals were considerably higher than those later prescribed in the guides. For example, on 21 October 1942 the Surgeon General’s Office informed the commander of a 1,500-bed general hospital that his allotment should consist of eighty officers of the Medical Corps, ten of the Medical Administrative Corps , and additional members of other corps.61 An allotment based on the revised table of organization for numbered general hospitals would have had 23 fewer Medical Corps officers, and one based on the December 1942 guide for named hospitals would have had 34 fewer Medical Corps officers and 13 more Medical Administrative Corps offi- cers. High allotments were somewhat off- set by the fact that in most cases the num- ber of Medical Corps officers actually assigned failed to equal the allowance. Hospital commanders therefore com- plained of shortages, but their complaints seem to have been based on this discrep- ancy alone and not on a consideration of all their resources. In addition to assigned physicians, many hospital commanders had at their disposal medical officers of units attached for training as well as those awaiting assignment in Medical Depart- ment pools. Moreover, later in the war hospitals had to get along with even fewer assigned Medical Corps officers, and as commanders continued to assert that their hospitals provided a high standard of medical care their complaints of shortages of physicians during this period should be taken at something less than face value.62 61 Ltr, Lt Col Paul A. Paden to Brig Gen R[oyal] Reynolds, Kennedy Gen Hosp, 21 Oct 42. SG; 323.7-5 (Kennedy GH)K. 62 (1) An Rpts, 1942, Chiefs Med Br SvCs, lst-9th SvCs. HD. (2) An Rpts, 1942, Lovell, Hoff, Billings, Kennedy, and Ashburn Gen Hosps, and Sta Hosps at Fts Benning and Belvoir, and Cps Adair, Lee, Bland- ing, and Chaffee. HD. MINOR CHANGES IN HOSPITAL ADMINISTRATION 133 Replacement of physicians in adminis- trative jobs by Medical Administrative Corps officers began in 1942. At the begin- ning of the war the personnel guide for named hospitals permitted but did not re- quire the use of Medical Administrative Corps officers in certain positions. (Table 4) At that time the Surgeon General’s Office apparently considered them primarily as assistants to Medical Corps officers in the more responsible administrative posi- tions.63 Early in 1942, therefore, physi- cians, sometimes with Medical Adminis- trative Corps assistants, held such positions as executive officer, registrar, adjutant, mess officer, medical detachment com- mander, and medical supply officer in many hospitals in the zone of interior. In compliance with General Staff and SOS directives,64 The Surgeon General made plans during 1942 to use Medical Admin- istrative Corps officers more widely. First he proposed to increase the supply by opening a second Medical Administrative Corps officer candidate school.65 Then in June he requested certain hospital com- manders to make studies of the positions which administrative officers could fill.66 Before such studies could be completed, a War Department directive, issued on the recommendation of SOS headquarters, ordered the commanding generals of the Air and Ground Forces and of corps areas to relieve Medical Corps officers of all duties not requiring professional medical training and to replace them with Medical Administrative Corps or Branch Immate- rial officers.67 This action left to individual commanders the decision as to which positions were suitable for administrative officers. Generally they were considered to be those of detachment commander, med- ical supply officer, adjutant, and regis- trar.68 By the end of 1942 service com- mands reported that administrative offi- cers had replaced physicians in adminis- trative positions to the extent which supply of the former permitted.69 The qualifying phrase was important, for a shortage of Medical Administrative Corps officers for use in the zone of interior existed through- out 1942 70 and their widespread substitu- 63 (1) Ltr, Act SG to the Hon D. Lane Powers, Mem of Cong, 29 Mar 41. SG: 210.2-1. (2) Ltr, Lt Col John M. Welch to Dr Wilburt C. Davison, Dean, Sch of Med, Duke Univ, 31 Jan 42. SG; 210.1-1. (3) Ltr, Col George F. Lull to Col C[harles] M. Walson, 5 Jun 42. Same file. (4) Ltr, Brig Gen Wfilliam] L. Sheep, CG Lawson Gen Hosp to Col H. D. Offutt, 12 Feb 42. SG; 323.7-5 (Lawson GH)K. 84 (1) Memo, ACofS G-l WDGS for SG thru Pers Div SOS, 1 Apr 42, sub: Availability of Physicians. (2) Memo, AGofS G-l WDGS for Pers Div SOS, 9 May 42, same sub. (3) Memo, CG SOS for SG, 22 May 42, same sub. All in HRS; G-1/16331-16335. 65 (1) Ltr, SG to Pers Sec SOS, 26 May 42, sub: Procurement Objective, MAC. (2) Memo, CG SOS for CofSA, 29 May 42, sub: Increase in Procurement Objective, MAC, with 2d ind, SG to Chief Pers Serv SOS, 6 Jun 42. (3) Memo, CG SOS for CofSA, 5 Jun 42, same sub. (4) Ltr, TAG to SG, 13 Jun 42, same sub. All in AG: 210.1(l-14-42)(2) Sec 2A. 66 Memo, SG for COs Sta Hosps at Sheppard Fid, Fts Lewis, Ord, Sam Houston, Leonard Wood, Devens, Indiantown Gap Mil Res, Cp Lee, and Fitz- simons, Army and Navy, Wm. Beaumont, Walter Reed, and Lawson Gen Hosps, 29 Jun 42, sub: Con- servation of Available MG Offs. SG: 322.051-1. Ltr, TAG to CGs AGF, AAF, all GAs, 13 Jul 42, sub; Relief of MG Offs from Duties Which Do Not Require Professional Med Tng. AG: 210.31(7-10- 42)(4). 68 (1) Ltr, CG 8th CA to TAG, 22 Jul 42, sub: Re- lief of MG Offs. AG; 210.31 (7-10-42)(4). (2) Memo, SG for Dir Mil Pers SOS, [10 Oct 42]. SG: 322.051-1. (3) Ltr, Lt Gol J[ames] R. Hudnall, SGO to Lt Col Arthur J. Redland, 5th SvC, 10 Aug 42. SG; 320.3-1 (5th SvC). 69 (1) Rpt, Conf of CGs SvCs [SOS], 2d sess, 17 Dec 42, pp. 19, 33, 96. HD: 337. (2) An Rpts, 1942, Chief Med Br (Surg) 3d and 9th SvCs. HD. 70 (1) Ltr SPMCQ 322.056.-1, SG to TAG, 28 Sep 42, sub: Increase in Procurement Objective AUS for Duty with MAC (SG). AG: SPGA 210.1 Med 1-20. (2) Memo, SG for Dir Mil Pers SOS [10 Oct 42], SG; 322.051-1. (3) Ltr SPMCM 210.1-1, SG to Dir Mil Pers SOS, 13 Oct 42, sub: Procurement Objective, MD. AG; SPGA 210.1 Med 1-20. (4) Memo, Lt Gol 134 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR tion for Medical Corps officers remained to be carried out during the later war years. Changes in the composition of the en- listed staffs of hospitals were more general. Experience in the employment of civilians had already demonstrated that able- bodied enlisted men could be replaced by personnel of other types. During the first year and a half of the war the practice of substitution was extended. Limited service enlisted men (that is, those with physical defects which disqualified them for service with the field forces) and Women’s Army Auxiliary Corps enlisted women were added to civilians as replacements for enlisted men who were physically qualified for general service. Early in 1942 hospital commanders often had fewer enlisted men than they considered desirable, and the Surgeon General’s Office reported continual short- ages for Medical Department activities. Large numbers were needed for the many new hospitals opening in the zone of inte- rior. Units going overseas had to have full complements and hospitals called upon to supply them often had difficulty securing replacements.71 In July SOS headquarters issued a directive, recommended by the Surgeon General’s Office, to give such hospitals priorities on replacement requisi- tions.72 About the same time it announced that the Army would begin in August to induct limited service men and assign them directly to hospitals and other zone of interior installations.73 These measures were apparently helpful, for by the end of 1942 many hospitals reported that their allotments were full.74 Even so, a few com- manders complained of shortages,75 but generally, complaints were less of short- ages than of difficulties in using limited service men and civilians. Hospitals had had experience with lim- ited service enlisted men as early as December 1941, when the War Depart- ment began to transfer physically unfit men from field force units to zone of inte- rior installations.76 At first hospitals ab- sorbed men of this type readily because they were few in number and were used to fill vacancies, supplementing existing forces of able-bodied men. Gradually it became the practice to withdraw able- bodied men from hospital staffs for service with field forces and to use limited service men not as supplements but as substitutes for them.77 As this happened hospital commanders encountered difficulties. The 71 (1) Memo, SG for Dir Mil Pers SOS [10 Oct 42]. SG: 322.051-1. (2) DF WDGAP 322.051, ACofS G-l WDGS to SG thru Mil Pers Div SOS, 28 Oct 42. Same file. (3) Rpt, SGs Conf with CA and Army Surgs, 25-28 May 42, pp. 20, 31. HD; 337. (4) An Rpts, 1942, Chief Med Br 2d and 5th SvCs. HD. 72 Ltr SPX 220.31 (7-1 1-42)EG-SPMCP-PS-M, CG SOS to CGs SvCs and GGs Gen Hosps, 28 Jul 42, sub: Filler Repls for Units Ordered Overseas. SG: 220.31- 73 SOS Cir Ltr 25, 10 Jul 42, sub: Asgmt of Limited Serv EM. SG: 220.31-1. 74 An Rpts, 1942, Floff, Ashford, Billings, Lovell, Tilton, Hammond, Bushnell, Torney, O’Reilly, and Lawson Gen Hosps and Sta Hosps at Gps Wheeler, Murphy, Young, Croft, Roberts, Chaffee, McCoy, Sheppard Fid, and Fts Knox and Riley. HD. 75 An Rpts, 1942, Sta Hosps at Jefferson Bks and Cp Lee. HD. 76 Ltr AG 220.31 (12-18-41)EA-A, TAG to all Army, CA, and Exempted Sta Comdrs other than AC and G of Armored Force, 23 Dec 41, sub: Clearing Fid Force Units of Pers not Physically Qualified for Fid Serv. SG: 220.31-1. 77 (1) SOS Cir 13, 12 May 42, sub: Absorption of Limited Serv Pers in Overhead Instls of SOS. AG: 220.3(12 May 42)(2). (2) WD Memo W615-3-42, 17 Aug 42, sub: Asgmt of Limited Serv Pers. HD: 220.31- (3) Ltr AG 220.31 (4-5-43)PE-A-SPOA, CG ASF to C of Tec Servs, 7 Apr 43, sub: Util of Limited Serv Pers. Same file. Basil C. MacLean for Gen Bliss thru Col Schwichten- berg, 6 Nov 43, sub: Observations Based on Recent Visits for Varying Periods to Nine Gen Hosps. SG: Gen Bliss’s Off files, “Util of MCs in the ZI” (19) # 1. MINOR CHANGES IN HOSPITAL ADMINISTRATION 135 field forces tended to place “problem” men in the limited service category and to promote others just before transfer—ac- tions bound to create morale problems for receiving hospitals.78 Moreover, limited service men were often unable to do a full day of hard work, and hospitals—operat- ing around the clock—found it difficult to assign all of them to special jobs within their physical limitations. Of equal impor- tance, such men had often had no Medical Department training. Hospitals therefore had to maintain continuous training pro- grams for newcomers. Even so they could not always train enough technicians, for in many instances physical incapacity hap- pened to be coupled with low mentality and little education.79 By the end of 1942 this problem had become so serious that The Surgeon General sought a commit- ment from SOS headquarters to assign to the Medical Department greater numbers of limited service men of good caliber.80 Failing in this, he resorted to the establish- ment in April 1943 of special regiments to train whatever limited service men the Medical Department might receive.81 As limited service men came to consti- tute a larger part of the enlisted force, hos- pitals gradually began to think of civilians as supplementing rather than replacing enlisted men. By the end of 1942 many hospitals with full complements of enlisted men also had sizable numbers of civilian employees. In recruiting civilians, hospital commanders encountered the same prob- lems they had experienced in 1941. In addition, they found it increasingly diffi- cult to maintain stable civilian forces. As able-bodied civilian employees were in- ducted into the armed services, they had to be replaced by women and elderly or physically-handicapped men. Even the widespread use of civilians of these types failed to bring stability, for they left hospi- tals in growing numbers to take better paying jobs elsewhere. Competition with war industries and other government agencies was keen and hospital wage- scales were frequently lower than those prevailing in surrounding areas. As a re- sult, hospital commanders found the use of civilians “very vexatious, time consum- ing, and expensive,” 82 and by the end of 1942 some of them began to think it would be better to replace civilians with limited service men, however unsatisfactory, or with members of the Women’s Army Aux- iliary Corps.83 When the question of using Waacs in Army hospitals was first raised in the spring of 1942, The Surgeon General ex- pressed opposition because, he said, their use would conflict with civilian personnel employment, would interfere with train- ing of enlisted men, and would create diffi- 78 (1) Ltr AG 220.31 (4-1-42)EA-A, TAG to CG AGF, CGs Eastern, Western, Southern, and Central Def Comds, and all CA Comdrs, 2 Apr 42, sub: Clear- ing Fid Force Units of Pers Not Physically Qualified for Fid Serv. SG: 220.31-1. (2) Ltr AG 220.31(7-2- 42), TAG to CGs AGF, AAF, SOS, etc., 14 Jul 42, same sub. Same file. 79 (1) An Rpts, 1942, Sta Hosps at Ft Knox, Gps Roberts, Bowie, Maxey, Chaffee, Atterbury, Lee, Wolters, Forrest, and Hoff and Tilton Gen Hosps. HD. (2) An Rpts, 1942, Chiefs Med Br 1st, 2d, 3d, and 7th SvCs. HD. 80 (1) Memo, SG for Dir Mil Pers SOS thru Dir Tng SOS, 3 Dec 42, sub: Asgmt of Class I and Class II Limited Serv Pers to MRTCs. SG: 220.31-1. (2) Memo SPGAE/220.3( 12-3-42)-132, Dir Mil Pers SOS for SG, 10 Dec 42, same sub. Same file. 81 Ltr, CG ASF per SG to CGs MRTCs, MDETS, etc., 16 Apr 43, sub; Util of Limited Serv Pers. HD: 220.31-1. 82 Ltr, CO LaGarde Gen Hosp to Col G[eorge] F. Lull, SGO, 28 Dec 42. SG: 323.7-5(LaGarde GH)K. 83 The above paragraph is based on: An Rpts, 1942, Ashford, Billings, Bushnell, Hoff, Percy Jones, Tilton, and Torney Gen Hosps, and Sta Hosps at Ft Riley, and Gps Atterbury, Blanding, Chaffee, Croft, Howze, Lee, Maxey, Roberts, Wheeler, Wolters, and Young. HR 136 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR culties centering around housing and recre- ation.84 During 1942, as civilians became increasingly hard to get and keep and as limited service men replaced those quali- fied for overseas service in growing num- bers, the idea gradually gained currency among hospital commanders, service com- mand surgeons, and members of the Sur- geon General’s Office that Waacs, who could not leave their jobs and who had sufficient ability and education to absorb technical training, were a “better bet” than either civilians or limited service en- listed men,85 Meanwhile, as plans were made to expand the women’s corps, both the War Department General Staff and SOS headquarters put pressure on all of the services, including the Medical De- partment, to use Waacs extensively to release men for combat duty.86 About the same time, the Wadhams Committee rec- ommended their employment in hospi- tals.87 Accordingly, early in 1943 the Sur- geon General’s Office began to plan for their assignment to Medical Department installations. At first The Surgeon General decided to conduct experiments at Halloran (New York) and Valley Forge (Pennsylvania) General Hospitals to see what jobs Waacs could fill.88 Failing to obtain WAAC units for this purpose, on 26 January 1943 he appointed a board of officers, composed of the chief of his Hospitalization Division and members of the Personnel and Train- ing Divisions, to study the problem. Soon afterward he requested reports from serv- ice commands, the Air Forces, the Trans- portation Corps, and the Army Medical Center on hospital jobs which Waacs could fill, the numbers needed, and the con- struction required to house them.89 From these surveys The Surgeon General’s board found that the Air Forces planned to use Waacs in all hospitals having 200 or more beds and that the commanders of SOS hospitals having 500 or more beds felt that they could use them to replace from 30 to 50 percent of their enlisted men. Not all hospital commanders, it should be noted, were enthusiastic about using Waacs, their attitudes depending to a large extent upon what General Grant, the Air Surgeon, called the “personal equation.” 90 The board estimated that 84 Memo, Lt Col Gilman G. Mudgett, SOS for SG, 3 1 Mar 42, sub: Possible Use of Mems of the WAAC in Army Hosps, with 1st ind, SG to CG SOS, 14 Apr 42; and 2d ind SPTRS 290 (WAAC)(3-21-42), CG SOS to SG, 29 Apr 42. SG: 322.5-1 (WAG). 85 (1) Ltrs, CO LaGarde Gen Hosp to Col H. D. Offutt, SGO, 21 and 29 Sep 42, and to Col G. F. Lull, SGO, 28 Dec 42. SG: 323.7-5 (LaGarde GH)K. (2) An Rpts, 1942, Cp Howze and Sheppard Fid Sta Hosps, and Chief Med Br 3d SvC. HD. (3) Ltr, CO Valley Forge Gen Hosp to SG, 19 Jan 43, sub: Re- quest Allocation and Asgmt of a WAAC Unit, with 1st ind. SG; 322.5-1. (4) Ltr, Col G. F. Lull, SGO to Col W. H. Smith, LaGarde Gen Hosp, 5 Jan 43. SG: 323.7-5(LaGarde GH)K. (5) Ltr, Lt Col D[aniel] J. Sheehan, SGO to Brig Gen James E. Baylis, CG MRTG, Cp J. T. Robinson, Ark, 22 Feb 43. HD: 220.31-1. 86 (1) Memo S635-2-42, 22 Oct 42, sub; Asgmt of WAAC. AG; 320.2(10-l-32)(3) Sec 16. (2) Memo, CG SOS for C of Sup and Admin Servs, 22 Oct 42, sub: Data for Study on Use of WAAC. Same file. 87 Extracts from Memo, CG SOS for SG, 26 Nov 42, and from 2d ind, CG SOS to SG, 21 Dec 42, in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 88. HD. 88 (1) Extract from 3d ind, SG to CG SOS, 16 Jan 43, on extract from Memo, CG SOS for SG, 26 Nov 42. (2) Extract from 1st ind, SG to CG SOS, 8 Mar 43, on extract from Memo, GofS SOS for SG, 26 Feb 43. Both in Cmtee to Study the MD, 1942-43, Actions on Recomd, Recomd No 88. HD. 89 (1) SG OO 41, 26 Jan 43. (2) Memo, CG SOS per SG for CG 1st SvC, attn Chief Med Br, 29 Jan 43, sub: Employment of WAAC in Sta and Gen Hosps, ZI. FID: 322.5-1. The same letter was sent to all Serv- ice Commands. (3) Memos, SG for CG AAF, MDW and AMC, and for CofT, 3 Feb 43, same sub. Same file. 90 1st ind, CG AAF per Air Surg to SG, 26 Feb 43, on Memo, SG for CG AAF attn AF Surg, 3 Feb 43, sub: Employment of WAAC in Sta and Gen Hosps, ZI. SG: 322.5-1. MINOR CHANGES IN HOSPITAL ADMINISTRATION 137 more than ten thousand Waacs would be needed for hospitals and in March 1943 recommended that WAAC headquarters be asked what number they could sup- ply.91 The Surgeon General then sent each service commander a tabulation of Waac requirements for hospitals in his com- mand, for inclusion in the Waac requisi- tion which it was anticipated SOS head- quarters would require each to submit.92 Soon afterward, Waac recruiting collapsed and WAAC headquarters could promise The Surgeon General, on 2 June 1943, only 150 to 170 women for training each month, beginning in September 1943.93 The extensive use of Waacs in hospitals therefore had to wait. Problem of Furnishing Supplies and Equipment for Hospitals Providing sufficient medical supplies and equipment for large numbers of new station and general hospitals, and for old hospitals that were expanding with un- precedented rapidity, as well as for dispen- saries, infirmaries, induction stations, and medical units destined for overseas service, presented the Medical Department a problem of great magnitude.94 It was par- tially simplified by the practice of issuing hospital assemblages as single items. Using equipment lists prepared during the emer- gency period, medical depots packed assemblages which included, within the limits of supplies and equipment available, all items needed to establish hospitals of various sizes and kinds, ranging from 25-bed station hospitals to 1,000-bed gen- eral hospitals. As new hospital plants were constructed the Surgeon General’s Office had assemblages of appropriate sizes shipped to them. As established hospitals were expanded, local medical supply offi- cers requisitioned standard assemblages to fit their needs.95 This system not only saved time and personnel that would have been required to list the manifold items re- quired for each hospital but also relieved local supply officers, many of whom were unacquainted with tables of equipment and inexperienced in estimating hospital needs, of the necessity of determining what items would be required for hospital expansions. Changes in the requisitioning procedure used by hospitals to meet recurrent oper- ational needs became imperative as soon as the wartime expansion began. Before the war, hospitals were permitted to make only quarterly and emergency requisi- tions, all of which had to be reviewed by corps area surgeons before being sent to depots for filling. To enable hospitals to meet urgent needs that resulted from rapid expansions, as contrasted with emer- gency needs that could not be foreseen, The Surgeon General early in January 1942 permitted the submission of “special” requisitions at any time.96 To eliminate an unnecessary step and thus speed the requi- sitioning process, he began a system of 91 Rpt of Proceedings of Bd of Offs, n d, incl 4 to Memo, SG for Planning Serv WAAC Hq, 13 Mar 43, sub: Util of WAAC in MD. HD: 322.5-1. 92 Memo, CG SOS per SG for CG 3d SvC, 27 Mar 43, sub: Employment of WAAC in Sta and Gen Hosps, ZI. HD; 322.5-1. 93 (1) Memo, SG for CG ASF, 2 Jun 43, sub; Tec Tng for WAAC Pers. HD: 322.5-1. (2) Mattie E. Treadwell, The Women’s Army Corps, Ch. XIX. 94 Except where otherwise noted, this section is based on Richard E. Yates, The Procurement and Distribution of Medical Supplies in the Zone of the Interior during World War II (1946), pp. 169-87. HD. 95 (1) Ltr, SG to MD Depots, 2 Feb 42, sub: Med Depot Program for 1942. SG; 475.5-1. (2) SG Ltr 141, 2 Nov 42, sub: MD Equip Lists. (3) SG Ltr 156, 24 Nov 42, sub: Sup Policies and Procedures, ZI Instls. 96 SG Ltr 2, 8 Jan 42, sub; Requisitions. 304244 0—55 11 138 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR direct supply on 10 February 1942. After that date hospital medical supply officers could submit requisitions directly to depots, without corps area intervention.97 In the early months of the war, the Medical Department continued to be handicapped by a shortage of many items. As a result, depots found it necessary to ship incomplete assemblages and partially filled requisitions. Missing items were placed on back order, to be shipped when available. Among the items which hospi- tals most frequently failed to receive were dental supplies and equipment, surgical instruments and operating room equip- ment, laboratory equipment, X-ray devel- oping-tanks and cassettes, hospital furni- ture including beds, and food carts. New hospitals suffered most from these short- ages. In a few instances the receipt of incomplete assemblages delayed their opening or the opening of some of their clinics and wards. When hospitals opened with incomplete equipment they usually had to send surgical patients to near-by hospitals and have dental, laboratory, and X-ray work done elsewhere. To make up for shortages that continued to exist, they resorted to borrowing, improvising, and purchasing in the open market. Some bor- rowed beds from the local quartermaster and such items as X-ray developing-tanks, cassettes, and food carts from other Army hospitals or from Veterans Administration facilities. Others improvised X-ray devel- oping-tanks and food carts. Many had their own “utilities” personnel build miss- ing items of hospital furniture. Sometimes, when money was available, hospitals pur- chased necessary supplies on the local market. In some instances, officers used their own instruments and in one case, where there was a shortage of typewriters, civilian typists were required to provide their own. While these shortages undoubt- edly taxed the ingenuity of hospital com- manders and operating personnel, they failed, apparently, to affect medical care adversely, for hospital commanders seemed able to arrange for the use of local civilian or near-by Army facilities without undue difficulty.98 In the latter part of 1942 The Surgeon General intensified his efforts to solve medical supply problems. Most measures taken toward that end, such as the im- provement of depot operations, are out- side the scope of this study. Two deserve consideration here. The requisition system was completely revised and placed on a monthly basis, effective 1 January 1943. After that date hospitals submitted sepa- rate monthly requisitions for standard- expendable, standard - nonexpendable, and nonstandard items. They could still submit “special” and emergency requisi- tions.99 Concurrently, the stock-control system was revised. The system formerly in effect had permitted hospitals to keep large stocks on hand and had not required accurate “due in” records. As a result some hospitals held in storage items that were needed by others, and medical sup- ply officers often did not know which items of their requisitions remained to be shipped by depots. In the fall of 1942, therefore, the Surgeon General’s Office established lower stock levels and devised a new stock- 97 SG Ltr 11,10 Feb 42, sub: Direct System of Sup for Posts, Gps, and Stas. 98 The above paragraph is based on information in the following: An Rpts, 1942, Chiefs Med Br 1st, 3d, 4th, 5th, 6th, 7th, and 9th SvCs; Ashford, Bushnell, Billings, Deshon, Harmon, Hoff, and Percy Jones Gen Hosps; and Sta Hosps at Fts Belvoir and Bliss, Shep- pard Fid, and Gps Adair, Atterbury, Butner, Cooke, Howze, Maxey, and McCoy. HD. 99 SG Ltr 156, 24 Nov 42, sub; Sup Policies and Procedures, ZI Instls. MINOR CHANGES IN HOSPITAL ADMINISTRATION 139 record card for posts and general hospitals. These changes not only produced better supply administration but also released large amounts of supplies and equipment for redistribution to hospitals suffering from shortages.100 The combination of measures begun in 1942, along with com- pletion of the hospital expansion program during 1943, resulted in a greatly im- proved supply situation. During the rest of the war hospitals and service command surgeons reported generally that requisi- tions were promptly filled and that the supplies and equipment which they re- ceived were of good quality and of suffi- cient quantity to meet their needs.101 100 For example, see the following: An Rpts, 1943, Surg 7th SvC, and Sta Hosps at Gps Lee and Maxey. HD. 101 (1) Memo, Dir Sup Planning Div SGO for Act Chief, Sup Serv SGO, 22 Dec 43, sub: Rpt of Visits to Hosp Instls. SG; 333.1-1. (2) Memo, Dir Distr and Reqmts Div SGO for Mr. Edward R. Reynolds, 20 Jan 44, sub: Data for Inclusion in . . . Rpt on Ac- complishments of SGO. SG; 024.-1. (3) An Rpts at random; for example, An Rpts, 1943, Hoff, Percy Jones, Ashford, and Dibble Gen Hosps; An Rpts, 1944, Surg 2d, 5th, and 9th SvCs, and Beaumont, Baker, Birmingham, and Lovell Gen Hosps; An Rpts, 1945, Surg 2d SvC, and Beaumont and Birmingham Gen Hosps. HD. CHAPTER VIII Providing Hospitalization for Theaters of Operations In the first year and a half of the war the Medical Department had to provide hospitalization for reinforced garrisons in overseas departments and bases, for new forces sent to hold lines of supply and communication throughout the world, and for task forces engaged in the first de- fensive-offensive operations against the enemy. Meanwhile it had to organize, train, and equip other units for use when the Army should become engaged in full- scale offensives. Early in 1942 the Pacific held first claim on hospital units sent overseas. In the summer emphasis shifted to Europe and North Africa, and there- after hospitals went to those theaters in in- creasing numbers. By the latter part of the year, after emergency shipments had been made, it was possible to take stock of hospitalization already furnished to the- aters with a view to establishing a basis for further planning. Meeting Early Emergency Needs Status of Hospital Units and Assemblages When the Japanese struck Pearl Har- bor the Medical Department had 22 gen- eral, 24 station, 17 evacuation, and 8 surgical hospital units that had been acti- vated as training units. Of these, 3 station hospitals were already overseas and 9 sta- tion, 12 general, 4 evacuation, and 3 surgical hospital units included in the War Department pool of task force units were authorized almost 100 percent of their table-of-organization enlisted strength and from 50 to 75 percent of their commissioned strength. The rest had half or less than half of their enlisted strength and from three to five officers each. In addition to the training units, affiliated hospital units consisting chiefly of professional commissioned personnel— doctors and nurses—had been organized (but not activated) as follows: 41 general, 11 evacuation, and 4 surgical hospitals. Under prewar plans, it will be recalled, affiliated units were to be called to active duty as needed immediately upon the outbreak of war, were to be supplied with enlisted personnel, and were then to go into service without further ado.1 Accord- ing to a report of The Surgeon General in November 1941, hospital assemblages had already been issued to 3 station and 2 evacuation hospital units; while assem- blages for 2 general, 11 station, 4 evacua- tion, and 3 surgical hospital units were packed and ready for immediate issue from depots, and those for 10 general, 9 1 See above, pp. 5-6, 40. HOSPITALIZATION FOR THEATERS OF OPERATIONS 141 station, 17 evacuation, and 5 surgical hos- pital units were being packed but were not yet ready for issuance.2 Plans for Meeting Emergency Needs Early in January 1942 The Surgeon General outlined to G-3 the system he wished to use in meeting emergency needs. Affiliated units would be called to active duty and each would receive approxi- mately one half of its authorized enlisted strength from a training unit. The rest of its personnel would be supplied by recep- tion centers, zone of interior installations, and other medical units. Each training unit which transferred personnel to an affili- ated unit would retain a cadre, in order to train additional “fillers” for other affili- ated units. Some training units, especially station hospital units, would be sent over- seas as needed, having first been brought to authorized strength with both enlisted and commissioned personnel transferred from other medical units or installations. Each unit would draw individual equip- ment, clothing, and motor transport at its home station. Only those going overseas would receive hospital assemblages, pref- erably at ports of embarkation.3 Soon after he had proposed this system The Surgeon General realized that modi- fications would be necessary. The activa- tion of training units at reduced strength, a policy adopted on his recommendation in 1941, resulted in the hurried assembly, often at ports of embarkation, of addi- tional personnel to make up the other half of a unit. Members of units going overseas therefore frequently had little time to become acquainted with one another’s capabilities before embarkation. Installations from which “fillers” were drawn suffered from resulting personnel and training problems. To obviate these difficulties The Surgeon General recom- mended in February 1942 that all train- ing units be activated at full table-of-or- ganization enlisted strength.4 He received the support in March 1942 of the SOS Hospitalization and Evacuation Branch and in April of AGF headquarters. In May G-3 approved the proposal.5 The Surgeon General secured only par- tial approval of his stand in opposition to the issuance of hospital assemblages be- fore the departure of units for theaters. After completing a survey of storage space in corps areas, G-4 in December 1941 dis- approved a request that General Magee had made in November to hold assem- blages in depots until units were assigned missions involving medical care.6 General Magee then sought approval of his posi- tion in a personal conference with General Somervell, who was at that time the As- sistant Chief of Staff, G-4. On the basis of his understanding of the agreement reached then, General Magee resubmit- ted his request.7 Instead of approving it, 2 Ltr, SG to TAG, 5 Nov 41, sub: Equip for Med Units in WD Pool of Task Forces. SG: 475.5-1. :i Memo, SG for AcofS G-3 WDGS, 13 Jan 42, sub: Activation . . . Med Units, with incls. HD: 326.01-1. 4 (1) Memo, Act SG for ACofS G-3 WDGS, 28 Feb 42, sub: Orgn and Dispatch of MD TofOpns Units. SG: 322.3. (2) An Rpts, 1942, of following Gen Hosps: 2d, 30th, 42d, 105th, 118th, and 210th, and of follow- ing Sta Hosps; 10th, 12th, 13th, 17th, 151st, 166th, and 172d. HD. 5 (1) Memo G-4/24499-178, Maj William L. Wil- son for [Lt] Gen [LeRoy] Lutes, 12 Mar 42, sub: Basic Plans for Hosp and Evac. HD; Wilson files, “No 472, Hosp and Evac, 1941-42.” (2) Ltr, CG AGE for CG SOS, 23 Apr 42, sub: Auth of Grades and Ratings for MD Tactical Hosp. AG: 221(7-1-41) Sec 1H, Pt 1. (3) Ltr, TAG to CGs AGE, AAF, SOS, Armored Force, etc., 6 May 42, same sub. Same file. 6 D/S G-4/31793, ACofS G-4 WDGS to SG, 31 Dec 41, sub: Comments on Draft of Ltr, ‘Current Pol- icies and Procedures for . . . Sups.’HD: 475.5-1. 7 Memo, SG for ACofS G-4 WDGS, 10 Jan 42, sub: Equip for Numbered Hosps. HD: 475.5-1. 142 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR as The Surgeon General had expected, G-4 now proposed a compromise. Unit assemblages would be declared controlled items. As such, they would not be issued through corps areas to units upon requisi- tion but would be issued directly as the War Department determined. Mean- while, The Surgeon General would make fractional issues of unit equipment for training purposes.8 Although he concurred in this compro- mise, officially published on 21 January 1942,9 The Surgeon General did not give up hope that he could continue to hold unit assemblages in medical depots until numbered hospitals were assigned opera- tional missions. Once they were declared controlled items, the most practical meth- od of achieving this end would be to se- cure War Department agreement not to require their issuance prior to that time. This might be done indirectly. Conse- quently, on 24 January 1942 The Surgeon General requested G-4 to include in movement orders for numbered hospital units ordered overseas a paragraph direct- ing The Surgeon General to ship appro- priate assemblages to ports of embarka- tion or staging areas. On 6 February 1942 G-4 approved this recommendation.10 As will be seen later, neither the 21 January 1942 compromise nor the approval of the inclusion of a paragraph in movement or- ders settled the controversy over the issu- ance of equipment. Methods of Meeting Emergency Needs In defense areas—the Atlantic bases, the Panama Canal Zone, Alaska, and Hawaii—where hospitals already existed, the hospital situation was serious though not critical. To meet emergency needs ex- isting facilities could be expanded and ad- ditional “provisional” hospitals could be established by spreading thin the person- nel and equipment already available. Army patients could also be hospitalized in civilian institutions wherever they were available.11 Hence few hospital units went to those areas in the first few months fol- lowing Pearl Harbor. Between 1 January and 30 June 1942, 2 general hospitals were sent to the Panama Canal Zone and 3 general and 4 station hospitals to Hawaii to supplement existing and impro- vised hospitals in those areas.12 In addi- tion, troops sent to garrison new bases in- cluded medical detachments to operate the hospitals needed for their care,13 but the more pressing needs of other areas generally took precedence in the shipment both of numbered hospitals and supple- mentary personnel and equipment.14 Troops deployed to protect shipping lanes and to hold the enemy while prepa- rations for the offensive went forward re- 8 Memo for Record on D/S, AGofS G-4 WDGS for TAG, 16 Jan 42, sub: Equip for MD Units, and on Memo, Chief Planning Br G-4 WDGS for Brig Gen B. B. Somervell, 16 Jan 42, same sub. HRS: G-4/33344. 9(1) Memo, SG for AGofS G-4 WDGS, 17 Jan 42. SG: 475.5-1. (2) Ltr AG 400 (1-16-42)MD- D-M, TAG to SG, 21 Jan 42, sub: Equip for MD Units. HRS: G-4/33344. 10 (1) Memo, SG for AGofS G-4 WDGS, 24 Jan 42, sub: Proposed Modification of Mvmt Orders. SG: 475.5-1. (2) D/S, AGofS G-4 WDGS for TAG, 6 Feb 43, same sub. HRS: G-4/33344. 11 An Rpt, Med Activities Newfoundland Base Comd, 1942; An Rpt, Med Activities Surg Trinidad Sector and Base Comd, 1942; An Rpt, Dept Surg Panama Canal Dept, 1942; An Rpt, MD Activities Hawaiian Dept, 1942, sec I. HD. 12 Ltr AG 221(1-31-42)EA-C, TAG to CG Hawai- ian Dept, 18 Feb 42, sub; Grades and Ratings, MD, Hawaii. SG: 320.2-1 (Hawaiian Dept) AA. 13 An Rpt, Med Activities US Army Force, Aruba, NWI, 1942, and Hist Record, US Army MD in Greenland, Jul 41-Feb 43. HD. 14 Paraphrase of Rad AG 320.2(1-12-42) MSC-A, TAG to CG Hawaiian Dept, 14 Jan 42. SG: 320.2-1 (Hawaiian Dept)AA. HOSPITALIZATION FOR THEATERS OF OPERATIONS 143 quired hospitalization in areas that had no American facilities. The greatest im- mediate need was in the South and South- west Pacific. During the period from ,1 January to 1 July 1942, inclusive, 2 evacu- ation, 2 surgical, 4 general, and 14 station hospitals were sent to Australia; 2 evacu- ation, 2 general, and 2 station hospitals to islands in the South Pacific; and 2 station hospitals to islands other than the Ha- waiian group in the Central Pacific. Dur- ing the same period, 1 general and 1 sta- tion hospital went to Northern Ireland, a general hospital to Iceland, and 2 general and 3 station hospitals to England. In May and June 1942, hospitals were sent also to India, to care for troops engaged in supply and service activities there, and to Northwest Canada, to care for those who were helping to build the Alcan highway. Meanwhile other hospital units were be- ing earmarked for task forces, especially for the Gymnast (North Africa), Magnet (Northern Ireland), and Bolero (Eng- land) operations. These demands drew heavily upon available units and assem- blages and sometimes made it impossible for The Surgeon General and OPD to meet without modification requests of theater commanders.15 (Tabled) In sending numbered hospital units overseas, The Surgeon General departed from prewar plans, using training units as well as affiliated units. This was caused in part by the character of the war. Station hospitals, for which no affiliated units had been organized, were needed for defense forces sent out early in 1942 more than were surgical, evacuation, and general hospitals. Moreover, the earmarking of some affiliated hospitals for task forces that were formed early but sent out later, or not at all, may have tied up enough affiliated units to require the use of train- ing units in meeting overseas needs be- tween Pearl Harbor and 2 July 1942. At any rate, all station hospitals and the two surgical hospitals dispatched during this period were nonaffiiliated units. Of the thirty-seven station hospitals sent out, sev- enteen had been activated during 1941 and the rest after war began. Both surgi- cal hospitals were nonaffiliated units that had been activated in 1941. Of the fifteen general hospitals shipped, nine were affili- ated units supplied (except for one) with enlisted personnel from training units ac- tivated during 1941. The remainder were nonaffiliated training units activated in 1941. Of the 4 evacuation hospital units sent out, 2 were affiliated units and 2 were nonaffiliated units activated in 1940 and 1941. Thus the prior activation and train- ing of normal Army units proved more valuable in meeting emergency hospital needs than did the formation and organi- zation of units affiliated with civilian hos- pitals or schools. Modification of Hospitals for Overseas Areas Development of NewTypes of Units Early in the war it was necessary to de- velop new types of hospitals to meet the needs of island-type warfare and of mo- torized operations on land. Experience in planning hospitalization for the earliest task forces and garrisons for islands in the 15 (1) Memo, Lt Col A[rthur] B. Welsh for Brig Gen L[arry] B. McAfee, 1 Apr 42. HD; Welsh Plan- ning file. (2) Memo for Record on IAS, 5 Apr 42, sub: Hosp Units for SUMAC [Australia] and SPOONER [New Zealand], HRS: WPD 704.2(3-9-42). (3) Memo, Maj A. B. Welsh for Gen Magee, 23 Jan 42, sub: Status of Hosp Units. HD: 320.2 (Trp Basis). 144 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Table 5—Hospital Units Shipped Over- seas, 7 December 1941 to 1 July 1942 Pacific revealed the need for hospitals that were smaller and more mobile than the only hospital available for that pur- pose—the 250-bed station hospital. As a result, the Surgeon General’s Office and the medical section of General Headquar- ters collaborated in developing a new type of hospital, called the field hospital, in the first months of 1942. When G-4 called upon the Surgeon General’s Office to de- velop an “island-type hospital,” the latter submitted the table of organization for this unit. The General Staff approved the table and it was published on 28 February 1942.16 The field hospital had a headquarters and three hospitalization units. Each of the latter could operate independently with a capacity of 100 beds. As a single unit the hospital could care for 380 pa- tients. Staffed to care for minor ills and in- juries and equipped to function in the field under tents, the field hospital or any one of its hospitalization units could serve as a fixed hospital on islands, in other iso- lated areas, or at air bases distant from other facilities. Having sufficient trans- portation to move its own personnel and equipment, any unit of the hospital, when reinforced with surgical personnel, could be used as a mobile hospital to support ground troops in combat or task forces in landing operations. In addition, the field hospital or any of its units, The Surgeon General asserted, could be readily trans- ported by air—an assertion supported by Unit No. of Beds Date of Ac- tivation Date of Em- barkation Destination General Hospitals -2d 1,000 31 Jan 42 1 Jul 42 England - 4th 1,000 13 Jan 42 23 Jan 42 Australia “ Sth 5 00 3 Jan 42 19 Feb 42 N. Ireland b « 18th 500 20 Apr 42 26 May 42 New Zealand “ 30th 1,000 IS May 42 4 Jun 42 England ° 42d 500 20 Apr 42 19 May 42 Australia “ 105th 1,000 20 Apr 42 19 May 42 Australia » 118th 500 21 Apr 42 19 May 42 Australia » 142d 500 20 Apr 42 26 May 42 New Zealand 147th 1,000 1 May 41 16 Jun 42 Hawaii 148th 1,000 10 Feb 41 21 Mar 42 Hawaii 204th 1,000 10 Feb 41 8 Apr 42 Hawaii 208th 500 1 Jun 41 18 Feb 42 Iceland 210th 1,000 1 Jun 41 8 Jan 42 Panama, C. Z. 218th 750 6 Jun 41 8 Jan 42 Panama, C. Z. Station Hospitals 1st ISO 10 Feb 41 30 Jan 42 Christmas Island 2d 250 16 Mar 42 18 May 42 Australia 3d 250 18 Mar 42 30 Jun 42 England Sth 250 7 Jan 41 17 Feb 42 Australia 8ch 250 10 Feb 41 17 Jan 42 Bora Bora 9th 250 11 Feb 41 23 Jan 42 Australia 10th 350 10 Feb 41 14 Jan 42 N. Ireland 12th 250 10 Feb 41 18 Feb 42 Australia 13th 250 16 Mar 42 18 May 42 Australia 16th ISO 16 Mar 42 3 Jun 42 England 17th 250 16 Mar 42 18 May 42 Australia 18th 250 16 Mar 42 18 May 42 Australia 22d 250 10 Feb 41 27 Feb 42 Hawaii 25th 250 24 Mar 42 28 May 42 Liberia 26th ISO 10 Feb 41 31 Jan 42 Canton Island 44th 50 4 Jun 42 14 Jun 42 Canada 4Sth 50 29 May 42 12 Jun 42 Canada 46th 25 2 Jun 42 17 Jun 42 Canada 47th 250 18 Jun 41 18 Feb 42 Australia 71st 250 14 Apr 42 9 May 42 Fiji Islands 9Sth 50 30 Apr 42 27 May 42 India 97th 50 28 Apr 42 27 May 42 India 98th 50 28 Apr 42 27 May 42 India 99th 50 28 Apr 42 27 May 42 India 100th 50 1 May 42 27 May 42 India 109th 250 1 Jun 41 23 Jan 42 New Caledonia IS 1st 250 1 Jun 41 30 Jun 42 England 153d 250 1 Jun 41 18 Feb 42 Australia ISSth 500 1 Jun 41 18 May 42 Australia 156th 250 3 Jun 41 11 Mar 42 Hawaii 159th 750 1 Jun 41 19 Mar 42 India 165th 250 1 Jun 41 27 Feb 42 Hawaii 166th 250 1 Jun 41 19 May 42 Australia 171st 250 3 Apr 42 18 Mav 42 Australia 172d 250 20 Mar 42 19 May 42 Australia 174th 250 29 Mar 42 18 May 42 Australia 175th ISO 17 Feb 42 14 Mar 42 Ascension Island Evacuation Hospitals 1st 750 1 Aug 40 4 Mar 42 Australia - 7th 750 22 Jan 42 7 Apr 42 Tonga tabu 10th 750 10 Feb 41 4 Mar 42 Australia -Sid 750 12 Jan 42 23 Jan 42 New Caledonia Surgical Hospitals 28th 400 10 Feb 41 4 Mar 42 Australia 33d 400 25 Jan 41 4 Mar 42 Australia - Affiliated units. 6 This unit returned trom Nova Scotia to Boston on 4 March 1942, and embarked again at New York on 12 May 1942. Sources: Unit cards filed in Orgn and Directory Section, Oprs Br, AGO, and annual reports filed in HU 16 (1) Interv, MD Historian with Brig Gen Alvin L. Gorby, 21 Feb 52. HD: 000.71. (2) Ltr AG 400(1- 19-42)MSC-D, TAG to SG, 22 Jan 42, sub: Equip for Island Type Hosp. SG: 475.5-1. (3) DF G-3/42108, ACofS G-3 WDGS to AGofS G-l and G-4 WDGS, 17 Feb 42, sub: T/O and E for a Fid Hosp Unit, with inch AG: 320.2(10-30-41)(2). (4) History of Organization and Equipment Allowance Branch [SGO], 1939-44, p. 5. HD. HOSPITALIZATION FOR THEATERS OF OPERATIONS 145 loading and flight tests during the latter part of 1942.17 The field hospital thus surpassed in flexibility any other hospital which the Medical Department had. In order to make units of that type available, SOS headquarters arranged for the activation of five in April 1942.18 A few months later, when the troop basis was revised, author- ity was granted for the activation of twen- ty-two by the end of 1942. During the months following the devel- opment of the field hospital, the Surgeon General’s Office revised the table of or- ganization for station hospital units to provide, in effect, additional types of fixed hospitals. At the beginning of the war the station hospital table of organization pro- vided only for those of 250-, 500-, and 750-bed capacities.19 When station hospi- tal units of smaller capacities were needed, The Surgeon General had to pre- pare special tables for their activation. In May 1942, for example, a special table of organization for a 150-bed station hospital was issued.20 Two months later the revised version of the regular table was ready for publication. It provided for station hospi- tals of seventeen different sizes, ranging in capacity from 25 to 900 beds.21 The inclu- sion of station hospital units of various sizes in the 1943 troop basis simplified The Surgeon General’s problem of recom- mending hospital support for small garri- son forces. At the same time that small fixed-hos- pital units were being supplied for garri- son forces scattered throughout the world, the Surgeon General’s Office was develop- ing a combat zone hospital that was more mobile and required less personnel than either the 400-bed surgical hospital or the 750-bed evacuation hospital. The latter had no motor transport for its own move- ment and could be used only in relatively stable situations. The surgical hospital, de- veloped in 1940, was only partially mo- bile. Its surgical unit was authorized enough transport to move itself but its two hospital units had only “utility” vehicles.22 In order to provide a more mobile com- bat zone hospital, The Surgeon General developed a 400-bed motorized evacua- tion hospital. Its table of organization, concurred in by the Ground Surgeon and approved by G-3, was published on 2 July 1942.23 This unit, unlike the surgical and 750-bed evacuation hospitals, at first had enough motor transport to move all of its personnel and equipment at one time. It differed from the surgical hospital in organization also. It will be recalled that the latter had three independent units with separate headquarters—a sur- gical unit and two ward units. The motor- ized evacuation hospital, on the other hand, had no separate units and only one headquarters, but it could be split into two self-contained 200-bed surgical hospi- tals. This change in organization resulted 17 (1) Memo, SG for TAG, 1 Feb 42, incl to DF G-3/42108, ACofS G-3 WDGS to ACofS G-l and G-4 WDGS, 17 Feb 42, sub: T/O and E for Fid Hosp Unit. AG: 320.2(10-30-41)(2). (2) Ltr, SG to CG USAFIA, 26 Jun 42, sub: Fid Hosp, T/O 8- 510. HD: Wilson files, 400 “Med Equip and Sups.” (3) Memo, SG for GG SOS, 3 Oct 42, with 2d, 5th, and 6th inds. SG; 704.-1. 18 Memo, SG for CG SOS, 22 Mar 42, sub: Ac- tivation of Fid Hosp Units, with 1st ind, CG SOS to SG, 1 Apr 42. SG: 322.3-33. 19 T/O 8-508, Sta Hosp, GomZ, 25 Jul 40. 20 T/O 8-560S, Sta Hosp (150-bed), 23 May 42. 21 T/O 8-560, Sta Hosp, GomZ, 22 Jul 42. 22 T/O 8-232, Evac Hosp, 1 Oct 40, and T/O 8-231, Surg Hosp, 1 Dec 40. 23 (1) History of Organization and Equipment Allowance Branch [SGO], 1939-44, p. 4. HD. (2) Memo for Record on Memo, CG SOS for TAG, 1 Jul 42, sub: T/O for Evac Hosp (Motorized). AG: 320.3(10-30-41)(2) Sec 8D. (3) T/O 8-581, Evac Hosp, Motorized, 2 Jul 42. 146 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR in a saving of both enlisted and commis- sioned personnel—a factor of importance in the development of the new unit.24 The motorized evacuation hospital soon superseded the surgical hospital in the troop basis, although the table of or- ganization of the latter was not rescinded until August 1944.2S In August 1942 AGF headquarters, with the concurrence of The Surgeon General and the Ground Surgeon, had surgical hospitals, only three of which were used as such during the war, redesignated and converted into motorized evacuation hospitals. In No- vember 1942 units of the new type were included, along with 750-bed evacuation hospitals, as mobile units in the 1943 troop basis.26 Since none of the hospital units avail- able at the beginning of the war or devel- oped in Washington in the following year met the needs of small combat forces fighting in Pacific jungles, the Southwest Pacific Area attempted during 1942 to solve its own problem. To provide surgical support for task forces employed in areas where the only practicable means of transportation was by foot, the chief sur- geon of that area developed a 25-bed portable surgical hospital. It was designed to permit its equipment and supplies to be carried in 35- to 40-pound packs by its own personnel or by native bearers. It could therefore move along with combat troops through jungle trails, either to pre- pare casualties for the long litter-haul to the rear or to care for them until more adequate hospitals could be established. In September 1942 SWPA headquarters activated twenty-six such “provisional” units with personnel taken from other hos- pitals. Receiving reports of this develop- ment, The Surgeon General soon after- ward adopted the portable surgical hospital as a regular unit. In November 1942, forty-eight were included in the 1943 troop basis. In May 1943 ASF head- quarters ordered the activation of twenty under a special table of organization which was published the following month.27 Changes Affecting the Mobility of Hospitals By the fall of 1942 circumstances devel- oped which tended to cancel some of the results of earlier attempts of The Surgeon General to increase the mobility of hospi- tals. Shortages of motor equipment and of shipping space prompted the General Staff, on 2 October 1942, to direct the three major commands to reduce the motor vehicles authorized for their respec- tive units.28 In compliance with this order AGF headquarters reduced the transport of the motorized evacuation hospital (making it a semimobile unit) and the Surgeon General’s Office reduced that of the field hospital. These hospitals were 24 (1) Comparison of T/O 8-231, 1 Dec 40, and T/O 8-581, 2 Jul 42. (2) See also Off Diary of Col Albert G. Love, Chief HD, SGO, 8 Sep and 9 Oct 42. HD. 25 (1) Memo, Col Arthur B. Welsh for Gen Kirk, 2 Dec 43. SG: 322.15-1-MEDG. (2) WD Cir 333, 15 Aug 44. 26 (1) Memo 32.02/29(Med)(R)-GNGCT/( 1 Aug 42), CG AGF for ACofS G-3 WDGS, 1 Aug 42, sub: Redesignation of Surg Hosp as Evac Hosp, with Memo for Record. Ground Med files: “Maneuvers, 1942.” (2) Ltr, SG to CG ASF, 26 Apr 43, sub: Status of Surg Hosps. SG; 322.15-1. 27 (1) An Rpt, Chief Surg SWPA, 1942. HD. (2) Ltr, Comdr-in-Chief SWPA to CG SOS, 21 Nov 42, sub; Improvement of Equip and Orgn, with 2 inds. SG: 322.15-10. (3) Memo, CG ASF for TAG, 26 May 43, sub: Constitution and Activation of Ptbl Surg Hosp. AG: 322(5-26-43). (4) T/O & E 8-572S, Ptbl Surg Hosp, 4 Jun 43. 28 Ltr, TAG to CGs AGF, AAF, and SOS, 2 Oct 42, sub: Review of Orgn and Equip Reqmts. AG: 400(8-10-42)(1) sec 22. HOSPITALIZATION FOR THEATERS OF OPERATIONS 147 left with enough transport for partial movements only. Each had to employ its vehicles in shuttle fashion or supplement them with “pool” vehicles in order to move from one location to another.29 Re- ductions in allotments of motor vehicles to other hospital units had insignificant ef- fects upon mobility, because their vehicles were used for administrative purposes only.30 Other ways of increasing the mobility of hospitals than by the formation of new units were reductions in the size and weight of equipment and improvements in methods of packing it. When war be- gan, equipment lists of all hospitals con- tained types and quantities of items such as office desks, armchairs, and kitchen equipment which were ordinarily used only in hospitals in the United States.31 In view of shortage of shipping space and the need for mobility in overseas hospitals, SOS headquarters directed The Surgeon General on 12 March 1942 to eliminate all unnecessary equipment and to reduce the gross weight and cubic displacement of station and general hospital assemblages by at least 40 percent.32 The Surgeon General replied that his Office had already begun that process. On 30 June 1942 he reported that the required reduc- tion had been made in station hospital assemblages and that it would be made in others at an early date.33 During the fol- lowing summer special boards appointed by The Surgeon General reviewed equip- ment lists of all hospitals, making reduc- tions as they could, and sent the revised lists to medical depots for use in making up hospital assemblages. By November 1942 The Surgeon General reported to the Wadhams Committee that the gross weight and cubic displacement of all hos- pitals designed for overseas service had been reduced by an average of 40 to 42 percent.34 By that time many hospitals with heavy bulky equipment were already in operation in overseas theaters.35 Shortly before The Surgeon General reported reductions in the size and weight of hospital equipment, the Ground Sur- geon raised the question of its packing. He informed the Surgeon General’s Office that equipment of evacuation hospitals was so packed that it did not lend itself readily to manual handling and speedy unpacking for setups. Meanwhile the 15th Evacuation Hospital, stationed at Fort George G. Meade, Maryland, conducted experiments in packing under the super- vision of the Ground Surgeon.36 The Sur- geon General learned that this hospital 29 (1) T/O 8-510, Fid Hosp, 28 Feb 42 and 8 Apr 43; T/O 8-581, Evac Hosp, Motorized, 2 Jul 42; and T/O 8-581, Evac Hosp, Semimobile, 8 Jan 43. (2) 1st ind 323.3 GNRQT-1/18390 (10-2-42), CG AGF to TAG, 1 Dec 42, on Ltr, TAG to GGs AGF, AAF, and SOS, 2 Oct 42, sub: Review of Orgn and Equip Reqmts. AG: 400 (8-10-42)(l) sec 22. (3) Ltr, SG to CG SOS, 14 Dec 42, sub: Changes in Fid Hosp. SG: 322.15-10. (4) 2d ind, SG to CG SOS, 10 Feb 43, on Ltr, Comdr-in-Chief SWPA to CG SOS, 21 Nov 42, sub: Improvement of Equip and Orgn. Same file. 30 For example, see T/O 8-550, Gen Hosp, 1 Apr 42, and T/E 8-550, Gen Hosp, 19 Mar 43. 31 Memo entitled “Correcting Info as to Confiden- tial Document Submitted by Mr. [Corrington] Gill, Entitled ‘Rpt to Cmtee on Data from Files of Hosp and Evac Br, Plans Div, SOS,’ ” submitted as incl to Ltr, SG to Col Sanford Wadhams, Chm, Cmtee to Study the MD, 7 Nov 42. HD: 321.6. 32 Memo, Oprs Div SOS for SG, 12 Mar 42, sub: Increase in Mobility of Fid Force Hosps. SG: 475.5-1. 33 Memos, SG for Oprs Div SOS, 2 1 Mar and 30 Jun 42. SG: 475.5-1. 34 Memo cited, n. 31. 35 (1) Memo SPOPH 701, CG SOS for SG, 19 Oct 42, sub; Info Submitted by Chief Surg SWPA. HD: Wilson files, “Book IV, 16 Mar 43-17 Jun 43.” (2) Ltr, Med Insp NATO to SG, 27 Jan 43, sub: Obser- vations on Med Serv in NATO. HD: Wilson files, “Experience in Med Matters from Overseas Forces.” 38 Comment by Brig Gen Frederick A. Blesse on first draft of this chapter. HD: 314 (Correspondence on MS) HI, Incl 1. 148 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR had developed a method of packing its equipment so that each crate or package could be handled by two men and con- tained items used in one particular section of a hospital only.37 In November 1942 General Magee appointed a board of offi- cers to study this accomplishment and submit recommendations for more practi- cal methods of packing and assembling equipment than those being used by med- ical depots.38 As a result of this investiga- tion, The Surgeon General’s Supply Serv- ice drew up specifications for the stand- ardized packing and crating of equipment of motorized evacuation hospitals.39 Subsequently, during 1943, the system found satisfactory for evacuation hospitals was adopted for other units. Each box, properly marked, now contained supplies and equipment for use in a particular sec- tion of a hospital only. This system speeded unpacking and repacking for movement in the field by making it possi- ble to assemble at a particular spot all supplies and equipment needed for a ward, an operating room, or an office, and by making it unnecessary to unpack equipment not required when only part of a hospital was being established.40 Reductions in the Personnel of Hospital Units Modifications in tables of organization of existing hospitals, like changes in equip- ment and motor transport, were required by other than medical considerations. During the early part of 1942 both G-l and SOS headquarters put considerable pressure on The Surgeon General to save commissioned personnel, especially Medi- cal Corps officers, lest there be insufficient numbers to go around, on the scale already planned, in a 7,500,000-man Army. Among the steps they directed him to take was the revision of tables of organ- ization, both to reduce the number of of- ficers authorized and to substitute Medi- cal Administrative Corps for Medical Corps officers.41 Having already begun the process of revision, The Surgeon Gen- eral replied that he would continue it.42 In April the revised tables for general, surgi- cal, and convalescent hospitals and hospi- tal centers were published; in July, those for evacuation and station hospitals.43 These revisions resulted in the saving of Medical Corps officers more by cuts in the number of such officers in each unit than by the substitution of Medical Adminis- trative for Medical Corps officers. The reason lay perhaps in the fact that tables of organization for numbered hospitals, unlike personnel guides for zone of interior 37 (1) Ltr, SG to CG SOS, 7 Oct 42, sub: Evac Hosp Equip. SG: 475.5-1. (2) An Rpt, 15th Evac Hosp Motorized, 1942. HD. 38 (1) 1st ind, GG SOS to SG, 15 Oct 42, on Ltr, SG to CG SOS, 7 Oct 42, sub: Evac Hosp Equip. SG: 475.5-1. (2) SG OO 462, 11 Nov 42, sub: Bd of Offs to Study Equip of New 400-Bed Motorized Evac Hosp. 39 (1) Rpt of Bd for . . . a 400-bed Evac Hosp [13 Nov 42]. SG: 475.5-1. (2) Memo, Lt Col R[euel] E. Hewitt for Col F[rancis] C. Tyng, 19 Dec 42. Same file. 40 (1) Richard E. Yates, The procurement and Dis- tribution of Medical Supplies in the Zone of the In- terior during World War II (1946), p. 146. HD. (2) An Rpt, Med Assembly Unit Atlanta ASF Depot, 1943. HD. 41 (1) Memo, ACofS G-l WDGS for SG thru Pers Div SOS, 1 Apr 42, sub: Availability of Physicians. HRS: G-l/16331-16335. (2) Memo, CG SOS for SG, 22 May 42, sub: Availability of Physicians. Same file. 42 (1) Memo, SG for Pers Div SOS, 27 Apr 42. HRS: G-l/16331-16335. (2) Memo, SG for Dir Mil Pers SOS, 5 Jun 42, sub; Availability of Physicians. Same file. 43 T/O 8-550, Gen Hosp, 1 Apr 42; T/O 8-570, Surg Hosp, 1 Apr 42; T/O 8-590, Conv Hosp, 1 Apr 42; T/O 8-540, Hosp Gtr, 1 Apr 42; T/O 8-580, Evac Hosp, 750-bed, 2 Jul 42; T/O 8-560, Sta Hosp, 22 Jul 42. HOSPITALIZATION FOR THEATERS OF OPERATIONS 149 installations,44 already required the use of Medical Administrative Corps officers in a considerable proportion of administra- tive positions. The revised tables also re- duced the number of nurses authorized for some hospitals. In general, greatest changes were made in large communica- tions zone units, such as 1,000-bed general and 750-bed station hospitals. In the for- mer, 17 Medical Corps officers and 15 nurses were eliminated; in the latter, 13 Medical Corps officers and 15 nurses. In each, one Medical Administrative Corps officer, one Sanitary Corps officer, and one warrant officer were added as replace- ments for some of the Medical Corps offi- cers eliminated. In smaller communica- tions zone units, such as the 250-bed sta- tion hospital, and in combat zone units, such as the 750-bed evacuation and the 400-bed surgical hospital, no personnel reductions were made, but from one to three Medical Administrative or Dental Corps officers were substituted for a like number of Medical Corps officers. The development of the 400-bed motorized evacuation hospital for use in the combat zone resulted in a considerable saving of both Medical and Nurse Corps personnel, because the new unit required fifteen phy- sicians and twelve nurses fewer than did the surgical hospital which it replaced in the troop basis.45 In the fall of 1942 emphasis shifted from reductions in the numbers of officers and nurses to those of enlisted men. With a growing need for manpower economy in the Army, the General Staff in October directed the three major commands to re- vise downward their tables of organiza- tion.46 By then responsible for tables of combat zone hospital units, AGF head- quarters revised the tables of both the 400- bed and 750-bed evacuation hospitals. With The Surgeon General’s concurrence, the number of enlisted men in a motorized evacuation hospital was reduced from 248 to 217; in a 750-bed unit, from 318 to 308. The revised tables reflected, incidentally, as did others published later, the militari- zation of hospital dietitians and physical therapists, who until December 1942 had served as civilian employees.47 Cuts in the personnel of communications zone hospi- tal units did not occur at this time, be- cause SOS headquarters considered it “inadvisable,” in view of revisions of tables within the preceding year, to direct any further “arbitrary reduction.” 48 Hospital Units in the Troop Basis Throughout 1942 and 1943 the number of hospital units in the troop basis in- creased significantly with each of its revi- sions but always remained smaller than The Surgeon General considered ade- quate for the Army being mobilized. Us- ing World War I casualty and evacuation experiences as a basis, The Surgeon Gen- eral estimated that fixed beds should be 44 See above, p. 133. 45 T/O 8-508, Sta Hosp, 25 Jul 40; T/O 8-560, Sta Hosp, 22 Jul 42; T/O 8-507, Gen Hosp, 25 Jul 40; T/O 8-550, Gen Hosp, 1 Apr 42; T/O 8-232, Evac Hosp, 1 Oct 40; T/O 8-580, Evac Hosp, 2 Jul 42; T/O 8-231, Surg Hosp, 1 Dec 40; T/O 8-570, Surg Hosp, 1 Apr 42; T/O 8-581, Evac Hosp, Motorized, 2 Jul 42. 46 Ltr, TAG to CGs AGE, AAF, and SOS, 2 Oct 42, sub: Review of Orgn and Equip Reqmts. AG: 400(8-10-42)(l) sec 22. 47 (1) T/O 8-580, Evac Hosp, 750-bed, 23 Apr 43, and T/O 8-581, Evac Hosp, Semimobile, 8 Jan 43. (2) Memo 320.2/53(Med) GNRQT-3/26660 (11-18- 42), CG AGE for AGofS G-3 WDGS, 1 Jan 43, sub: T/O and T/E 8-581, Evac Hosp, Semimobile. AG: 320.3 (10-30-41)(l) sec 8D. (3) Memo 321/732(Med) GNRQT 3/37444, CG AGE for AGofS G-3 WDGS, 16 Apr 43, sub: T/O and T/E, Evac Hosp (750 pnts). Same file. 48 Memo SPGAE 011.1 (10-14-42), CG SOS for AGofS G-3 WDGS, 7 Dec 42, sub: Review of Orgn and Equip Reqmts. AG: 400(8-10-42)(l) sec 22. 150 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR provided for 10 to 15 percent of the strength of each theater of operations.49 He calculated mobile bed requirements in the early part of 1942 on the basis of 1 convalescent, 4 surgical, and 10 evacua- tion hospitals for each type-army. The time when these units should be activated depended upon such factors as the amount of training required by each, the rate of troop movement to overseas areas, and the amount of combat action which might be encountered. At the beginning of 1942 both G-3 and the Chief of Staff believed that the mobili- zation of service units should be delayed because the training of divisions required more time than that of nondivisional units and a lack of shipping limited forces that could be sent overseas during 1942.50 Hence, in the troop basis issued on 17 Jan- uary 1942, which provided for a 71-divi- sion, 3,600,000-man Army by the end of the year, there were included only 2 con- valescent, 28 evacuation, 8 surgical, 45 general, and 40 station hospital units.51 The Surgeon General urged that addi- tional units be authorized, but the General Staff disapproved. In its opinion the 55,000 beds provided for in 45 general and 40 station hospitals would be ade- quate for the 550,000 troops which, it was expected, could be sent overseas during 1942.52 In the spring of 1942 plans were made to send a larger number of troops over- seas during the rest of the year. Under the Bolero plan, thirty divisions, or 1,000,000 men, were to be sent to the United Kingdom for an operation against the continent either late in 1942 or early in 1943. In May the President raised the size of the Army to be mobilized by the end of 1942 to 4,350,000.53 The number of units originally thought requisite in view of these changes was reduced considerably in the course of discussions among represen- tatives of SOS and AGE headquarters and the Surgeon General’s Office, and on 23 May 1942 SOS headquarters recom- mended to G-3 that 2 convalescent, 6 evacuation, 8 surgical, 62 general, 103 station, 22 field hospitals and 9 hospital centers should be included in the revised troop basis, in addition to the units already authorized.54 G-3 considered the recom- mended number of fixed-hospital units too large, but approved it when The Surgeon General explained that Bolero alone would require 100,000 beds, or more than the number authorized in the additional units.55 49 (1) Albert G. Love, “War Casualties,” Army Med- ical Bulletin No. 24 (1931), pp. 53-68. (2) Off Diary of Col Albert G. Love, Chief HD SCO, 6 Mar 42. HD. 50 Kent R. Greenfield, Robert R. Palmer and Bell I. Wiley, The Organization of Ground Combat Troops (Washington, 1947), p. 199, in UNITED STATES ARMY IN WORLD WAR II. 51 Ltr, TAG to C of Arms and Servs, etc., 1 7 Jan 42, sub; Mob and Tng Plan, 1942. AG; 381(12-27- 41)(2). 52 (1) Memo, Act SG for ACofS G-3 WDGS, 28 Feb 42, sub: Orgn and Dispatch of MD TofOpns Units. SG: 322.3-1. (2) 2d ind AG 320.2(1-29-42) MSC-C, TAG to SG, 18 Feb 42, on Memo, C of Air Staff for SG, 29 Jan 42, sub: Expansion Program of AAF for Calendar Year 1942. HD; 320.2(Trp Basis). 53 Greenfield et al., op. cit., pp. 201-06. Also see Ray S. Cline, Washington Command Post: The Operations Division (Washington, 1951), pp. 143-63, in UNITED STATES ARMY IN WORLD WAR II; and Mau- rice Matloff and Edwin M. Snell, Strategic Planning for Coalition Warfare, 1941-42 (Washington, 1953), pp. 190-96, in UNITED STATES ARMY IN WORLD WAR II, for more information on Bolero. 54 (1) Memo, Lt Col A. B. Welsh for the Record, 13 Apr 42. HD: 320.2(Trp Basis). (2) Memo SPOPP 320.2 Serv Units (5-23-42), Dep Dir Oprs SOS for ACofS G-3 WDGS, 23 May 42, sub; Reqmts of Serv Units. . . . SG: 475.5-1. 55 (l)Memo WDGCT 320.2(5-23-42), ACofS G-3 WDGS for CGs AGE and SOS, 25 May 42, sub: Reqmts of Serv Units. . . . SG: 475.5-1. (2) Memo, SG for Oprs Div SOS, 30 May 42, same sub. SG: 320.3-1. (3) Memo, ACofS G-3 WDGS for CG SOS, 5 Jun 42, same sub. Same file. HOSPITALIZATION FOR THEATERS OF OPERATIONS 151 During the late summer and fall of 1942 plans for the 1943 troop basis, through which a 7,500,000-man Army was to be mobilized by the end of 1943,56 called for sizable increases in the numbers of hospi- tal units of all types. For the support of ground troops in combat, 7 convalescent, 20 evacuation, 52 semimobile evacuation, and 48 portable surgical hospitals were authorized for activation by December 1943. The number of fixed-hospital units which G-3 authorized—52 field, 192 gen- eral, and 327 station hospital units—was less than The Surgeon General recom- mended.37 G-3’s authorization of the smaller number apparently resulted from a shortage of physicians to staff more. The Surgeon General believed that enough beds and other equipment to care for the maximum estimate of sick and wounded men would have to be provided in any event. He therefore recommended again an increase in authorized units and urged that he be permitted, if his recommenda- tion should be disapproved, to procure adequate equipment for overseas hospitals regardless of the troop basis.38 Both G-3 and OPD agreed to the latter proposition and SOS headquarters arranged to assure the procurement of equipment which The Surgeon General considered necessary.59 The Question of Equipping and Using Numbered Hospitals in the fpne of Interior Throughout 1942 and most of 1943 the Surgeon General’s Office and SOS head- quarters were engaged in an inconclusive dispute over the issuance of equipment to numbered hospital units and the use of such units on a functional basis in the United States. This dispute, like the one over planning for zone of interior hospi- talization already discussed, exemplified difficulties resulting from misunderstand- ing about the respective responsibilities of the Surgeon General’s Office and the SOS Hospitalization and Evacuation Branch. Of more significance, it involved the fol- lowing problems; the method of training hospital units in the United States, the contribution of such units to the medical service during training periods, and whether or not such units should receive full issues of equipment in the United States. After war began most hospital units in the zone of interior continued primarily as schools for tactical training. A few were issued full assemblages and operated hos- pitals on maneuvers. As a rule, though, under a policy announced in January 1942 and already discussed, hospital units received only field training equipment, soldiers’ individual equipment, and motor transport, for use in unit field training. The Surgeon General expected them to receive technical training and experience with professional supplies and equipment in zone of interior hospitals. This “parallel” method of training seemed satisfactory when only one or two units were located on a particular post, but delay in construc- tion of housing for a hospital unit near each of twenty-two general hospitals and 56 Greenfield et at., op. cit., pp. 212-17. 57 (1) Diary, Hosp and Evac Br SOS, 28 Oct 42. HD: Wilson files, “Diary.” (2) Memo, SG for CG SOS, 25 Jan 43. HD: 632.-2. (3) Table, Auth Units (Hosp Type) in 1942 and 43 Trp Basis. HD: 320.2 (Trp Basis). 58 (1) Memo, SG for CG SOS, 25 Jan 43. HD: 632.-2. (2) Ltr, SG for GG SOS, 6 Mar 43, sub: Ade- quacy of Plans for Overseas Hosp. SG: 322.15-1. 59 (1) Memo SPOPH 701(3-6-42), Dir Plans Div ASF for Gen [LeRoy] Lutes, 15 Mar 43, sub: Ade- quacy of Plans for Overseas Hosp. HD: Wilson files, “Book HI, 1 Jan 43-15 Mar 43.” (2) 1st ind, ACofS for Oprs SOS to SG, 16 Mar 43, on Ltr, SG to CG SOS, 6 Mar 43, same sub. SG: 322.15-1. 152 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR thirty-four station hospitals in the United States, as The Surgeon General re- quested,60 caused units to be grouped on posts wherever troop housing was avail- able. Whenever this happened there were so many officers and men of numbered units in each named hospital concerned that they had to take turns serving along- side of, or “parallel” to, their opposite numbers.61 This entire system was challenged early in 1942. By March Colonel Wilson was convinced that hospital units could be best prepared for overseas service by being issued complete equipment and by being required to function as hospitals in the United States.62 Moreover AGF head- quarters wanted to train unit personnel in the storage, maintenance, and repair of hospital equipment and to have hospital units self-sufficient in so far as messing and administration were concerned. In May, therefore, AGF headquarters recom- mended that all hospital units scheduled for maneuvers and all newly activated units be given full issues of equipment for permanent retention.63 The Surgeon Gen- eral was willing to make some concessions to the Ground Forces but not to issue com- plete assemblages as SOS headquarters directed in June and again in August 1942. In a paper duel which his Office fought with SOS headquarters over this matter, The Surgeon General reached a point by 7 September 1942 of agreeing to the issuance of housekeeping equipment, but he requested approval of a policy of withholding all other equipment in assem- blages until units were assigned to opera- tional missions.64 By this time SOS headquarters had decided not only to force The Surgeon General to issue complete assemblages to all units but also to require him to employ units under SOS control in the zone of interior medical service. There seem to have been several reasons for this decision. In September 1942 a report from the Southwest Pacific Area emphasized the desirability of issuing equipment to units in training to permit them to learn to pack and move it easily and to reduce its size and weight by eliminating unnecessary items.65 Moreover, many units were be- coming restless from long periods of train- ing without opportunities either to func- tion as hospitals or to assist in zone of inte- rior hospital operations; and stories of doctors being called from civilian practice only to sit and wait around Army camps 60 Memo, Act SG for ACofS G-3 WDGS, 28 Feb 42, sub: Orgn and Dispatch of MD TofOpns Units. SG: 322.3-1. 61 (1) For example, see the An Rpts, 1942 and/or 1943 of 3d, 6th, 23d, 50th, 79th, and 108th Gen Hosps and An Rpt, 1943, 36th Sta Hosp. HD. (2) Consoli- dated Rpt, SGs Observers for 1942 Maneuvers; trans- mitted to ASF Hq by Memo, SG for Dir Tng ASF, 16 Jun 43. Ground Med files: “Rpt of Maneuver Ob- servers, SGO, 1942.” (3) Memo, Dir Planning Div ASF for Gen Lutes, 4 Aug 43, sub: Sta Hosp in Ma- neuver Areas. Ground Med files: 354.2 “Maneuvers.” 62 Memo G-4/24499-178, Maj W. L. Wilson for Gen Lutes, 12 Mar 42, sub: Basic Plans for Hosp and Evac. HD: Wilson files, “No 472, Hosp and Evac, 1941-42.” 63 Ltr 475.5/49-GNSPL (5-26-42), CG AGF to Dir Oprs SOS, 26 May 42, sub: Equip for Med Units. HD; Wilson files, 400 “Med Equip and Sups.” 64 (1) 2d ind, SG to Dir Oprs SOS, 29 May 42; 3d ind, GG SOS to SG, 22 Jun 42; 4th ind, SG to Dir Oprs SOS, 30 Jun 42; 5th ind, GG SOS to SG, 9 Jul 42; 6th ind, SG to Dir Oprs SOS, 20 Jul 42; 7th ind, CG SOS to SG, 6 Aug 42; and 8th ind, SG to GG SOS, 7 Sep 42, on Memo 475/826-GNSPL(5-22-42), CG AGF for Dir Oprs SOS, 22 May 42, sub: Equip for MD LTnits. SG: 475.5-1. (2) Memo, Lt Col A[rthur] B. Welsh for Gen [Larry B.] McAfee, 11 Jun 42. HD; 320.2(Trp Basis). (3) Diary, Hosp and Evac Br SOS, 13 Aug 42. HD: Wilson files, “Diary.” 65 Ltr, Col P[ercy] J. Carroll to ACofS G-4 USASOS SWPA, 19 Sep 42, sub: Data for Lt Col [Willard S.] Wadelton. HD: Wilson files, “Experience in Med Matters from Overseas Forces.” Colonel Wil- son had asked Colonel Wadelton to get information for him on a visit of the latter to SWPA. HOSPITALIZATION FOR THEATERS OF OPERATIONS 153 began to reach the public and the Army Inspector General.66 At the same time, it appeared that there would be insufficient Medical Department enlisted men and Medical Corps officers to supply both zone of interior installations and numbered units with their authorized numbers, and the General Staff began a drive for more efficient personnel utiliza- tion.67 The chief of the SOS Hospitaliza- tion and Evacuation Branch believed that personnel required for zone of interior hospitals could be reduced by using num- bered hospital units to help operate such installations. Furthermore, he believed that a reserve of hospital beds for emer- gencies could be provided by issuing equipment to numbered units.68 In addi- tion, some of the obstacles to assemblage- issuance and unit-use were being re- moved. Although equipment was still in short supply, the Surgeon General’s Office and SOS headquarters were making re- newed efforts to increase its availability. Housing, including warehouse space for equipment which had been authorized in the spring of 1942, was expected to be available for occupancy between Septem- ber 1942 and January 1943.69 Finally the Wadhams Committee was appointed early in September 1942, and SOS headquar- ters may have expected its support in this instance.70 Whether because of one, some, or all of these reasons, SOS headquarters on 16 September and again on 12 October 1942 directed The Surgeon General to prepare a plan for the use of numbered hospital units in the zone of interior medi- cal service and on 17 September 1942 requested his comments on the draft of a policy requiring the issuance of assem- blages to all hospital units in training.71 Receipt of these communications caused confusion and consternation in the Sur- geon General’s Office. The Operations Service called for comments from other sections—the Supply, Professional, and Personnel Services and the Hospital Con- struction, Hospitalization, and Training Divisions. After several conferences to dis- cuss the action that should be taken, final decision was to request no change in the policy on the issuance of equipment and to submit no plan for the use of numbered units. To support this decision, the Sur- geon General’s Office marshaled an array of arguments. The most important seem to have been lack of sufficient equipment to permit the issuance of assemblages to all 66 (1) Memo for Record on Memo SPOPH 320.2, ACofS Oprs SOS (init WLWfilson]) for SG, 16 Sep 42, sub; Asgmt, Tng, and Util of TofOpns Med Units. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” (2) Diary, Hosp and Evac Br SOS, 25 Sep 42. HD: Wilson files, “Diary.” (3) Memo, Dir Mil Pers Div SGO for Dir HD SGO, 14 Apr 44. HD: 326.1-1. 67 See above, pp. 131-37, and Memo, DepCofSA for SG thru GG SOS, 17 Oct 42, sub; Availability of Physicians. SG; 322.05-1. 68 Memo SPOPM 322.15, Chief Hosp and Evac Br SOS for Gen Lutes, 15 Sep 42, sub; Directive for Hosp and Evac Oprs. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” 69 (1) Memo, Chief Hosp and Evac Br SOS for Gen Lutes, 23 Aug 42, sub: Status of Procurement of Med Supplies. HD: Wilson files, 440 “Med Sups.” (2) Memo, CofEngrs for SG, 19 Sep 42, sub: Eld Hosp Units. HD; 632 “Housing.” 70 Colonel Wilson stated to the Committee that one of the problems of the Medical Department was the development of a system for training medical units with their equipment before going overseas. Ltr, Chief Hosp and Evac Br Plans Div Oprs SOS for Chm, Cmtee to Study the MD, 21 Oct 42, sub: Med Prob- lems. HD: Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” 71 (1) Memo SPOPH 320.2, ACofS Oprs SOS (init WLW[ilson]) for SG, 16 Sep 42, sub: Asgmt, Tng, and Util of TofOpns Med Units. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” (2) 1st ind SPOPH 320.2 (9-26-42), ACofS Oprs SOS (same init) to SG, 1 2 Oct 42, on Memo, SG for Oprs Div SOS, 26 Sep 42, same sub. HD: 632 “Hosp-Housing.” (3) Draft Ltr SPOPP 475, CG SOS to SG, 17 Sep 42, sub: Equip for MD Units. SG: 475.5-1. 304244 0—55 12 154 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR units and fear that the zone of interior medical service would be left in the lurch if numbered units were used to furnish it and were then sent overseas. To these were added other arguments. According to the Surgeon General’s Office, units needed equipment neither for training nor for emergency hospitalization. Those in train- ing could get experience with equipment in zone of interior hospitals and equip- ment required for emergencies could be shipped from depots when needed. Units were not qualified either to repack equip- ment for overseas shipment or to deter- mine deletions and substitutions to reduce total weight. The former should be done by depots to prevent breakage and the lat- ter could be done properly only by quali- fied boards and representatives of The Surgeon General. Units could not replace regularly assigned personnel in zone of interior hospitals without interrupting care of the sick and lowering the standard of professional work. Their mere presence near such hospitals constituted an ade- quate reserve of hospital facilities for emergencies; and their use as units would not reduce zone of interior personnel re- quirements because their members were already assisting in the medical service under the system of parallel training. Finally, The Surgeon General stated that he had no reason to believe that unit train- ing was deficient. In requesting that exist- ing policy on assemblage-issuance not be changed, The Surgeon General’s supply representative explained personally to SOS headquarters the shortage of medical equipment. In refusing to submit a plan for the use of numbered units, The Sur- geon General called attention to a plan for providing an effective medical service for a 7,500,000-man Army with 48,000 to 50,000 physicians which he was submit- ting at the request of the Deputy Chief of Staff of the Army.72 In this instance, SOS headquarters adopted a more lenient attitude toward The Surgeon General’s action than might have been expected. Perhaps this resulted from an awareness of the critical aspect of the medical supply situation and from some hesitancy to push The Surgeon Gen- eral when he had orders from the Deputy Chief of Staff of the Army to present a “plan.” Perhaps it resulted from the ap- parent inclination of the Wadhams Com- mittee toward The Surgeon General’s position rather than that of the SOS Hos- pitalization and Evacuation Branch.'4 At any rate, SOS headquarters tabled the directive requiring a plan for the use of numbered units,74 and the chief of its Hospitalization and Evacuation Branch worked out a compromise on the assem- blage-issuance question. He adopted a new definition of assemblages, proposed by the SOS Plans Branch: henceforth assemblages would contain only Medical Department items. Items needed by hos- pitals but supplied by other services, such 72 (l)Memo, SG for Oprs Div SOS, 26 Sep 42, sub: Med Unit Assemblages. SG: 475.5-1. (2) Memo, SG for Oprs Div SOS, 26 Sep 42, sub: Asgmt, Tng, and Util of TofOpns Med Units, with 2d ind, Act SG to Chief Oprs Div SOS, 14 Nov 42. SG: 320.2. Numer- ous memos from chiefs of various sections of SGO giving these arguments are in HD: 632 “Hosp-Hous- ing.” 73 Cmtee to Study the MD, 1942, Testimony, pp. 1869ff. HD. After the war General Lutes stated that General Somervell personally directed a “lenient at- titude” toward the Surgeon General’s Office because of the Wadhams Committee’s report. He was proceed- ing cautiously, General Lutes stated, to determine who was correct. Ltr, Lt Gen LeRoy Lutes to Col R[oger] G. Prentiss, Jr, 8 Nov 50. HD: 314 (Corre- spondence on MS) HI. 74 3d ind SPOPH 320.2 (9-26-42), CG SOS to SG, 22 Nov 42, on Memo, SG for Oprs Div SOS, 26 Sep 42, sub; Asgmt, Tng, and Util of TofOpns Med Units. SG: 320.2. HOSPITALIZATION FOR THEATERS OF OPERATIONS 155 as the Quartermaster Corps, would not be included in assemblages and would be is- sued whenever units requested them. The Surgeon General would determine the time when enough Medical Department equipment was available to issue complete assemblages to all units. Until that time he would make partial issues. Afterward, he would issue complete assemblages to all hospital units under AGF control. Assem- blages for station and general hospitals under SOS control would be located in Medical Department depots so that deliv- ery could be made in emergencies within seven days and so that units in training might readily inspect and study them.75 When the Surgeon General’s Office found even this policy unsatisfactory, SOS head- quarters delayed announcing it officially until the medical supply situation had im- proved. Then, on 18 January 1943, SOS headquarters had the new policy pub- lished.76 At the beginning of the new year a com- bination of circumstances caused a revival of the question of using numbered units in the zone of interior. Contrary to what might have been expected, the “plan” which The Surgeon General submitted to the Deputy Chief of Staff on 14 December 1942 did not deal with this question, but only with the bulk allotment of Medical Corps officers to the three major com- mands.77 Soon afterward, in January 1943, the SOS Director of Training received criti- cism from at least one service command of deficiencies in unit training. About the same time the chief of the SOS Hospitali- zation and Evacuation Branch reported that failure to use units while in the United States was being criticized pub- licly. He then requested and received authority from his superior officer in SOS headquarters to collaborate with the SOS Training Director and the Surgeon Gen- eral’s Office in working out a plan to answer such criticism.78 In a subsequent conference of representatives of the Sur- geon General’s Office AGF headquarters, and SOS headquarters, it was “unani- mously agreed,” the last reported, that The Surgeon General would estimate the amount of medical personnel required for hospital service at each camp of 10,000 or greater population, would determine the minimum permanent staff required for each hospital at those camps, and would make a definite plan, based upon OPD shipment schedules, for the use of num- bered units to operate such hospitals under the supervision of permanent staffs.'9 The chief of the SOS Hospitalization and Evacuation Branch then took a trip around the country and found, he re- ported, that each service command sur- geon agreed that he could operate a satis- 75 (1) Draft memo SPOPH 475(9-26-42), CG SOS for SG, 23 Oct 42, sub: Equip for Fid Med Units. HD: Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” (2) Diary, Hosp and Evac Br SOS, 1 Nov 42. HD: Wilson files, “Diary.” (3) Memo SPOPH 475(9-26-42), Chief Hosp and Evac Br SOS for Chief Plans Br SOS, 2 Nov 42, sub: Med Unit Assemblages. HD: Wilson files, “Book 2, 26 Sep 42-31 Dec 42.” 76 (1) WD Memo W700-4-43, 18 Jan 43, sub: Equip for Fid Med Units. HD: Wilson files, “Book HI, 1 Jan 43-15 Mar 43.” (2) Memo SPOPH 440, Chief Hosp and Evac Br SOS for Gen Lutes, 27 Jan 43, sub: Status of Procurement of Med Sups. Same file. 77 Memo, Act SG for DepCofSA thru Mil Pers Div SOS, 14 Dec 42, sub: Availability of Physicians. SG: 322.051-1. 78 (1) Memo, CG SOS (Tng Div) for SG, 5 Jan 43, sub; Tng of MG Pers. SG: 353.-1. (2) Memo SPOPH 320.2, Chief Hosp and Evac Br SOS for Gen Lutes, 1 6 Jan 43, sub; Asgmt, Tng, and Util of TofOpns Med Units. HD: Wilson files, “Book HI, 1 Jan 43-15 Mar 43.” 79 (1) Diary, Hosp and Evac Br SOS, 20 Jan 43. HD: Wilson files, “Diary.” (2) Memo, Maj J[ohn] S. Poe for the Record, 21 Jan 43, sub; Conf 4A526 Pen- tagon Bldg, 20 Jan 43. HD: 632 “Hosp-Housing.” 156 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR factory hospital service under the proposed plan.80 The plan which The Surgeon General presented on 14 April 1943 indicated that agreement on the subject had not been unanimous. Instead of providing for the use of numbered units to operate zone of interior hospitals, it called for the use of members of such units, on a two-for-one basis, to make up deficits in personnel— that is, differences between assigned and authorized strength in zone of interior hospitals. “This was done,” The Surgeon General stated, “because the primary function of the T/O unit is TRAIN- ING.”81 By this time seventy-eight general hos- pitals were reported “back-logged” in the United States, with no immediate pros- pect of employment overseas. Both the chief of the ASF Hospitalization and Evac- uation Branch and the ASF Director of Training feared that the General Staff would reduce the number of Medical De- partment units in the troop basis if they were not fully used.82 Before he could take further action toward that end Colonel Wilson was succeeded in his position in SOS headquarters by Col. (later Brig. Gen.) Robert C. McDonald, and for a time the question remained in abeyance. Meanwhile changes occurred in the training and use of some hospital units. Completion of housing near zone of inte- rior hospitals made it possible to train more personnel than before on a “paral- lel” basis;83 and year-round use by the Ground Forces of the A. R Hill Military Reservation and the Desert Training Cen- ter provided opportunities for several units to function as hospitals, furnishing medical and surgical care for patients in those areas.84 The issuance of assemblages to evacuation hospital units under the re- vised policy permitted them to train with full equipment and work out a system of functional packing to increase unit mobil- ity.85 Yet as a rule general and station hos- pital units still lacked assemblages in the United States and had infrequent oppor- tunities to function as hospitals before go- ing overseas. Meanwhile, the time which some of them spent in training lengthened considerably. For example, although affili- ated units had been intended for prompt shipment overseas, the fifty-one affiliated general hospital units that were eventu- ally sent out remained in the United States for an average of eight months. One, the 27th General Hospital unit, stayed in this country seventeen months. (Tables 6,7) The unsolved problems of assemblage- issuance and unit-use faced Surgeon Gen- eral Kirk when he succeeded General Magee in June 1943. Soon afterward he took them up with Colonel McDonald. Perhaps the entry of new participants made solution easier, for neither was un- alterably committed to the position of his predecessor. In addition, despite his ASF position, Colonel McDonald identified himself closely with the Medical Depart- ment and held personal views of these 80 Memo SPOPI 337, CG SOS (init WLW[ilson]) for SG and CofT, 30 Apr 43, sub: Resume of Confs. HD: Wilson files, “Book IV, 16 Mar 43-1 7 Jun 43.” 81 Ltr, SG to CG ASF, 14 Apr 43, sub: Asgmt of TofOpns Units for Tng. SG: 632.-1. 82 (1) Memo SPOPI 322(4-14-43), AGofS Oprs SOS (init WLWfilson]) for Dir Tng ASF, 19 Apr 43, sub; Asgmt of TofOpns Units. HD: Wilson files, “Book IV, 16 Mar 43-17 Jun 43.” (2) Memo SPTRU 370.5 (4-19-43), Dir Tng ASF for AGofS Oprs ASF, 27 Apr 43, same sub. SG; 353.-1. 83 1st ind, SG to Dir Tng SOS, 9 Jan 43, on Memo, CG SOS for SG, 5 Jan 43, sub: Tng of MG Pers. SG: 353.-1. 84 See above, pp. 104-06. 85 An Rpts, 1943, of following Evac Hosps; 27th, 32d, 39th, 51st, 99th, 103d, 106th, 1 10th, and 145th. HD. HOSPITALIZATION FOR THEATERS OF OPERATIONS 157 Number of Unit Affiliation Date of Activation Date of Embarkation Initial Destination 1st Bellevue Hospital, New York, N. Y 10 Jun 43 28 Dec 43 England 2d Presbyterian Hospital, New York, N. Y 31 Jan 42 1 Jul 42 England 3d Mt. Sinai Hospital, New York, N. Y 1 Sep 42 4 May 43 N. Africa 4th Western Reserve University, Cleveland, Ohio 13 Jan 42 23 Jan 42 Sth Harvard University, Boston, Mass 3 Jan 42 19 Feb 42 N. Ireland “ 6th Massachusetts General Hospital, Boston, Mass IS May 42 7 Feb 43 N. Africa 7th Boston City Hospital. Boston, Mass 10 Jun 43 S Dec 43 England 9th Society of the New York Hospital, New York, N. Y IS Jul 42 31 Jul 43 Guadalcanal 12th Northwestern University, Chicago, 111 Presbyterian Hospital, Chicago, 111 ' 28 Jan 42 12 Dec 42 N. Africa 13th IS Jan 43 S Jan 44 New Guinea 1/th Harper Hospital. Detroit, Mich 15 Jul 42 30 Jul 43 N. Africa 18th The Johns Hopkins Hospital, Baltimore, Md 20 Apr 42 26 May 42 New Zealand 19th Rochester General Hospital, Rochester, N. Y 24 Jul 42 5 Sep 43 England 20th University of Pennsylvania, Philadelphia, Pa IS May 42 19 Jan 43 India 21st Washington University, St. Louis, Mo 12 Jan 42 20 Oct 42 England 23d Buffalo General Hospital, Buffalo, N. Y IS Jul 42 29 Jul 43 N. Africa 24th Tulane University, New Orleans, La IS Jul 42 21 Aug 43 N. Africa 2Sth Cincinnati General Hospital and University of' Cincinnati, Ohio 10 Jun 43 23 Dec 43 N. Africa 26th University of Minnesota, Minneapolis, Minn 1 Feb 42 20 Oct 42 England 27th University of Pittsburgh, Pittsburgh, Pa 15 Jul 42 5 Jan 44 Australia 29th University of Colorado, Denver, Colo 1 Sep 42 3 Nov 43 New Caledonia 30th University cf California, San Francisco, Calif 15 May 42 4 Jun 42 England 31st Denver General Hospital, Denver, Colo 1 Jun 43 18 Oct 43 Espiritu Santo 32d University of Indiana, Indianapolis, Ind IS Jan 43 5 Sep 43 England 33d Albany Hospital, Albany, N. Y 15 Jul 42 7 Jul 43 N. Africa 36th Wayne University, Detroit, Mich 28 May 43 20 Aug 43 N. Africa 37th 15 Jan IS May 43 7 Jul 21 Sep 43 38th Jefferson Medical College, Philadelphia, Pa 42 42 Egypt (Suez) 39th Yale University, New Haven, Conn IS Jul 42 3 Nov 42 New Zealand 42d University of Maryland, Baltimore, Md 20 Apr 42 19 May 42 Australia 43d Emory University, Atlanta, Ga 1 Sep 42 21 Aug 43 N. Africa 44 th University of Wisconsin, Madison, Wis IS Jan 43 25 Sep 43 Australia 4Sth Medical College of Virginia, Richmond, Va IS May 42 21 Mar 43 N. Africa 46th University of Oregon, Portland, Oreg IS Jul 42 21 Aug 43 N. Africa 47 th College of Medical Evangelists, Loma Linda, Calif 10 Jun 43 11 Jan 44 New Guinea 5 0th Seattle College, Seattle, Wash 4 Sep 42 29 Dec 43 England S2d Syracuse University, Syracuse, N. Y Western Pennsylvania Hospital, Pittsburgh, Pa 1 Sep 42 6 Jan 43 England 38th IS Jan 43 8 Oct 43 England 64 th Louisiana State University, New Orleans, La IS Jul 42 21 Aug 43 N. Africa 63 th Duke University, Durham, N. C IS Jul 42 13 Oct 43 England 6/th Maine General Hospital, Portland, Maine 1 Sep 42 24 Nov 42 England 70th St. Louis University, St. Louis, Mo 1 Jun 43 21 Aug 43 N. Africa 71st Mayo Foundation of University of Minnesota, Rochester, Minn 10 Jun 43 Disbanded 24 fun 43b 79th Long Island College of Medicine, Brooklyn, N. Y 21 Sep 42 9 Oct 43 N. Ireland 105th Harvard University, Boston, Mass 20 Apr 42 19 May 42 Australia 108th Loyola University, Chicago, 111 10 Jun 43 8 Oct 43 England 118th The Johns Hopkins Hospital, Baltimore, Md 21 Apr 42 19 May 42 Australia 127th University of Texas, Galveston, Tex. . . 15 Jan 43 8 Oct 43 England 142d University of Maryland, Baltimore, Md. . . 20 Apr 42 26 May 42 New Zealand 297th Cook County Hospital, Chicago, 111 10 Jun 43 30 May 44 England 298th University of Michigan, Ann Arbor, Mich 27 Jun 42 20 Oct 42 England 300th Vanderbilt University, Nashville, Tenn 17 Jul 42 21 Aug 43 N. Africa “This unit returned from Nova Scotia to Boston on 4 March 1942 and embarked again at New York on 12 May 1942. 6 The professional and enlisted personnel of this unit was used to staff the 233d and 237th Station Hospitals, which embarked for Aus- traha on 5 January 1944. The 233d Station Hospital was reorganized and redesignated the 247th General Hospital on IS October 1944. After the war, on 7 February 1947, the 237th Station Hospital and the 247th General Hospital were consolidated to form again the 71st General Hospital, an inactive unit, to preserve its affiliation with the Mayo Foundation. Sources: Unit cards filed in Orgn and Directory Section, Oprs Br, AGO; from annual reports filed SG files pertaining to individual units. in HD; and miscellaneous AG and Table 6—Affiliated General Hospital Units problems similar to those advocated by the Surgeon General’s Office.86 General Kirk believed that the current policy on assemblage-issuance might be partly responsible for a problem which theaters had reported and complained of—the receipt of equipment for a single hospital on several vessels at widely sepa- rated ports.87 In July 1943, therefore, he requested its reconsideration. First he pro- posed a return to the policy advocated by 86 Interv, MD Historian with Brig Gen Robert C. McDonald, Ret, USA, 5 Mar 51. HD: 000.71. 87 An Rpt, Issue Br Sup Serv SGO, FY 1944. HD. 158 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Table 7—Affiliated Evacuation Hospital Units Number of Unit Affiliation Date of Activation Date of Embarkation Initial Destination 2d 7th St. Luke’s Hospital, New York, N. Y New York Post-Graduate Medical School, New 22 Jan 42 4 Sep 42 N. Ireland York, N. Y 22 Jan 42 7 Apr 42 Tongatabu 8th University of Virginia, Charlottesville, Va 8 Aug 42 2 Nov 42 N. Africa 9th Roosevelt Hospital, New York, N. Y 24 Aug 42 26 Sep 42 England 12th Lenox Hill Hospital, New York, N. Y 12 Aug 42 6 Jan 43 England 14th City Hospital, New York, N. Y 15 Aug 42 10 Jul 43 India 16th Michael Reese Hospital, Chicago, 111 15 Oct 42 14 Apr 43 N. Africa 21st Oklahoma School of Medicine, Oklahoma City, Okla. 17 Aug 42 29 Aug 43 Guadalcanal 25th West Suburban Hospital, Oak Park, 111 18 Aug 42 19 Oct 42 New Zealand 27th University of Illinois, Chicago, 111 15 Oct 42 3 Apr 44 N. Africa 30th University of Texas, Galveston, Tex.“ 15 Jul 42 7 Sep 43 Australia 38th Charlotte Memorial Hospital, Charlotte, N. C 16 Apr 42 5 Aug 42 England 48th Rhode Island Hospital, Providence, R. I 13 Aug 42 18 Jan 43 India 51st Sacramento County Hospital, Sacramento, Calif. . . . 24 Oct 42 3 Apr 44 N. Africa 52d Pennsylvania Hospital, Philadelphia, Pa 12 Jan 42 23 Jan 42 New Caledonia 56th Baylor University, Dallas, Tex 4 Apr 42 16 Apr 43 N. Africa 59th 73d San Francisco Hospital, San Francisco, Calif Los Angeles County General Hospital, Los Angeles, 6 Apr 42 12 Dec 42 N. Africa Calif 2 Jan 42 20 Jan 43 India 77th University of Kansas, Kansas City, Kans 10 May 42 5 Aug 42 England 92d St. Mary’s Hospital, Pueblo, Colo.6 25 Aug 42 28 Jun 43 Australia “ The 30th Evacuation Hospital was supplied with professional personnel from the 30th Surgical Hospital, a unit affiliated with the University of Texas but never activated. On 13 September 1942 the 30th Evacuation Hospital was redesignated the 30th Evacuation Hospital (Motorized): early in January 1943 it was changed to the 30th Evacuation Hospital, Semimobile. b The 7th Surgical Hospital, a nonaffiliated unit activated on 1 August 1940, was redesignated the 92d Evacuation Hospital (Motorized) on 25 August 1942. Early in 1943 it was renamed the 92d Evacuation Hospital, Semimobile Officers and nurses of the 64th Surgical Hospital, a unit affiliated with St. Mary’s Hospital, Pueblo, Colo., and never activated, had been assigned to the 7th Surgical Hospital. In July 1945 the 64th Surgical Hospital was reconstituted on the inactive list of the Army to preserve its identity and its affiliation with St. Mary’s Hospital. Sources: Unit cards filed in Orgn and Directory Section, Oprs Br, AGO; from annual reports filed in HD; and miscellaneous AG and SG files pertaining to individual units. his predecessor—withholding all equip- ment for hospital units until they reached ports of embarkation—and then a com- promise between that and the existing policy. Ultimately he withdrew both pro- posals. After an investigation of split ship- ments, Colonel McDonald reported that the current policy seemed to have little effect in causing such a problem. Further- more, representatives of The Surgeon General agreed that a change in policy might produce a six-to-twelve month pe- riod of confusion in supply matters.88 Thus the policy on the issuance of equipment to 88 (1) Ltr, SG to CG ASF, 10 Jul 43, sub: Equip for Fid Med Units. SG: 475.5-1. (2) 1st ind SPOPI 008 (7-10-43), CG ASF to SG, 9 Aug 43, on basic Ltr just cited. HD: Wilson files, “Day File, Aug 43.” (3) Ltr, SG to CG ASF, 6 Aug 43, sub: Equip for Fid Med Units. HRS: ASF Control Div, 334 “Procedure Cmtee, G-58.” (4) Diary, Hosp and Evac Br ASF, 27 Aug 43. HD: Wilson files, 400 “Med Equip and Sups.” (5) Memo for Record, 7 Sep 43, on Memo, SG for Col R. C. McDonald, Plans Div Oprs ASF, 7 Sep 43. SG: 475.5-1. (6) 1st ind SPOPI 440 (6 Aug 43), CG ASF to SG, 28 Aug 43, on basic Ltr cited in (3) above. HD: Wilson files, “Day File, Aug 43.” HOSPITALIZATION FOR THEATERS OF OPERATIONS 159 numbered medical units, which the Sur- geon General’s Office had formerly op- posed, remained in effect for the rest of the war.89 General Kirk called for a full discussion of the question of using numbered hospital units in the zone of interior medical serv- ice in his first conference with service com- mand surgeons. They agreed that the existing situation was deplorable. For ex- ample, one stated that it was difficult, when several units were located on a sin- gle post, to schedule their personnel for “parallel training” without having men “falling all over each other.” Another, stressing morale, stated that one unit had been in his command “so long that they’ve worn out all of their films showing them over and over, and they’ve worn out all their shoes doing the same hikes. . . .” In general, service command surgeons seemed favorably inclined toward the pro- posal to use numbered units in the opera- tion of zone of interior hospitals, but sev- eral feared that administrative difficulties might arise unless units and their com- manding officers were placed under the control of station surgeons. Others be- lieved that professional problems might develop if numbered units were with- drawn from named hospitals either for field training or for overseas service with- out adequate personnel being left behind to operate zone of interior hospitals.90 To avoid such a situation, the Surgeon Gen- eral’s Office announced that the adoption of any plan for the use of numbered units to operate zone of interior hospitals was contingent upon two conditions: first, the assignment of two hospital units to the named hospital in which they were to serve, and second, the existence of suitable barracks to house such units. Colonel Mc- Donald agreed to these conditions and suggested that the Surgeon General’s Office prepare a plan for trial on one post The chief of The Surgeon General’s Train- ing Division lacked enthusiasm for this proposal but agreed to investigate its pos- sibilities.91 Accordingly he drafted a plan by November 1943 for consideration by other officers of the Surgeon General’s Office, but their comments indicated no diminution of opposition to the basic idea.92 By that time events were taking place which were to cause the whole matter to be dropped. In September 1943 the Gen- eral Staff forbade the use of War Depart- ment funds to build more housing for numbered hospitals in the United States, thereby denying quarters for the two units per named hospital which The Surgeon General had recommended.93 The next month the ASF Hospitalization and Evacuation Branch, which had initiated 89 (1) See above, pp. 45-46, 141-42. (2) RptofSub- cmtee on Employment of Med Resources, Cmtee on Med and Hosp Serv of Armed Forces, Off SecDef, 25 May 48, pp. 394-95. HD. 90 (1) Rpt, SGs Conf with Chiefs Med Br SvCs, 14-17 Jun 43, pp. 242, 244, 245, 259, 260. HD: 337. (2) Memo, CG SOS (SG) for CGs of SvCs, 12 Jul 43, sub: Asgmt of TofOpns Units for Tng . . . , with inds from SvCs in reply. SG: 353.-1. 91 Rpt, SGs Conf with Chiefs Med Br SvCs, 14-17 Jun 43, pp. 253-64. HD: 337. (2) Diary, Hosp and Evac Br ASF, 16 Jun 43. HD: Wilson files, “Diary.” 92 (1) Memo, Maj G[arl] G. Sox for Col A. B. Welsh, 10 Nov 43, sub: Comments on Tentative Plan for the Functional Employment of Numbered ASF Med Units. (2) Memo, Maj John S. Poe for no ad- dressee, 10 Nov 43, sub: Comments on Col Wake- man’s Proposal. (3) Memo, Col A. B. Welsh for Gen R. W. Bliss, 12 Nov 43. (4) Memo, Col A. H. Schwichtenberg for Gen R. W. Bliss, 13 Nov 43, sub: Comments on Tentative Plan. . . . All in SG: 322.3-1. 93 (1) Memo, Maj J. S. Poe for Col Hfoward] T. Wickert, 7 Jul 43. HD: 632 “Hosp Housing.” (2) Memo Maj J. S. Poe for Col A. B. Welsh, 16 Sep 43. Same file. 160 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR and pushed the proposal, was abolished. Of greater importance was the change in conditions that had prompted the pro- posal in the first place. From the middle of 1943 onward the pressing need for hos- pitals overseas caused the departure of most units which had been held back as well as the prompt shipment of others after brief periods of training.94 This dis- posed of the argument that services of per- sonnel, especially doctors, were being wasted. It meant also that fewer and fewer units were left for use in hospitals at home. Finally, during the latter half of 1943 the troop population of the United States be- gan to shrink so rapidly that the general employment of numbered hospital units to assist with medical care in the zone of interior perhaps no longer seemed useful. As a result, the long and tedious contro- versy between the Surgeon General’s Of- fice and ASF headquarters over the equip- ment and use in the United States of num- bered hospital units reached an inconclu- sive end. Preparing for the Support of Offensive Warfare Shift of Emphasis Away From the Pacific By about the middle of 1942, when em- phasis in providing hospitalization for theaters shifted from the Pacific to other areas of the world, emergency needs re- sulting from the Japanese attack had been met and preparations for the invasion of North Africa were under way. To support the build-up of troops in the United King- dom and subsequent successful North African operations, hospitals went in in- creasing numbers to both the European and the North African theaters in the last half of 1942 and the early months of 1943. During the same period other units were sent to scattered areas throughout the world to care for troops engaged in serv- ice functions in support of more active theaters. Since combat on a large scale had not yet begun, fixed hospitals were needed more than mobile ones, and sta- tion more than general hospitals. For ex- ample, by 15 March 1943 the War De- partment had shipped overseas, according to The Surgeon General’s records, 140 station hospitals, ranging in size from 25- to 750-bed capacity, 27 general hospitals, and 14 field hospitals, but only 2 convales- cent, 3 surgical, 17 750-bed evacuation, and 6 400-bed evacuation hospitals.95 Of those shipped after 30 June 1942, the major portions were units that had been activated and trained after the war began. A few of the units that were activated dur- ing 1941 and were still in the United States in mid-1942 were sent overseas in the following months, but the majority of the older units continued during the early war years as training units, furnishing filler personnel for others activated during 1942 and 1943 or for affiliated units pre- viously organized. (Tables 8, 9, 10, 11.) As in the first six months of the war, although affiliated units continued to come on active duty on The Surgeon General’s rec- ommendation, many did not go overseas immediately. For example, although forty- two affiliated general hospital units had been activated by the middle of January 1943, only nineteen of them had been shipped by 15 March 1943. The remain- 94 (1) See below, pp. 218-23. (2) Memo, Dep Chief Oprs Serv SCO for Dir Hosp Div SCO, 1 7 Feb 44, with inch SG: 323.3. 95 Table entitled Medical SOS Units as of 15 March 1943. SG: 322.05-1. HOSPITALIZATION FOR THEATERS OF OPERATIONS 161 Table 8—Use of Nonaffiliated General Hospital Units Activated During 1941 Unit Desig- nation Date of Activation Supplied Enlisted Personnel for Affiliated Units that Embarked January-July 1942 Went to Theaters of Operations January-July 1942 Supplied Cadres for Other Units and Later Went Over- seas Supplied Cadres for Other Units and Later Were Inactivated Unit Desig- nation Date of Embarka- tion Destination Date of Embarka- tion Destination Date of Embarka- tion Date of Inactivation Date of Disband- ment S3d 10 Feb 41 29 Dec 43 S6th 1 Feb 41 4th 23 Jan 42 12 Oct 43 63d 10 Feb 41 IS Jan 43 66th 10 Feb 41 Sth 19 Feb 42 15 Apr 43 11 Nov 44 147th 1 May 41 16 Jun 42 21 Mar 42 148th 10 Feb 41 183d 10 Feb 41 14 Jan 43 11 Nov 44 203 d 10 Feb 41 105 th 19 May 42 29 Dec 43 204th 10 Feb 41 8 Apr 42 207th 10 Feb 41 30th 4 Jun 42 IS Jan 43 11 Nov 44 208th 1 Jun 41 18 Feb 42 209th 1 Jun 41 2d 1 Jul 42 10 Jun 43 11 Nov 44 210th 1 Jun 41 8 Jan 42 Panama Canal Zone. 212th 1 Jun 41 IS Jan 43 IS Jan 43 IS Jan 43 15 Apr 43 213th 27 Jun 41 11 Nov 44 214th 1 Jun 41 215th 16 May 41 42d 19 May 42 11 Nov 44 216th 1 Jun 41 13 Mar 44 217th 1 Jun 41 142d 26 May 42 28 Feb 44 218th 6 Jun 41 8 Jan 42 222d 16 Jun 41 18th 26 May 42 1 Apr 44“ 223d 17 Jun 41 IS Apr 43 11 Nov 44 ° As 134th General Hospital. Sources: Unit cards filed in Orgn and Directory Section, Oprs Br, AGO, and annual reports filed in HD. der stayed in this country in a training status until later in 1943 or early in 1944. (See Table 6) Negro Hospital Units Among the hospital units prepared early in the war for overseas service were two with Negro personnel. Their activa- tion and use, like the establishment of all- Negro wards and hospitals in the United States,96 resulted from The Surgeon Gen- eral’s opposition to the integration of Negro and white personnel in providing medical service for the Army—a position in line with the War Department’s general policy on the use of Negro personnel.97 On 24 March 1942 the 25th Station Hospital, a 250-bed unit, was organized at Fort Bragg (North Carolina). All of its members were Negroes except four officers—the commander and his immediate staff. The use of white officers to command Negro units was a common practice of the War Department and was not considered a vio- lation of the policy of segregation. Its 96 See above, pp. 110-12. 97 John H. McMinn and Max Levin, Personnel (MS for companion vol. in Medical Dept, series), HD., and Ulysses Lee, The Employment of Negro Troops, a forthcoming volume in the series UNITED STATES ARMY IN WORLD WAR II. 162 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Table 9—Use of Nonaffiliated Station Hospital Units Activated During 1941 Unit Desig- nation Date of Activation Embarked During 1941 Embarked January-July 1942 Embarked After 1 July 1942 Date Destination Date Destination Date Destination 41 42 Sth 41 17 Feb 42 7th 10 Feb 41 26 Sep 42 Sth 10 Feb 41 17 Jan 42 9th 11 Feb 41 42 10th 41 14 Jan 42 11th 41 S Sep 41 12th 41 18 Feb 42 22d 10 Feb 41 27 Feb 42 26th 10 Feb 41 31 Jan 42 47th 18 Jun 41 18 Feb 42 109th 41 23 Jan 42 IS 1st 41 30 Jun 42 lS2d 41 S Aug 42 England. 153d 41 18 Feb 42 154th 41 Iraq. ISSth 41 42 156th 41 42 IS 9th 41 19 Mar 42 160th 41 S Aug 42 England. 16Sth 41 27 Feb 42 166th 41 19 May 42 167th 12 Jul 41 168th 12 Jul 41 S Sep 41 Sources Unit cards filed in Orgn and Directory Section, Oprs Br, AGO, and annual reports filed in HD. advisability for hospital units was later questioned, and it was not followed in the case of other Negro hospital units acti- vated during World War II. An advanced detachment of the 25th Station Hospital embarked in May 1942 for Liberia to sup- port a force of construction engineers, per- sonnel of the Air Transport Command and the Royal Air Force, natives employed by the Army at Roberts Field, and elements of a task force charged with protecting an airstrip and American rubber interests. After quarters were constructed overseas, the remainder of the unit, including its nurses, joined the advanced detachment on 10 March 1943. About the same time an all-Negro 150-bed unit, the 268th Sta- tion Hospital, was activated at Fort Huachuca (Arizona). After a period of training, it embarked for the Southwest Pacific theater in October 1943 and ar- rived in Australia in November.98 Establishing a Basis for Future Planning Toward the end of 1942 the shift in em- phasis from defensive measures to prep- arations for the offensive made it neces- sary to take stock of hospitalization already supplied in order to plan effec- tively for the future. Records of the num- ber of hospital units shipped did not necessarily represent the number of beds available in the several theaters. In some instances, for reasons not often divulged to The Surgeon General, OPD diverted 98 (1) An Rpt, 25th Sta Hosp, 1943, and Quarterly Hist Rpt, 268th Sta Hosp, 7 Jul 44. HD. (2) Diary, Col Stephen D. Berardinelli, 21 Jun 42 to 21 Dec 43. In his possession. (3) Interv, MD Historian with Col Berardinelli, formerly CO of 25th Sta Hosp, 24 Feb 50. HD: 000.71. HOSPITALIZATION FOR THEATERS OF OPERATIONS 163 Table 10—Use of Nonaffiliated Evacuation Hospital Units Activated During 1940 and 1941 Supplied Enlisted Personnel for Affiliated Units Went to Theaters of Operations Disbanded after Sup- plying En- listed Per- sonnel to Other Units (Date) Unit Desig- nation Date of Activation Unit Desig- nation Date of Embarkation Destination Date of Embarkation Destination 1 Aug 40 4 Mar 42 3d 8th 2 Nov 42 24 Aug 42 24 Aug 42 4th 10 Feb 41 2d 4 Sep 42 18 Jan 43 26 Sep 42 48th 6th 10 Feb 41 9th 24 Aug 42 10th 10 Feb 41 11th 10 Feb 41 2 Nov 42 15th 1 Jun 41 1 Jun 41 7 Feb 43 19th 7th 7 Apr 42 6 Jan 43 19 Oct 42 25 Aug 42 12th 23d 16 May 41 25 th 18 Aug 42 5 2d 23 Jan 42 16 Apr 43 14 Apr 43 36th 1 Jun 41 1 Jun 41 S6th 19 Feb 44 37th 16th 13 Nov 42 41st 1 Jun 41 13 Nov 43 42d 27th 3 Apr 44 5 Aug 42 10 Jul 43 29 Aug 43 20 Jan 43 IS Oct 42 77th 43d 1 Jun 41 14th 15 Aug 42 S3d 1 Jun 41 17 Aug 42 73d S4th 31 Jul 43 68th 10 Feb 41 3 Apr 44 12 Dec 42 23 Oct 42 59th ® Converted from 7S0- to 400-bed evacuation hospitals before being sent overseas. Sources: Unit cards filed in Orgn and Directory Section, Oprs Br, AGO, and annual reports filed in HD. units to different destinations from those for which they were originally earmarked. It sometimes happened that units arrived at overseas ports without equipment, which was shipped on other vessels, and therefore could not set up for actual oper- ations. At other times assemblages were shipped as expansion units, for theaters to issue as needed to numbered hospitals that were already operating, to overseas hospi- tals that had operated during peacetime and were now being expanded, or to pro- visional hospitals that were being estab- lished with theater personnel. Further- more, the U.S. Army was receiving hospitalization in some areas through reverse lend-lease. Thus The Surgeon General could not rely upon records of shipment of hospital units and assem- blages for accurate information about beds available overseas. Nor could he de- pend upon statistical health reports (Med- ical Department Form No. 86ab). De- signed to supply his Office regularly with information about admissions and disposi- tions of patients and about available and occupied beds in all Army hospitals, these reports often reached Washington only after considerable delay and differed in many instaces from other available records." 99 Memo, SG for Oprs Div SOS, 3 1 Oct 42, sub: Bed Capacities for Fixed Hosps at Overseas Bases. SG; 632.2. 164 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Table 11—Use of Nonaffiliated Surgical Hospital Units Activated During 1940 and 1941 Unit Designation Date of Activation Redesignation in U. S. Date of Embarkation Initial Destination Redesignation Overseas Unit Date Unit Date 6th Surg Hosp.... 7th Surg Hosp.... 28th Surg Hosp.... 33d Surg Hosp.... 48th Surg Hosp.... 61st Surg Hosp... . 63d Surg Hosp.... 74th Surg Hosp.... 1 Aug 40 1 Aug 40 10 Feb 41 25 Jan 41 10 Feb 41 1 Jun 41 1 Jun 41 1 Jun 41 91st Evac (Mtz).... 92d Evac (Mtz) 31 Aug 42 25 Aug 42 25 Aug 42 25 Aug 42 25 Aug 42 12 Dec 42 28 Jun 43 4 Mar 42 4 Mar 42 2 Aug 42 16 Apr 43 28 Apr 43 16 Apr 43 N. Africa 93d Evac (Mtz) 94th Evac (Mtz).... 95th Evac (Mtz).... Australia Australia England N. Africa N. Africa N. Africa 360th Sta Hosp. . . 361st Sta Hosp.... 128th Evac (SM).. 28 Oct 43 28 Oct 43 1 May 43 Sources: Unit cards filed in Orgn and Directory Section, Opts Br AGO, and annual reports filed in HD. In July 1942, therefore, to get more ac- curate and more current information than he had, The Surgeon General called upon SOS headquarters for assistance.100 Find- ing that neither SOS headquarters nor OPD had accurate records of the beds available in various theaters, the SOS Hospitalization and Evacuation Branch requested the latter, on 6 August 1942, to require all overseas commanders to submit a report on the capacities and numerical designations of their fixed hospitals.101 This request was approved and, as the re- ports came in, the Surgeon General’s Of- fice, the SOS Hospitalization and Evacua- tion Branch, and OPD were able to get an accurate picture of hospitalization overseas at that time. It showed that the ratio of fixed beds to troop strength ranged from 2.09 percent in some areas to 24.1 percent in others.102 Even after reports of overseas bed ca- pacities had been received and tabulated, several obstacles to planning for the future had to be removed. In the first place, The Surgeon General was uncertain about his authority to make recommendations con- cerning overseas hospitalization, in view of the hospitalization and evacuation policy which was published on 18 June 1942 making overseas commanders re- sponsible for “the operation of all medical facilities under their control and for future planning in connection therewith” (italics added).103 Despite this policy, SOS head- quarters assured him that he could make recommendations about hospitalization and evacuation in theaters whenever ap- propriate. The Surgeon General also felt that he received insufficient information, both from higher authorities in the War Department and from surgeons in thea- 100 (1) Memo, SG for Dir Oprs SOS, 11 Jul 42. SG: 632.2. (2) Memo, SG for Oprs Div SOS, 29 Jul 42, sub: Fixed Hosp Beds Overseas. HD: 632.-1 “Hosp Overseas, Bed Status.” 101 (1) Memos SPOPM 323.7 and SPOPH 632, CG SOS for ACofS OPD WDGS, 6 and 27 Aug 42, sub: Fixed Hosp Fac Available to Overseas Forces. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” (2) 1st ind, CG SOS to SG, 14 Aug 42, on Memo, SG for Oprs Div SOS, 29 Jul 42, sub: Fixed Hosp Beds Over- seas. HD: 632.-1, “Hosp Overseas, Bed Status.” 102 (1) Memo SPOPH 632(Hosp), CG SOS for SG, 20 Oct 42, sub: Bed Capacities of Fixed Hosps at Overseas Bases. HD: 632.-1 “Hosp Overseas, Bed Status.” (2) Memo, SG for Oprs Div SOS, 31 Oct 42, same sub, with 1st ind SPOPH 632(10-31-42), CG SOS to SG, 16 Nov 42. Same file. 10:i Ltr AG 704 (6-1 7-42)MB-D-TS-M, TAG to CGs AGF, AAF, SOS, Theaters, etc., 18 Jun 42, sub: WD Hosp and Evac Policy. HD; 705.-1. HOSPITALIZATION FOR THEATERS OF OPERATIONS 165 ters, to enable him to plan intelligently and effectively for overseas hospitalization. While much information he desired from higher authorities was classified for secur- ity reasons, the SOS Hospitalization and Evacuation Branch attempted to provide him with more information about oper- ational plans than he had previously re- ceived.104 Furthermore, in collaboration with the Surgeon General’s Office that Branch took action which led to the estab- lishment in January 1943 of a system of montly reports from overseas commands. Submitted first as sections of the Monthly Sanitary Reports and after July 1943 as Reports of Essential Technical Medical Data (ETMD’s), these reports contained information about admission and evacua- tion rates, availability of hospital beds, suitability of hospital units and their equipment, and other factors of impor- tance to The Surgeon General in planning theater medical services.105 In addition, beginning with General Magee’s trip to North Africa in the winter of 1942-43, representatives of the Surgeon General’s Office made personal inspections of over- seas areas in order to gain firsthand infor- mation about their medical services.106 Further obstacles to planning were lack of sufficient experience with battle casual- ties thus far in World War II to estimate accurately hospital admission rates and lack of an official evacuation policy—that is, a policy governing the selection of pa- tients for evacuation to the United States in terms of the days of hospitalization which they were expected to require. In their absence The Surgeon General used for planning purposes the battle-casualty admission rates of World War I and as- sumed a policy of returning to the United States all patients who required 120 or more days of hospitalization. To establish a firmer basis for planning, he recom- mended in the spring of 1943 the estab- lishment of an official evacuation policy but such action was not taken until later in the year.107 In providing hospitals for overseas serv- ice early in the war, the Medical Depart- ment discovered and attempted to correct shortcomings and errors in its prewar planning. It was discovered early that the activation and training of normal Army units was more valuable in meeting emer- gency hospital needs than the formation and organization of units affiliated with civilian hospitals and schools. Moreover, it soon appeared that units planned for the- aters of operations were not suitable for all situations encountered in a modern global war and units of new types had to be de- 104 (1) Memo SPMCP 704.-1, Act SG for Oprs Div SOS, 16 Nov 42, sub: Status of Hosp Overseas, with 1st ind SPOPH 701 (11-16-42), ACofS Oprs SOS to SG, 24 Nov 42. (2) Memo SPOPH 701 (1 1-16-42), CG SOS for ACofS OPD WDGS, 24 Nov 42, same sub. (3) Memo OPD 701 (1 1-24-42), ACofS OPD WDGS for CG SOS, 23 Jan 43, same sub. All in HD: 632.-1 “Hosp Overseas, Bed Status.” 105 (1) Rad CM-OUT 5938-5957, TAG to CGs Overseas Comds. SG: 370.2-1. (2) Memo SPOPH 440, CG SOS for TAG, 28 Dec 42, sub: ETMD from Overseas Forces, with Memo for Record. HD: Wilson files, “Book IV, 16 Mar 43-17 Jun 43.” (3) Diary, SOS Hosp and Evac Br, 4 Dec 42. HD; Wilson files, “Diary.” (4) Ltr AG 350.05 (12-28-42)OB-S- SPOPH-M, TAG to CGs Overseas Comds, 2 Jan 43, sub: ETMD from Overseas Forces. HD; Wilson files, “Experience in Med Matters from Overseas Forces.” (5) Ltr AG 350.05 (28 Jun 43)OB-S-D-M, TAG to CGs Overseas Comds, 14 Jul 43, same sub. HD: 350.05 “Mil Info.” 106 Memo, SG for CG SOS, 12 Jan 43. HRS: Hq ASF, Gen [Wilhelm D.] Styer’s files, “Med Dept.” 107 (1) Memo SPMCP 704.-1, Act SG for Oprs Div SOS, 16 Nov 42, sub: Status of Hosp Overseas, with 1 inch HD: 632.-1 “Hosp Overseas, Bed Status.” (2) Memo, Dir Control Div ASF for CG ASF, 2 Apr 43, sub: Situation with Respect to Army Hosp. SG: 322.15. (3) Memo, SG for CG ASF, 15 Apr 43, sub: Evac Policy for Overseas Theaters. SG: 705.-1. (4) See below, pp. 215-16. 166 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR veloped—field hospitals, motorized evac- uation hospitals, and portable surgical hospitals. The size and weight of equip- ment of all hospital units had to be re- duced and new methods of packing had to be developed in order to increase the mo- bility and transportability of hospitals. Shortages of Medical Corps officers ap- peared and required reductions in the number authorized by tables of organiza- tion developed during the emergency period. Shortages of equipment continued to plague the Medical Department and partially accounted for The Surgeon Gen- eral’s insistence upon withholding its is- suance until hospital units were assigned to missions involving the care of patients. In this connection, The Surgeon General also resisted demands of higher author- ities to plan for the use of numbered hos- pitals in the zone of interior medical serv- ice. Meanwhile other units were being activated and trained, and toward the end of General Magee’s administration meas- ures were taken to find out what hospital facilities theaters actually had and to place planning for future needs on a sounder basis. PART THREE HOSPITALIZATION IN THE LATER WAR YEARS MID-1943 TO 1946 Introduction By the middle of 1943 the peak of the preparation phase of the war had been reached, and the United States and its Allies were ready to assume the offensive against the Axis powers. From then until the spring of 1945 troops moved steadily overseas, the number in the United States dropping from 5,355,683 to 2,753,455 and the number overseas growing from 1,637,- 419 to 5,403,931. In the fall of 1943, one body of American troops landed in Italy, carrying the offensive from North Africa to the European continent; others, by their attacks upon islands in the Gilbert and Marshall groups in the Pacific, began a two-pronged drive toward Japan. By the middle of the following year the Allies mounted their main attack against Ger- many, landing on the coast of France on 6 June 1944. Soon afterward the Central Pacific advance reached the Marianas and Southwest Pacific forces returned to the Philippines. Despite a German coun- teroffensive in December 1944, Allied forces moved inexorably toward victory in Europe and on 7 May 1945 Nazi Ger- many surrendered. Meanwhile, American troops in the Pacific pushed closer to the main Japanese islands, completing the re- conquest of the Philippines and gaining control of islands in the Ryukyus chain. Then, on 10 August 1945, the Japanese Government sued for peace. Immediately afterward the Army’s strength began to decline. By the beginning of 1946 the number of troops overseas dropped to 1,573,620 and of those in the United States to 1,895,6522 Combat developments inevitably in- fluenced the provision of hospitalization. With the movement of troops overseas the need for beds in station hospitals in the United States declined rapidly. On the other hand requirements for beds in hos- pitals of all types in theaters as well as in hospitals caring for overseas evacuees in this country mounted. The number of casualties and of soldiers with serious ill- nesses grew with the widening scope and increasing intensity of combat and the ex- posure of largeV groups to disease hazards in various parts of the world. Estimating the number of beds that would be needed under such circumstances proved to be considerably more difficult than calculat- ing the number needed for an Army in training. Moreover, to meet requirements for hospitalization, whatever they might be, the Medical Department had only limited means. New construction had been curtailed as the peak of the training phase had been reached; demands of overseas theaters for troops for combat operations and of the home front for civilian em- ployees to produce war materials reduced the manpower pool, both military and civilian, upon which the Medical Depart- ment could draw; and in the fall of 1943 the number of doctors allowed the Army was limited to 45,000. These limitations meant that emphasis had to be placed upon more effective use of the means 1 (1) Strength of the Army, STM-30, 1 Mar 47. (2) Biennial Report . . . Chief of Staff, 1943-45, pp. 1-87. 304244 0—55 13 170 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR available. Instead of building new hospi- tal plants, for example, the Medical De- partment had to expand and improve those already built or use vacated station hospitals and troop housing. Changes had to be made in the hospital system to avoid waste of personnel and equipment. Pol- icies for hospitalization had to be modified in order to hold bed requirements to the lowest practical number. And the organ- ization and administrative procedures of hospitals had to be standardized and sim- plified to permit relatively smaller and more heterogeneous staffs to operate them. The task of using limited means effec- tively and of planning their allocation among major commands in the United States and among theaters in all parts of the world fell to Surgeon General Kirk when he succeeded General Magee in June 1943. General Kirk maintained con- tinuity in the program of hospitalization, preserving many established policies and furthering developments already begun, but he also evolved new policies to meet changing situations and established new methods of operation. Meanwhile, he ex- panded and strengthened his own office and sought changes in the existing War Department organization to facilitate dis- charge of his responsibility for the health and medical care of the Army. CHAPTER IX Further Changes in Organization and Responsibilities for Hospitalization Relationship of The Surgeon General With Other War Department Agencies With the emergence of problems cre- ated by a shift from the defensive to the of- fensive phase of the war, changes occurred in the organization for hospitalization. One of the most fundamental was implicit in a gradual change in the relationship of The Surgeon General with ASF head- quarters and the General Staff. Although The Surgeon General remained under the jurisdiction of ASF headquarters until after the end of the war, there was a grow- ing trend in 1944 and 1945 toward his restoration to a position of direct contact with the General Staff. This trend resulted from efforts made by General Kirk to re- gain authority for his office commensurate with its responsibilities and from gradual resumption by the General Staff of some of the functions assumed earlier by the Army Service Forces.1 In the last half of 1943 the authority and responsibility of OPD for logistic mat- ters as well as the strategic direction of the- ater forces were confirmed and strength- ened. G-l became concerned about allo- cation of personnel for medical service throughout the world, and G-4 devoted growing attention to bed requirements and the hospital system in general. In ad- dition, two Special Staff units, the War Department Manpower Board and the Inspector General’s Office, took a hand in such matters. As this happened ASF headquarters lost some of its former authority and tended to become in some matters merely a formal channel of communication. Fi- nally, early in 1945 this trend culminated in a War Department circular which, while not removing him from ASF juris- diction, affirmed The Surgeon General’s position as the chief medical officer of the Army and officially authorized him to deal directly with the Chief of Staff and 1 For full information on this development see John D. Milled, The Organization and Role of the Army Serv- ice Forces (Washington, 1954), Chs. IX and X; and Ray S. Cline, Washington Command Post: The Opera- tions Division (Washington, 1951), Ch. XIV; both in UNITED STATES ARMY IN WORLD WAR II. 172 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR the General Staff, without interference by ASF headquarters, on matters affecting the health of the Army.2 In approving the publication of this circular the Secretary of War announced that it should be fur- ther interpreted as also giving The Sur- geon General direct access to the Secre- tary himself.3 A change in the organization of ASF headquarters reflected both its decrease of authority in phases of hospitalization in which the General Staff took a more ac- tive interest as well as a gradual return to the Surgeon General’s Office of certain functions connected with hospitalization and evacuation. In April 1943 the ASF Hospitalization and Evacuation Branch, whose head after February 1943 was Col. Robert C. McDonald, was reduced to a section of the Zone of Interior Branch of the Planning Division. In the following November the statement of this section’s functions was revised to eliminate word- ing that could be interpreted as giving it operational responsibilities for any aspect of hospitalization. Meanwhile, Medical Department officers who had been as- signed there in 1942 were transferred to other posts, two of them to the Surgeon General’s Office. In February 1944 the entire section was abolished and its re- maining functions were transferred to other units of the ASF Planning Division.4 This Division, along with others such as the Mobilization and Control Divisions, continued to exercise considerable author- ity over hospitals at ASF installations and over ASF hospital units being prepared for overseas service.5 Another aspect of General Kirk’s drive to regain authority with which to dis- charge responsibilities of his office was his effort to increase control by the Medical Department in general and by his Office in particular over medical installations, including hospitals, in service commands. Soon after he took office, General Kirk tried to have service command surgeons recognized as staff officers of service com- manders rather than as chiefs of medical branches under the intermediate control of supply divisions. His efforts were not at first successful, but toward the end of 1943 General Somervell directed service com- mand headquarters to conform as closely as practical to ASF headquarters. In most service commands the surgeon was then elevated, as were other technical service heads in the service commands, to a posi- tion as staff officer directly under the serv- ice commander himself.6 After that, the Surgeon General’s Office began to achieve closer co-ordination with service command surgeons and, through them, to exercise closer supervision over hospitalization. Early in 1944 comparative studies of matters affecting the operation and ad- ministration of hospitals, such as the amount of personnel assigned to them, the efficiency with which they treated and disposed of patients, and the number of beds which they set up for use, were made by the Surgeon General’s Office, and let- ters calling attention to the implications of these studies were sent to service com- mand surgeons monthly.7 Also, in 1944 2 (1) WD Gir 120, 18 Apr 45. (2) Millett, op. cit., pp. 298-310. 3 Memo, SecWar for [CofSA], 6 Apr 45. HRS; G-l file, 020 “SGO (10 Feb 45).20 Apr 45.” 4 History of Planning Div, ASF, vol. I, pp. 33, 40- 45, 61, 67, 78, 79, 80, 81. HRS. Officers transferred from ASF headquarters to SGO were Lt. Col. John C. Fitzpatrick and Maj. Henry McC. Greenleaf. 5 (1) ASF Manual M 301, ASF Orgn, 15 Aug 44. 6 Edward J. Morgan and Donald O. Wagner, The Organization of the Medical Department in the Zone of the Interior (1946), HD., pp. 97-99. 7 Such letters are filed in SG: 323.7-5 for each serv- ice command. FURTHER CHANGES 173 the Surgeon General’s Office adopted the “flying circus” method of inspection for hospitals. Representatives of such seg- ments of the Office as the Professional Consultants Divisions, the Nursing Divi- sion, the Supply Service, the Personnel Service, and the Construction Branch, under the leadership of the chief of the Hospital Division and accompanied by service command surgeons or their repre- sentatives, flew from one hospital to another making thorough inspections of their operations. Such inspections achieved closer co-ordination between offices of The Surgeon General and service com- mand surgeons and reduced confusion in the field which had formerly resulted from successive inspections by separate indi- viduals and from the receipt of instruc- tions from different staff officers.8 Only minor changes were made in the division of responsibility for numbered hospital units between the Ground and Service Forces. Upon recommendation of AGF headquarters and the Surgeon Gen- eral’s Office, responsibility for portable surgical hospitals was lodged with the Ground Forces in the winter of 1943-44.9 In the middle of the next year the Ground Surgeon concurred in a recommendation of the Surgeon General’s Office for trans- fer of responsibility for convalescent hos- pitals (units designed for the care of short- term patients in combat zones) from the Service to the Ground Forces.10 Whereas both the Surgeon General’s Office and ASF headquarters joined with the Gen- eral Staff and the Ground Forces in estab- lishing a general basis for the allotment of mobile hospital units to theaters, AGF headquarters was primarily responsible for the more detailed preparation of mo- bile hospitalization for separate theaters. Planning for fixed hospitalization in thea- ters for troops of all major commands— Air, Ground, and Service Forces—con- tinued to be, but not without opposition by the Air Forces, a responsibility of the Surgeon General’s Office and ASF head- quarters.11 Uncertainty about the extent of the Air Forces’ authority over hospitalization con- tinued. Surgeon General Kirk believed that all hospitals in the United States should be combined into one system un- der his supervision,12 but the Air Surgeon renewed his efforts to establish a separate and complete hospital system for the Air Forces. Activities in this connection caused a major change in the zone of in- terior hospital system.13 Attempts to estab- lish separate AAF hospitals in theaters of operations, though less successful, exem- plified the Air Surgeon’s drive for a com- pletely separate medical service. 8 Tab F, sub: Dev of a New Syst of Hosp Insp, to Memo, Dir Hosp Div SGO and Resources Anal Div SGO for Dir HD SGO thru Chief Oprs Serv SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. Examples of reports of flying circus in- spections are found in SG: 333.1 for each service com- mand. 9 (1) Memo for Record, by [Col] R. B. S[kinner], 26 Aug 43. Ground Med files: Transfer Binder Jour- nal, 1943. (2) 6th ind SPMCP 322.15-17 (Cp Mack- all)C, Chief Oprs Serv SGO to SG, 11 Nov 43, on Ltr, CG Airborne Comd AGF to CG AGF, 4 Sep 43, sub; Ptbl Surg Hosp. AGF: 321 No 5. (3) Memo 353- GNGPS (4 Sep 43), CofS AGF for CofSA attn ACofS G-3 WDGS, 29 Nov 43, sub: Ptbl Surg Hosp. AGF: 321 No 5. (4) Memo, ACofS G-3 WDGS to CG ASF, 1 Dec 43, sub: Ptbl Surg Hosp. AGF: 321 No 5. 10 (1) Memo SPMOO 400.34 (24 Jul 44), CG ASF for CG AGF thru SG, 25 Jul 44, sub: Present Status of Certain MAC Offs with Gonv Hosps, with inds and incls. (2) DF 320.3 (24 Feb 44), Dep ACofS G-3 WDGS to CG ASF, 22 Jul 44, same sub. Both in SG: 320.3-1. 11 Interv, MD Historian with Col Arthur B. Welsh, 27 Dec 50. HD: 000.71. 12 Rpt, SGs Conf with Chiefs Med Br SvGs, 14-17 Jun 43, p. 7. HD: 337. 13 See below, pp. 182-85. 174 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Efforts of the Air Surgeon To Get Separate Hospitals for Theater Air Commands Under the War Department reorgani- zation and policies established early in 1942, theater air commands, unlike ground commands, had no authority or control over hospital units used in support of troops in combat zones. Like ground forces, on the other hand, they were de- pendent upon service forces hospitals for the care of personnel in communications zones. In some theaters local air and the- ater surgeons arranged for the attachment, but not the assignment, of a limited num- ber of either mobile or fixed hospitals to theater air commands,11 but the Air Sur- geon considered this arrangement unsatis- factory. He wanted theater air commands to have complete control of their own hos- pitals. The reasons he most often gave for this position were the loss of control by air commands of personnel sent to service forces hospitals, the loss of man-days caused by transferring patients to service forces hospitals and awaiting their return to duty through the replacement system, the lowered morale of air forces personnel which resulted from their temporary ab- sence from air commands, and the need of air forces men for professional care that was “directed from an aero-medical view- point.” 15 The Surgeon General, on the other hand, believed that supplying fixed hospitals to overseas areas on a theater basis, rather than on a major command basis, achieved a more effective use of available resources. In the fall of 1943 the Air Surgeon at- tempted to get numbered hospital units included in the War Department troop basis as AAF units. Success would have meant that such units would be activated and trained by the Air Forces and would be sent to theaters as air units for use by air commanders and not by theater or communications zone commanders. This attempt failed because of lack of support by the Air Staff and opposition of the Sur- geon General’s Office and ASF headquar- ters.16 To secure data for use in winning greater support from the Air Staff and in countering ASF arguments, the Air Sur- geon in March 1944 sent to surgeons of all theater air commands a questionnaire about the desirability of separate hospitals for air forces personnel.17 Meanwhile there arose the question of the assignment to air commands of hospi- tals located in Newfoundland at bases transferred in the fall of 1943 from the Newfoundland Base Command to the Air Transport Command. After several months of negotiations, AAF headquar- ters, ASF headquarters, the Surgeon Gen- 14 (1) Air Evaluation Board, SWPA, The Medical Support of Air Warfare in the South and Southwest Pacific, 7 December 1941-15 August 1945, pp. 43Iff. HD. (2) Ltr, Surg 9th AF to Air Surg, 20 Aug 44. HD: TAS, “9th AF (Col Kendricks).” 15 Study, unsigned, n d [1944], sub: Study of Over- seas Hosp. HD: TAS, “Hosp for AAF Units Over- seas.” Also see Ftrs from Air Surg, cited below. 16 (1) Memo, Air Surg for C of Air Staff, 29 Nov 43. (2) Comment 2, Col H. G. Chenault, MC, Air Surg Off to AC of Air Staff, Personnel, 6 Dec 43, on above. (3) Comment 1, Col H. C. Chenault, MC to AC of Air Staff OC & R, 13 Dec 43, sub; Air Base Hosps for Overseas Air Bases in 1944 AAF Trp Basis, on unknown basic memo. (4) Memo, unsigned [CG AAF] for CofSA, n d, sub: Hosp at AF Bases and Stas Outside Continental Fimits of US. (5) Memo, CG AAF for CG ASF, 16 Feb 44, sub; Med Care of AAF Pers, with inch All in HD: TAS, “Hosp for AAF Units Overseas.” A full discussion of the Air Surgeon’s attempts to get separate hospitals for theater air com- mands is in Hubert A. Coleman, Organization and Administration, AAF Medical Services in the Zone of the Interior (1948), pp. 409-32. HD. 17 Study, unsigned, n d [1944], sub: Study of Over- seas Hosp. HD; TAS, “Hosp for AAF Units Over- seas.” FURTHER CHANGES 175 eral’s Office, and the General Staff agreed that the numbered hospitals at such bases would be returned to the United States and that the North Atlantic Wing of the Air Transport Command would operate dispensaries in their place. While such in- stallations were in reality small hospitals, use of the term “dispensaries” kept nomi- nally intact the War Department policy of having service forces provide fixed hospi- talization for all forces in theaters of operations.18 Before this decision had been reached the President received complaints about the hospitalization of air troops in the United Kingdom, and in March 1944 he sent a committee composed of Surgeon General Kirk, Air Surgeon Grant, and Dr. Edward A. Strecker, a prominent civilian physician, to investigate the hospital situ- ation there. They found insufficient cause for complaints and in April the President approved their recommendation that no change be made in the hospital system in the European Theater.19 Planning for the B-29 very-long-range - bomber program in April 1944 presented a favorable opportunity for pressing for separate air forces hospitals in the Pacific. When an OPD representative stated that ASF hospital units were not available for assignment to the Central Pacific area for the XXI Bomber Command, AAF head- quarters offered to furnish them. OPD was on the verge of authorizing it to do so when the Surgeon General’s Office pro- posed instead the transfer of certain hos- pital units from the less active South Pacific to the Central Pacific.20 The Air Surgeon then urged the Air Staff to take such “drastic” action that the Army Chief of Staff would be forced to make a decision as to whether or not the- ater air forces could have separate hospi- tals.21 To support his position the Air Sur- geon used replies which he had received from his March questionnaire. While they did not show a unanimous desire among air command surgeons for separate hospi- tals, they gave the Air Surgeon substanti- ating data for his position. The Air Staff remained nonetheless unconvinced of the wisdom or desirability of pressing for sep- arate air forces hospitals generally. In- stead, the Air Staff directed the Air Sur- geon to prepare a study showing the need of the XX Bomber command, at that time located in India, for separate hospi- tals. Because he found it hard to divorce a desire for separate hospitals in all theaters from the question of separate hospitals for the XX Bomber Command, the Air Sur- geon had difficulty preparing a study which the Air Staff would approve. He fi- nally succeeded, only to be turned down by the commanding general of the Air Forces, who knew, according to officers in 18 (1) Diary, Hosp Div SGO, 4 Apr 44. HD: 024.7- 3. (2) 1st ind, SG to ACofS OPD WDGS, thru CG ASF, 5 Sep 44, on DF OPD 320.2 (30 Aug 44), ACofS OPD WDGS to CG ASF, 30 Aug 44, sub: Designa- tion of Certain AAF Sta Hosps. SG: 322 “Hosp Misc 1944.” 19 (1) Memo, F. D. R[oosevelt] for Gen Marshall, 26 Feb 44. (2) Memo WDCSA 632 (28 Feb 44), CofSA for The President, 29 Feb 44. (3) Memo, Air Surg, and Dr. Edward A. Strecker for CofSA thru Dep Theater Comdr ETOUSA, 20 Mar 44. (4) Ltr, SecWar to The President, 29 Mar 44. (5) Memo, Sec WDGS for CG ASF, CG AAF, SG, and Air Surg, 10 Apr 44. All in AG: CofS files 632, 1944-46. 20 (1) Comment 1, Air Surg to AC of Air Staff OC & R, 5 May 44, sub: Med Serv for XXI Bomber Comd. HD: TAS, “Hosp for AAF Units Overseas.” (2) Memo, Dep Dir MOOD SGO for Record, 15 May 44. HD: MOOD “Pacific.” (3) Memo OPD 320.3 PTO (17 May 44), ACofS OPD WDGS for CG ASF and CG AAF, 17 May 44, sub: Air Base Hosps in Sup- port of VLR, with Memo for Record. HD; TAS, “Hosp for AAF Units Overseas.” 21 Memo, Air Surg for C of Air Staff, 26 Jun 44, sub: AAF Med Serv and Hosp Overseas. HD: TAS, “Hosp for AAF Units Overseas.” 176 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR AAF headquarters, that the Army Chief of Staff opposed “duplicate medical serv- ices.” 22 Thus, overseas air forces never re- ceived official authority to establish separate hospitals. In some theaters they set up hospitals under the guise of dispen- saries, while in others they operated hos- pitals that were loaned to them by theater commanders.23 Expanding and Strengthening the Surgeon General’s Office Correlative to General Kirk’s attempts to gain greater authority and higher status for The Surgeon General was the expan- sion and strengthening of his own Office.24 In July 1943 The Surgeon General combined his Hospitalization and Evacu- ation Division with his Hospital Construc- tion Division to form a single unit: the Hospital Administration Division. Pro- posed by ASF headquarters as a means of simplifying the organization of the Sur- geon General’s Office,25 this step concen- trated related functions—hospital con- struction, hospital administration, and evacuation—under one officer, who was subordinate in turn to the new chief of the Operations Service, Col. (later Brig. Gen.) Raymond W. Bliss. The new Division, whose director from August 1943 to Au- gust 1945 was Col. Albert H. Schwichten- berg, had four branches. The Policies Branch, under Ft. Col. Basil C. MacLean until he was succeeded by Lt. Col. James T. McGibony in the fall of 1944, was re- sponsible for establishing and publishing policies on hospital administration. The Evacuation Branch was in charge of the bed-credit system in general hospitals. The Construction Branch, whose new chief after 5 October 1943 was Lt. Col. (later Col.) Achilles L. Tynes, was respon- sible for co-ordinating the work of the Surgeon General’s Office with the Engi- neers in the construction and maintenance of hospital plants. The fourth branch, the Liaison Branch, was new and was estab- lished to meet needs that had developed in the course of the war. It was charged with maintaining liaison with the Trans- portation Corps in the movement of pa- tients, with The Provost Marshal General in the hospitalization of prisoners of war, and with the Women’s Army Corps in the hospitalization and employment of Wacs.2(i During the winter of 1943-44 a major expansion and reorganization occurred. Personnel limitations and prospective combat-casualty loads complicated prob- lems of planning and providing hospitali- zation for the Army. Furthermore, there was some belief in both ASF headquarters and the Surgeon General’s Office that the latter should be more active than in the past in planning hospitalization and in 22 (1) Comments 1 to 12, on Memo, Air Surg for C of Air Staff, 26 Jun 44, sub; AAF Med Serv and Hosp Overseas. (2) Memo, unsigned [CG AAF] for CofSA, 23 Jul 44, sub: Twentieth AF Responsibilities. (3) Comments 13 to 16, on Memo, unsigned [CG AAF] for CofSA, n d, sub: XX Bomber Comd. All in HD: TAS, “Hosp for AAF Units Overseas.” 23 This statement is based upon numerous letters between Col. Walter S. Jensen, MG, Chief Surgeon of Hq. AAF, Pacific Ocean Area, and Maj. Gen. David N. W. Grant, USA, Air Surgeon. HD; TAS, “20th AAF/POA (Col Jensen).” 24 Although reorganizations that were made were general and affected many units of his Office, only those concerned with hospitalization and evacuation will be considered here. For a discussion of the gen- eral reorganization, see Blanche B. Armfield, Organ- ization and Administration (MS for companion vol. in Medical Dept, series), HD. 25 Memo, SG for CG ASF, 18 Jun 43, sub: Orgn of SCO, with 1st ind, CG ASF to SG, 1 Jul 43, and 2d ind, SG to CG ASF, 7 Jul 43. SG; 024.-1. 26 Morgan and Wagner, op. cit., pp. 28-33. Infor- mation about personnel assignments was taken from SG office orders and personnel records on file in SGO. FURTHER CHANGES 177 supervising hospital operations,27 Perhaps with tongue in cheek, the director of The Surgeon General’s Control Division pro- posed in September 1943 that this should be considered a “new activity.”28 At any rate, early the next year the Surgeon Gen- eral’s Office began to negotiate with ASF headquarters for the transfer of personnel to establish a “Facilities and Personnel Utilization Branch” in the Hospital Ad- ministration Division. Organized by Dr. Eli Ginzberg, an economist and statis- tician on loan from the ASF Control Divi- sion, this Branch was charged in February 1944 with making comprehensive hospi- talization plans, including the calculation of bed and personnel requirements, the utilization of available buildings and per- sonnel, and the modification of the hospi- tal system to achieve greater efficiency and economy in operations.29 Soon after- ward, in an attempt to achieve greater co-ordination among operational seg- ments of his Office, The Surgeon General reorganized his entire Operations Serv- ice.30 The revamped Service had two deputy chiefs. One was responsible, among other things, for the provision of hospitals for theaters of operations, while the other dealt with hospitalization and evacuation in the zone of interior. Under the Deputy Chief for Hospitals and Domestic Operations were a Hospital Division and four liaison units. Three of the latter had previously existed as sec- tions of the Liaison Branch of the Hospi- tal Administration Division: the Prisoner- of-War Liaison Unit, the Women’s Medi- cal Unit, and the Transportation Liaison Unit. The fourth, the Army Air Forces Liaison Unit, was mainly a paper unit, for it was headed by the Hospital Division director who was already charged with maintaining liaison with the Air Sur- geon’s Office. Like the Hospital Admin- istration Division which it succeeded, the Hospital Division had four branches. The Evacuation and Construction Branches continued without change; the Policies Branch was renamed the Administration Branch; and there was the newly created Facilities Utilization Branch.31 These changes were more apparent than real because Colonel Schwichten- berg, who was already serving as chief of the Hospital Division, continued in that post and became also the Deputy Chief for Hospitals and Domestic Operations. Thus, chiefs of the branches of the Hospi- tal Division and heads of the liaison units continued under his supervision in much the same relationship as before. The changes were significant, however, in that (1) the person responsible for hospital ac- tivities was given higher status than for- merly, (2) the new branch of the Hospital Division, the Facilities Utilization Branch, was charged with making comprehensive plans for hospitalization in the United States and with arranging for the execu- tion of those plans with other interested units in the Surgeon General’s Office, and (3) the amount of personnel available for work on hospital plans and operations was increased until there were twenty- three officers and thirty-six civilians un- 27 (1) Memo, Dir Control Div SCO for [Maj] Gen [Norman T.] Kirk, 13 Jan 44, sub: Proposal for Over- all Plan for Most Effective Util of Off Almt, Civ Pers, and Space in the SCO and for Modifications in Pres- ent Orgn. SG: 320.3 GG. (2) Tab A, sub: Estab of a Statistical Management Unit in the Oprs Serv, to Memo cited n. 8. 28 Memo, Dir Control Div SGO for Chief Liaison Br Oprs Serv SGO, 30 Sep 43. Off file, Gen Bliss’ Off SGO, “Util of MCs in ZI” (19)# 1. 29 Diary, Hosp Admin Div SGO, 3 and 8 Jan 44; and Diary, Fac Util Br (later Resources Anal Div) SGO, [7 Feb 44]. HD; 024.7-3. 30 Morgan and Wagner, op. cit., pp. 44-51. 31 Ibid. 178 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR der the supervision of the Deputy Chief for Hospitals and Domestic Operations in July 1944.32 The Office of the Deputy Chief for Plans and Operations replaced the old Plans Division, which had been headed since July 1943 by Col. Arthur B. Welsh. In this Office were three divisions; the Mobilization and Overseas Operations Division, the Technical Division, and the Special Planning Division. The Mobilization and Overseas Opera- tions Division, developed from a branch of the same name in the former Plans Division, had three branches. Its Theater Branch maintained current information on the status of Medical Department units in each overseas theater; made studies of bed requirements of the several theaters; formulated plans for the employment of Medical Department units, personnel, and equipment in each theater; and prepared recommendations to higher commands on changes in the status or organization of medical services overseas. In this work it maintained close liaison with the ASF Planning Division. The Troop Units Branch planned and recommended the types and numbers of ASF medical units required under current authorizations for each theater; planned the activation, re- organization, shipment, disbandment and inactivation of such units; and main- tained liaison with the ASF Mobilization Division. The Inspection Branch, formerly a branch of the Plans Division, continued to receive and review reports from theaters of operations, such as the reports of essen- tial technical medical data (ETMD’s); maintained records of trips of inspection made by representatives of the Surgeon General’s Office; and interviewed and cir- culated reports of interviews with medical personnel returned from overseas areas. The Technical Division included among its many duties the preparation and revi- sion of tables of organization and equip- ment, Medical Department equipment lists, and tables of allowances. The Special Planning Division was re- sponsible for plans for the demobilization of the Medical Department and for the medical care of civilians in occupied coun- tries.33 A separate unit of the Operations Serv- ice, the Strategic and Logistic Planning Unit, was responsible for determining “the adequacy of all phases of Medical Depart- ment operations, and plans therefor, to the extent necessary to insure timely placing of sufficient personnel, equipment and supplies to meet all authorized require- ments,” 34 from March to November 1944. On the latter date it was absorbed by the Mobilization and Overseas Operations Division.35 This multiplicity of offices might give an erroneous impression of division of re- sponsibility were it not pointed out that one man, Colonel Welsh, served at the same time as Deputy Chief of the entire Operations Service, Deputy Chief for Plans and Operations, and Director of the Mobilization and Overseas Operations Division.36 (Chart 7.) Further changes, representing perhaps a logical extension of those already made, occurred during the remainder of the war. 32 An Rpt, FY 1944, Hosp and Dom Oprs SGO. HD. 33 (1) Morgan and Wagner, op. cit., pp. 44-51. (2) An Rpts, MOOD SGO, FY 1944 and 1945. (3) An Rpt, Spec Planning Div SGO, FY 1944. (4) An Rpt, Tec Div SGO, FY 1945. All in HD. 34 Memo, Dir Strategic and Logistic Planning Unit SGO for Chief Oprs Serv SGO, 6 Jun 44, sub: Rpt of Accomplishments of the SGO. HD: 319.1-2 (MOOD Oprs Serv SGO). 35 An Rpt, MOOD SGO, FY 1945. HD. 36 Orgn Directory, SGO, 20 Mar 44. HD: 461. Chart 7—Organization of the SGO for Hospitalization and Evacuation, 1943-45 CHIEF OF OPERATIONS SERVICE JULY 1943 HOSPITAL ADMINISTRATION DIV | TRAINING DIVISION PLANS DIVISION POLICIES BRANCH EVACUATION BRANCH MOBILIZATION AND OVERSEAS OPERATIONS BRANCH ORGANIZATION AND EQUIPMENT ALLOWANCE BRANCH CONSTRUCTION BRANCH RESEARCH COORDINATION BRANCH LIAISON BRANCH FIELD EQUIPMENT DEVELOPMENT BRANCH TRANSPORTATION CORPS INSPECTION BRANCH PLANS COORDINATION BRANCH WOMENS ARMY CORPS OFFICE OF THE ■PROVOST MARSHAL GENERAL CHIEF OF OPERATIONS SERVICE FEBRUARY 1944 DEPUTY CHIEF STRATEGIC AND (4) LOGISTICS PLANNING UNIT DEPUTY CHIEF FOR HOSPITALS AND DOMESTIC OPERATIONS TRAINING DIVISION DEPUTY CHIEF FOR PLANS AND OPERATIONS PRISONER OF WAR LIAISON UNIT WOMENS MEDICAL UNIT (2) TRANSPORTATION LIAISON UNIT (I) A AF LIAISON UNIT MOBILIZATION AND OVERSEAS OPERATIONS OIV. SPECIAL PLANNING DIVISION TECHNICAL DIVISION | HOSPITAL DIVISION CONSTRUCTION BRANCH EVACUATION BRANCH (I) ADMINISTRATION BRANCH FACILITIES (3) UTILIZATION BRANCH THEATER BRANCH INSPECTION BRANCH TROOP UNITS BRANCH JUNE 1945 CHIEF OF OPERATIONS SERVICE RESOURCES ANALYSIS DIVISION DEPUTY CHIEF FOR I HOSPITALS AND | DOMESTIC OPERATIONS] DEPUTY CHIEF DEPUTY CHIEF FOR PLANS AND OPERATIONS HOSPITAL DIVISION MEDICAL REGULATING UNIT A AF LIAISON UNIT SPECIAL PLANNING DIVISION MOBILIZATION AND OVERSEAS OPERATIONS DIVISION CONSTRUCTION BRANCH ADMINISTRATION BRANCH POW LIAISON UNIT I EVACUATION BRANCH COMBINED WITH TRANSPORTATION LIAISON UNIT TO FORM MEDICAL REGULATING UNIT IN MAY 1944 2. TRANSFERRED TO PROFESSIONAL ADMINISTRATIVE SERVICE IN AUGUST 1944 3. BECAME RESOURCES ANALYSIS DIVISION IN OCTOBER 1944 4. FUNCTIONS TRANSFERRED TO MOBILIZATION AND OVERSEAS OPERATIONS DIVISION IN NOVEMBER 1944 THEATER BRANCH TECHNICAL DIVISION TRAINING DIVISION INSPECTION BRANCH TROOP UNITS BRANCH 180 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR In May 1944 the Evacuation Branch was removed from the Hospital Division and was merged with the Transportation Liai- son Unit to form a Medical Regulating Unit under Lt. Col. John C. Fitzpatrick.37 This step combined under one head the control of the use of beds in general hospi- tals and the movement of patients to those beds. In August 1944 the Women’s Medi- cal Liaison Unit, whose function was more advisory than operational, was transferred from the office of the Deputy Chief for Hospitals and Domestic Operations to the new Professional Administrative Service. In October 1944 the Facilities Utilization Branch was removed from the Hospital Division and given higher status and re- sponsibility, as the Resources Analysis Di- vision, under the direct supervision of the chief of the Operations Service. Its head was Doctor Ginzberg, who by this time had been formally transferred from ASF headquarters to the Surgeon General’s Office.38 Continuing the trend of central- izing operational activities and separating administrative from advisory functions, responsibility for the operation of the re- conditioning program was transferred in April 1945 to the Hospital Division, leav- ing the Reconditioning Consultants Divi- sion free to concentrate in an advisory capacity on matters of policy.39 Other units in the Surgeon General’s Office continued to contribute, in varying degrees, to hospital operations. Among them, the Personnel and Supply Services were perhaps the most important. As in- creasing attention was given to manage- ment techniques, the Control Division entered the hospital operations field and, in co-operation with the Hospital Divi- sion, attempted to standardize and sim- plify hospital administrative procedures.40 37 Memo for Record, by Col Tracy S. Voorhees, Dir Control Div SCO, 3 May 44, sub: The MRO Set-up. SC: 024.-1. 38 An Rpt, Resources Anal Div SCO, FY 1945. HD. 39 (1) Morgan and Wagner, op. at., pp. 49, 50, and 69. 40 See below, pp. 261-65. CHAPTER X Adjustments and Changes in the Zone of Interior Hospital System As the tempo and extent of the war in- creased, changes and adjustments were made in the hospital system. Among the more important reasons for them were the necessity of using limited personnel re- sources—particularly doctors—more ef- fectively than formerly; the continuing efforts of the Air Surgeon to gain greater control over hospitalization of Air Forces men; the necessity of caring for large num- bers of prisoners of war; and the growing number of patients requiring specialized treatment and care. In the fall of 1943 several groups attempted to solve the problem of limited personnel resources. Among them were the “Kenner Board,” a group of officers appointed by The Sur- geon General and headed by Brig. Gen. Albert W. Kenner to study Medical De- partment personnel utilization; the Hos- pital and Control Divisions of the Surgeon General’s Office; the ASF Control Divi- sion; and the Inspector General’s Office. These groups agreed that certain steps were desirable: reduction in size and num- ber of station hospitals; merger of neigh- boring hospitals to eliminate overlapping and duplication; and removal of convales- cent patients from the wards of general hospitals. They disagreed on the question of how to operate two sets of hospitals (those of the Army Air Forces and those of the rest of the Army) with a minimum of duplication of facilities and waste of per- sonnel. Subsequently their opinions were reflected in changes made in the hospital system.1 Closure of Surplus Station Hospital Facilities The first adjustment needed was the closure of station hospital plants, or parts of them, to keep step with the shrinkage in military population as troops moved over- 1 (1) Mins of Mtgs and Rpt of Bd of Off to Study the Util of MC Offs, 1 7 Sep 43-6 Nov 43. HD: 334 “Kenner Bd.” (2) Memo, Dr. Eli Ginzberg, Control Div ASF for Chief Oprs Serv SCO thru Dir Control Div ASF, 30 Nov 43, sub: Surv of Gen Hosps. SC; 333.1- (3) Memo, Lt Col Basil C. MacLean, Hosp Admin Div SCO for Gen [Raymond W.] Bliss thru Col [Albert H.] Schwichtenberg, 6 Nov 43, sub: Ob- servations Based on Recent Visits ... to 9 Gen Hosps. Off file, Gen Bliss’ Off SCO, “Util of MCs in ZI” (19)# 1. (4) Notes on Visit to McCloskey, O’Reilly, and Percy Jones Gen Hosps, 11 Dec 43, by Col Tracy S. Voorhees, Control Div SCO. SC: 333.1- (5) Memo, WDCSA 333 (4 Nov 43), DepCofSA for IG,4 Nov 43, sub: Util of Med Off Pers in ZI Instls. AG; 320.2 (18 Apr 44) (1). 182 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR seas. When this was done doctors no longer needed to care for troops in train- ing could be released for assignment either to hospitals scheduled for overseas service or to general hospitals in this country. In the fall of 1943 both the Surgeon Gen- eral’s and the Air Surgeon’s Offices made surveys to this end.2 By the close of the year “considerable reductions” had been made in the sizes of AAF hospitals, and the Surgeon General’s Office was plan- ning a general procedure for adjusting capacities of all station hospitals to the troop populations which they served.3 To avoid overcrowding in hospital plants that were by then larger than needed, The Surgeon General’s Hospital Administra- tion Division proposed a resumption of the practice of placing beds in wards only and of allotting to each bed 100 square feet of floor space, a practice which had been abandoned earlier when the need for beds was greater. This Division also rec- ommended that local commanders be held responsible for reducing the sizes of station hospitals to authorized capacities.4 ASF headquarters and the General Staff approved these proposals and pub- lished regulations to effect them early in 1944.5 Concurrently The Surgeon Gen- eral’s Facilities Utilization Branch began to urge service command surgeons to in- crease efforts to shrink station hospitals under their supervision.6 To judge the progress made, The Surgeon General changed the way in which station hospital beds were reported in the summer of 1944. Until that time hospitals reported “con- structed capacities”—that is, the number of beds which plants were constructed to hold—and hence reports showed neither the number of beds actually in use nor the number currently authorized. Under the new system they reported “authorized beds”—that is, beds for which were allot- ted supplies and personnel. The first such reports revealed that considerable prog- ress had been made in the contraction of station hospitals.7 On 26 May 1944 the reported capacity (constructed capacity) of all AAF and ASF station hospitals had been about 259,000, or 6.2 percent of the zone of interior troop strength. By 7 July 1944 the “authorized capacity” of station hospitals was reported to be about 134,000 (3.3 percent of the troop strength at that time) and of station and regional hospitals together about 198,000 (4.9 percent).8 Establishment of Regional Hospitals Closure of surplus AAF and ASF sta- tion hospitals did not eliminate the prob- lem of operating dual sets of hospitals (for the Air Forces and for the rest of the Army) without duplication of plants and 2 (1) Ltr, Asst to Chief Med Br S&S Div Hq 9th SvC to COs ASF Hosps 9th SvG, 26 Oct 43, sub: Util of Hosp Fac. SG: 632.-1. (2) Ltr, SG to CG 2d SvC attn SvC Surg, 23 Dec 43, sub: Anal of Data Obtained in Recent Questionnaire of SG on Req Hosp. SG: 705.-1 (2d SvC)AA. (3) Tabs C and D of Memo, CG AAF (Air Surg) for CofSA attn G-4, 7 Oct 44, sub; Reduction of ZI Hosps. HRS: G-4 file, “Hosp and Evac Policy.” 1 Ltr, SG to Budget Off for WD, 27 Dec 43, sub: Sta Hosp Beds in ZI Instls. SG: 632.-2. 4 (1) Diary, Hosp Admin Div SGO, 4 Jan 44. HD: 024.7-3. (2) Ltr, SG to Budget Off for WD, 27 Dec 43, sub: Sta Hosp Beds in ZI Instls. SG: 632.-2. 5 (1) WD Cir 43, 1 Feb 44. (2) AR 40-1080, C 2, 9 Jun 44. (3) ASF Cir 196, 27 Jun 44. fi Ltr, CG ASF by SG (Oprs Serv Hosp Div, Fac Util Br) to CGs SvCs attn SvC Surg, 28 Apr 44, sub: Redesignation of Sta Hosp Bed Capacities. HD: Re- sources Anal Div file, “Hosp.” 7 Form SG-396, Weekly Health Report, was re- vised 1 May 1944. The revised version was first used in Report 27, vol. IV, for the week ending 7 July 1944. Weekly Rpts, AML. 8 (1) Weekly Health Rpts, vol. IV, No 21, and No 27. AML. (2) ASF Monthly Progress Rpt, Sec 7, Health, 31 Jul 44, p. 34, compared bed capacities of ASF sta hosps as of 26 May 44 and 30 Jun 44. ADJUSTMENTS IN ZONE OF INTERIOR 183 waste of personnel, and attempts to solve it led to a major change in the hospital system early in 1944. Although prohibited from operating general hospitals and car- ing for overseas patients, the Air Forces, it will be recalled, had built up station hos- pitals to the point where many were staffed and equipped to give general-hos- pital-type care, and the Air Surgeon op- posed transferring Air Forces patients to general hospitals, operated by the Service Forces, when there were AAF station hos- pitals capable of treating and caring for them. On the other hand, Surgeon Gen- eral Kirk opposed separate Air Forces sta- tion hospitals.9 If they were to continue, he contended, their staffs should be re- duced in quantity and quality to the level required to care for only minor ills and in- juries, and patients from the Air Forces as well as from the rest of the Army who re- quired treatment for serious ills and injuries should be concentrated, along with specialists to treat them, in general hospitals. In the fall of 1943 he attempted to achieve this goal (1) by requesting the General Staff either to permit him to re- assign doctors from AAF hospitals as he saw fit or to direct the Air Forces to release specialists for duty with the Service Forces10 and (2) by proposing a revision of the policy governing transfer of patients to general hospitals. ASF headquarters approved the latter suggestion and a re- vised policy was published in November 1943. In addition to establishing criteria for the selection of cases for transfer to general hospitals, this policy clearly lim- ited station hospitals to such operations as appendectomies, herniotomies, and the treatment of simple fractures of the ex- tremities.11 The inference was that spe- cialists were not needed in station hospi- tals. Almost immediately the Air Forces pro- tested that such restrictions would reduce their hospitals to dispensaries and would waste the skills and abilities of their staffs.12 Despite The Surgeon General’s insistence that, on the contrary, Medical Corps officers would be used more effec- tively if specialists and patients requiring specialized care were concentrated rather than scattered,13 the Deputy Chief of Staff of the Army directed a compromise be- tween the positions of the Air Surgeon and The Surgeon General. The Air Forces were to release some medical officers for ASF assignments but the policy on the transfer of patients to general hospitals was to be revised to permit AAF station hospitals to perform any operations, how- ever complicated, for which they had ade- quate staffs.14 Early in 1944 The Inspector General reopened the question of the manning and use of AAF station hospitals. Reporting on a survey made by General Snyder, he 9 Statement of Maj Gen Norman T. Kirk, Rpt, SGs Conf with Chiefs Med Br SvCs, 14-17 Jun 43, pp. 7-8. HD: 337. 10 (1) Memo, SG for CofSA thru GG ASF, 13 Sep 43, with 1st ind, CG ASF to CofSA, 13 Sep 43. HRS: Hq ASF Gen Styer’s files, “Med Dept.” (2) Memo SPGAP 320.2 (8 Nov 43), Dir MPD ASF for ACofS G-l WDGS, 8 Nov 43, sub: Critical Shortage of Med Specialists in ASF. SG: 322.051-1. 11 (1) Ltr SPMCR 300.5-5, SG to AG, 10 Nov 43, sub: Policy Regarding Trf of Pnts to Named Gen Hosps. AG: 704.1 1 (10 Nov 43) (1). (2) WD Cir 304, 22 Nov 43. 12 Memo, CG AAF for ACofS G-l WDGS, 2 Dec 43, sub: Med Serv. AG: 704.00 (2 Dec 43). 13 (1) Memo SPMC 701.-1, SG for Dir MPD ASF, 9 Dec 43, sub: Med Serv-AF. (2) T/S SPGAM 705 (Gen) (3 Dec 43)-31, CG ASF to ACofS G-l WDGS, 13 Dec 43, same sub. (3) Ltr SPMCM 322.051-1, SG to CG ASF, 15 Dec 43, sub: MG Offs for Asgmt to ASF T/O Units. All in AG: 704.1 1 (2 Dec 43). 14 (1) Memo WDCSA 705 (24 Dec 43) DepCofSA for ACofS G-l WDGS, 24 Dec 43, sub: Sec 2, WD Cir 304, 22 Nov 43. AG: 704.1 1 (2 Dec 43). (2) WD Cir 12, 10 Jan 44. 184 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR recommended on 13 January 1944 that AAF station hospitals that were staffed and equipped to serve as general hospitals should be used in that capacity for pa- tients not only from the Air Forces but from the Service and Ground Forces as well. The Deputy Chief of Staff accord- ingly directed the commanding generals of the Air and Service Forces to prepare a combined plan for hospitalization “on a regional and military population basis, ir- respective of command or service jurisdic- tional boundaries.” 15 To comply with this directive and still maintain the status quo, The Surgeon General drew up a plan based upon the Secretary of War’s policy of permitting only the Service Forces to operate general hospitals and of assigning all overseas evacuees, with few exceptions, to their care. He proposed that general hospitals should be of two types, those staffed for specialized treatment and those staffed for “all work,” and that station hospitals of both the Air and Service Forces should be staffed according to manning tables ap- plicable to both alike.16 The Air Surgeon, on the other hand, attempted to use this opportunity to get authority to operate hospitals equal in all respects to those of the Service Forces. He proposed that hos- pitals be designated as specialized hospi- tals, regional hospitals, and station hospi- tals; and that they be staffed on the basis of their workloads and functions instead of by manning tables.17 Since none were to be called general hospitals, none would be restricted by the Secretary of War’s policy and hospitals of all three types could presumably be operated by both the Air and Service Forces. When representatives of the Air Sur- geon and The Surgeon General could not agree upon a plan to submit to the Deputy Chief of Staff, the Air Forces designated certain of their installations as “regional hospitals” and called attention to this de- velopment as their way of complying with the directive.18 Subsequently, the entire problem of agreement upon a joint plan was referred to the Chiefs of Staff of the Air and Service Forces for solution.19 The outcome was a major change in the hospital system. Agreed upon by the AAF and ASF Chiefs of Staff, approved by the Deputy Chief of Staff of the Army, and authorized in April 1944, it represented a compromise between the proposals of The Surgeon General and the Air Surgeon. To the familiar station and general hospitals were now added the regional hospital, an entirely new species, and the convalescent hospital, an outgrowth of the convalescent centers and annexes already in use on a small scale. The Service Forces alone were to continue to operate general hospitals, but both the Air and Service Forces were to operate station, regional, and convales- 15 (1) Ltr IG 333.-Med Pers, IG to DepCofSA, 13 Jan 44, sub: Util of Med Off Pers in ZI Instls. (2) Memo, DepCofSA for CGs ASF and AAF, 26 Jan 44, same sub. Both in Off file, Gen Bliss’ Off SGO, “Util of MCs in ZI” (20)#2. 16 Memo, SG for CG ASF, 29 Feb 44, sub: Util of Med Off Pers in ZI Instls, in Rpt to CG ASF from SG, Plan for Util of Med Off Pers in ZI, 29 Feb 44. HD: 322.051-1. 17 (1) Memo, Hq AAF for SG, 26 Feb 44, sub: Pro- posed Plan, SGO, for the Util of MG Offs in ZI. Off file, Gen Bliss’ Off SGO, “Util of MCs in ZI” (19) # 1. (2) Draft Memo, CGs AAF and ASF for DepCofSA, [Feb 44], sub; Util of Med Off Pers in ZI Instls, pre- pared by Hq AAF. HD; Resources Anal Div files, “Hosp.” 18 (1) A History of Medical Administration and Practice in the Fourth Air Force (1945), vol. I, pp. 43-44. HD: TAS. (2) An Rpt, 1944, AAF Regional Hosp Maxwell Fid. HD. (3) Draft Memo, CGs AAF and ASF for DepCofSA, [Feb 44], sub: Util of Med Off Pers in ZI Instls, prepared by Hq AAF. HD: Re- sources Anal Div files, “Hosp.” 19 History of Control Division, ASF, 1942-45, App, p. 246. HD. ADJUSTMENTS IN ZONE OF INTERIOR 185 cent hospitals. Regional hospitals were to be staffed not only to care for patients re- quiring merely the treatment usually given in station hospitals but also to serve as general hospitals for zone of interior pa- tients. General hospitals were to have the most highly specialized staffs and to them were to be transferred all patients evacu- ated from theaters of operations, except those needing only convalescent care. General hospitals were also to accept pa- tients from the zone of interior who needed specialized treatment not given in regional hospitals. Hospitals of all four types were to serve troops on an area basis, irrespective of the command to which the troops or the hospital belonged, and a hos- pital was to transfer patients to another having better qualified personnel only if patients needed treatment which the transferring hospital was not staffed to give.20 Thus, while the Service Forces re- tained the right to operate all general hos- pitals and in them to care for all theater of operations evacuees who needed further hospital treatment, the Air Forces gained the right to operate regional hospitals which were, in effect, general hospitals for zone of interior patients. Although this change in the hospital system did not achieve integration of Air and Service Forces hospitalization, it did produce certain advantages. In June the War Department designated as regional hospitals thirty AAF and thirty ASF sta- tion hospitals agreed upon between The Surgeon General and the Air Surgeon.21 Soon afterward both The Surgeon General and the Air Surgeon issued directives cov- ering the transfer of patients from station to regional hospitals.22 For several months ASF station hospitals had difficulty in adjusting to the idea of transferring com- plicated cases to regional instead of gen- eral hospitals, and there was little joint use of hospitals by the Air and Service Forces;23 but by the latter part of 1944 The Inspector General reported that the estab- lishment of regional hospitals had elimi- nated much duplication.24 During 1945, when the patient load became heavy be- cause of the influx of patients from theaters of operations, the care of the more serious and complicated cases from the zone of interior in regional hospitals permitted general hospitals to devote themselves almost entirely to the treatment of overseas evacuees.25 The question of whether regional hospi- tals could take over still more of the gen- eral hospital load—and perhaps become general hospitals themselves—came up early in 1945. When The Surgeon General asked for about 70,000 more beds in gen- 20 WDCir 140, 11 Apr 44. 21 Memo, CG ASF for DepGofSA, 31 May 44, sub: Designation of Regional Hosps and Conv Hosps. AG: 705 (3 Apr 44)(1) “Util of Med Off Pers in ZI Instls.” (2) WD Cir 228, 8 Jun 44. The number of regional hospitals was adjusted later as the need arose. For example, see WD Cirs 352, 30 Aug 44, and 115, 11 Apr 45. 22 (1) Ltr, SG to CGs SvCs attn SvC Surg, 6 Jul 44, sub: Bed Credits in Regional and Gen Hosps, Tab G to IG Rpt, 28 Dec 44. (2) Ltr, CG AAF (Air Surg) to CG Tng Comd AAF, 2 Sep 44, sub: Bed Credits. (3) AAF Reg 25-17, 6 Jun 44, sub: AAF Hosp and Evac in Continental US. All in HRS: WDCSA 632 (25 Sep 44), “Hosp in ZI.” 23 (1) Ltr, CG ASF (Dep SG) to CG 9th SvC, 21 Sep 44, sub: Specialized Hosp. SG; 323.3 (9th SvC)AA. Similar letters found under same file number for dif- ferent service commands. (2) Memo, 1st Lt Robert J. Myers, AUS, Med Stat Div SGO for Capt Edward A. Lew, 18 Sep 44, sub: Distr of Puts in Regional Hosps as of 25 Aug 44. SG: 632.2. 24 Memo, Act IG for DepGofSA, 28 Dec 44, sub: Hosp Fac in ZI. HRS: WDCSA 632 (25 Sep 44) Case No 28, “Hosp Fac in ZI.” 25 (1) Tab B of Memo, Dir Hosp Div and Dir Re- sources Anal Div SGO for Dir HD SGO thru Chief Oprs Serv SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (2) Interv, MD Historian with Lt Col James T. McGibony, MG, formerly Chief Hosp Div SGO, 20 Feb 50. HD: 000.71. 304244 0—55 14 186 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR eral and convalescent hospitals to handle the growing influx of patients from over- seas, G-4 directed the Air Forces to inves- tigate the possibility of caring for overseas patients in AAF regional hospitals.26 Tak- ing the position that maximum use had to be made of all available beds in order to justify requests for additional beds in gen- eral and convalescent hospitals, G-4 later directed that overseas casualties should be placed in 4,000 beds in AAF regional hos- pitals which the Air Surgeon offered for that purpose. G-4 stated that this was an emergency measure and did not alter cur- rent policies (presumably the policy estab- lished by the Secretary of War in 1943 that all overseas patients, with minor ex- ceptions, should be treated in general hos- pitals).27 The Air Surgeon, who formerly had attempted to get separate general hospitals for the Air Forces and wanted to care for overseas casualties in AAF hospi- tals, urged immediate compliance with G-4’s directive.28 The Surgeon General opposed this move. Having previously estimated that there were 12,000 vacant beds in AAF and ASF regional hospitals, he agreed that regional hospitals could be used for the purpose proposed but held that there were certain objections to doing so and that the expedient should be resorted to only in an emergency which, he contended, had not yet arisen.29 ASF headquarters supported The Surgeon General and appealed G-4’s directive to the Deputy Chief of Staff. The latter referred the question for investiga- tion on 19 March 1945 to The Inspector General, who recommended two months later (14 May) that vacant beds in both ASF and AAF regional hospitals should be used in the manner proposed by G-4. G-4 then sought the Secretary of War’s ap- proval of a directive making this recom- mendation effective. On 20 June the Sec- retary met with G-4 and The Surgeon General, whose opinions on The Inspector General’s report he had already received. By that time “events had overtaken this disagreement,” G-4 reported, for the war in Europe had ended, and “there was no longer a necessity” of using regional hospi- tal beds to take the load off the general hospital system. The Surgeon General con- curred with this statement and the original demand was accordingly dropped. 50 This development did not alter the fact that occupancy of general hospital beds at the end of June—despite provision of addi- 26 Memo WDGDS 7486, ACofS G-4 WDGS for CG AAF, 11 Jan 45, sub; Care of Add Pnts at AAF Regional Hosps. HRS: G-4 file, “Hosp and Evac Policy.” 27 (1) Memo, GG AAF (Air Surg) for ACofS G-4 WDGS, 13 Feb 45, sub: Care of Overseas Casualties in AAF Regional Hosps. HRS: G-4 file, “Hosp and Evac Policy.” (2) Memo WDGDS 9049, Dep ACofS G-4 for CG AAF and ASF, 27 Feb 45, same sub. HRS; G-4 file, “Hosp, vol. II.” (3) Memo, Lt Col C. A. Dixon, G-4 for ACofS G-4 WDGS, 3 Mar 45, sub: Conf on Use of AAF Regional Hosp Beds. Same file. 28 Memo, Air Surg for ACofS G-4 WDGS, 22 Mar 45, sub; Progress Rpt on Care of Overseas Casualties in AAF Regional Hosps. HD; TAS 210.721b, “Care of Overseas Casualties in AAF Hosps.” Other memo- randums on this subject are in the same file. 29 T/S, Act SG to ACofS G-4 WDGS thru CG ASF, 22 Feb 45, sub: Care of Overseas Casualties in AAF Regional Hosps. HRS: G-4 file, “Hosp, vol. II.” 30 (1) 1st ind SPOPG (27 Feb 45), GG ASF to DepGofSA, 5 Mar 45, on Memo WDGS 9049, Dep ACofS G-4 WDGS for GGs ASF and AAF, 27 Feb 45, sub: Care of Overseas Casualties in AAF Regional Hosps. HRS; Hq ASF Planning Div file, 700 “Hosp and Evac.” (2) Memo, DepGofSA for IG, 19 Mar 45, sub: ZI Hosp. HRS; Hq ASF Lt Gen Lutes’ files, “Hosp and Evac, Jun 43-Dec 46.” (3) Memo WDSIG 333.9-Hosp Fac (2), IG for DepGofSA, 14 May 45, sub; Rpt of Surv of ZI Hosps. SG: 333 WDGSA 632 (14 May 45). (4) Memo, Chief Planning Br G-4 for ACofS G-4 WDGS, 2 1 Jun 45, sub: Conf with Sec- War on Rpt of Surv of ZI Hosps, with incl, Memo, Col Kyle (aide to SecWar) for SecWar [31 May 45], sub: ZI Hosps. HRS: G-4 file, “Hosp, vol. IV.” ADJUSTMENTS IN ZONE OF INTERIOR 187 tional beds in the first half of 1945, placing large numbers of general hospital patients on leave and furlough for 90 days, and adoption of measures to speed the disposi- tion of patients—ran above what was nor- mally considered the saturation point (80 percent of capacity) while the occupancy of regional hospital beds was considerably lower.31 Whether this situation was prefer- able to redistributing the patient load depended on the cogency of arguments against the suitability of regional hospitals for handling overseas patients. Several were of doubtful weight, such as that the use of these hospitals would “not have facilitated” observance of the War Depart- ment’s policy of hospitalizing patients near their homes. On this point the Inspector General’s Office and indeed The Surgeon General’s own Resources Analysis Divi- sion estimated that 15 to 20 percent of the beds available in regional hospitals were located in areas where population was dense but general hospital beds few in number. To the argument that existing space in general hospitals (that is, on 5 March 1945) was still adequate, the reply might have been that it was being kept so partly by establishing additional beds in general hospitals which The Surgeon Gen- eral had requested. It was also argued that filling the beds of regional hospitals with long-term patients would use up ex- cess capacity needed to provide extra hos- pitalization for troops that would be returned from Europe for redeployment to the Pacific. To this the Inspector General’s Office replied that the need in the latter case would arise only after the peak load had been passed. Nor did the Inspector General’s Office agree with The Surgeon General’s contention that difficulties would result from mixing overseas patients with those from the zone of interior in regional hospitals. Greater importance may or may not be attached to The Sur- geon General’s argument that the admin- istrative difficulties of adding a large number of hospitals to those already treat- ing overseas patients would have out- weighed the gain of 12,000 beds. But it could not be denied, of course, that “diver- sion of patients from the general hospital system would prevent control of treatment by the agency now charged with their care. This last argument perhaps held the key to the entire matter. After the establish- ment of regional hospitals to serve in effect as general hospitals for zone of interior patients, the chief remaining distinction between hospital systems of the Air and Service Forces was that ASF general hos- pitals, but no AAF hospitals at all, were authorized to care for patients returning from overseas areas for further medical 31 See below, pp. 210-12. Normally a hospital was considered full when 80 percent of its beds were oc- cupied, because some of its beds were always required for dispersion. In August 1944 the Facilities Utiliza- tion Branch, SGO, proposed reducing the “dispersion factor” in estimating requirements from 20 to 15 per- cent because of a “liberal furlough policy.” (Memo, Eli Ginzberg for SG, 18 Aug 44. HD: Resources Anal Div file, “Hosp.”) In estimating requirements in Jan- uary 1945 no beds for dispersion were included “on the assumption that furloughs will provide the neces- sary number of empty beds.” (Memo, Asst SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen Hosp Program, ZI. SG: 323.3.) 32 (1) 1st ind SPOPG (27 Feb 45), GG ASF to DepCofSA, 5 Mar 45, on Memo WDGDS 9049, Dep ACofS G-4 WDGS for CGs ASF and AAF, 27 Feb 45, sub: Care of Overseas Casualties in AAF Regional Hosps. HRS: Hq ASF Planning Div file, 700 “Hosp and Evac.” (2) T/S, Act SG to Dep ACofS G-4 WDGS thru CG ASF, 22 Feb 45, same sub. HRS: G-4 file, “Hosp, vol. II.” (3) Memo WDSIG 333.9- Hosp Fac (2), IG for DepCofSA, 14 May 45, sub; Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (4) Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 20 Jan 45, sub: Sta and Re- gional Hosp Backup for Gen Hosp Syst. SG: 632.2. 188 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR and surgical treatment. To have placed some of them in AAF regional hospitals would have narrowed if not eliminated that distinction. An officer who partici- pated in these transactions afterward inter- preted the controversy in these terms—the desire of the Air Surgeon to eliminate that distinction and the determination of The Surgeon General to maintain it.33 This view seems plausible when the previous efforts of the Air Surgeon to secure a hos- pital system equal to that of the Service Forces are considered. It may also derive color from the fact that The Surgeon Gen- eral, in tracing for the benefit of the Secre- tary of War the events leading up to the controversy, started with a reference to the Air Surgeon’s attempt to secure general hospitals for AAF casualties in 1943.34 Further evidence to support such an inter- pretation is the accusation by the Air Sur- geon and members of his staff that The Surgeon General was using delaying tac- tics. They charged that while he agreed to employ regional hospital beds for overseas casualties in an emergency he deliberately spun out negotiations in an effort to avoid taking that step at all.35 In any event, the distinction between general and regional hospitals remained, and it continued to be the official policy of the Army to treat overseas evacuees in general hospitals only. Development of Convalescent Hospitals Convalescent hospitals were first author- ized as types of Army hospitals in the zone of interior in April 1944, but their origin lay in the early war years.36 Under author- ity granted by the Secretary of War in July 1943, the Air Forces announced the estab- lishment of eight convalescent centers in September 1943. They were to operate in conjunction with station hospitals and were to rehabilitate AAF patients who had been treated in other hospitals or who had been evacuated from theaters of opera- tions solely because of operational fa- tigue.37 In June 1943 the Service Forces began to establish convalescent annexes in hospital barracks, leased schools and inns, or vacated Army housing. Operated as parts of general hospitals, such annexes normally housed convalescent patients only from the hospitals to which they be- longed, but one of them—the convalescent annex of England General Hospital, set up in leased hotels with a capacity for 2,600 patients—served as a convalescent center for patients from other general hospitals as well.38 Partly because of difficulties in find- ing suitable housing for annexes, the pro- gram was slow in getting under way and convalescent patients accounted for ap- proximately 75 percent of the patient load of general hospitals in the fall of 1943. Groups studying the hospital system at that time agreed that convalescent pa- tients should be removed from the wards 33 Interv, MD Historian with Col John C. Fitzpat- rick, MG, formerly MRO, SGO, 18 Apr 50. HD; 000.71. 34 Memo, Chief Planning Br G-4 for ACofS G-4 WDGS, 21 Jun 45, sub: Conf with SecWar on Rpt of Surv of ZI Hosps. HRS; G-4 file, “Hosp, vol. IV.” 35 (1) Record of Tel Conv between [Maj] Gen [D. N. W.] Grant and [Brig] Gen Raymond W. Bliss, 7 Mar 45. HD: TAS 210.721b “Care of Overseas Casualties in AAF Hosps.” (2) Memo, [Lt Col Alonzo A. Towner, MG] for Gen Grant, n d. Same file. 36 See above, pp. 117-20. 37 AAF Memo 20-12, 18 Sep 43. HD: AAF Memo 5-20 series. 38 (1) 1st ind SPRMC 322 (18 Jun 43), CG ASF to SG, 22 Jun 43, on unknown basic Itr. SG: 632.-1. (2) Res Adopted by Fed Bd of Hosp, incl to Memo SPRMC 632 (19 Oct 43), CG ASF for CofEngrs, 27 Oct 43, sub: Auth for Estab of Conv Retraining Units at Gen Hosps. CE: 683 Pt I. (3) Ltr, SG to CG ASF, 30 Oct 43, sub: Program for Providing Conv Fac. SG: 632.-1. (4) An Rpt, 1944, Surg 2d SvC. HD. ADJUSTMENTS IN ZONE OF INTERIOR 189 of general hospitals to permit fuller use of the latter’s highly specialized staffs.39 During 1944 the convalescent hospital program received impetus from several sources. Early that year, after his Office had estimated the patient load for 1944, The Surgeon General requested that addi- tional beds be provided in convalescent “facilities,” rather than in general hospi- tals, to save personnel and to permit the reconditioning of patients for return to duty in a nonhospital atmosphere. In March ASF headquarters approved this proposal, and during subsequent months service commands, acting under ASF authority, established convalescent centers in vacated barracks at Daytona Beach (Florida), Camp Lockett (California), Camp Carson (Colorado), Camp Atter- bury (Indiana), Fort Sam Houston (Tex- as), Fort Custer (Michigan), and Fort Devens (Massachusetts).40 Meanwhile, a War Department circular authorized convalescent hospitals, as dis- tinct from convalescent centers, annexes, and facilities. Accordingly, in June 1944 the War Department designated as con- valescent hospitals two ASF and five AAF convalescent centers which The Surgeon General and the Air Surgeon selected for that purpose. Two months later, thirteen additional ASF convalescent centers were designated as hospitals, and subsequently other changes were made in the number in operation.41 These hospitals remained in an experimental stage for the rest of 1944. Those of ASF served as places for housing and feeding ambulatory patients and for preparing them through physical and military training for return to duty. Changes in barracks provided for such hospitals were held to a minimum. They therefore lacked classrooms, shops, and gymnasiums that were later—in 1945— considered essential. In addition, the scope of activities of convalescent hospitals was not clearly defined; their organization was not precisely outlined by higher authori- ties; and they had little personnel and equipment of their own.42 An exception to this general situation was the Old Farms Convalescent Hospital, in Avon, Conn. Established in May 1944 as a result of The Surgeon General’s and the President’s interest in the rehabilita- tion of blinded war casualties, this hospital soon afterward received personnel and equipment for a social-adjustment train- ing program which continued throughout the war.43 In the fall and winter of 1944 several events brought the convalescent hospital program to full fruition. During a move- ment of higher authorities to reduce the numbers of beds in the United States, G-4 took up the matter of convalescent hospi- tals and in November, as a part of a com- promise solution of the bed requirement problem, authorized 40,000 beds in AAF 39 (1) Memo, unsigned and unaddressed, 23 Aug 43, sub: Status of Program for Estab of Conv Retrain- ing Units. SG: 632.-1. (2) Memo, Dir Hosp Admin Div SGO for Chief Oprs Serv SGO, 4 Dec 43, sub: RptofTripto . . . Gen Hosps. SG: 333.1-1. 40 (1) See below, pp. 201-02. (2) Memo, SG for CG ASF, 10 Mar 44, sub: Conv Fac. Off file, Gen Bliss’ Off SGO, “Med Clarification of Disposition Policy.” (3) ASF Cir 93, 4 Apr 44. (4) An Rpts, 1944, Surg 1st, 4th, 5th, 6th, and 7th SvCs; and An Rpts, 1944, Brooke Gen and Conv Hosps and Mitchell Conv Hosp. HD. 41 WDCirs 140, 11 Apr 44; 228, 7Jun44; and 352, 30 Aug 44. 42 (1) Memo, SG for Dir Pers ASF, 22 Jul 44, sub: Estab of Conv Hosps. HD: 322 “Estab of Conv Hosps.” (2) Memo, Eli Ginzberg for Pres WDMB, 23 Aug 44. HRS: ASF Planning Div file, 700 “ZI Hosp.” (3) ASF Monthly Progress Rpt, Sec 7, Health, 31 May 44. (4) An Rpts, 1944, Surg 2d, 4th, 5th, and 7th SvGs; An Rpt, 1944, Mitchell Conv Hosp; An Rpts, 1945, Brooke and Wakeman Hosp Gtrs. HD. 43 (1) History, Old Farms Convalescent Hospital [1947]. HD: 319.1-2. (2) SG Ltr 162, 11 Sep 43. 190 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR and ASF convalescent hospitals.44 This established a basis for the procurement of personnel and equipment for such instal- lations. A few weeks later, on 4 December 1944, the President directed the Secretary of War to permit no overseas casualty to be discharged from the service until he had received “the maximum benefits of hospitalization and convalescent facili- ties,” including “physical and psychologi- cal rehabilitation, vocational guidance, prevocational training and resocializa- tion.” 45 Such unlimited support from the Commander in Chief helped the Medical Department to get necessary means for an elaborate convalescent program, which The Surgeon General’s Reconditioning Consultants Division announced in De- cember 1944.46 During the first half of 1945, ASF con- valescent hospitals were supplied with personnel and equipment of their own; the barracks in which they were located were remodeled; shops, classrooms, gym- nasiums and recreational facilities were provided; and elaborate programs consist- ing of technical and prevocational train- ing, general education, vocational coun- seling, occupational therapy, recreation, athletics, and entertainment were set up.47 Thus, toward the end of the war, emphasis in the convalescent program shifted from the preparation of patients for return to duty to their preparation for return to civilian life. The operation of convalescent hospitals was a major factor in enabling the Med- ical Department to care for the peak load of patients in the summer of 1945. It con- tributed to maximum use of specialists in general hospitals. Furthermore, convales- cent hospitals provided a better psycho- logical environment for the care of many patients, especially those suffering from neuropsychiatric disorders, than did gen- eral hospitals.48 Their value in the treat- ment of medical and minor surgical cases, however, was questioned in the middle of 19 45,49 and general hospitals gradually adopted a practice of discharging patients of those types directly to civilian life. Merger of Adjacent Hospitals Besides suggesting the removal of con- valescent patients from general hospitals, groups studying the hospital system in the fall of 1943 proposed the merger of adja- cent hospitals into single installations. The establishment of regional hospitals accom- plished this in part, for in some cases near- by station hospitals were either wholly or partially merged with regional hospitals.50 In the same period the Ninth Service Command consolidated the Vancouver Barracks Station Hospital with Barnes General Hospital, which was located on the same post.51 The next April The Sur- 44 Memo, ACofS G-4 WDGS for CGs ASF and AAF, 17 Nov 44, sub: ZI Hosps. SG; 322 “Hosp Misc.” 45 Ltr, Franklin D. Roosevelt to SecWar, 4 Dec 44. HRS: ASF Control Div file, 705 “Cut-back in Gen and Conv Fac.” 46 (1) ASF Cir 419, 22 Dec 44, sub: Conv Hosp Re- vised Program. (2) TM 8-290, Educ Reconditioning, Dec 44. (3) TM 8-291, Occupational Therapy, Dec 44. (4) TM 8-292, Physical Reconditioning, Dec 44. 47 (1) An Rpt, FY 1945, SG. HD. (2) Richard L. Loughlin, [History of] Reconditioning [in the U. S. Army in World War II], (1946), HD. (3) Memo WDSIG 333.9 Hosp Fac (2), IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (4) An Rpts of Conv Hosps for 1945. HD. (5) Memo, Lt Col Gerard R. Gessner for Chief Hosp Div SGO, 4 Jun 45. HD: 333.1-1. 48 An Rpt, FY 1945, SG; and An Rpt, FY 1945, Hosp and Dorn Oprs, SGO. HD. 49 Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 7 Jun 45, sub: Criteria for Reduction in Hosp Fac. SG: 323.3 “Hosp.” 50 Memo, IG for DepCofSA, 28 Dec 44, sub: Hosp Fac in ZI. HRS: WDCSA 632 (25 Sep 44). 51 1st ind, CG 9th.SvC to CG ASF attn SG, 22 Sep 43, on Ltr, SG to CG 9th SvC, 24 Aug 43, sub: Com- bination of Sta Hosp with Gen Hosp. SG: 323.7-5 (Barnes GH)K. ADJUSTMENTS IN ZONE OF INTERIOR 191 geon General’s Facilities Utilization Branch made a study of other sets of gen- eral and station hospitals located on the same Army posts, comparing personnel required to operate them as separate in- stallations with that needed for their operation as consolidated hospitals. It ap- peared that fewer Medical Corps officers, particularly specialists, and fewer nurses would be needed if station hospitals were merged with near-by general hospitals.52 The Surgeon General’s Office anticipated more efficient operation from the super- vision of the activities of two installations by one rather than two commanding of- ficers. Moreover, the commaders of gen- eral hospitals were subject to less control by post commanders than were those of station hospitals—an advantage from The Surgeon General’s viewpoint. The merg- ers were not expected to increase the num- ber of general hospital beds immediately, because general hospitals thus enlarged would still have to care for troops stationed on their posts. Later as troops moved over- seas, beds formerly used for station hospi- tal patients could be transferred to general hospital use.53 Accordingly, five station hospitals were consolidated with five gen- eral hospitals in the summer of 1944, as follows; Fort Devens Station Hospital with Lovell General Hospital, Fort Dix Station Hospital with Tilton General Hos- pital, Fort Bliss Station Hospital with William Beaumont General Hospital, Fort Benjamin Harrison Station Hospital with Billings General Hospital, and Dante Hospital in San Francisco with Letterman General Hospital.54 Attempts To Limit the Use of General Hospitals as Debarkation Hospitals Another change in the hospital system occurred when The Surgeon General modified the existing practice of using gen- eral hospitals located near ports as receiv- ing and evacuation hospitals. Throughout the later war years Halloran, Stark, and Letterman General Hospitals continued to serve as debarkation hospitals, the lat- ter two being devoted almost exclusively to that function as the evacuation load grew heavier. At various times during 1944 and 1945 other general hospitals— Lovell, Barnes, McGuire, Birmingham, LaGarde, Madigan, and Mason—served also in that way.55 General hospitals ac- cepted their roles as receiving and evacua- tion, or debarkation hospitals reluctantly because the processing of patients in transit did not require the fullest use of specialized equipment and staffs and be- cause hospitals engaged in that function had alternating periods of activity and idleness, depending upon the arrival of ships with patients.56 Several officers in the Surgeon General’s Office were also dissatisfied with the practice of having 52 Memo, Chief Fac Util Br SCO for Chief Oprs Serv SCO, 24 Apr 44, sub: Pers Study of Five Con- tiguous Sets of Sta and Gen Hosps. FID: Resources Anal Div file, “Hosp.” 53 (1) Ltr, SG to Fed Bd Hosp, 27 Jun 44, sub: Com- bination of Named Gen Hosp and Adj Sta Hosp. SG: 323.7-5. (2) Draft Ltr, SecWar (prepared by SGO) to Fed Bd Hosp, 12 Jul 44. SG: 322 “Hosp.” (3) Interv, MD Historian with Maj Gen Norman T. Kirk, 20 Nov 51. HD; 314 (Correspondence on MS)V. 54 Diary, Hosp Cons Br SGO, 15 and 20 Jul 44. HD: 024.7-3. 55 (1) Weekly Health Rpts, vol. IV7, No 1, 7 Jan 44; No 24, 16 Jun 44; No 32, 11 Aug 44; No 34, 25 Aug 44; and No 40, 6 Oct 44. AML. (2) An Rpt, FY 1945, Hosp and Dom Oprs, SGO. HD. (3) Memo, Dir Re- sources Anal Div SGO for Dir HD SGO, 25 Sep 45, sub: Operational Problems and Accomplishments in Med Serv, World War II. HD; 319 “Hosp.” (4) Memo, SG for WDMB, 4 Oct 44, sub: Debarkation Hosps. SG; 322 “Hosp.” 56 (1) Memo, CO Halloran Gen Hosp for CG 2d SvC attn Surg, 21 Feb 44, sub: Increased Bed Capac- ity. SG: 632.2 (Halloran GH)K. (2) Diary, Hosp Admin Div SGO, 11 Jan 44. HD: 024.7-3. (3) S/S, SG to CG ASF, 25 Nov 44, sub: 300-Bed Expansion by Conversion, McGuire Gen Hosp, with inds. SG: 632.-1 (McGuire GH)K. 192 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR general hospitals perform dual functions. The Medical Regulating Officer, for ex- ample, thought that this practice inter- fered with efficient operation of the evac- uation system, and others agreed with hospital commanders that it was wasteful of both personnel and equipment.57 When changes in the hospital system were being considered early in 1944. The Surgeon General proposed establishment of a new type of hospital, to be known as a receiv- ing and evacuation hospital and to be manned and equipped to perform only the processing of patients in transit.58 This proposal was not accepted, and the circu- lar outlining the revised hospital system in April 1944 provided for the continued use of existing types of hospitals—station, general, or regional—for debarkation purposes.59 After that, in the summer of 1944, Stark, Letterman, and Halloran separated general hospital functions from debarkation work, becoming to that ex- tent two hospitals in one.60 As the need for beds in both general and debarkation hospitals increased, The Surgeon General attempted to keep to a minimum the use of general hospitals for debarkation processing. In the summer of 1944 he secured approval of ASF head- quaters to use the Camp Edwards Station Hospital, instead of Lovell General Hos- pital, as a debarkation hospital for the port of Boston. This action, he explained, would make available more general hos- pital beds in New England, a heavily populated section with only two general hospitals. It would also help to economize in the use of Medical Corps officers, since debarkation hospitals required less elab- orate staffs than general hospitals.61 In the winter of 1944, as he planned to meet higher bed requirements which his Office had estimated for 1945, The Surgeon General proposed to use other station hos- pitals—those located at staging areas and operated by the Chief of Transportation— to free some general hospitals of debar- kation work and to provide additional debarkation beds that would be needed for the anticipated load of casualties.6" A survey made by the Inspector General’s Office had already shown that staging area hospitals were being used only slightly, since few troops were being moved overseas.63 The Chief of Transpor- tation agreed to convert hospitals in the staging areas of the ports of Boston (Camp Myles Standish), New York (Camp Kil- mer and Camp Shanks), and Hampton Roads (Camp Patrick Henry) into de- barkation hospitals.64 This action made it 57 (1) Memo, Lt Col John C. Fitzpatrick, MRO, for Col A. H. Schwichtenberg, Hosp Div SCO, 23 May 44. TC; 370.05. (2) Memo, Same for Chief Oprs Serv SCO, 1 Sep 44, sub: Rpt of Visit to San Francisco. HD: 705 (MRO, Fitzpatrick Stayback). (3) Memo, Lt Col Basil C. MacLean for Brig Gen R. W. Bliss, Chief Oprs Serv SCO thru Col A. H. Schwichten- berg, Dir Hosp Admin Div, 2 Feb 44, sub: The More Efficient Util of Army Hosp Fac. Off file, Gen Bliss’ Off SCO, “Util of Army Hosp Fac.” 58 Classification of Med Instls, Tab B to SGs Plan for the Util of Med Off Pers in ZI, 29 Feb 44. HD: 322.051-1. 59 WDCir 140, 11 Apr 44. 60 An Rpts, 1944, Stark, Halloran, and Letterman Gen Hosps. HD. 81 (1) Memo, Dep SG for CG ASF, 1 Jun 44, sub: Util of Comd Fac: Designation of Cp Edwards a Gen Hosp. Off file, Gen Bliss’ Off SGO, “Util of Army Hosp Fac.” (2) Ltr, CG 1st SvC to GG ASF attn SG, 7 Jun 44, sub: Instls for Debarkation Hosp. SG: 322.15-1. (3) An Rpt, 1944, Cp Edwards Sta Hosp. HD. 62 Memo, SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen Hosp Program, ZI. SG: 323.3. 63 Memo, Act IG for DepCofSA, 28 Dec 44, sub; Hosp Fac in ZI. HRS: OCS 632 (25 Sep 44) Case No 28, “Hosp Fac in ZI.” 64 (1) 1st ind SPTOM 632, CofT to SG, 17 Jan 45, on Memo, SG for Med Liaison Off, OCofT, 9 Jan 45. SG: 632. (2) Diary, Lt Col H. A. Huncilman, Plan- ning Div ASF, 25, 27, and 29 Jan 45. HRS: Hq ASF Planning Div file, 700 “ZI Hosps.” (3) Diary, Hosp Div SGO, 31 Jan 45. HD; 024.7-3. ADJUSTMENTS IN ZONE OF INTERIOR 193 Table 12—ASF Debarkation Hospitals October 1944 March 1945 June 1945 August 1945 Port and Hospital Total Beds Dbktn Beds Gen Hosp Beds Total Beds Dbktn Beds Gen Hosp Beds Total Beds Dbktn Beds Gen Hosp Beds Total Beds Dbktn Beds Gen Hosp Beds Boston Edwards 2, 128 2, 128 0 “3, 200 1,700 800 2,400 0 2, 950 900 2, 050 0 (h) Boston POE 1. 700 1,700 1, 700 New York 4, 134 2, 799 1,335 5, 350 2,000 2, 300 2,700 2,000 2, 300 1,000 2, 650 0 5,350 2,000 2, 700 2,000 2, 300 500 2, 650 0 5, 350 2,000 2,700 2,000 2, 650 0 Kilmer Shanks 0 2, 300 0 Mason 3, 032 2,032 2,532 2,032 3, 032 500 2,532 Hampton Roads McGuire 1, 777 1,577 200 Patrick Henry 1, 100 1, 100 0 1, 100 1, 100 0 Charleston 2,400 2, 162 238 2,400 2,125 275 2,400 2,125 275 2, 400 2, 125 275 New Orleans 926 150 776 1,176 0 1,176 1, 300 0 1, 300 Los Angeles 1,727 717 1,010 1,777 800 977 800 800 0 800 800 0 San Francisco Letterman 2, 338 2,000 338 3, 500 3, 140 360 3, 500 3, 140 360 3, 500 3, 140 360 Seattle Madigan 3, 880 500 3,380 4, 300 1,000 3, 300 4, 300 1,000 3, 300 4,380 1,000 3,380 19, 310 12, 033 7,277 31,835 18, 665 13,170 30, 232 18, 265 11,967 21,462 12, 265 9, 197 All Sta Hosps Used for Debarkation purposes.. 2, 128 2, 128 0 7, 100 7, 100 0 7,900 7,900 0 2, 800 2,800 0 All Gen Hosps Used for Debarkation purposes.. 17, 182 9,905 7,277 24, 735 11, 565 13,170 22, 332 10, 365 11,967 18, 662 9,465 9, 197 ° Camp Edwards Station Hospital was designated a General Hospital in February 1945. b In this table no figures are listed for beds in hospitals at the times when those hospitals were not being used for debarkation purposes. Sources: (1) Memo SPMCH, SG for WDMB, 4 Oct 44, sub; Debarkation Hosp. SG No. 13, 30 Mar 45; No. 25, 22 Jun 45; and No. 35, 31 Aug 45. : 322 Hosp. (2) Weekly Hosp Rpts, vol. II, unnecessary to devote more space in Hal- loran General Hospital to debarkation work and made it possible to free all of McGuire General Hospital and the Camp Edwards Station Hospital, which was con- verted into a general hospital, for special- ized medical and surgical treatment. (Table 12) Later in 1945 the Camp Haan Regional Hospital took over from Bir- mingham General Hospital the processing of patients debarked at Los Angeles.60 Thus, the Surgeon General’s Office tried gradually to limit the practice of using general hospital facilities for debarkation work. As the evacuation of patients by air in- creased during 1944 and 1945 the Air Forces selected certain station and region- al hospitals located near important land- ing fields to receive and process patients 65 (1) Memo, Dir Resources Anal Div SGO for Maj [James J.] Souder, 22 Mar 45, sub: Debarkation Beds. HD: Resources Anal Div file, “Hosp.” (2) Diary, Hosp Div SGO, 7 and 11 Apr 45. HD: 024.7-3. (3) Memo, CG ASF for CofEngrs, 1 1 Apr 45, sub: Pnt Unloading Fac, Cp Haan Hosp. SG: 322 “Hosp.” 194 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR brought to them. By October 1944 beds were set aside in eleven AAF hospitals for this purpose." Six were used for debark- ing patients in emergencies only. The other five, located at Mitchel Field (New York), Coral Gables (Florida), Hamilton Field (California), Great Falls (Montana), and Portland (Oregon), were devoted al- most exclusively to processing patients evacuated by air.67 In the late spring of 1945 the Air Forces, with the concurrence of The Surgeon General, planned to establish a new type of zone of interior in- stallation, called a holding facility, at the Fairfield-Suisun Field (California). It was designed to perform only one function— the processing of patients who were in transit to other hospitals for definitive treatment.68 Although the war ended be- fore it was constructed, its approval repre- sented a further development in the move- ment toward the use of less elaborate facilities than general hospitals for debar- kation purposes. Extension of the Practice of Establishing Specialized Centers Extension and further development of the practice of establishing centers for specialized treatment in general hospitals constituted another adjustment in the hos- pital system during the later war years. Until the middle of 1944 specialty centers in general hospitals took up only a small proportion of their total beds and were established piecemeal to meet needs as they arose, without regard to eventual re- quirements for beds for specialized treat- ment. This situation came about because an army in training needed less specialized care than one in combat, because it was difficult to predict types and amount of specialized treatment that would be needed, and because hospitals themselves opened successively rather than all to- gether. By the time of the invasion of Europe, the peak patient load had been estimated and the last of the general hos- pitals, with the exception of four tempo- rary ones authorized in 1945, were about to begin operation. Enough experience in hospital admissions had accumulated to permit a breakdown of the anticipated patient load in terms of types of wounds, diseases, and injuries. Furthermore, an in- creasing shortage of specialists made their concentration for maximum use more im- perative than ever. Thus, whatever the need for a thoroughgoing program earlier, it became more important and easier to formulate one by the middle of 1944. Therefore, in the summer of that year The Surgeon General’s Facilities Utilization Branch collaborated with his professional consultants in a study of the need for spe- cialized centers and in the preparation of a comprehensive plan to meet it.69 The general features of this plan, an- nounced in a War Department circular in August 1944, remained unchanged through the remainder of the war. Related ,i(i AAF Debarkation Hosp, incl to Memo, SG for WDMB, 4 Oct 44, sub: Debarkation Hosp. SG: 322 “Hosp.” 67 Memo, Act IG for DepCofSA, 28 Dec 44, sub; Hosp Fac in ZI. HRS: OGS 632 (25 Sep 44) Case No 28, “Hosp Fac in ZI.” 68 (1) S/S, CG AAF to ACofS G-4 WDGS, CofSA, and SecWar, 27 Apr 45, sub: Debarkation Hosp, Fair- field-Suisun Army Air Fid. (2) DF WDGDS 12801, ACofS G-4 WDGS to CofSA, 10 May 45, same sub. (3) Ltr, SecWar to Brig Gen Frank T. Hines, Chair- man Fed Bd Hosp, 15 May 45. All in HRS: OGS 632. 69 (1) Ltr, SG to GG 4th SvC attn SvC Surg, 14 Jun 44, sub: Specialized Gen Hosp. SG: 323.7-5 (4th SvC) A A. Similar letters were sent to the rest of the service commands. (2) Plan for Specialized Hosp, by [Dr.] Eli Ginzberg, Spec Asst to Dir Hosp Div SGO, 27 Jul 44. HD; Resources Anal Div file, “Hosp.” (3) ASF Monthly Progress Rpt, Sec 7, Health, 31 Jul 44, pp. 29-31. ADJUSTMENTS IN ZONE OF INTERIOR 195 specialties were grouped in the same hos- pital to improve the quality of professional care. For example, neurosurgical and neurologic centers were established to- gether, and centers for general medicine were set up in hospitals specializing in the treatment of arthritis, tuberculosis, and rheumatic fever. Attempts were made to locate specialty centers in relation to pop- ulation density, to permit compliance as far as possible with the policy of hospital- izing patients near their homes. Success in such attempts was limited by at least two factors; (1) there were proportionately fewer general hospitals in densely popu- lated areas such as the Northeast than there were in the South and Southwest, where they had been located initially to serve large concentrations of troops in training, and (2) it was either possible or desirable to establish only a limited num- ber of centers—in some instances as few as two—in certain specialties such as tu- berculosis, arthritis, and treatment of the blind. The size of centers increased as the patient load grew. Although professional consultants of the Surgeon General’s Office believed that they should be kept reasonably small, the Facilities Utilization Branch considered it more economical of personnel, particularly specialists, to limit the number but increase the size of cen- ters. In the fall of 1944, for example, am- putation centers were increased from 500 to 750 beds each and neurosurgical cen- ters from 250 to 500. Subsequently, to care for the peak patient load, capacities were further increased, some centers hav- ing 2,000 or more beds. Centers for additional specialties were established to meet new needs and achieve fuller use of specialists of all kinds. For example, patients suffering from tropical diseases and trench foot became so nu- merous as to warrant the designation of centers for the treatment of those condi- tions, and a shortage of internists prompted the establishment of general medicine as a specialty. General and orthopedic surgery also became special- ties as the field of surgery was narrowed by the establishment of centers for various surgical specialties. As a result, the major portion of beds in general hospitals was gradually given over to specialized treat- ment, and general hospitals became in effect specialized hospitals. By the time the peak patient load was reached in June 1945, there were 234 centers for 21 spe- cialties with a total of 132,178 beds in 65 general hospitals in the United States.'0 General Hospitals for Prisoners of War A further change in the hospital system resulted from the capture by American forces of large numbers of prisoners of war. For German and Italian prisoners who became sick or were injured while in in- ternment camps in this country, the sys- tem of hospitalization formerly established was changed only slightly during the lat- ter half of the war. Such prisoners con- tinued to be treated in station hospitals located either in internment camps or on near-by Army posts and, when they needed a higher type of care, in general 70 (1) See last note above. (2) WD Gir 347, 25 Aug 44. (3) ASF Cir 284, 30 Aug 44. (4) Ltr SPMCH 323.3 (7th SvC)AA, SG to CG 7th SvC attn Surg, 10 Aug 44, sub: Specialized Gen Hosps. HD: Resources Anal Div file, “Hosp.” (5) Tab B to Memo, Dir Hosp Div and Dir Resources Anal Div for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (6) Table entitled “Authorized Patient Capacities in General Hospitals by Specialty as of 30 June 1945,” prepared by Resources Analysis Divi- sion, 30 June 1945. Off file, Resources Analysis Div, SGO. 196 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR hospitals operated for U. S. Army pa- tients. All Japanese prisoners were con- centrated, since they were few in number, in the station hospital at Camp McCoy, Wis.71 In the second half of 1943 the offices of The Surgeon General and The Provost Marshal General collaborated in estab- lishing procedures for the reception, ex- amination, and transportation of a new category of prisoners—those evacuated as patients from theaters of operations.72 Early the next year they restated these procedures and designated five general hospitals located near ports to receive and sort such patients and to transfer them to other hospitals for further treatment. At the same time, they specified certain gen- eral hospitals for the care of tuberculous, insane, blind, and deaf prisoners; and, in order to simplify the observance of secu- rity and administrative regulations, they adopted a practice of concentrating all prisoners who needed general-hospital- type care—those evacuated as patients from theaters of operations as well as those transferred from internment camps—in one general hospital if possible, and in not more than three in any instance, in each service command.73 These steps did not solve all problems. Some general hospitals continued to be inadequately prepared to carry out security measures; and even though prisoners were concentrated more than formerly, they were still scattered among hospitals in nine service com- mands. Such dispersal made difficult the work of a commission charged with deter- mining the eligibility of some prisoners for repatriation as well as that of a group re- sponsible for certifying others for “pro- tected status” as medical personnel, under the terms of the Geneva Convention.74 In anticipation of an influx of prisoner- of-war patients after the invasion of Eu- rope and in the hope of solving some of the administrative problems caused by the existing system of hospitalization, The Surgeon General’s liaison officer with The Provost Marshal General proposed in July 1944 that at least one general hospital be devoted exclusively to German prisoners of war. It could be used to sort incoming patients, to treat those needing general- hospital-type care, to process those eligible for repatriation, and to hold others await- ing certification as protected personnel.' ’ His superior, the Deputy Chief for Hospi- tals and Domestic Operations, adopted this idea and announced on 21 July 1944 that The Surgeon General was designat- ing Glennan General Hospital as a Ger- man prisoner-of-war general hospital. " Two months later The Surgeon General asked for an entire Army post for use as a second hospital of this type. Because of 71 (1) WD Cirs 235, 12Jun 44, and 347, 25 Aug 44. (2) PW Cirs 18, 29 Mar 44; 20, 7 Apr 44; and 38, 15 Jul 44. Off file, PW Off, OPMG. (3) TWX, PMG to CG each SvC, 4 Jan 45, in An Rpt, FY 1945, PW Liaison Unit SGO. HD. (4) Diary, Hosp Div SGO, 7 Oct 44. HD: 024.7-3. (5) Hosp, Evac, and Disposi- tion of PW Pnts in US, by Lt Col James T. McGibony, MC. HD: 383.6. 72 WD Gir 214, 15 Sep 43. 73 PW Gir 11, 8 Feb 44. Off file, PW Off, OPMG. 74 (1) Memo SPMGA 383.6 (59), Maj Rene H. Juchli for Act Dir PW Div OPMG, 23 Feb 44, sub; Rpt of -Second Repatriation of German PW. (2) Memo SPMGA 383.6 (59), same for Asst PMG, 10 Apr 44, sub: Immed Designation of Cp for Reception of Protected Pers and Repatriable PW. (3) Ltr, same to PMG, 13 May 44, sub: Rpt of Third Repatriation Move, German PW. (4) Ltr, same to Dir Hosp Admin Div SGO, 13 Aug 44, sub: Rpt of Handling PW as Observed at NYPE and Halloran Gen Hosp. All in HD; 319.1-2. 75 Memo, Chief PW Liaison Unit SGO for SG attn Col A. H. Schwichtenberg, 17 Jul 44, sub: Re- ception, Hosp, Treatment, and Disposition of Pnts among PW and Protected Pers. HD: 319.1-2. 76 Memo, Dep Chief for Hosp and Dom Oprs SGO for PMG, 21 Jul 44, sub: Hosp Fac for PW. HD: Re- sources Anal Div file, “Hosp.” ADJUSTMENTS IN ZONE OF INTERIOR 197 pressure at this time to reduce the number of beds in hospitals in the United States, ASF headquarters suggested the use of vacant beds in existing hospitals instead. The Surgeon General objected to this pro- posal, averring that all existing general hospital beds—according to his esti- mates—would be needed by the end of the year for American patients, that the treatment of prisoner-of-war patients who needed general-hospital-type care in sta- tion hospitals would violate the terms of the Geneva Convention, and that the dis- persion of prisoner-patients among many regional and station hospitals was wasteful of both medical and police personnel. Early in October, therefore, ASF head- quarters and G-4 approved the designa- tion of the station hospital at Camp Forrest (Tennessee) as Prisoner of War General Hospital No. 2.77 The establishment of a third prisoner-of-war general hospital was made unnecessary by a change in policy. At the end of October 1944 the Chief of Staff directed the European theater not to transfer prisoner-of-war patients to the United States except rabid Nazis and those desired for questioning for intel- ligence purposes.78 After V-E Day, the repatriation of prisoners made it possible to return Glennan General Hospital to the treatment of Americans in June 1945, to discontinue the general hospital at Camp Forrest in December 1945, and to close that camp itself in April 1946.79 The operation of two general hospitals devoted exclusively to the care of prisoner- of-war patients simplified administrative and security problems and ultimately saved American medical personnel. Pris- oner-patients arriving at ports in this country were transferred to either Glen- nan or Camp Forrest. There they were sorted into three groups. Those who were convalescent were transferred to conva- lescent annexes; those requiring care for only minor ills or injuries were sent to near-by prisoner-of-war station hospitals; and those requiring more specialized treat- ment were kept at one of the prisoner-of- war general hospitals. In addition, prisoners who were eligible for repatria- tion or for certification as protected per- sonnel were held in special facilities at these hospitals. After their eligibility had been verified, the former were returned to Germany and the latter were assigned to the staffs of prisoner-of-war hospitals to care for their compatriots.80 For a time, prisoner-of-war general hospitals had duplicate staffs of American and German personnel. In January 1945 the chief of The Surgeon General’s Prisoner of War Liaison Unit reported that the German staffs of such hospitals were requesting re- patriation because they were given little opportunity to do actual medical and surgical work. He recommended the re- moval of all American medical personnel except the minimum required for key supervisory positions. The next month the Surgeon General’s Office issued directives 77 (1) Memo, SG for CG ASF, 13 Sep 44, sub; Add Hosp Fac for PW Puts. SG: 383.6. (2) Memo, SG for CofS ASF, 4 Oct 44, sub: Hosp Fac for German PW Pnts. SG: 322 “Hosp.” (3) Diary, Hosp Div SGO, 6 Oct 44. HD: 024.7-3. 78 (1) Rad CM-OUT-53 129, Marshall to Eisen- hower, 27 Oct 44. SG: 383.6. (2) Memo SPMOC 383.6 (30 Oct 44), CG ASF for SG, n d, sub: Hosp Fac for German PW Pnts. Same file. 79 (1) Diary, Hosp Admin Br Hosp Div SGO, 8 May 45. HD: 024.7-3. (2) Diary, PW Liaison Unit SGO, 24 May 45. Same file. (3) Hosp, Evac, and Dis- position of PW Pnts in the US, by Col McGibony, MC. HD: 383.6. 80 (1) Diary, Hosp Div SGO, 7 Oct 44. HD: 024.7- 3. (2) Memo, Chief Med Liaison Br for Asst PMG, 27 Jan 45, sub: Study of Enemy Repatriation. HD: 319.1-2. (3) Ltr, Chief PW Med Liaison Unit SGO to SG and PMG, 7 Apr 45, sub: Rpt of Visit to PW Gen Hosp No 2, Cp Forrest, Tenn. Same file. 198 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR to require compliance with this recom- mendation.81 Establishment of Hospital Centers A final change in the hospital system was the establishment of hospital centers. During 1944 convalescent hospitals were opened in several instances on the same posts as general hospitals. With the expan- sions of 1945 these hospitals grew beyond all previous expectations. For example, by April 1945 the Percy Jones General and Convalescent ffospitals, with their an- nexes, had a strength, including both pa- tients and operating personnel, of more than 16,500. This was greater than that of an infantry division. These installations occupied not only the Percy Jones Gen- eral Hospital building, located in Battle Creek, Mich., but also almost all of Fort Custer, which was situated near by. In most instances such installations operated under separate commanders. Each had its own administrative organization for activities such as receiving and disposing of patients; feeding, clothing, and paying both patients and operating personnel; and handling mail, personnel records, and legal problems. Each exercised adminis- trative control over its own patients, re- quiring the transfer of records and a change of command every time a patient was transferred from one to the other.82 Early in 1945, the chief of the Surgeon General’s Operations Service decided that combination of such installations under a hospital center commander would sim- plify the administration of supply and service activities and would permit the transfer of patients between adjacent gen- eral and convalescent hospitals without red tape. This had proved to be true when hospital centers were established overseas. Meanwhile, the Percy Jones General Hos- pital had already begun to centralize under a single head each activity common to both hospitals. Therefore the Opera- tions Service sent representatives to ob- serve its organization and operations, and to discuss with its commander plans for establishing hospital centers. These rep- resentatives found merit in such central- ization, and the SurgeonGeneral’s Office decided to apply it to other installations.83 In establishing hospital centers the Medical Department encountered several difficulties. There was opposition in the General Staff, because G-3 feared that additional personnel would be requested to man hospital center headquarters.84 The Surgeon General’s Office believed that the integration of activities common to both general and convalescent hospitals under a single command would actually save personnel and therefore agreed to a condition imposed by the General Staff in approving hospital centers. Personnel for center headquarters would be a part of, and not an addition to, that already pro- vided for general and convalescent hospi- tals.85 On 11 April 1945 the War Depart - 81 (1) Memo SPMGO(4)383.6, Chief Med Liaison Br SCO for Dep Chief Hosp and Dom Oprs SCO, 8 Jan 45, sub: Util of Enemy Protected Pers. HD; 319.1-2. (2) Rad, Lull (SCO) to CGs 4th, 7th, 8th, and 9th SvCs, 5 Feb 45. HD: 319.1-2. (3) An Rpt, FY 1945, Hosp and Dom Oprs SCO. HD. 82 An Rpts, 1945, Percy Jones, Wakeman, and Cps Butner and Carson Conv Ctrs. HD. 83 Interv, MD Historian with Col McGibony, MC, 20 Feb 50. HD: 000.71. 84 Diary, Hosp Div SCO, 31 Mar and 2 Apr 45. HD: 024.7-3. 85 (1) WD AGO Form No 026, Request and Jus- tification for Publication, prepared by SCO, 24 Feb 45, sub: Hosp Ctr (ZI). (2) Memo SPMCH 300.5 (WD Cir), SC for TAG thru CG ASF, 6 Mar 45, sub: Proposed Amendment to WD Cir 140, 1944. (3) Memo, SG for ACofS G-4 WDGS, 31 Mar 45, same sub. (4) DF WDGDS 11065, ACofS G-4 WDGS to TAG, 2 Apr 45, same sub. All in AG: 705 (4-3-44) (1). (5) WD Cir 105, 4 Apr 45. ADJUSTMENTS IN ZONE OF INTERIOR 199 ment announced that nine hospital cen- ters, each composed of a general and a convalescent hospital, would be estab- lished at Camp Pickett, Va.; Camp But- ner, N. C.; Camp Edwards, Mass.; Camp Carson, Colo.; Camp Atterbury, Ind.; Fort Custer, Mich.; Fort Sam Houston, Tex.; Fort Fewis, Wash.; and Camp For- rest, Tenn.86 Focal commanders then ran into problems in consolidating and reor- ganizing general and convalescent hospi- tals into hospital centers, hacking authori- tative standard guides, center commanders proceeded according to their own ideas or the demands of the local situation to set up organizations, establish administrative procedures, and work out relationships with subordinate components, on the one hand, and with post headquarters, on the other.87 Despite these difficulties the establish- ment and operation of hospital centers proved advantageous. The administration of supply and service activities by center headquarters freed hospital commanders of administrative detail, saved personnel, and avoided duplication of effort in those fields. Centralization also made it easy to shift personnel between hospitals as it was needed. Finally, the operation of a single registrar’s office for both general and con- valescent hospitals made it possible to move patients from one to the other by simple inter-ward transfers, rather than by the complicated procedures required when they were moved between separate installations.88 The establishment of hospital centers represented the last of a succession of ad- justments in the hospital system during the war. While most of them were prompted primarily by the necessity of using limited resources effectively, other considerations entered in. For example regional hospitals developed partially from attempts of the Air Forces to establish a completely separate medical service while convalescent hospitals received an addi- tional impetus from a belief that convales- cent patients could best be restored to physical condition for full duty or prepared for return to civilian life in an installation with a nonhospital atmosphere. Some of the changes made in the latter part of the war, such as specialization in general hos- pitals, had their origins earlier and were designed to improve the quality of hospital care. Others, such as the merger of adja- cent station and general hospitals and the establishment of hospital centers, were ex- pected to improve administration. Since most of the changes were the result of war- time demands, when peace came the need for them no longer existed and the hospital system in the United States reverted to its prewar form. 86 WD Cir 115, 11 Apr 45. 87 (1) An Rpt, FY 1945, Percy Jones Hosp Ctr; and An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD. (2) Edward J. Morgan and Donald O. Wagner, The Organization of the Medical Department in the Zone of the Interior (1946), pp. 162-64. HD. 88 An Rpts, 1945, Percy Jones, Wakeman, and Cps Carson and Butner Hosp Gtrs; and An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD. CHAPTER XI Bed Requirements in the Zone of Interior bers of combat casualties than numbers of patients resulting from the normal inci- dence of diseases and accidental injuries. Nevertheless, estimates had to be made and it was important to make them as accurate as possible. Failure to have enough beds at any particular moment would not only subject The Surgeon Gen- eral and the Army to severe criticism but would also jeopardize the treatment of American casualties. To have more beds than were needed would waste personnel and might mean, in the face of the ceiling imposed upon Medical Corps officers, in- adequate manning of the hospitals pro- vided. The Surgeon General’s Office, ASF headquarters, the General Staff, and other agencies of the Government participated in determining bed requirements, and dif- ferences of opinion that arose among them illustrated the complexity of the process. Despite the restrictive personnel situ- ation in the fall of 1943, The Surgeon General’s Ffospital Division continued to consider the problem of meeting bed re- quirements primarily in terms of construc- tion. Following the former practice of fig- uring bed requirements on the basis of World War I experience, it estimated that the number of required station hospital beds would decrease from about 256,000 in December 1943 to about 80,000 in De- cember 1945, but that the number of beds needed in general hospitals would increase While most changes in the hospital sys- tem, discussed in the foregoing chapter, were expected to conserve medical re- sources, especially physicians, they obvi- ously were not expected to reduce the total number of beds that would be needed. In some instances, such changes actually tended to increase bed requirements, for policies making it impossible to place pa- tients of a particular type in any available vacant bed occasionally required the pro- vision of more beds than otherwise needed. Under current policies, for example, va- cant beds in regional hospitals could not be used for overseas patients to reduce the number of additional beds required in general hospitals. Also, vacant beds in sta- tion hospitals could not be used for prisoner-of-war patients requiring general- hospital-type care to avoid the establish- ment of special prisoner-of-war general hospitals. Furthermore, the practice of providing different types of hospitals for different types of patients complicated the calculation of requirements, since beds needed for different groups had to be esti- mated separately. Another factor which increased the difficulty of estimating bed requirements was the transition from the defensive to the offensive phase of the war. Because of uncertainty about the tempo and scope of combat operations and about the kind of warfare to be encountered it was always more difficult to predict num- BED REQUIREMENTS IN THE ZONE OF INTERIOR 201 from about 98,500 to over 122,000 in the same period.1 To meet the anticipated need for general hospital beds, The Sur- geon General in September 1943 requested ASF headquarters to earmark and retain funds that had been appropriated but not used for the construction of approximately fifteen additional general hospitals. The latter refused, insisting that any additional general hospital beds that would be needed could be established without further con- struction in station hospital buildings that would become surplus as troops moved overseas.2 First Attempt To Base Requirements on an Estimate of the Patient Load Late in 1943 the prospect of the inva- sion of Europe, along with limited amounts of available personnel, and uncertainty about the patient load, necessitated a more realistic appraisal of requirements and resources than any formerly made. The Surgeon General borrowed personnel from ASF headquarters, it will be recalled, to establish a special group in his Office for this purpose. In the winter of 1943-44 this group, later known as the Facilities Utilization Branch, attempted to predict the size of the patient load throughout the world during 1944.3 It admitted that it was “up against the difficulty of working with figures that had little firmness,” 4 and its calculations rested upon a series of estimates: the number of troops to be en- gaged in combat; the rate at which troops in theaters would suffer wounds, acciden- tal injuries, and diseases; and the propor- tion of patients in theaters that would be evacuated to the United States. Some of the estimates were based on current World War II information while others rested primarily upon World War I experience. Projected troop strengths for theaters were known, but the proportion of troops to be engaged in combat had to be estimated. Records were available to show the rate at which disease and non- battle injuries occurred, but information about World War II battle-injury rates was meager. To estimate these rates the experience of the Meuse-Argonne fighting in World War I was combined with that of the Tunisian campaign (1943), Tarawa operation (1943), and the German cam- paign in Russia (1941). Information about the German campaign, incidentally, was found in a study prepared by the Office of Strategic Services. The proportion of over- seas patients who would be evacuated to the United States was estimated on the basis of World War I experience, “rein- forced by the derived estimate of the Ger- man experience in the Russian campaign.” This estimate—30 percent of estimated battle casualties and 3 percent of estimated disease and nonbattle-injury cases—dif- fered only slightly from figures for World War I. These estimates were used to cal- culate the number of patients who would need beds in theaters of operations as well as the number who would be evacuated to the United States. To arrive at the number of patients from the zone of interior who 1 (1) Memo, SG (Hosp Cons Br) for CofEngrs, 24 Aug 43, sub; Review of Est for FY 1944. SG; 632.-2. (2) Ltr, SG (Hosp Cons Br) to CofEngrs, 18 Nov 43, sub: MD Cons Reqmts for FY 1945. SG; 632.-1. (3) 1st ind, SG (Hosp Cons Br) to CofEngrs, 24 Jan 44, on Ltr, CofEngrs to SG, 18 Jan 44, sub; Engr . . . Estimates, FY 1945. SG: 632.-1. 2 Ltr, SG to CG ASF, 2 Sep 43, sub; Retention of Appropriated Funds for Gen Hosp Cons, with 1st ind, Reqmts Div ASF to SG, 19 Sep 43. SG; 632.-1. 3 (1) An Rpt, F Y 1944, Dep Chief Hosp and Dom Oprs SGO. HD. (2) Tab A, sub: Estab of a Statistical Management Unit in the Oprs Serv, to Memo, Dir Hosp Div SGO and Dir Resources Anal Div SGO for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt forFY 1945. HD: 319.1-2. (3) Ltr, [Dr.] Eli Ginzberg to Col Calvin H. Goddard, 2 Jan 52. HD: 314 (Corre- spondence on MS)V. 4 Hosp and Evac: A Re-estimate of the Pnt Load and Fac, Feb 44, Introduction, p. 1. HD; 705.-1. 304244 0—55 15 202 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR would need beds in general hospitals, re- cent experience in transfers from station hospitals (0.5 percent of the troop popula- tion) was applied to the projected strength for 1944. From the calculations and interpreta- tions of this study the Surgeon General’s Office estimated that 140,000 beds would be required during 1944 to accommodate patients evacuated from theaters of oper- ations and transferred from zone of in- terior hospitals. Such patients would nor- mally have been provided for in general hospitals, but on this occasion The Sur- geon General did not ask for an increase in general hospital beds to 140,000 or even to the 115,000 which, according to his previous calculations on the old percent- age basis, would be needed by the end of 1944. Instead, in view of the limited num- ber of physicians available and the fact that about 75 percent of the patients in general hospitals were convalescent, he accepted the existing authorization of 100.000 general hospital beds and pro- posed in February 1944 that an additional 40.000 beds be provided in convalescent “facilities.” Such facilities could be oper- ated either as annexes of general hospitals or as separate installations and would re- quire lower ratios of personnel (especially physicians) to patients than did general hospitals.5 Suspecting that The Surgeon General’s figures were too high, ASF headquarters made a thoroughgoing study of its own. Its Planning Division conferred with rep- resentatives of the Surgeon General’s Of- fice, the Office of the Chief of Transporta- tion, and other interested staff divisions of ASF headquarters. It also communicated with the chief surgeons of the European and North African theaters. Different agencies, using battle-casualty admission rates that varied widely, arrived nonethe- less at similar estimates of the patient load, particularly for the first ninety days of op- erations on the European continent.6 In March 1944, therefore, ASF headquarters for the most part approved The Surgeon General’s recommendation. It authorized the conversion of vacant barracks to pro- vide 25,000 beds for convalescent patients and agreed to earmark space for 25,000 more if needed.7 The Surgeon General then began to establish convalescent facil- ities thus authorized but ASF headquar- ters apparently did not seek approval of the General Staff (G-4) for the expansion. As a result the Medical Department failed to get adequate personnel and equipment for the facilities that were established until the approval of G-4 was finally obtained in the fall of 1944. Movement To Reduce the Number of Hospital Beds in the United States During the spring and summer of 1944 other problems, such as changes in the hospital system and the provision of med- ical support for theaters of operations,8 demanded more attention than zone of 3 The above two paragraphs are based on the fol- lowing: (1) Hosp and Evac: A Re-estimate of the Pnt Load and Fac, Feb 44. HD: 705.-1. (2) Memo, SG for Dir Plans and Oprs ASF, 22 Feb 44, sub: Hosp and Evac. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” (3) Ltr, Eli Ginzberg to Col Galvin H. Goddard, 2 Jan 52, HD: 314 (Correspond- ence on MS)V. 6 (1) Memo, Dir Plans and Oprs ASF for Dir Plan- ning Div ASF, 28 Feb 44, sub: Hosp and Evac. HRS: Hq ASF Gen Lutes’ files, “Hosp and Evac, 1943-46.” (2) Memo, Dir Planning Div ASF for Dir Plans and Oprs ASF, 1 Mar 44, sub: Hosp and Evac. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” (3) Memo, Dir Planning Div ASF for Chief ZI Br Planning Div ASF, 2 Mar 44, same sub. Same file. (4) Hosp and Evac: An Anal, Mar 44. HRS: Hq ASF Planning Div Program Br file. 7 Memo, CofS ASF for Dir Plans and Oprs ASF, 28 Mar 44, sub: Conf on Hosp and Evac. HRS; ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” 8 See above, pp. 181-99, and below, pp. 214-37. BED REQUIREMENTS IN THE ZONE OF INTERIOR 203 interior bed requirements, but gradually a tendency developed among many agen- cies to question the need for all of the beds previously authorized. By the fall of 1944 this tendency developed into a general movement to reduce their number. The demand to reduce the number of beds in zone of interior hospitals arose at first from observation of the low rate of oc- cupancy. Statistics published by the Sur- geon General’s Office showed that only about half of the beds in all hospitals in the United States were used during most of 1944.9 (Chart 8.) Furthermore, opti- mism about an early end of the war made it seem unlikely to officers in ASF head- quarters and the General Staff that the occupancy rate would increase appre- ciably.10 Meanwhile various expedients were being used to supply theaters with their quotas of beds, among them the ship- ment of hospital units without full com- plements of professional personnel.11 The Deputy Chief of Staff expressed the opin- ion that this practice would be unneces- sary if medical personnel and facilities were properly used. He therefore directed The Inspector General in September 1944 to investigate duplication of hospitaliza- tion in the United States.12 By that time ASF headquarters, the War Department Manpower Board, and divisions of the General Staff had already begun to make their own estimates of bed requirements in the zone of interior. A reduction in the authorized ratio of station hospital beds had been made sev- eral days before the Deputy Chief of Staff criticized the use of medical resources. As early as May 1944, in the course of discus- sions with the General Staff about nurse requirements, The Surgeon General’s Fa- cilities Utilization Branch had informally proposed a reduction from 4 to 3.6 per- cent of troop strength.13 The General Staff accepted this suggestion immediately, but it was not until 20 September 1944 that a new ratio of 3.5 percent—formally pro- posed by The Surgeon General in Au- gust—was established by War Depart- ment directive.14 The same directive, however, authorized for the first time a ratio for regional hospital beds: 0.5 per- cent of troop strength. Formerly used to estimate the number of beds in general hospitals needed to care for zone of in- terior patients transferred from station hospitals, this figure was adopted because such patients were eventually to be trans- ferred to regional instead of general hos- pitals. Since no corresponding reduction was made in the number of beds author- ized for general hospitals it is difficult to see that the reduction in the station hospi- tal bed ratio meant any reduction in the total number of beds authorized. In any event, this action must have seemed to authorities higher than The Surgeon Gen- eral as only a step in the right direction. The ASF Director of Plans and Oper- ations proposed a reduction in the number 9 (1) Weekly Health Rpts, vol. IV, Nos 1-39, 1944. AML. (2) ASF Monthly Progress Rpts, Sec 7, Health, Mar-Aug 44. 10 (1) Remarks by Col Albert H. Schwichtenberg, MC, in Notes on Conf of AAF Gomd Surgs, Off of Air Surg, 16-20 Apr 45. SG: 337. (2) Interv, MD His- torian with Lt Col James T. McGibony, MG, 20 Feb 50. HD: 000.71. 11 See below, pp. 218-28. 12 (1) Mins, Mtg of Gen Council, 25 Sep 44. HRS: AGO Reference Collection. (2) Memo WDGSA 632 (25 Sep 44), DepCofSA for IG, 25 Sep 44, sub: Hosp Fac in ZI. HRS; WDGSA 632 (25 Sep 44), Case 28, “Hosp Fac in ZI.” 13 Memo SPMCH 211 Nurses, Eli Ginzberg for Maj Armour, G-3 WDGS, 25 May 44, sub: Almt of Nurses. HRS: G-3 files, 210-219 incl, “vol. II.” 14 (1) DF, Dep ACofS G-3 WDGS to WDMB, G-l and G-4, lOJun 44, sub: Almt of Nurses. HRS; G-3 files, 210-219 incl, “vol. II.” (2) Memo, SG (init E. G[inzberg]) for ACofS G-3 and G-4 WDGS thru CG ASF, 29 Aug 44. SG: 632.2. (3) Memo WDGCT 211 (26 May 44), Dep ACofS G-3 WDGS for CG ASF, 18 Sep 44, sub: Almt of Nurses. Same file. (4) AR 40- 1080, C 3, 20 Sep 44. * Excludes dispensaries, convalescent facilities (but includes convalescent hospitals after establishment in June 1944), venereal disease facilities, college training units, and nonfixed hospitals at maneuver areas. Source: Weekly Health Reports, ASF, Med Statistics Div, SGO. Chart 8—Hospital Beds Authorized and Occupied by Type of Hospital in Continental United States 1943 and 1944 REGIONAL STATION ALL HOSPITALS* GENERAL BED REQUIREMENTS IN THE ZONE OF INTERIOR 205 of beds in all hospitals on 4 September 1944. Pointing to the low occupancy rate, to the expectation that regional hospitals would relieve general hospitals of zone of interior patients, and to the fact that bat- tle casualties and their evacuation from overseas had been less than estimated, he called upon The Surgeon General to ana- lyze the entire hospital program with a view to reducing the number of beds in station and regional hospitals by 25 per- cent and in general hospitals to 80,000.15 To effect this reduction would have meant closing from twelve to twenty general hos- pitals—a proposal made verbally by the War Department Manpower Board dur- ing the same month.16 The Surgeon General agreed that too many station hospital beds had been pro- vided, but he pointed out that he had al- ready begun to reduce their number. In opposing other reductions he emphasized future possibilities. He called attention to the tendency of sick rates and hospital occupancy to be higher in winter than in summer, to the likelihood of heavier battle casualties, to the prolongation of the war beyond what had been expected, to the expectation that patients from overseas would need longer periods of hospitaliza- tion in the United States than anticipated, and to the prospect that more beds would be needed in all types of zone of interior hospitals when the war in Europe ended and redeployment to the Pacific began. He also pointed out that the transfer of patients from Europe and North Africa had hardly begun because of the Euro- pean theater’s opposition to evacuating patients in troop transports and North Africa’s lack of adequate shipping.17 The bed surplus, in short, was only temporary and earlier estimates would prove correct. These arguments failed to change the opinion of the ASF Director of Plans and Operations, but on 25 September 1944 his proposal to require The Surgeon General to make the desired reductions was quashed by General Somervell, who con- sidered it unwise to order such cuts in the face of The Surgeon General’s opposi- tion.18 Two days before, on 23 September 1944, G-4 directed both AAF and ASF headquarters to reduce the beds in station and regional hospitals to the number au- thorized by the new ratios (3.5 and 0.5 percent of troop strength respectively) and to plan a further reduction of 25 percent in each—the same cut proposed earlier by ASF headquarters.19 Later G-4 appar- ently directed ASF headquarters to plan reductions in the number of general hospi- tal beds also.20 The Air Surgeon and The Surgeon General readily agreed to reduce beds to current authorizations, but they objected to a further lowering of the bed ratio. Such action, they said, would allow no vacant beds for dispersion or epidemics. It would limit beds in station hospitals to 2.6 percent and in regional hospitals to 15 Memo SPOPP 632 (23 Aug 44), CG ASF (Dir Plans and Oprs) for SG, 4 Sep 44, sub; ZI Hosp Pro- gram. HRS: ASF Planning Div file, 700 “ZI Hosp.” 16 (1) Remarks by Col Schwichtenberg, MG, in Notes on Conf of AAF Comd Surgs, Off of Air Surg, 16-20 Apr 45. SG: 337. (2) Transcription of written answers by Maj Gen Norman T. Kirk, USA, Ret, to questions in Ltr of 10 Nov 50, from Editor, Hist Med Dept in World War II. HD: 314 (Correspondence on MS) I. 17 Memo, SG (init E. G[inzberg]) for CG ASF, 15 Sep 44, sub: ZI Hosp Program. HRS: Hq ASF Plan- ning Div file, 700 “ZI Hosp.” 18 (1) Memo, Dir Plans and Oprs ASF for CG ASF, 23 Sep 44, sub: ZI Hosp Program, with inch HRS: ASF Planning Div file, 700 “ZI Hosp.” (2) MRS, [Gen] Somervell to [Maj Gen Wilhelm D.j Styer, 25 Sep 44, atchd to Memo just cited. Same file. 19 Memo WDGDS 3221, ACofS G-4 WDGS for CGs AAF, AGF, ASF, 23 Sep 44, sub: Reduction of ZI Hosp. SG: 322 “Hosp Misc.” 20S/S WDGDS 4166, ACofS G-4 WDGS to DepCofSA, 20 Oct 44, sub: ZI Hosp Reqmts. HRS; G-4 files, “Hosp and Evac Policy.” 206 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR 0.4 percent of troop strength, while beds actually occupied in station hospitals ranged from 2.5 to 2.7 percent of troop strength.21 While this argument was in progress the question of general-hospital bed requirements was being discussed among G-4, The Surgeon General, and the War Department Manpower Board. In these discussions the Manpower Board raised two new issues: the propriety of lumping together the capacities of all types of hospitals when considering pres- ent and future needs and of counting beds in convalescent facilities as part of these resources. The Manpower Board followed both practices. It considered all beds in convalescent facilities as hospital beds and added to them the beds in station, region- al, and general hospitals to arrive at a total number of beds already established. Comparing the number of patients in all hospitals with this total, the Board con- cluded that a surplus of 78,000 beds existed in the United States.22 The Surgeon Gen- eral contended that beds in convalescent facilities should not be considered as hospi- tal beds, since the Board had until then refused to allocate personnel for them. He insisted, moreover, that beds in hospitals of different types were not interchange- able. For example, under existing policies vacant beds in station and regional hospi- tals could not be used for overseas evac- uees. Nor were all beds in general hospi- tals available for the treatment of such patients. Some were used for prisoners of war, non-Army patients, and Army pa- tients from surrounding areas who needed only minor care and treatment, while others had to be set aside to receive evacuees in transit from ports to hospitals of definitive treatment. He argued, there- fore, that the Manpower Board’s conclu- sion about a surplus of hospital beds was invalid.23 The final decision which the General Staff made in the face of conflicting argu- ments proved to be a compromise. After further study by G-4 of the beds required in all types of hospitals, the Staff agreed in November 1944 to authorize 40,000 con- valescent beds —10,500 of them in AAF hospitals. This was substantially the num- ber recommended by The Surgeon Gen- eral and the Air Surgeon and already set up in convalescent hospitals. The Man- power Board now reluctantly agreed to provide staffs for them. Moreover, the Staff required no cut in the existing num- ber of beds in general hospitals or in the ratio authorized for regional hospitals. On the other hand it directed a cut in the ratio of station hospital beds, but only from 3.5 to 3 percent of troop strength instead of to the 2.6 percent first suggested. 24 The Air Surgeon apparently considered this 21 (1) Memo, CG AAF for CofSA attn G-4, 30 Sep 44, sub; Reduction of ZI Hosp. HRS; G-4 files, “Hosp and Evac Policy.” (2) Memo, CG AAF (Air Surg) for GofSA attn G-4 Div, 7 Oct 44, same sub. Same file. (3) T/S SPMG 322 Hosp, SG to Dir Plans and Oprs ASF, 30 Sep 44, same sub. HRS: Hq ASF Planning Div file, 700 “ZI Hosp.” (4) Memo, SG (init E. G[inzberg]) for Dir Plans and Oprs ASF, 25 Oct 44, same sub. SG: 632.2. (5) Memo SPOPP 700, CG ASF for ACofS G-4 WDGS, 30 Oct 44, same sub. AG; 323.3 (4 Sep 44)(1). 22 Memo WDSMB 323.3 (Hosp), Pres WDMB for CofSA, 16 Oct 44, sub: ZI Hosp Reqmts. HRS; G-4 files, “Hosp and Evac Policy.” 23 (1) Memo, Eli Ginzberg, Spec Asst, Dir Hosp Div SGO for Pres WDMB, 23 Aug 44. (2) Memo, SG for CG ASF, 15 Sep 44, sub: ZI Hosp Program. (3) Inf Memo, Dir Resources Anal Div SGO for Lt Col Hun- cilman (ASF), 26 Dec 44, sub: Background for Staff- ing Conv Hosps. All in HRS: Hq ASF Planning Div file, 700 “ZI Hosp.” 24 (1) S/S WDGDS 4166, ACofS G-4 WDGS to Dep CofSA, 20 Oct 44, sub: ZI Hosp Reqmts. (2) S/S WDGDS 4956, same to same, 8 Nov 44, same sub. (3) Memo, CG AAF (Air Surg) for ACofS G-4 WDGS, 31 Oct 44, sub: AAF Conv Hosps. (4) Memo, Dep SG (init A. H. S[chwichtenberg] and E. Gfinzberg]) for ACofS G-4 WDGS, 2 Nov 44, sub: Reqmts for ASF Conv Fac. (5) S/S WDSMB 323.3 (Hosp), Pres WDMB to GofSA, 13 Nov 44, sub: ZI Hosps. All in HRS: G-4 files, “Hosp and Evac Policy.” BED REQUIREMENTS IN THE ZONE OF INTERIOR 207 compromise satisfactory, but The Surgeon General’s representatives insisted that no reduction at all should be made.25 In an- nouncing the Staffs decision on 17 No- vember 1944, G-4 directed both AAF and ASF headquarters to study the hospital situation further in the light of actual ex- perience and to submit by 15 J anuary 1945 any recommendations which they might have on changes in requirements.26 Changes in the Manner of Reporting Beds The movement to reduce the number of hospital beds caused a change in the method of reporting them. ASF head- quarters decided that “unrefined data” on hospitalization, published by the Surgeon General’s Office in Weekly Health Re- ports and in ASF Monthly Progress Re- ports, gave erroneous impressions and made it difficult to arrive at sound conclu- sions about the adequacy of hospital facil- ities.27 Earlier the Surgeon General’s Of- fice had warned that a distinction needed to be made between the total number of beds in general hospitals and the smaller number available for “true general-hospi- tal cases.” To obtain the latter figure one must subtract from the total the number of beds necessarily vacant because of the practice of distributing patients into wards according to disease, sex, and rank, as well as those set aside for other purposes—such as the care of station-hospital-type pa- tients, civilians, veterans, and Navy per- sonnel, and the debarkation processing of patients arriving from theaters of opera- tions.28 This implied that to get a true pic- ture of hospitalization not only the capac- ity of hospitals by type but their capacity to handle particular types of patients should be known, and that the number of beds set aside for special purposes and lost through dispersion should be taken into account. The Surgeon General’s regular reports began to take notice of this latter factor in statistics for the end of September 1944. Previously he had reported the number of beds authorized (which was reasonably close to the number normally available) and the number occupied. Now he added a figure for “effective beds” in general hospitals. It was obtained by subtracting an allowance for dispersion and for “de- barkation beds” from the number of au- thorized beds. The following month he presented similar figures for regional and station hospitals, and at the same time gave the percentage of effective beds occu- pied in each class of hospital. This per- centage, for all general hospitals, was 76.5; the percentage of authorized beds that were occupied (a figure previously given but now dropped) would have been 58.1. The next month, instead of reporting simply beds occupied, The Surgeon Gen- eral showed “patients remaining,” a fig- ure which included not only the number of patients occupying beds but also the number temporarily absent on sick leave, on furlough, and without leave. The ratio of “patients remaining” to “effective beds” was given. In the case of general hospitals, taken collectively, this ratio amounted to 25 (1) Memo, CG AAF (Air Surg) for CofSA attn G-4, 7 Oct 44, sub; Reduction of ZI Hosps. HRS: G-4 files, “Hosp and Evac Policy.” (2) Diary, Plans and Policy Sec, ASF Planning Div, 31 Oct 44. HRS: Hq ASF Planning Div file, 700 “ZI Hosp.” (3) Memo, Dir Hosp Div (init E. G[inzberg]) for Col [William B.] Higgins, G-4, 31 Oct 44, sub: Sta and Reg Hosp Bed Reqmts. SG: 632.2. 26 Memo WDGDS 5391, ACofS G-4 WDGS for CGs AAF and ASF, 17 Nov 44, sub: ZI Hosps. SG: 322 “Hosp Misc.” 27 (1) Memo SPOPP 705, CG ASF for SG, 20 Nov 44, sub: Data on Status of Hosp Beds and Pers, ZI. AG; 323.3 (4 Sep 44) (1). (2) Memo, Maj Gen W. D. Styer for Gen Lutes, 9 Nov 44. HRS: Hq ASF Plan- ning Div file, 700 “ZI Hosp.” 28 Memo, Eli Ginzberg, Spec Asst, Dir Hosp Div SGO for Pres WDMB, 23 Aug 44. HRS: Hq ASF Planning Div file, 700 “ZI Hosp.” 208 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR 91.3 percent. The ratio of beds occupied to “effective beds” would have been 73.9 percent; of beds occupied to beds author- ized, 56.4 percent.29 Thus, although there was little change in actual occupancy, the new system of reporting makes it appear that hospitals were being more fully utilized than formerly. By this time (November 1944) a series of conferences on bed reporting had al- ready started under the auspices of ASF headquarters,30 and in February 1945 conclusions were reached regarding the other factor considered necessary to a true presentation of the hospital situation. In that month the Surgeon General’s Office and the ASF Planning Division agreed upon a system of reporting beds, patients, and operating personnel in terms of types of care or types of beds, regardless of their location in particular types of hospitals.31 Four months later the ASF Monthly Progress Report carried such information. It showed that although there were 213,- 373 beds in general and convalescent hos- pitals, only 180,760 were used as general and convalescent hospital beds.32 Meeting Increased Requirements for the Peak Patient Load Meanwhile the tide had long since turned in the drive to reduce hospital bed capacity. Not long after G-4’s compro- mise decision of 17 November 1944, The Surgeon General’s Resources Analysis Division made a new study of bed require- ments that showed a need for more beds in general and convalescent hospitals than G-4 had authorized. There were several reasons for this study; completion by the Medical Regulating Officer of new esti- mates of patients to be evacuated from theaters during 1945, the prospect that re- deployment would interfere with the use of station hospital buildings for any pos- sible overflow from general hospitals, and G-4’s directive that further recommenda- tions about bed requirements be submitted by 15 January 1945.33 In this study the Resources Analysis Division concentrated upon general and convalescent hospitals rather than upon station and regional hospitals, for there was little possibility either that G-4 would raise the bed ratio for the last two or that the Surgeon General’s Office would rec- ommend reducing it. In estimating re- quirements for beds in general and convalescent hospitals, the Division calcu- lated the numbers of beds that would be needed for three groups of patients: de- barkees, zone of interior and non-Army patients, and overseas patients. The mini- mum number of debarkation beds needed, it was assumed, was one half the antic- ipated monthly evacuee load, or approxi- mately 17,500. Experience showed that 33,000 beds in general hospitals were used by zone of interior and non-Army patients 29 ASF Monthly Progress Rpts, Sec 7, Health, 30 Sep, 31 Oct, and 30 Nov 44. 30 (1) Memo SPOPP 720 (9 Nov 44), Dir Plans and Oprs ASF for CofS ASF, 30 Nov 44, sub: Status of Hosp Beds and Med Pers, ZI. AG: 323.3 (4 Sep 44)(1). (2) Diary, ASF Planning Div (Lt Col H. A. Huncilman), 28 Nov 44. HRS: Hq ASF Planning Div file, 700 “ZI Hosp.” (3) Memo SPOPP 700, Dir Plan- ning Div for Gen Wood, 26 Dec 44, sub; ZI Hosps. HRS: Hq ASF Planning Div file, “Hosp and Evac.” (4) Memo, Maj W. H. Hastings (ASF) for Lt Col Ft. A. Huncilman, 25 Jan 45, sub: Hosp Occupancy Data for Monthly Progress Rpt. HRS: Hq ASF Plan- ning Div file, 700 “ZI Hosp.” 31 ASF Cir 68, 26 Feb 45. 32 ASF Monthly Progress Rpt, Sec 7, Health, 30 Jun 45. 33 (1) Interv, MD Historian with Col John C. Fitz- patrick, MG, formerly MRO, SCO, 18 Apr 50. HD: 000.71. (2) Memo, Eli Ginzberg for the Record, 28 Nov 44. HD; 560.-2 (Hosp Ships). (3) Memo for Rec- ord on Memo, CG ASF for SG, 13 Dec 44, sub; Gen Hosp Program, ZI. HRS: Hq ASF Planning Div file, “Hosp and Evac.” Documents dealing with conflict- ing claims to the use of station hospitals are in HRS; G-4 file, 602.3. (4) Memo SPOPP 322, CG ASF for SG, 7 Dec 44, sub: ZI Hosps. SG: 322 “Hosp Misc.” BED REQUIREMENTS IN THE ZONE OF INTERIOR 209 despite the policy of transferring compli- cated cases from station to regional, in- stead of general, hospitals. Beds for over- seas evacuees receiving definitive treat- ment were computed on the basis of the number to be brought in each month, as forecast in the study made by the Medical Regulating Officer, and on the average length of time they were expected to stay in hospitals. From these calculations, it appeared that patients in general and con- valescent hospitals would reach a peak number of 198,000 in August 1945. If 17,- 500 beds were set aside for debarkation processing, a total of about 215,000 beds would then be needed. Additional beds for dispersion were not included in this number because it was anticipated that the patient load would ordinarily be lower than the estimated peak and that many patients would leave beds vacant when they went on leaves and furloughs.34 This study led The Surgeon General on 8 January 1945 to ask for 70,000 addition- al general and convalescent hospital beds. He proposed that 49,500 of them should be in general hospitals and that they should be provided as follows: 10,000 by converting the convalescent annexes of general hospitals into wards; 17,500 by using hospital barracks for patients instead of enlisted men of the medical detach- ment, for whom other housing would be provided; 8,000 by placing ambulatory patients of general hospitals in post bar- racks; 9,000 by converting four station hospitals into temporary general hospitals; and 5,000 by using beds in staging area hospitals for debarkation purposes, thus freeing an equal number of beds in gen- eral hospitals for patients needing pro- longed care. The Surgeon General sug- gested that about 20,500 additional beds in convalescent hospitals could be pro- vided by using vacant barracks located near by. In this connection it should be noted that he followed a policy of expand- ing existing hospitals rather than estab- lishing new ones because smaller ratios of personnel to patients were required for large than for small installations and scarce specialists were used more advan- tageously by concentrating rather than dispersing them.35 A combination of circumstances inter- vened in December 1944 and January 1945 to cause the General Staff to consider favorably this request. In mid-December the Battle of the Bulge put to flight all thoughts of an early end to the war in Europe. About the same time, approval by the Joint Chiefs of Staff of the Medical Regulating Officer’s estimates of evacuees to be received during 1945 made it appear that the number of patients in zone of in- terior hospitals would increase. In addi- tion, a directive from the Chief of Staff on 3 December 1944 requiring the European theater to use transports for evacuation assured the early return to the United States of many patients from that area.36 Of perhaps more importance, the Secre- tary of War wrote to the Chief of Staff early in January; “If we later prove to 34 (1) Memo SPMCH 322 (Hosp-Cp Edwards)G, SG for CG ASF, 21 Nov 44, sub: Use of Gp Edwards as a Debarkation Hosp. HRS: G-4 file, 602.3. (2) Memo, Asst SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub; Gen Hosp Program, ZI with tabs and incls. HRS: Hq ASF Planning Div file, “Hosp and Evac.” (3) Diary, Resources Anal Div, SGO, 19, 20, 22, and 23 Dec 44. HD: 024.7-3. 35 (1) Memo, Asst SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen Hosp Program, ZI, with Tabs A-J. HRS: Hq ASF Planning Div file, “Hosp and Evac.” (2) Memo, SG for CG ASF, 4 Jan 45, sub: Gen and Conv Hosps. Same file. (3) Memo, SG for Col Prichard, 22 Feb 45, sub: Background Info Covering the Gen Hosp Expansion Program. SG; 632. 36 (1) Interv, MD Historian with Lt Col J[ames] T. McGibony, MG, 20 Feb 50. HD: 000.71. (2) JCS Doc- ument 1199, 16 Dec 44. SG: 560.2. (3) Rad CM- OUT-72113 (3 Dec 44), CofSA to CG Hq ComZ ETO and CG UK Base Sec, 3 Dec 44. SG: 560.2. 210 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR have erred [in forecasting requirements] I want to make sure that we have erred on the side of too much.” 37 Finally, The Sur- geon General’s Resources Analysis Divi- sion seems to have established better rela- tions than formerly with the War Depart- ment Manpower Board and a new Deputy Chief of Staff of the Army, perhaps in- clined to be more favorable to The Sur- geon General’s position than his predeces- sor, had taken office in October 1944.38 During the early part of January 1945, Surgeon General Kirk vigorously pushed his program for additional beds in per- sonal conferences with the commanding general of the Service Forces, members of the General Staff, the Deputy Chief of Staff, the Chief of Staff, and perhaps also the Secretary of War. On 20 January 1945 it was approved.39 In succeeding months G-4 and The Surgeon General differed about the num- ber of additional beds actually required. G-4 suggested, it will be recalled, that the number might be reduced by placing overseas patients in vacant beds in AAF regional hospitals. The Air Forces offered beds for that purpose and emphasized, along with G-4, the desirability of using them to reduce the number of additional beds required in other hospitals. When The Surgeon General and ASF headquar- ters argued that no emergency existed to require such use of regional hospitals, G-4 asked ASF headquarters on 3 April 1945 for a justification of the number of beds authorized in January.40 Meanwhile the Surgeon General’s Of- fice had reappraised its former estimate of requirements. Beginning in December 1944 the number of evacuees arriving in the United States from all theaters in- creased each month until in March 1945 it surpassed by about 12,000 the monthly average on which planning at the end of December had been based.41 This trend indicated that the peak load in general and convalescent hospitals would occur in June, two months earlier than previ- ously expected, and that it would be higher by 46,000 patients than the 198,- 000 estimated in December 1944. Accord- ingly, in the latter part of March 1945 the Surgeon General’s Office asked ASF 37 Memo, SecWar for CofS, n d, included as Tab B to Memo, WDCSA 700 (13 Jan 45), Asst DepGofSA for ACofS G-l, G-2, G-3, G-4, and OPD WDGS and for CGs ASF, AGF, and AAF, 13 Jan 45, sub: Med Mission Reappraised. FIRS: G-4 file, “Hosp, vol. II.” 38 Weekly Diary, Resources Anal Div SGO, 13 Jan 45. HD: 024.7-3. Lt. Gen. Joseph T. McNarney was succeeded by Lt. Gen. Thomas T. Handy as Deputy Chief of Staff, United States Army, in October 1944. Info supplied by OCS files. 39 General Kirk had a conference with the Chief of Staff on 26 December 1944, with the commanding general, ASF, on 5 and 8 January 1945, and with members of the General Staff and the Deputy Chief of Staff on 18 January 1945. (1) Memo WDCSA 632 (26 Dec 44), Gen George C. Marshall for Gen Thomas T. Handy, 26 Dec 44. HRS: OCS 632. (2) Notes for Gen Kirk on Gonf with Gen Marshall, Sum- mary, 25 Dec 44. HD: Resources Anal Div file, “Hosp.” (3) MRS SPGAA 705 (4 Jan 45), MPD ASF for Dir Plans and Oprs ASF, 11 Jan 45, sub: Gen and Conv Hosps. HRS: Hq ASF Planning Div files, “Hosp and Evac.” (4) Weekly Diary, Resources Anal Div, SGO, 13 Jan 45. HD: 024.7-3. (5) Memo, Lt Col Huncilman, ASF for the Record, 19 Jan 45. HRS: Hq ASF Planning Div files, “Hosp and Evac.” (6) DF WDGDS 7623, SecWar (G-4) to CG ASF, 20 Jan 45, sub: Gen Hosp Program, ZI. HD: Resources Anal Div file, “Hosp.” 40 (1) See above, pp. 185-86. (2) DF WDGDS 11208, ACofS G-4 WDGS to GG ASF, 3 Apr 45, sub: Gen Hosp Program for ZI. HRS: Hq ASF Planning Div file, 700 “Hosp.” 41 The increase by month from November 1944 through March 1945 was as follows: Total Patients Year and Month Returned to U.S. November 1944 19,700 December 1944 32,511 January 1945 33,382 February 1945 38,251 March 1945 44,845 These figures are from statistics compiled by the Medi- cal Regulating Officer on the basis of monthly reports by port surgeons and the Air Transport Division. History . . . Medical Regulating Service. . . . BED REQUIREMENTS IN THE ZONE OF INTERIOR 211 Table 13—Hospitalization Data as of 29 June 1945 Number of Patients Patients Reported per 100 Beds Type of Hospital Number of Authorized Beds Total Occupying Beds Army—Absent Percent Beds Occupied Army Non-Army lough, or for other reasons General ° 152, 971 186, 916 118,717 5,811 62, 388 122 81.4 Convalescent (AAF and ASF) b 59, 978 58, 345 41, 752 4 16, 589 97 69.6 AAF Convalescent 11,600 6, 240 5,534 0 706 54 47.7 ASF Convalescent 48, 378 52, 105 36, 218 4 15, 883 108 74.8 Regional (AAF and ASF) SO, 078 38,045 33, 842 2,944 1, 259 76 73.4 AAF Regional 19,960 14, 554 13,172 936 446 73 70.6 ASF' Regional 30,118 23, 491 20, 670 2, 008 813 78 75.2 Station (AAF and ASF) 51,561 34, 980 28, 305 6,338 337 68 67.1 AAF Station 21, 306 11,728 10, 045 1,577 106 55 54.5 ASF Station 30, 255 23, 252 18, 260 4,761 231 77 76.0 General and Convalescent 212, 949 245, 261 160, 469 5,815 78, 977 115 78.0 General, Convalescent and Regional 263, 027 283, 306 194,311 8, 759 80, 236 107 77.2 All Hospitals 314,588 318, 286 222, 616 15,097 80, 573 101 75.5 “ General hospitals—only general hospitals proper. 4 Convalescent hospitals—included both separate convalescent hospitals and those operated in connection with general hospitals. Source: Weekly Hospitalization Report, vol. II, No. 26. AML. headquarters for 9,000 additional debar- kation beds and for 25,000 additional con- valescent beds.42 Perhaps in recognition of the inconsistency of requesting additional beds at a time when they were arguing that no emergency existed to require the use of vacant beds in regional hospitals for overseas patients, representatives of the Surgeon General’s Office and ASF head- quarters agreed in conference on 5 April 1945 not to pass this request on to G-4. Instead, they would care for the higher number of patients in beds already au- thorized by placing more patients on leave and furlough, by speeding the dis- position of cases being treated, and by limiting general and convalescent hospi- tals more strictly to overseas patients. ASF headquarters agreed to some additional construction to increase the capacity of existing debarkation facilities and justi- fied the beds authorized in January by ex- plaining to G-4 the upward trend in patient evacuation.43 The peak patient load in the zone of in- terior occurred at the end of June 1945, approximately two months after V-E Day.44 An analysis of hospital-occupancy figures at that time shows that all beds in general, convalescent, and regional hospi- tals were needed and that even more might have been required if many pa- tients had not been placed on leave or furlough. For example, the patient census of general, convalescent, and regional hos- 42 (1) Memo, SG for Dir Plans and Oprs ASF, 19 Mar 45, sub: Temp Debarkation Reqmts. SG: 632.2. (2) Memo, SG for CG ASF, 23 Mar 45, sub: Gen Hosp Program, ZI. SG: 322 “FIosp.” 43 (1) Memo, SG for CG ASF, 6 Apr 45, sub: Gen Hosp Program, ZI, with 1st ind. SG: 322 “Hosp.” (2) 1st ind, GG ASF to ACofS G-4 WDGS, 9 Apr 45, on DF WDGDS 11208, ACofS G-4 WDGS to CG ASF, 3 Apr 45, same sub. HRS: Hq ASF Planning Div file, 700 “ZI Hosp.” 44 This statement is based upon figures in Weekly Hospitalization Reports that include both Army and non-Army patients as of midnight of Friday of each week. Statistical Review, World War II: A Summary of ASF Activities, prepared by the Statistics Branch, Con- trol Division, ASF, lists the average number of Army patients each month and shows the peak load occur- ring during July. 212 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Chart 9—Hospital Beds Authorized and Occupied, and Patients Reported in All Hospitals in the Continental United States: June 1944-December 1946 I »• BEOS AUTHORIZED PATIENTS REPORTED (Incl. obsent from hospital)^1 BEDS OCCUPIED ♦Excludes debarkation beds and patients after February 1945. Source: Weekly Health Reports, ASF, Med Statistics Div, SGO. pitals was 283,306, while the number of beds in those hospitals was only 263,027. Of these beds, 203,070 were occupied. The rest of the patients—80,236—were absent from hospitals on leave or fur- lough. Not all hospitals were equally used, and the patient load was unevenly distributed. General hospitals were filled beyond the saturation point, normally considered to be 80 percent of their total bed capacities, and had more than 62,000 patients on leave. Regional hospitals, on the other hand, were only 73.4-percent occupied, and had few patients on leave. This suggests either that beds in these hos- pitals might have been reduced in number or that some might have been used for overseas patients to relieve general hospi- tals of part of their heavy load. In general, ASF hospitals showed higher occupancy ratios than did those of the Air Forces. This raises the question of whether the number of beds in the latter might have been reduced or vacant beds in them used for more non-AAF personnel. The low oc- cupancy of both AAF and ASF station hospital beds indicates that the Staff had been justified in reducing their ratio to 3 percent and in suggesting even further reductions. A more even distribution of patients and a fuller utilization of all hospitals would have been achieved, perhaps, by modifications of existing hospitalization policies but this was precluded chiefly by the separation of zone of interior hospitals into AAF and ASF hospitals and by the struggle for power between The Surgeon General and the Air Surgeon. (Table 13, Charts 9, 10) Chart 10—Hospital Beds Authorized and Occupied, and Patients Reported by Convalescent, Regional, General, and Station Hospitals in Continental United States: June 1944-December 1946 CONVALESCENT REGIONAL 51 GENERAL STATIONS' a Patients reported by regional hospitals, not shown, varied from 1,500 to 2,500 more than beds occupied. b Includes convalescent facilities, but excludes convalescent annexes at general hospitals after December 1944. 0 Excludes debarkation beds after February 1945. d All regional hospitals became station hospitals in December 1946. 0 Patients reported by station hospitals, not shown, usually ranged between 1,300 and 2,500 more than beds occupied. This applies to the period Dec 1944 to Sept 1945, the war months for which figures are available. Source: Weekly Health Reports, ASF, Med Statistics Div, SGO. CHAPTER XII Estimating and Meeting Requirements of Theaters for Hospital Beds Although estimates of beds required for theaters were generally made separately from those for the zone of interior, devel- opments attending the estimation of re- quirements for both areas were in some respects similar. Such similarities occurred despite the fact that co-ordination between interested divisions of the Surgeon Gen- eral’s Office was incomplete. Until the late summer of 1943 the Plans Division of the Surgeon General’s Office continued to plan hospitalization for ac- tive overseas theaters on t he basis of a 10- to 15-percent ratio of fixed beds to troop strength.1 One reason for this high ratio was that the director of the Division, aware of public criticism which the Medi- cal Department would incur if it ever failed to have enough beds, desired to have a sufficient number to meet promptly a greatly accelerated build-up of troops overseas and still have enough left to con- stitute a safety factor.2 Another reason of equal cogency was that sufficient informa- tion about various factors that affected bed requirements during World War II was not yet available to justify the estab- lishment of lower ratios than those de- rived from World War I experience. Factors Influencing Bed Requirements Among the factors that influenced bed requirements were: (1) overseas troop strengths, both actual and projected; (2) disease and nonbattle-injury hospital- admission rates; (3) battle-casualty hospi- tal-admission rates; (4) the average length of time patients stayed in hospitals; and (5) evacuation policies. While troop strengths and admission rates for disease and nonbattle-injury cases could be de- termined with reasonable accuracy, ad- mission rates for battle casualties could be estimated only roughly and were there- fore uncertain at best. The average length of time that patients stayed in hospitals depended upon some factors that were un- controllable, such as the severity of wounds and the seriousness of illnesses, and upon others, such as evacuation poli- 1 For example, see Ltr, SG to GG ASF, 13 Jul 43, sub: Trp Basis for Pacific Area. SG; 320.2. 2 Interv, MD Historian with Col Arthur B. Welsh, MG, 27 Dec 50. HD; 000.71. According to Colonel Welsh the safety factor was an undeployed reserve within the United States for use in case the enemy employed atomic, chemical, or biological weapons effectively. REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 215 cies, that could be determined by the War Department. Evacuation policies governed the num- bers and types of patients to be trans- ferred from theaters to the zone of interior and were expressed in terms of days. For example, a theater which evacuated all patients requiring 120 or more days of hospitalization was said to have a “120- day policy.” Under such a policy a thea- ter would retain for treatment in its own hospitals all patients who, it was expected, could be returned to duty within 120 days and would evacuate the balance, not at the end of the 120-day period, but as soon as they were able to travel and convey- ances were available. Under a 120-day policy the average length of stay of patients in theater hospitals was shorter than under a 180-day policy and more patients were evacuated to the zone of interior. It was estimated, for example, that 30 percent of all battle-casualty patients were returned to the United States under the former, while only 20 percent were returned under the latter. Thus the evacuation policy affected the number of hospital beds required in theaters. It also affected the number needed in the United States to hospitalize evacuees, the amount of transportation required for patients, and the number of replacements needed by theaters. From a theater commander’s viewpoint, the ideal arrangement was to hospitalize in theaters those patients who could be returned to duty within a “rea- sonable” period of time, thus reducing the number of replacements needed, and to evacuate the rest as soon as possible, thus reducing the number of hospital units and the amount of equipment shipped into and used in the theater. The Surgeon General believed that a 120-day policy more nearly approached the ideal than did any other.3 Establishment of Official Evacuation Policies Although the Surgeon General’s Office and ASF headquarters had tried to get official evacuation policies established in the spring of 1943, final action was delayed until August. Being of vital concern to theaters, evacuation policies were nor- mally established by the War Department only after consultation with theater head- quarters, and several months were re- quired to get comments on a proposal of The Surgeon General in May 1943 that a 120-day policy be officially adopted.4 These replies revealed that all theaters except the European and Asiatic (China- Burma-India) agreed upon the desirability of that policy. Having enough beds to operate under a 180-day policy, both the European and Asiatic theaters preferred the latter. It permitted them to return to duty a greater proportion of experienced personnel. It also enabled them to save shipping required both to evacuate pa- tients to the United States and to return replacements to theaters. In addition, the European theater favored a 180-day pol- icy because it lacked hospital ships for evacuation and its chief surgeon opposed returning patients to the United States in transports. Although the South Pacific, Southwest Pacific, and North African the- aters preferred a 120-day policy, they re- quested permission to continue operations under a 90-day policy because of short- 3 (1) ASF Monthly Progress Rpt, Sec 7, Health, 31 Dec 44, pp. 29-34. HD. (2) Memo SPOPP 370.05, Dir Planning Div ASF for Dir Plans and Oprs ASF, 24 Jan 45, sub: Review of “Elements of an Evac Policy.” HRS; ASF Hq Planning Div File, 370.05 “Hosp and Evac.” 4 WD Memo W40-12-43, Evac Policy for Overseas Comds, 8 May 43. HD: Wilson files, 008 “Policy re Evac for Overseas.” See p. 165. 216 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR ages of beds. After analysis of these replies, the War Department announced on 28 August 1943 that it was establishing a 180- day policy for the European and Asiatic theaters and a 120-day policy for all others to become effective as soon as required hospital and transportation facilities were available.5 Establishment of Bed Ratios for Theaters of Operations A few days before theater evacuation policies were announced, official bed ratios had been authorized for theaters for the first time in World War II. Early in August 1943, when the Surgeon General’s Office and the General Staff were concerned about means of meeting the needs of the Army with the number of physicians authorized, The Inspector General re- ported that members of his staff, including General Snyder, had found in a survey of North African operations that battle- casualty rates had been lower than antici- pated and that hospitalization require- ments had been met during the first two campaigns with less than half the number of beds originally considered essential.6 In view of this report the Deputy Chief of Staff of the Army directed OPD to survey bed requirements of all theaters “in the light of experience to date.” Meanwhile, OPD was to limit the total number of beds shipped overseas, whether in fixed or mo- bile hospitals, to 8 percent of theater troop strengths.7 In the study that followed, both OPD and the Surgeon General’s Office agreed that fixed and mobile beds should be esti- mated and authorized separately because they served different purposes. Designed to support divisions in combat, mobile hospitals cared for patients requiring only short-duration treatment before return to duty and prepared others for evacuation to the rear. Thus sufficient numbers of fixed hospital beds were needed in the rear to take over patients whom mobile hospitals could not return to duty. Both offices agreed also that theaters should be supplied with “50-percent expansion equipment”—that is, with enough equip- ment to permit each fixed hospital to ex- pand its bed capacity for short periods of time by 50 percent, without any increase in its authorized personnel. This would provide a safety factor for emergencies. Both offices further agreed that combat operations up to that time furnished an insufficient basis for estimating future rates of battle-casualty admissions, but they differed as to how this should affect the establishment of fixed-bed ratios. A com- putation by the Surgeon General’s Office of beds needed in each theater for disease and nonbattle-injury cases, based on expe- rience between the last of 1941 and the early part of 1943, did not alter its opinion that the 10- to 15-percent ratio should still be adhered to. It therefore recommended that this ratio be officially authorized. Be- lieving that fewer beds would suffice, OPD used The Surgeon General’s rates for dis- ease and nonbattle injuries along with limited information available about World War II battle-casualty rates to develop 5 WD Memo W40-19-43, Policy on Evac of S&W from Overseas Comds, 28 Aug 43. HD: Wilson files, 008 “Policy re Evac from Overseas Comds.” Replies of theaters to the War Department memorandum of 8 May 43 are found in SG: 705.-1. 6 (1) Memo, IG for DepCofSA, 10 Aug 43, sub; Ests of Battle Casualties as Affecting Repls and Plans for Evac and Hosp. HRS: OPD, 700 “ETO.” (2) Memo, IG for DepCofSA, 10 Aug 43, sub: Surv of the Orgn and Opr of the MD Fac in NATOUSA and Sicily. Same file. 7 Memo WDCSA 333 (10 Aug 43), DepCofSA for ACofS OPD WDGS, 13 Aug 43, sub: Surv of the Orgn and Opr of the MD. HRS: OPD, 700 “ETO.” REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 217 other ratios of fixed beds that ranged from a low of 4 percent for one theater to a high of 10 percent for others. Abandoning its former position because of the limited number of physicians now available, the Surgeon General’s Office concurred in recommending these ratios. As a result, on 24 August 1943, the Deputy Chief of Staff approved the pro- posal to authorize fixed and mobile beds separately, agreed to supply all theaters with 50-percent expansion equipment, and authorized ratios of fixed beds as follows: 8 percent for the European and Asiatic (China-Burma-India) theaters, 10 percent for the South and Southwest Pacific the- aters, 6.6 percent for the North African theater, 6 percent for the Middle East- Central-African theater, and 4 percent for the American (the Western Hemisphere, exclusive of the United States) theater.8 A short time later a ratio of 7 percent was established for the Central Pacific,9 and the 8 percent ratio for the Asiatic theater, which at first applied only to American troop strength, was revised in February 1944 to provide 8 percent each for the American forces and the Chinese Army in India.10 In establishing such ratios the Deputy Chief of Staff announced that he was not thereby authorizing additions to the troop basis. It remained to be seen whether quotas of beds authorized for various theaters could be met with units already included in the troop basis. Mobile bed requirements were agreed upon in a conference which OPD held with representatives of G-3, G-4, ASF headquarters, the Ground Surgeon, and The Surgeon General, and were approved on 23 August 1943 by the Deputy Chief of Staff. For planning purposes, beds were authorized in evacuation hospitals for 3 percent, and in convalescent hospitals for 1 percent, of the troops in combat zones. Although there was misunderstanding about what this meant in terms of units, it was generally considered that one 400-bed evacuation hospital would be supplied for every division (except airborne divisions, which were not authorized evacuation hospitals) and for each group of army or corps troops equivalent in number to a division; that one 3,000-bed convalescent hospital would be supplied for each group of nine divisions; and that three portable surgical hospitals would be supplied, whenever theaters used them, for each division. If 750-bed evacuation hospitals were used, they were to be supplied in numbers sufficient to give a quantity of beds equal to that authorized in 400-bed hospitals. It was expected that portable surgical hospitals would be used only in the Pacific and Asiatic theaters and that convalescent hospitals would be used as mobile units chiefly in the European and North African theaters.11 In addition, spe- 8 (1) Memo, SG for ACofS OPD WDGS, 17 Aug 43, sub: Fixed Hosp, Overseas. SG: 701.-1. (2) Memo, Act ACofS OPD for DepCofSA, 20 Aug 43, sub: Surv of Orgn and Opr of the MD, with notation: “Ap- proved as amended,” by order of SecWar, by Gol W. A. Schulgren, Asst Sec WDGS, 24 Aug 43. HRS: OPD, 700 “ETO.” 9 This ratio was established before April 1944. See Memo, CG ASF for CofSA thru ACofS G-4 WDGS, 10 Apr 44, sub: Overseas Hosp. HRS: ASF Planning Div Program Br file, “Hosp, Apr 44.” 10 (1) Memo OPD 632 (19 Sep 43), ACofS OPD WDGS for DepCofSA, 24 Sep 43, sub: Hosp—Asiatic Theater. HRS: WDCSA 632. (2) DF OPD 632 (22 Oct 43), ACofS OPD WDGS to TAG, 1 Feb 44, sub: Hosp in the Asiatic Theater (Beds). HRS: G-4 file, “Hosp and Evac Policy.” 11 (1) Memo, [Col] R[obert] B. S[kinner] for Rec- ord, 26 Aug 43. Ground Med files; Chronological file (Col Skinner). (2) Memo, Act ACofS OPD WDGS for DepCofSA, 28 Aug 43, sub: Surv of the Orgn and Opr of the MD. HRS: OPD, 700 “ETO.” (3) Memo, Col A[rthur] B. Welsh for Record, 7 Sep 43. SG: 632.-2. 304244 0—55 16 218 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR cial provision had to be made for the hos- pitalization of Chinese troops in the Asiatic theater. For the Chinese Army in India (which had an authorized strength of 57,000) beds were authorized in evacu- ation hospitals on a 2-percent ratio; and for the Chinese Army in China, beds were authorized in portable surgical hospitals at the rate of one such unit for each of twenty-seven divisions.12 Ratios of mobile beds authorized at this time remained unchanged during the war; 13 but some theaters never received full quotas and therefore had to improvise mobile hospitals, while others found it de- sirable to use, in addition to authorized mobile hospital units, some fixed hospital units (field hospitals) as mobile hospitals.14 Efforts to Provide Theaters With Authorized Quotas of Beds After bed ratios and evacuation policies were established, adjustments had to be made in hospital facilities in each theater. Some, notably the South Pacific, Central Pacific, and European theaters, had less than their authorized quotas of mobile beds. Others, the Southwest Pacific, Asi- atic, and North African, had more.15 A few areas, for example Alaska and the Middle East, had more fixed beds than authorized, while others—the European, North African, Pacific and Asiatic the- aters—had fewer.16 Theaters that had too many mobile and too few fixed beds were permitted either to convert excess mobile hospital units into fixed hospital units, as was done in the Southwest Pacific area,17 or to use mobile units as fixed units, with- out conversion or reorganization, as was done in the Asiatic and North African theaters.18 When these changes did not erase defi- cits of fixed beds, other methods of increas- ing capacities were employed. The most obvious was to send additional hospital units to theaters. Between September and December 1943, 24 general hospital units, 10 field hospital units, and 39 station hos- pital units were shipped from the United States,19 but they were insufficient to sup- ply all theaters with authorized bed capacities. Another method was to enlarge hospi- tals already in theaters by increasing capacities authorized various units by tables of organization and equipment. This was economical of personnel. In the fall of 1943 a 750-bed station hospital, for example, required 40 officers (of whom 24 were Medical Corps officers), 75 nurses, and 392 enlisted men, while three 250-bed 12 (1) Memo OPD 632 (19 Sep 43), ACofS OPD WDGS for DepGofSA, 24 Sep 43, sub; Hosp—Asiatic Theater. HRS: WDGSA 632. (2) DF OPD 632 (22 Oct 43), ACofS OPD WDGS to TAG, 1 Feb 44, sub: Hosp in the Asiatic Theater (Beds). HRS: G-4 file, “Hosp and Evac Policy.” 13 Memo SPMDA 322.05, SG for SecWar, 10 Jan 45, sub: The Med Mission Reappraised. HRS; G-4 file, “Hosp and Evac, vol. II.” 14 These developments will be discussed fully in a volume planned for this series on hospitalization and evacuation in theaters of operations. 15 Table Showing Mobile Hosp Units in Theaters, Tab X to Memo, Act ACofS OPD WDGS for DepCofSA, 28 Aug 43, sub: Surv of Orgn and Opr of the MD. HRS: OPD, 700 “ETO.” 16 See Chart 11. 17 (1) Memo OPD 320.2 (5 Oct 43), ACofS OPD WDGS for CG ASF, 9 Oct 43, sub: Evac Policy for Overseas Comds (Hosp Units). SG: 320.2. (2) Ltr AG 322 (14 Oct 43) OB-I-SPMOU-M, TAG to Comdr- In-Chief SWPA, 18 Oct 43, sub: Reorgn and Redes- ignation of Certain Hosp Units, SWPA. SG: 320.3-1. 18 (1) DF OPD 632 (22 Oct 43), ACofS OPD WDGS to TAG, 1 Feb 44, sub: Hosp—Asiatic The- ater (Beds). HRS: G-4 file, “Hosp and Evac Policy.” (2) Rpt, Asst Comdt MFSS, Carlisle Bks to SG, 29 Nov 43, sub: Visit to ETO and NATO, 1 Sep-24 Oct 43. SG; 333.1. 19 An Rpt, MOOD SGO, FY 1944. HD. REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 219 station hospitals required 63 officers (of whom 39 were Medical Corps officers), 90 nurses, and 450 enlisted men.20 For this reason the Surgeon General’s Office had proposed as early as the summer of 1943 that from 66% to 80 percent of all fixed beds should be in general hospitals (1,000- bed capacity) and the remainder in smaller units.21 In the fall of 1943 the Cen- tral Pacific theater enlarged the table-of- organization capacities of some of its hos- pitals in order to provide additional fixed beds with a minimum of additional per- sonnel,22 and in December 1943 The Sur- geon General asked other theaters to do likewise.23 A third method of increasing numbers of fixed beds was to expand hospitals be- yond table-of-organization capacities— that is, to have a 1,000-bed general hospi- tal, for example, set up beds and tempo- rarily care for more than 1,000 patients without any increase in personnel. Antici- pated in the provision that theaters be authorized 50-percent expansion equip- ment, this method was used in many in- stances, particularly in the Southwest Pacific and North African theaters, in the fall and winter of 1943.24 If bed capacities were not increased sufficiently by these means, theaters were permitted temporary “reductions” in offi- cial evacuation policies to enable them to transfer more patients to the United States. The South Pacific theater, for ex- ample, operated under a 60-day evacu- ation policy until January 1944 and changed to a 90-day policy in February, while the North African theater followed a 90-day policy until May 1944.25 Although some theaters objected to using the expedients discussed above,26 all succeeded in meeting hospitalization needs during the winter of 1943-44. While none having a deficit of fixed beds in the fall of 1943 reached its authorized quota by the end of the year, only one—the North African theater—had more patients than it did table-of-organization beds.27 While efforts were being made to supply theaters with authorized quotas of fixed beds, the Surgeon General’s Plans Divi- sion was looking toward the future. As theaters built up troop strengths and planned combat operations, they called upon the War Department for specific types and numbers of units to meet antici- pated needs. The OPD and G-3 Divisions of the General Staff, attempting to meet theater requests if possible, periodically issued a “Six Months Forecast”—a docu- ment showing units needed and the time 20 See T/O 8-560, Sta Hosp, 22 Jul 42 with G 1, 5 Sep 42, and C 2, 18 Sep 42. 21 (1) Draft Rad, CG ASF to CGs NATO, SWPA, USAF CBI, SPA, and ETO, 21 Jun 43. HD: Wilson files, “Day File, Jun 43.” (2) Memo for Record on Draft Memo, Asst to CofS ASF for AGofS OPD WDGS, 23 Jun 43, sub: Proposed Rad for Certain Overseas Theaters Concerning Fixed Hosp Policy. Same file. It is not readily apparent how such a per- centage could be applied generally, unless the essen- tial difference between functions of general and sta- tion hospitals were to be ignored. 22 Ltr AG 322 (24 Sep 43)OB-I-SPMOU-M, TAG to CG USAFCPA, SG, and Chiefs of Tec Servs, 28 Sep 43, sub: Reorgn of Sta and Gen Hosps in CPA. SG: 320.3-1. 23 (1) Diary, MOOB SGO, 4-10 Dec 43. HD: 024.7-5, “MOOB Diary.” (2) Rad CM-OUT-8738 (23 Dec 43), CG ASF to theater commanders. SG: 322.15-1. 24 (1) Notes atchd to Memo, Col William L. Wil- son, MC for Chief Control Div [SGO], 1 Nov 43, sub: Visit to SWPA. SG: 333.1-1 (Aust)F. (2) Rad CM- IN-9494 (15 Jan 44), Algiers to AGWAR, 14 Jan 44. SG; 322.15-1. 25 (1) Rad CM-IN-18720 (25 May 44), CG NATO to WD, 24 May 44. HRS: G-4 file, “Hosp and Evac Policy.” (2) Rad CM-OUT-42858 (28 May 44), WD to CG NATO, 27 May 44. Same file. 26 Theater objections will be discussed in a volume planned for this series on hospitalization and evacua- tion in theaters of operations. 27 See Chart 11. Chart 11—Fixed Hospital Bed Capacity, and Occupancy in Overseas Theaters: March 1943-December 1945 EUROPEAN THEATER THOUSAND MEDITERRANEAN THEATER CHINA-BURMA-INDIA THEATER Chart 11—Fixed Hospital Bed Capacity, and Occupancy in Overseas Theaters: March 1943-December 1945—Continued SOUTH PACIFIC THEATER THOUSAND In August 1944 this theater was absorbed into Pacific Ocean Area Theater CENTRAL PACIFIC & PACIFIC OCEAN AREA THEATERS PACIFIC OCEAN AREA CENTRAL PACIFIC After June, data combined with Southwest Pacific SOUTHWEST PACIFIC THEATER T/O BEDS TOTAL T/O BEDS, LESS 20% DISPER-.- _ SION AUTHORIZED BEDS* OCCUPIED BEDS ♦Based on War Department determined percentage of troop strength. Source: Hospitalization Overseas—Authorized Fixed Beds. HD: 024, Mob. and Overseas Oper. Div., Oper. Serv., SGO. 222 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR of their shipment.28 Flospital units listed in the “Forecast” did not always exist in this country, and it was sometimes necessary to make adjustments among units already activated. The Surgeon General’s Plans Division proposed such action. For exam- ple, in November 1943 the Mobilization and Overseas Operations Branch made a study of units required by the eighth revi- sion of the “Forecast” and found that more station hospital units of 750-, 250-, 200-, 150-, 100-, and 25-bed capacities had been activated than were needed but that fewer general and field hospital units had been activated than were required. The Surgeon General’s Office then recom- mended the inactivation and reorganiza- tion of certain station hospital units in order to supply personnel for the required number of general and field hospitals.29 ASF headquarters approved this recom- mendation and orders were issued to make it effective. At successive times later, as for example in September 1944, the Surgeon General’s Office suggested similar action to insure the availability of units in the types and sizes desired by theaters.30 In addition to recommending adjust- ments among types of hospital units being prepared for overseas service, the Surgeon General’s Office took other actions in the fall of 1943 to meet future needs. After the Deputy Chief of Staff authorized 50- percent expansion equipment for fixed hospitals in theaters, the Mobilization and Overseas Operations Branch co-operated with the Supply Service of the Surgeon General’s Office in securing authority to procure the equipment thus authorized.31 In addition, the troop basis of 1944 was re- viewed and G-3 agreed to increase the number of fixed hospital units included in it to provide 20,000 additional beds. Even so, the troop basis did not list enough units to supply all theaters with quotas author- ized by the Deputy Chief of Staff in August 1943.32 Finally, and not of least impor- tance, under a system of telegraphic re- porting initiated in July 1943, the Surgeon General’s Office began to receive from theaters fuller, more accurate, and more current data on which to base studies of admission rates.33 Problems encountered in the fall and winter of 1943 in providing theaters with authorized quotas of fixed beds were merely a preview of 1944. The increasing scope and intensity of combat operations created more pressing needs for hospitali- zation and at the same time, by using up more personnel in the form of replace- ments, accentuated the shortage of men for assignment to hospital units. From the early part of 1944 this shortage was so great that it became one of the controlling factors in planning overseas hospitaliza- tion. Early in February 1944 the Surgeon General’s Office warned ASF headquar- 28 An example of this document, Twentieth Revi- sion of the Six Months Forecast, Units and Availabil- ity, Data as of 20 Oct 44, Based on OPD Reqmts 5 Oct 44, G-3 Div WDGS is on file HD: 370.5. 29 (1) An Rpt, MOOD SGO, FY 1944. HD. (2) Diary, MOOB, 27 Nov-3 Dec 43. HD: 024.7-5, “MOOB Diary.” (3) Ltr, SG to GG ASF, 5 Nov 43, sub: Activations, Reorgns and Inactivations of Non- Div Med Units. SG: 322.3-1. 30 Ltr, SG to CG ASF, 8 Sep 44, sub: Reorgn of Med Units. SG: 320.3-1. 31 (1) Memo, SG for ACofS OPD WDGS, thru CG ASF, 9 Dec 43, sub: Recommended Changes in Vic- tory Program Trp Basis, Revision of 22 Nov 43, with ind. SG: 322.15-1. (2) Memo, Act Chief Sup Serv SGO for SG, 28 Dec 43, sub; Fixed Beds Overseas in Army Sup Program. SG; 632.-2. (3) Memo, Dep Chief Oprs Serv SGO for SG, 30 Dec 43. SG: 632.-2. 32 Memo for Record on DF, ACofS G-3 WDGS to ACofS OPD WDGS, 26 Jan 44. HR J: G-3 file, 700- 800. 33 Memo WDGDS 6442, Act ACofS G-4 WDGS for CG ASF, 7 Sep 43, sub: Hosp in Overseas Thea- ters, with 1st ind, SG to ACofS G-4 WDGS, 17 Sep 43. SG: 701.-1. REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 223 ters that it would be impossible to meet theater requirements unless enlisted men were supplied in sufficient numbers to activate and train the units authorized.34 Soon afterward ASF headquarters in- formed G-3 that the Service Forces had 72,813 fewer men than were needed to activate units according to schedule and that 27,160 men were needed for Medical Department units alone.35 Urgent requests from ASF headquarters for more men were of little avail, and during the first four months of 1944 only 12 general, 1 sta- tion, and 11 field hospital units were acti- vated. In May the Medical Department received its first substantial allotment of personnel for numbered hospitals during 1944 and activated that month 11 general and 3 field hospital units. Then, during subsequent months, as a result of the pol- icy of releasing from zone of interior instal- lations men who were qualified for over- seas service, additional men became avail- able, and during the five months begin- ning with June and ending with October 98 general, 8 station, and 43 field hospital units were activated.36 Thus few hospital units were activated during 1944 until the latter half of the year. The Medical Department also had diffi- culty in procuring enough Medical Corps officers to man the units activated. As early as February 1944 the director of the Surgeon General’s Military Personnel Division stated that there would not be enough Medical Corps specialists to staff hospitals being sent overseas and that some units would have to be shipped without specialists.37 A month later the Surgeon General’s Office reported to ASF head- quarters that physicians to staff forty gen- eral hospital units then in training could not be procured until June and that full officer strength for nine of the general hos- pitals activated in March would not be available until August.38 Use of Negro Hospital Units The use of Negro personnel-doctors, nurses, and enlisted men—to help relieve the general personnel shortage and meet theater needs for hospital units was com- plicated by existing policies and practices and by the attitude of theater command- ers and surgeons.39 Following a practice adopted early in the war—the organiza- tion of all-Negro units to provide oppor- tunities for the use of Negro doctors and nurses—the War Department activated a third Negro hospital unit—the 335th Sta- tion Hospital—in August 1943. Mean- while the 268th Station Hospital unit, which had been activated five months earlier, completed its training and in October 1943 embarked for the Southwest Pacific.40 34 (1) Ltr, SG to CG ASF, 15 Feb 44, sub: Projec- tion ofNon-Div Med Units. SG: 322.3-1. (2) An Rpt, MOOD SGO, FY 1944. HD. 35 (1) Memo, CG ASF for ACofS G-3 WDGS thru ACofS OPD WDGS, 18 Mar 44, sub; Projection of Non-Div Med Units, with incls. HRS: Hq ASF, Lt Gen LeR. Lutes’ file, “Hosp and Evac, Jun 43 thru Dec 46.” (2) Memo, CG ASF for ACofS G-3 WDGS, 26 Mar 44, sub: Med Units. Same file. 36 An Rpt, MOOD SGO, FY 1944. HD. 37 Memo, Dir Mil Pers SGO for Chief Oprs Serv SGO, 12 Feb 44, sub: Staffing of Gen Hosp Destined for Shipment to ETO. SG: 320.3-1. 38 Memo, Dir Mob Div ASF for Dir Plans and Oprs ASF, 25 Mar 44, sub: Status of Med Units. HRS: Hq ASF, Lt Gen LeR. Lutes’ file, “Hosp and Evac, Jun 43 thru Dec 46.” 39 These questions will be discussed fully in John H. McMinn and Max Levin, Personnel (MS for com- panion vol. in Medical Dept, series), HD. Also see Ulysses Lee, The Employment of Negro Troops, forthcoming volume in UNITED STATES ARMY IN WORLD WAR II. 40 (1) An Rpt, 335th Sta Hosp, 1944. HD. (2) Quarterly Rpt, 268th Sta Hosp, Jul 44. HD. 224 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR With the need to use Negro personnel increasing as difficulties in meeting theater requirements mounted, the War Depart- ment in January 1944 requested all the- aters to state whether or not they would use all-Negro hospital units. Most replied negatively. Fearing loss of the services of the 335th Station Hospital unit, The Sur- geon General in May 1944 appealed to ASF headquarters for “efforts [to] be made to obtain an appropriate assign- ment” for it.41 The same month he ap- pealed personally to the chief surgeon of the European theater to use Negro nurses in at least one hospital.42 The chief sur- geon agreed, and in July 1944 sixty-three Negro nurses, among whom were some who had formerly served with the 25th Station Hospital in Africa and had been returned to the United States at the end of 1943, arrived in the European theater. After a period of training they were assigned in September to replace white nurses in the 168th Station Hospital.43 Meanwhile an assignment for the 335th Station Hospital had been found. In June 1944 the chief surgeon of the China- Burma-India theater made a trip to Wash- ington to explain in person his desperate need for additional hospital units. Among the means of meeting the need, in view of the general shortage of units for shipment overseas, the low priority of the China- Burma-India theater, and the demands of other theaters, the use of the 335th Sta- tion Hospital was proposed. The theater surgeon agreed to accept this unit with an overstrength of sufficient size to permit the organization of an additional hospital in the theater.44 As a result the 335th Station Hospital embarked in August 1944 and was stationed on the Stillwell Road after its arrival in Asia. According to plan, it was reorganized in December 1944 and its capacity was reduced from 150 to 100 beds. The personnel thus made surplus, along with that carried as overstrength, was used to form another 100-bed all- Negro hospital unit—the 383d Station Hospital. Both units continued to serve together as one hospital until the 383d was sent to the Philippines in August 1945.45 Thus, although Negroes served in the Medical Department overseas in organic medical units of divisions and in such other units as sanitary companies, the use of Negro professional personnel in hospital units was limited to the 25th Station Hos- pital (a Negro unit with four white officers in command and supervisory positions), the 268th, 335th, and 383d Station Hospi- tals (all-Negro units), and the 168th Sta- tion Hospital (a white unit with Negro nurses). Estimating Requirements for Major Combat Operations Before the full impact of personnel shortages was felt, the Surgeon General’s Office began early in 1944 to estimate hos- pitalization and evacuation requirements for full-scale combat operations. In No- vember and December 1943 the Com- 41 Memo, SG for Dir Planning Div ASF, 17 May 44, sub: Overseas Employment of 335th Sta Hosp (Colored). AG: 370.05 (335th Sta Hosp) 1944-1. 42 Ltr, SG to Chief Surg, ETOUSA, 16 May 44. HD: ETO file, “Kirk-Hawley Corresp.” 43 An Rpt, 168th Sta Hosp, 1944. HD. 44 (1) Memo for Record, 30 Jun 44, sub: Hosp in CBI, by Chief Theater Br MOOD SGO. HD: 024 “MOOD (CBI).” (2) Ltr, Col Robert P. Williams, Theater Surg USAF in CBI to Col George E. Arm- strong, Dep Theater Surg USAF in CBI, 30 Jun 44. Same file. (3) Interv, MD Historian with Brig Gen Robert P. Williams, 13 and 15 Feb 50. HD: 000.71. 45 (1) An Rpt, 335th Sta Hosp, 1944. HD. (2) Final Rpt, 383d Sta Hosp, Jul 45. HD. (3) AG Unit Card, 383d Sta Hosp. Orgn and Directory Sec, Oprs Br, Admin Servs Div, AGO. REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 225 bined Chiefs of Staff met with President Roosevelt and Prime Minister Churchill at the Sextant conference in Cairo and then with the President, the Prime Minis- ter, and Marshal Stalin at Teheran.46 The decision of these conferences to mount both Overlord (the invasion of Europe from England) and Anvil (the invasion of Southern France from bases in the Medi- terranean) during May 1944 focused at- tention on the European and North Afri- can theaters,47 and twice during the win- ter of 1943-44 the Surgeon General’s Office made studies of their need for hos- pital beds. On the basis of the first, made by the Mobilization and Overseas Oper- ations Branch,48 The Surgeon General recommended to ASF headquarters that North Africa be supplied with additional hospital units and with additional per- sonnel for existing units to raise its bed capacity to its authorized quota, and to G-4 that the current bed ratios of both the European and North African theaters be raised.49 Both recommendations were dis- approved. OPD was handling requests from North Africa for additional person- nel and hospital units. Because of the shortage of personnel in the United States, it proposed that the North African theater increase is fixed-bed capacity by using personnel already in the theater to expand existing hospitals.50 G-4 disapproved rais- ing current bed ratios because it believed hospital units supplied under them would provide sufficient beds for the early phases of operations on the European continent. If additional beds should then be needed, they could be sent later. Meanwhile, both theaters could use expansion equipment to increase capacities of existing hospitals for emergencies, and the European thea- ter, if it should have a shortage of beds, could reduce its evacuation policy from 180 to 120 days and thus send a larger proportion of patients to the United States.51 The Surgeon General “strongly urged” that the decision not to send additional personnel and units to North Africa be re- considered. He concurred in the decision not to raise bed ratios, but recommended that it be considered temporary, pending accumulation of more definite informa- tion about needs. Furthermore, he warned that evacuation facilities (ships and planes) would have to be adequate to re- move patients from theaters if they were not given additional beds.52 Meanwhile, his office had begun another study of the needs of overseas theaters. The second study, made by the Facil- ities Utilization Branch of the Hospital Administration Division in connection with its attempt to estimate the number of beds that would be needed in the United States, covered estimated requirements of 16 Biennial Report . . . Chief of Staff, 1943-45, p. 27. 47 Memo SPOPP 337, Dir Plans and Oprs ASF for Dir Sup and Mat ASF; Chiefs of TC et al., 15 Dec 43, sub: Sextant Decisions. HRS: Hq ASF Planning Div Program Br file, “Gen, vol. 2, 17 Jul 44.” The inva- sions actually occurred later than planned. « (1) Diary, MOOB SCO, 11-17 Dec 43. HD; 024.7-5, “MOOB Diary.” (2) DF WOODS 9381, ACofS G-4 WDGS to ACofS OPD WDGS and GG ASF, 11 Jan 44, sub: Fixed Bed Hosps, NATO and ETO. HRS: G-4 file, “Hosp and Evac Policy.” 49 Memo, SG for Dir Planning Div ASF, 17 Jan 44, sub: Serv Units for NA Forces. HRS; Hq ASF Plan- ning Div Program Br file, “Hosp and Evac, vol. 3.” 50 Rad CM-OUT-8230 (21 Jan 44), ACofS OPD WDGS to CG NATO, 20 Jan 44. SG: 322.15-1. 51 DF WDGDS 9381, ACofS G-4 WDGS to ACofS OPD WDGS and CG ASF, 11 Jan 44, sub: Fixed Bed Hosps, NATO and ETO. HRS: G-4 file, “Hosp and Evac Policy.” 52 (1) Memo, SG for CG ASF, 17 Feb 44, sub: Serv Units for NA forces. HRS: Hq ASF Planning Div Pro- gram Br file, “Hosp and Evac, vol. 3.” (2) T/S, SG to ACofS G-4 WDGS thru GG ASF Planning Div, 9 Feb 44, sub; Fixed Bed Hosps, NATO and ETO. SG: 632.2. 226 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR all theaters as well as of the United States for hospitalization and evacuation facil- ities. Among the general conclusions drawn from this study were the following: under existing plans there would be a shortage of beds in both the European and North African theaters after the mounting of Overlord and Anvil; the number of patients that would be brought back to the United States each month would rise to 40,000, of whom 60 to 70 percent would be in the “helpless” category; there would be a shortage of space on transports and hospital ships for evacuation from the European and North African theaters; using only the evacuation facilities planned, not more than 20 percent of all patients would be returned on hospital ships; and air evacuation offered little promise of supplementing ships in view of past accomplishments.53 Ultimately action was taken upon each of these problems, but only those pertaining to theater hospi- talization will be discussed at this point. Decisions concerning overseas hospital- ization were made at a conference on 28 March 1944. At that time General Somer- vell directed (1) that the number of beds supplied to Europe and North Africa under existing ratios should be increased, (2) that the General Staff should be re- quested to raise the authorized ratio for North Africa from 6.6 to 8.5 percent, and (3) that bed requirements for all theaters should be reviewed.54 Plans to supply ad- ditional beds to Europe and North Africa were colored by the shortage of personnel and of trained hospital units in the United States. To furnish the European theater with a total of ninety-one general hospitals by the end of July, some had to be shipped before completion of training.55 The shortage of fixed beds in North Africa was alleviated, as OPD had suggested earlier, by expanding table-of-organization ca- pacities of existing hospitals with person- nel available in the theater. With War Department approval, that theater inac- tivated six 250-bed station hospitals and with personnel formerly assigned to them expanded twelve 1,000-bed general hospi- tals to 1,500-bed capacities and five to 2,000-bed capacities. This increased the fixed-bed capacity by 9,500 beds and brought the ratio of available beds to troops up to 6.4 percent.56 The question of raising the ratio for North Africa became involved in a gen- eral review of bed requirements for all theaters because the General Staff refused to consider the former before completion of the latter.57 Prepared by the ASF Plan- ning Division and the Strategic Logistics Planning Unit of the Surgeon General’s 53 (1) Hosp and Evac: A Re-estimate of the Pnt Load and Facilities, Feb 44. HD: 705.-1. (2) Memo, SG for CG ASF, 22 Feb 44, sub; Hosp and Evac. HRS; Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” 54 (1) Memo, CG ASF for Dir Planning Div ASF, 28 Mar 44, sub: Hosp. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” (2) Memo, CG ASF for Dir Plans and Oprs ASF, 28 Mar 44, sub: Conf on Hosp and Evac. Same file. 55 Memo, Chief Program Br Planning Div ASF for Col Bogart, ASF, 4 Apr 44, sub: ETO Hosp. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” 56 (1) Rad CM-IN-16542 (23 Mar 44), CG USAF NATO to WD, 23 Mar 44, sub; Expansion of Hosp. SG: 322.15-1. (2) Rad CM-OUT-20160 (7 Apr 44), War (OPD) to CG USAF NATO, 7 Apr 44. Same file. (3) Memo SPOPI 632, Dir Plans and Oprs ASF for ACofS G-3 WDGS, 29 Mar 44, sub; Expansion of Gen Hosps in NATO. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” 57 (1) Memo, CG ASF for CofSA, 30 Mar 44, sub; Deficiency of Fixed Hosp Units in NATO. HRS; Hq ASF Planning Div Program Br file, “Hosp and Evac, Apr 44.” (2) Memo WDGSA/37 1 NATO (3 1 Mar 44), CofSA for CG ASF thru ACofS OPD WDGS, 4 Apr 44, sub: Deficiency of Fixed Hosp Units in NATO. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 227 Office, the general review was presented to the General Staff on 10 April 1944.58 It was based upon recommendations of theaters, the average occupancy of beds in theaters during the previous six months, and the number of hospital units included in the troop basis. It represented an at- tempt to balance bed requirements against the number of hospital units already au- thorized. Most of its proposals were accepted by G-4: that the bed ratio of the Southwest Pacific should be reduced from 10 to 8 percent, and of the Central Pacific from 7 to 5 percent, and that ratios for the Euro- pean, Middle East, and American thea- ters should remain unchanged. G-4 rejected the proposal to raise the North African bed ratio above 6.6 percent, stat- ing that the theater had gotten along satisfactorily on it and that the invasion of Southern France was uncertain. North Africa’s later request (in May 1944) to change its evacuation policy from 90 to 120 days indicates that this decision was justified. G-4 also believed that the South Pacific ratio should be reduced from 10 to 6 percent (since the theater itself had recommended only 5 percent) instead of to 7 percent as ASF headquarters and the Surgeon General’s Office proposed. While the two latter authorities recommended that the China-Burma-India ratio be re- duced from 8 to 7 percent, G-4 thought that beds for the Chinese Army in India should remain at 8 percent and that the ratio for American troops only should be reduced to 7 percent. The Deputy Chief of Staff approved G-4’s findings. This meant that 351,528 of the 370,500 beds in units in the troop basis would be distributed among theaters, but that the remainder (18,972 beds) would be held in the United States as an undeployed reserve to meet unforeseen contingencies.59 Movement To Reduce Authorized Bed Ratios Continuing Difficulty in Providing Authorized Quotas of Beds Although beds authorized for theaters in the spring of 1944 did not exceed the number in hospital units in the troop basis, personnel shortages made it difficult to supply theaters with authorized quotas. A method formerly used—expansion of the table-of-organization capacities of the hospitals already in theaters—was applied again, particularly in the Southwest Pa- cific, where the closure of small hospitals released enough officers to expand capac- ities of larger hospitals by 7,250 beds and to permit the assignment elsewhere of 259 Medical Corps officers.60 Occasionally, reductions in bed ratios and in troop 58 (1) Memo, Dep Dir Plans and Oprs ASF for CG ASF, 4 Apr 44, sub: Overseas Hosp. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” (2) Memo, Dir Strategic Logistics Planning Unit SGO for Chief Oprs Serv SGO, 6 Jun 44, sub: Rpt of Accomplishments of SGO. HD: 319.1-2 (MOOD Oprs Serv SGO). 59 (1) Memo, CG ASF for CofSA thru ACofS G-4 WDGS, 10 Apr 44, sub; Overseas Hosp, with Tabs A-F. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, Apr 44.” (2) Memo WDGS 13077, ACofS G-4 WDGS for CG ASF, 27 Apr 44, sub: Overseas Hosp. HRS: Hq ASF Planning Div Pro- gram Br file, “Staybacks, 14 Apr-8 Aug 44.” (3) Memo, Dep Dir Plans and Oprs ASF for SG, 29 Apr 44, sub: Overseas Hosp. Same file. (4) Rad CM- OUT-42858 (28 Mar 44), Marshall to CG USAF NATO, 27 May 44. HRS: G-4 file, “Hosp and Evac Policy.” 60 (1) Memo for Record, by Lt Col Lamar C. Bevil, SGO, 4 Jul 44, sub: Conf with Surg SOS SWPA. SG; MOOD “Pacific.” (2) Memo, Dep Chief Oprs Serv SGO for SG, 5 Sep 44, sub; Anal of CM-IN-2287 (3 Sep 44) for SWPA. Same file. (3) An Rpt, MOOD SGO, FY 1945. HD. 228 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR strengths of one theater released hospital units for transfer elsewhere. In the sum- mer of 1944, for example, units no longer needed in the South Pacific area were transferred to the China-Burma-India, Central Pacific, and Southwest Pacific theaters.61 Moreover, changes in the zone of interior hospital system were expected not only to use personnel more efficiently at home but also to release some physi- cians for assignment to units earmarked for theaters. In addition, ratios of doctors, nurses, and enlisted men to beds were de- creased in numbered hospital units as well as in zone of interior hospitals.62 Further- more, hospitals were “short-shipped” to the European theater—that is, before completion of training and without bal- anced or full staffs of physicians. In such cases, the theater was expected to com- plete the training of units and to supply missing specialists and other Medical Corps officers. Such personnel was be- lieved to be available from several sources: from affiliated hospital units overstaffed with specialists and already in the theater, from hospital units in the theater that were being reorganized under revised tables of organization; and from infantry regiments where Medical Administrative Corps officers were replacing Medical Corps officers as battalion surgeons’ as- sistants.63 Finally, it was recognized that authorized bed quotas of theaters in some instances could not be met even by ex- pedients just discussed, and that a theater would then have “to take care of its own requirements.” 64 Review of Requirements of European Theater As difficulties were encountered in the summer and early fall of 1944 in meeting authorized fixed-bed quotas, The Surgeon General’s Mobilization and Overseas Op- erations Division began to review the needs of theaters to see if estimates had been too high and if authorized bed ratios might therefore be lowered. As early as July 1944 there were “preliminary indica- tions” that ratios authorized for both the European and the Southwest Pacific thea- ters could be lowered,65 but a directive of the Deputy Chief of Staff that require- ments of the European theater be re- viewed 30 days after the initial landing in France (or the mounting of Overlord) 61 (1) Rad WARX 62981, Marshall to Comdr-in- Chief SWPA; CG USAF CPA; CG USAF SPA; CG USAF CBI, lOJul 44, sub: Movement of Ptbl Surg Hosp in Pacific. (2) Rad WARX 72125, Marshall to CG USAF CBI, 26 Jul 44, sub: Departure of 18th and 142d Gen Hosps from SPA. (3) Rad CM-IN- 25976, CG USAF SPA to WD and CG USAF CPA, 3 1 Jul 44. All in SG: 322 “Hosp Misc 1944.” 62 See below, pp. 181-99, 248-50. 63 (1) Mins, Mtg of Staff Conf ASF, 13 Jul 44, incl 4 to Memo SPOPP 320.2, Act Dir Plans and Oprs ASF for Act CofS ASF, 21 Jul 44, sub: Status of Hosp units. HRS: Hq ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” (2) Rad CM-OUT-34789 (10 May 44), Marshall (OPD) to Eisenhower, 10 May 44. SG: 320.3. (3) Rad CM-IN-11147 (15 May 44), CG USE ETO to WD, 15 May 44. Same file. (4) Memo, Dep SG for CG ASF, 27 Jul 44. HD: MOOD “ETO.” (5) Rad CM-OUT-77546 (8 Aug 44), Mar- shall to Eisenhower, 8 Aug 44. Same file. (6) Rad CM-IN-2778 (30 Aug 44), Eisenhower to WD, 29 Aug 44. Same file. (7) Memo, SG for AGofS OPD WDGS thru CG ASF, 31 Aug 44, sub: Hosp in ETO. Same file. (8) Memo, SG for CG ASF, 5 Oct 44. SG: 322 “Hosp Misc 1944.” 64 (1) Memo with Memo for Record, Dir Plans and Oprs ASF for Joint Logistics Plans Cmtee, 6 May 44, sub; Med Reqmts—Twentieth AF. HRS: Hq ASF Planning Div file, “Hosp and Evac.” (2) Memo, Lt Col Lamar C. Bevil for Col Arthur B. Welsh, 18 Aug 44, sub: Est of Med Situation in CBI. HD; MOOD “CBI.” (3) Draft rad, AGofS OPD WDGS to CG USAF NATO, 12 Jul 44, with Memo for Record. HRS: OPD, 632 “Security Sec I.” 65 Memo, Act Dir Plans and Oprs ASF for Act CofS ASF, 25 Jul 44, sub; Hosp Reqmts, ETO. HRS: Hq ASF Planning Div Program Br file, “Staybacks, 15 Apr 44-8 Aug 44.” REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 229 focused attention upon that theater.66 During July 1944 the Surgeon General’s Office analyzed reports of hospital admis- sions for the first 32 days of operations in France and computed actual hospital ad- mission rates for that period. This analysis showed that the average battle-casualty rate had been lower than anticipated—51 per 1,000 per month instead of 60—al- though during one week it had been as high as 89 per 1,000. Other studies showed that the average length of time that pa- tients stayed in hospitals in the North African theater between the fall of 1942 and the middle of 1944 was 23.7 days. This was shorter than the average in Eu- rope during World War I—27.29 days. If admission rates in the future should ap- proximate those of the 32-day period of operations in France and if the average number of days patients stayed in hospi- tals should be as low as in the North Afri- can theater, the European theater would need fewer beds than at first anticipated. The Surgeon General’s Office computed the number that would be required under a variety of combinations of admission rates, lengths of stay, and evacuation poli- cies, and then calculated bed ratios that might be required under different sets of circumstances. It appeared that, under a 180-day evacuation policy, the highest ratio that would be needed under the most unfavorable circumstances was 12.05 per- cent and the lowest, under more favorable circumstances, was 5.46. Under a 120-day policy, the highest would be 8.06 and the lowest, 3.90 percent. It was thought that such ratios would provide sufficient beds not only for all patients hospitalized by the Army, including civilians and prison- ers of war, but also for their dispersion in wards. The Surgeon General therefore considered it safe to reduce the bed ratio of the European theater from 8 to 7 per- cent if at the same time the evacuation policy should be reduced from 180 to 120 days.67 ASF headquarters arrived at the same conclusion after taking into consideration certain additional facts. General and con- valescent hospitals in the United States had about half of their beds empty during the first half of 1944.68 At the same time, the European theater was not sending to the United States as many patients as it could on returning troop transports.69 Presumably a reduction in the evacuation policy would require the theater to return a great number of patients to the zone of interior and would therefore result in fuller use of available evacuation space on transports and of hospital beds in the United States. It would also make possible a reduction in the bed ratio of the Euro- pean theater and, consequently, in the number of hospital units that would have to be sent there. In view of these consider- ations, ASF headquarters recommended on 11 August 1944 that the authorized bed ratio for the European theater be re- duced from 8 to 7 percent and that its evacuation policy be lowered from 180 to 120 days.70 The Deputy Chief of Staff ap- 66 Memo with Memo for Record SPOPP 337, Plans and Oprs ASF for ACofS OPD WDGS, 1 Jul 44, sub; Fixed Hosp Data, with incls. HRS: Hq ASF Planning Div, “Hosp and Evac.” 67 (1) Ltr, SG to CG ASF, 1 Aug 44, sub: Overseas Hosp, with 2 incls. HRS; Hq ASF Planning Div Pro- gram Br file, “Hosp and Evac.” (2) An Rpt, MOOD SGO, FY 1945. HD. 68 See above, pp. 202-07. 69 Memo, SG for ACofS OPD WDGS thru GG ASF, 31 Aug 44, sub: Hosp in ETO. HD: 705 (MRO Fitzpatrick Staybacks, 1 May 44-29 Oct 44). 70 3d ind SPOPP 370.05 (8 Aug 44), Plans and Oprs ASF to ACofS G-4 WDGS, 1 1 Aug 44, with Memo for Record, on Ltr, SG to GG ASF, 1 Aug 44, sub; Overseas Hosp. HRS: Hq ASF Planning Div, “Hosp and Evac.” 230 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR proved this recommendation and the War Department informed the theater of the changes on 5 October 1944.71 Shift of Attention to the Pacific The review of fixed-bed requirements of the European theater had hardly been completed when the Chief of Staff of the Army Service Forces, returning from a visit to the Pacific, turned attention in that direction.72 He reported that increased operations against islands nearer the Jap- anese homeland and the necessity of car- ing for civilians on such islands might re- quire more hospitals than those already planned for the Pacific. ASF headquarters then directed The Surgeon General on 8 September 1944 to re-examine plans for hospitalization and evacuation in that area.73 In complying with this directive The Surgeon General’s Mobilization and Overseas Operations Division computed bed ratios by a different method from that used for the European theater. From sta- tistical reports it determined the actual ratio of occupied beds to troop strength during 1943 and 1944 and to this ratio it added estimated ratios of beds to troop strength to provide for casualties from in- creased combat operations, for dispersion within hospitals, for dispersion of hospitals within theaters (that is, to permit some beds to be vacant or unused either because hospitals were situated in places with little or no combat or because they were being moved from one place to another), for sol- diers of Allied armies, for prisoners of war, and for patients evacuated from mobile hospitals to permit such units to move. For example, in the Southwest Pacific area the ratio of occupied beds had been 3.75 per- cent; to this ratio were added the follow- ing: 1.00 percent for increased operation- al requirements, .90 percent for hospital dispersion, .45 percent for theater disper- sion, .45 percent for Allied soldiers and prisoners of war, and .45 percent for pa- tients from mobile hospitals.74 The sum of these ratios was 7.00 percent and was con- sidered the ratio of fixed beds to troop strength that would be required for the Southwest Pacific area. Ratios for other areas of the Pacific were also computed according to this method and on 14 Sep- tember 1944 The Surgeon General recom- mended a reduction in the ratio for the Southwest Pacific from 8 to 7 percent and an increase in that for the Pacific Ocean areas (a theater formed in August 1944 by the combination of the Central and South Pacific areas) from 6 percent in the South Pacific and 5 percent in the Central Pa- cific to 7 percent for the entire area. At the same time he recommended that the 120- day evacuation policy should remain in effect and that the Army Medical Depart- ment should continue free of responsibility for the care of civilians in occupied islands.75 71 Memo AG 704 (30 Sep 44) OB-S-SPOPP, TAG for CG ETO, 5 Oct 44, sub: Hosp and Evac Policy for the ETO. HD; MOOD “ETO.” 72 Memo, CofS ASF for SG, 27 Aug 44. HRS: Hq ASF Planning Div, “Hosp and Evac.” 73 Memo SPOPP 632.2, CG ASF for SG, 8 Sep 44, sub: Hosp and Evac, POA and SWPA. HRS: Hq ASF Planning Div, “Hosp and Evac.” 74 The reason for adding in the ratio of beds to troop strength to provide beds for patients evacuated from mobile hospital units to permit them to move is not clear. Actually, one of the chief functions of fixed hospitals was to receive patients evacuated from mo- bile hospitals to insure mobility. This had been pointed out by the Surgeon General’s Office in Au- gust 1943, and as a result the General Staff had agreed that fixed- and mobile-bed requirements would be computed separately. 75 1st ind, SG to Dir Plans and Oprs ASF, 14 Sep 44, on Memo SPOPP 632.2, Dir Plans and Oprs ASF for SG, 8 Sep 44, sub; Hosp and Evac, POA and SWPA. HRS; Hq ASF Planning Div, “Hosp and Evac.” REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 231 ASF headquarters approved these rec- ommendations, with minor modifications, but the General Staff took no final action upon them because a new study of hospi- tal bed requirements for all theaters soon superseded the study of requirements for the Pacific.76 The Manpower Board Estimates Requirements The drive of the War Department Man- power Board to save personnel by reduc- ing the number of hospitals in theArmy— a drive which threatened the closure of some hospitals in the United States in the fall of 1944—extended to overseas areas also.'' The method which the Board used to compute theater bed requirements differed from The Surgeon General’s. The Board proposed that the average nonef- fective rate (that is, the number of persons per 1,000 per day unfit for duty because of sickness or other disability) be converted into a ratio for authorizing fixed beds. Thus the number of authorized fixed beds would equal but not exceed the number of noneffectives. The Board contended that this method would provide sufficient hos- pitalization for all theaters, since beds were not actually needed for all noneffec- tives (some being treated in quarters) and since all hospitals could expand author- ized capacities by 50 percent. If any thea- ter should by chance accumulate more patients than beds, the Board stated, it could transfer greater numbers of patients to the United States, because in the Board’s opinion evacuation facilities and zone of interior hospital capacities already exceeded requirements. Arriving on the basis of statistics published by the Surgeon General’s Office at an average noneffec- tive rate of 50, the Board concluded that not more than 250,000 beds were needed for the 5,000,000 troops in all theaters of operations. It therefore advocated delet- ing from the troop basis fixed hospital units containing 120,000 beds in excess of this number.78 On the basis of this study, G-3 recom- mended on 29 September 1944 that all in- active general, station, and field hospital units (having authorized capacities total- ing 44,000 beds) should be deleted from the troop basis; that no further fixed hos- pital units be sent to theaters of opera- tions; that the active units in training in the United States, with a total authorized capacity of 20,000 beds, be kept in this country in the strategic reserve; and that the bed requirements of all theaters be re- studied by 1 November 1944.79 Although OPD believed that these rec- ommendations were “premature,” 80 G-4 directed ASF headquarters on 11 October 1944 to make an immediate review of fixed-bed requirements of all theaters on the basis of “the latest and most complete current experience data available to The Surgeon General” and warned that it was “particularly desired that no attempt be made in this study to arbitrarily justify 76 (1) Memo with Memo for Record SPOPP 370.05, GG ASF for AGofS OPD WDGS, 16 Sep 44, sub: Hosp and Evac, POA and SWPA. HRS: Hq ASF Planning Div, “Hosp and Evac.” (2) Memo WDGDS 3710, AGofS G-4 WDGS for DepGofSA, 5 Oct 44, sub: Hosps for SWPA and POA. HRS: OPD, 632 “Security Sec I.” 77 See above, pp. 203-05. 78 Memo WDSMB 323.3 (Hosp) (25 Sep 44), WDMB for AGofS G-3 WDGS, 25 Sep 44, sub: Fixed Hosp Reqmts for Overseas Theaters. HRS: G-4 file, “Hosp and Evac Policy.” 79 Memo WDGCT 705.1 (29 Sep 44), AGofS G-3 WDGS for GofSA, 29 Sep 44, sub: Fixed Bed Reqmts. HRS: G-4 file, “Hosp and Evac Policy.” 80 DF, Act AGofS OPD WDGS to AGofS G-4 WDGS, 7 Oct 44, sub: Fixed Bed Reqmts, with Memo for Record. HRS: OPD, 632 “Security Sec I.” 232 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR present figures on fixed bed hospitaliza- tion for theaters.” 81 General Review of Bed Requirements The study which the Surgeon General’s Office prepared in compliance with the G-4 directive was impressive. It included estimates of requirements of all theaters arrived at by two methods—the “admis- sion rate” method used earlier for the Eu- ropean theater and the “beds occupied” method used earlier for the Pacific. Each was supposed to serve as a check on the other. All estimates were based upon cer- tain principles or assumptions which the Mobilization and Overseas Operations Division considered important. First, hos- pitals could operate with 50 percent more patients than authorized beds for only short emergency periods and hence expan- sion capacities could not be considered available for normal needs. Second, beds for dispersion would be needed within hospitals and within theaters. Vacant beds in contagious wards could not be used for surgical patients, for example, and some hospitals would always be only partially filled because the shifting fortunes of war temporarily left them on quiet fronts. Finally, though evacuation policies might be changed in emergencies to permit the- aters to transfer larger proportions of pa- tients to the United States, the mainte- nance of policies already established was desirable. As much as possible this study was based upon World War II statistics, but in some instances rates and ratios still had to be estimated without the benefit of such data. For estimates by the “admission rate” method the Mobilization and Over- seas Operations Division used actual ad- mission rates for disease and nonbattle- injury patients for the period from July 1943 to June 1944 for most theaters. In some instances, these rates had to be ad- justed. For example, the daily admission rate (the number of patients admitted to hospitals per 1,000 men per day) for disease and nonbattle injuries for the Pa- cific Ocean area had been 1.7, but in anticipation of higher disease incidence in future operations nearer Japan an admis- sion rate of 2 was used. While the length of stay in hospitals—also used in this method—differed from one theater and from one time to another, ranging from 18 to 21 days, the actual average length of stay in hospitals in all theaters during World War II was used. In estimates of re- quirements by the “beds occupied” meth- od the ratio of occupied beds to theater troop strength during 1943 and 1944 was considered as a base to which were added ratios of beds for patients resulting from increased operations; those needed for transient, Navy, Allied, and prisoner-of- war patients; and those required for dis- persion. The ratio of occupied beds was actual, based on statistical reports, but the other ratios were estimated. Different ratios of beds for the same the- ater resulted from the use of the two methods of estimating requirements. For the European theater under a 120-day evacuation policy, for example, a ratio of 7.73 percent was needed according to esti- mates made by the “admission rate” method and of 7 percent according to the “beds occupied” method. Lower ratios of beds would be needed with 90-, 60-, or 30- day evacuation policies. Because zone of interior hospitalization and evacuation 81 DF WDGDS 3918, ACofS G-4 WDGS to CG ASF, 11 Oct 44, sub: Fixed Bed Reqmts for Overseas Theaters, with 1 inch HRS: Hq ASF Planning Div, “Hosp and Evac.” Also, SG: 632.2 “Bed Reqmts.” REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 233 facilities had been planned on the basis of a 120-day evacuation policy and because such a policy seemed more economical of personnel and shipping than lower ones, The Surgeon General recommended that the 120-day policy be continued and that estimated ratios of beds required under it be approved. Those ratios were the same as the ones already authorized for all the- aters except the American, China-Burma- India, Southwest Pacific, and Central Pa- cific. For the first three of these, The Sur- geon General proposed reductions in ratios from 4, 7, and 8 percent to 3, 6, and 7 percent respectively. For the last, he pro- posed an increase from 5 to 6 percent. In addition, he recommended that beds be provided in hospital units in the strategic reserve for 4 percent of the troops in that reserve. He proposed further that theaters be asked what evacuation policies and bed ratios they wanted and that, until their answers were received, no reduction should be made in the number of units in the troop basis, no personnel should be diverted from training for those units, and hospital units should continue to be shipped overseas as planned. ASF head- quarters approved this study and its rec- ommendations.82 Faced with varying estimates of bed re- quirements made by the War Department Manpower Board and G-3 on the one hand and by the Surgeon General’s Office and ASF headquarters on the other, G-4 had the problem of considering both and of arriving at recommendations that could be presented to the Deputy Chief of Staff for approval. As a result of conferences with representatives of The Surgeon Gen- eral and G-3,83 and of analyses of the dif- ferent studies, G-4 arrived at a compro- mise which favored The Surgeon General and on 2 November 1944 sent the follow- ing recommendations to the Deputy Chief of Staff: (1) that the bed ratios recom- mended by The Surgeon General be approved, with minor exceptions; (2) that the evacuation policies already authorized remain in effect; (3) that the shipment of hospital units to the European theater be slowed down in order to permit them to be better staffed and trained and to see if they were actually needed; and (4) that the four general hospital units and the four field hospital units that were in the troop basis but were not scheduled by OPD for shipment to any theater be deleted. On 22 November 1944, the Dep- uty Chief of Staff approved G-4’s recom- mendations. The bed ratios thus author- ized were as follows: for the European and Southwest Pacific theaters, 7 percent; for the Mediterranean theater (formerly North African), 6.6 percent; for the Pacific Ocean areas (formerly the Central and South Pacific), 6 percent; for the Middle Eastern theater, 6 percent; for the China and India-Burma theaters, 6 per- cent for all American troops and for 102,000 Chinese troops in India; and for the American theater, 3 percent.84 82 (1) 1st ind, SG to CG ASF, 18 Oct 44, with Tabs A through D, on Memo SPOPP 370.05, CG ASF for SG, 13 Oct 44, sub: Fixed Bed Reqmts for Overseas Theaters, with 1 inch (2) 1st ind SPOPP 705, CG ASF to ACofS G-4 WDGS, 24 Oct 44, with Memo for Record, on DF WDGDS 3918, ACofS G-4 WDGS to CG ASF, 11 Oct 44, sub: Fixed Bed Reqmts for Over- seas Theaters. Both in HRS; Hq ASF Planning div file, “FIosp and Evac.” 83 DF WDGDS 4602, Act ACofS G-4 WDGS to ACofS G-3 WDGS, 1 Nov 44, sub: Fixed Bed Reqmts, with Memo for Record. HRS: G-4 file, “Hosp and Evac Policy.” 84 (1) Memo WDGDS 4434, Act ACofS G-4 WDGS for DepCofSA, 2 Nov 44, sub: Fixed Hosp Bed Allowances for Overseas Theaters, with Tab A. HRS: Hq ASF Planning Div, “Hosp and Evac.” (2) Memo WDGDS 4477, ACofS G-4 WDGS for CG ASF, 22 Nov 44, sub as above. Same file. 304244 0—55 17 234 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR This re-examination of the needs of theaters for fixed beds achieved in part the desired end—saving of personnel through a reduction in the number of hospital units the Army would have. While it was being made, the General Staff deleted six general hospital units from the troop basis. Afterward it deleted four more general and four field hospitals.85 These were units which OPD had not scheduled for shipment but which the Surgeon General’s Office wished to hold in the United States as an undeployed reserve. The shipment of hospital units to the European theater was also slowed down. With the concur- rence of that theater, the General Staff planned to send 11 general hospital units to Europe during the last two months of 1944, instead of 30 that were scheduled, and to send the remaining 19 early in 1945.86 Although these actions may have helped the Medical Department, they did not solve all problems caused by person- nel shortages and it was still necessary to ship hospital units with less than full com- plements of personnel. For example, eleven of the general hospitals sent to Europe during the winter of 1944-45 had no nurses assigned to them upon departure from the United States.87 Experiences of theaters in hospitaliza- tion from November 1944 to May 1945 showed that enough fixed beds were sup- plied to meet actual requirements. During this period only two theaters, the South- west Pacific and the Asiatic, failed to re- ceive enough beds to fill authorized quotas. The others had numbers that either exceeded quotas consistently or reached them and then wavered slightly above or below. Even during periods when theaters had fewer beds than authorized, they also had fewer patients than the number of fixed beds present, with one ex- ception-—the European theater. (See Chart 11.) In the winter of 1944-45, its patient load increased rapidly and by January and February 1945 the number of patients occupying fixed beds was greater than the number of normal beds present in the the- ater.88 For a short time, then, attention was centered upon this problem. (Table 14.) The Problem of the European Theater in the Winter of1944-45 The situation in which there were more patients than normal fixed beds in the European theater arose from a variety of causes. During November and December 1944 hospital admissions increased rap- idly. In addition, stoppage by the War Department in the fall of 1944 of the transfer (with few exceptions) of prisoner- of-war patients to the United States re- sulted in the accumulation of 14,000 German patients in theater hospitals by the end of December. Furthermore, fail- ure of the European theater to follow evacuation policies set by the War Depart- ment (because of a shortage of hospital ships and the chief surgeon’s opposition to the use of transports for evacuation) cre- ated a backlog of Army patients awaiting 85 (1) Memo SPMDA 322.05, SG for SecWar, 10 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, “Hosp, vol. II.” (2) Memo for Record on Memo, CG ASF (SG) for CofSA, 17 Dec 44, sub: Adequacy of Hosp and Evac, ETO. HRS: Hq ASF Planning Div file, “Hosp and Evac.” 86 (1) Memo WDGDS 4434, Act ACofS G-4 WDGS for DepCofSA, 2 Nov 44, sub: Fixed Hosp Bed Allowances for Overseas Theaters. HRS: Hq ASF Planning Div file, “Hosp and Evac.” (2) MRS, Col Durward G. Hall (SGO) to Gen [George F.] Lull then Col A[rthur] B. Welsh then Col Carl [C.] Sox, 14 Nov (1944?). SG: 322 “Hosp Misc.” 87 Memo, Chief Atlantic Sec Theater Br MOOD SGO for Record, 8 Mar 45, sub: Substitution of En- listed Technicians for Nurses in ETO Hosps. HD: MOOD “ETO.” 88 An Rpt, SG, FY 1945* pp. 53-54. HD. REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS Europe North Africa Pacific Asiatic Year and Month (Mediterranean) South Pacific Central Pacific SouthwestPacific China-Burma-India Evacuation Policy Fixed- Bed Ratio Evacuation Policy Fixed- Bed Ratio Evacuation Policy Fixed- Bed Ratio Evacu- ation Policy Fixed- Bed Ratio Evacu- ation Policy Fixed- Bed Ratio Evacuation Policy Fixed-Bed Ratio 1943 Official 180 De Facto “ 180+ 8% Official 120 De Facto ° 90 6.6% Official 120 De Facto “ 60 10% 120 7% 120 10% 180 September December 1944 90 8% US Armv & 8% CAD 6% 5% 8% 7% IIS Armv * 8% U AT 6 June 120 July Pacific Ocean Area China India-Burma September October 120 180 7% Evacuation Policy Fixed-Bed Ratio Evacu- ation Policy Fixed- Bed Ratio Evacuation Policy Fixed-Bed Ratio November December 120 6% 120 7% 180 6% 180 6% US Army & 6% CAD 1945 January February 120 90 60 April 60 7% 60 60 6.6% May AFPAC June July Evacuation Policy Fixed-Bed Ratio 120 90 4% 120 90 4% 60 6% Evacuate all Patients by 1 March 1946 Regardless September 120 120 of E vacuatic >n Polic) December 120 4% 4% 4% “ Dates of change are approximate. b Chinese Army in India. Source: Documents cited in footnotes to relevant portions of Chapters XII and XVIII Table 14—Evacuation Policies and Authorized Bed Ratios, Major Theaters of Operations 236 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR transfer to the zone of interior. Mean- while, the theater actually had fewer fixed beds than it was credited with, because many of its field hospitals (normally counted as fixed hospitals) were being used as forward-area surgical hospitals and evacuation holding units.89 Informed of this situation early in December 1944,90 the General Staff, ASF headquarters, and the Surgeon General’s Office turned their attention to a solution of some of the the- ater’s problems. Difficulties of the War Department in meeting authorized quotas of fixed beds for all theaters precluded shipment to Europe of more hospitals than already scheduled. Therefore, G-4 decided that the European theater would have to care for prisoner-of-war patients in hospitals that were manned primarily by captured German medical personnel. On 28 De- cember 1944 the War Department in- formed the theater of this decision,91 and by February 1945 it had in operation or in the process of organization prisoner-of- war hospitals containing 13,000 beds.92 Failure of the theater to use vacant evacuation space on troop transports threatened not only to continue to con- tribute to a shortage of beds in Europe and insufficient use of those in the United States but also to create a serious evacua- tion problem. If patients were not evacu- ated as they accumulated it would be dif- ficult to get them out of the theater after the defeat of Germany, because transports would then be diverted to the Pacific and hospital ships would be unable to move the patient load as rapidly as desirable. On 3 December 1944, therefore, the Chief of Staff of the Army ordered the com- manding general of the European theater to use all evacuation space on transports, even if it required the theater to lower its evacuation policy to 90 days or less.9! As a result, the theater evacuated patients under a 120-day policy in January, a 90- day policy in February, and a 60-day pol- icy in March and April.94 By thus trans- ferring a larger proportion of its patient load to the zone of interior, the European theater reduced its requirements for addi- tional beds and contributed at the same time to the more effective use of beds in general hospitals in the United States. To enable the theater to establish as many fixed beds as it was credited with having, The Surgeon General proposed that it be authorized additional fixed beds to replace those in field hospitals being used as mobile units.95 The General Staff approved this proposal, and on 25 Decem- ber 1944 the War Department authorized both the European and Mediterranean theaters to subtract from fixed-bed totals the beds in field hospitals being used as mobile units and to replace them by ex- panding table-of-organization capacities of station and general hospitals already present.96 Later, ASF headquarters pro- 89 (1) An Rpt, MOOD SCO, FY 1945. HD. (2) In- terv MD Historian with [MaJ] Gen [Paul R.] Hawley, 18 Apr 50. HD: 000.71. 90 Ltr SHAEF 704-3 Med, SHAEF to GofSA thru AGofS G-4 WDGS, 4 Dec 44. SG: 632.2. 91 Rad, AGofS OPD WDGS to CG ComZ ETO and GG USAF MTO, 28 Dec 44. HRS: Hq ASF Planning Div, “Hosp and Evac.” 92 An Rpt, MOOD SGO, FY 1945. HD. 93 (1) Memo, Col William B. Higgins (G-4) for AGofS G-4 WDGS, 4 Dec 44, sub; Evac from ETO. HRS: G-4 file, “Hosp and Evac Policy.” (2) Rad CM-OUT-72113 (3 Dec 44), GofSA to CG ComZ ETO and CG UK Base Sec, 3 Dec 44. SG: 560.2. 94 Administrative and Logistical History of the Medical Service, Communication Zone-ETO, Ch 13, “Evacuation,” pp. 32-34. HD. 95 Memo, SG for CG ASF, 13 Dec 44. HRS: Hq ASF Somervell file, “SG 1944.” 96 Rad OPD 632 (26 Dec 44), AGofS OPD WDGS to CG ComZ ETO and CG USAF MTO, 26 Dec 44, sub: Hosp. HRS: Hq ASF Planning Div, “Hosp and Evac.” REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 237 posed that other theaters be given similar authority.97 In addition to the measures just dis- cussed, at the suggestion of the Chief of Staff G-4 sent to Europe one of its repre- sentatives, Col. (later Brig. Gen.) Craw- ford F. Sams, a Medical Corps officer, to discuss with the chief surgeon of the thea- ter and the chief medical officer of SHAEF the most effective use of the beds present.98 The situation in Europe was thereby so alleviated that by March it was possible to divert to the Pacific six of the general hos- pitals scheduled earlier for shipment to Europe.99 Meeting the needs of theaters for hospi- talization in the latter part of the war was characterized by efforts to estimate re- quirements as realistically as possible and by the necessity of using a variety of ex- pedients to provide quotas of beds actually authorized. Establishment in the second half of 1943 of official evacuation policies and bed ratios for various theaters placed planning on a sounder basis than formerly. The first ratios established were based only partially upon World War II experi- ence; but as statistics of casualty and dis- ease incidence accumulated they were studied repeatedly to determine whether or not ratios could be lowered. Though a reduction was at times possible, shortages of personnel continued to require some theaters to meet their quotas partially by expanding the table-of-organization ca- pacities of some units, using the emer- gency expansion of others, and employing units shipped from the zone of interior in- completely trained and staffed. Toward the end of 1944 it was necessary to force the European theater to observe War De- partment policies on evacuation in order to relieve the load on theater hospitals by transferring part of it to the United States. That theater also had to use other ex- pedients, such as the employment of cap- tured enemy personnel in the the treat- ment of prisoners of war, in order to have sufficient fixed beds for American Army patients. 97 Memo SPOPP 705, Act Dir Plans and Oprs ASF for ACofS OPD WDGS, 5 Jan 43, sub; Adequacy of Hosp in TofOpns—Deletion of Fid Hosps from Auth Fixed Beds, with Memo for Record. HRS: Hq ASF Planning Div, “Hosp and Evac.” 98 (1) Memo, G. G. M[arshall] (CofSA) for [Lt] Gen [Thomas T.] Handy, 26 Dec 44, WDGSA: 632 A 414. (2) Interv, MD Historian with Brig Gen Crawford F. Sams, 18 Jan 50. HD: 000.7 1. 99 (1) Memo, Act CofS ASF for Dir Plans and Oprs ASF, 24 Mar 45, sub: Hosps in ETO. HRS: Hq ASF Control Div files, 323.3 “Hosps.” (2) An Rpt, MOOD SGO, FY 1945. (3) Memo, Chief Planning Br G-4 WDGS for ACofS G-4 WDGS, 3 Apr 45, sub: Diver- sion of Hosps. HRS; G-4 files, “Hosp, vol. HE” CHAPTER XIII Changes in Policies and Procedures Affecting the Occupancy of Hospital Beds in the Zone of Interior An important feature of attempts to meet hospital requirements with limited resources was an extension of the practice begun on a small scale during the early war years of keeping patients who did not actually need hospital care from occupy- ing beds. This could be done by limiting admissions and shortening length of stay. Problem of Limiting Hospital Admissions More was done to shorten periods of patient-stay than to limit admissions. Two factors worked against the latter: (1) the Medical Department’s practice of admit- ting patients to hospitals before perform- ing complete diagnostic procedures and (2) policies of the General Staff governing discharges from the Army. Normally, zone of interior patients were sent to hospitals after only preliminary examinations by dispensary physicians and were then given more thorough examinations by hospital staffs. Early in the war, it will be recalled, some hospitals had established diagnostic clinics for the examination of patients be- fore their admission to wards. This prac- tice did not become general, and hospitals continued to admit patients first and to perform diagnostic procedures afterward.1 Some policies of the General Staff tended to increase rather than to limit hospital admissions. In July 1943, for example, the Staff issued a directive, against The Sur- geon General’s advice, to discharge from the Army men who did not meet minimum physical standards. This flooded hospitals with patients whose disabilities had to be observed and evaluated before they could be given disability discharges.2 Toward the end of 1943, when a manpower short- 1 See above, p. 121. Annual reports of hospitals are silent, with few exceptions, on the establishment of diagnostic clinics. See also Federal Medical Services— A Report with Recommendations, prepared for the Com- mission on Organization of the Executive Branch of the Government [Hoover Commission] by the Com- mittee on Federal Medical Services (Washington, 1949), pp. 20-21. 2 (1) WD Cir 161, 14 Jul 43. (2) An Rpt, 1943, Ft Bragg Sta Hosp. HD. (3) William G. Menninger, Psychiatry in a Troubled World (New York, 1948), pp. 551-52/ HOSPITAL BEDS IN THE ZONE OF INTERIOR 239 age developed, the Staff directed that men who could serve usefully in military as- signments, despite minor ailments, should be kept in the Army.3 While this reduced the disability-discharge load, it increased the number of men who returned to hos- pitals repeatedly with the same complaints and led to a tug of war between line offi- cers and the Medical Department over whether those who were not physically disabled but were noneffective should be given medical or administrative dis- charges.4 The Staff finally attempted to solve this problem by making it easier in the latter half of 1944 for line officers to grant administrative discharges and by authorizing in the spring of 1945 the dis- charge at separation centers of all combat- wounded enlisted men in the limited serv- ice category.5 To some extent these actions relieved hospitals of the care of men who did not need actual treatment at a time when these installations were reaching their peak load.6 Measures to Shorten the Length of Patient-Stay Shortening the time spent by patients in hospitals was another way of limiting oc- cupancy of beds to patients actually need- ing hospital care. Controlling the length of stay in an effort to limit the occupancy of beds to patients actually needing hospital care was a complicated and difficult proc- ess, for many factors affected it, some tending to increase and others to shorten it. Among them—aside from the serious- ness of patients’ wounds, injuries, and ill- nesses—were the speed with which patients were transferred to proper types of medical installations, the degree of re- covery they were expected to achieve while in Army hospitals, the efficiency with which hospitals completed diagnoses and treatments, and the administrative problems that were encountered in dispos- ing of patients after completion of treat- ment. Beginning in the fall of 1943 the Surgeon General’s Office devoted more attention than formerly to these factors in particular and to the length of stay in general. The attention given to the general prob- lem is illustrated by studies made in the Surgeon General’s Office and letters sent to service commands. During 1944 and 1945 the Facilities Utilization Branch and its successor, the Resources Analysis Divi- sion, made monthly studies of the length of time different hospitals kept patients before disposing of them. In the absence of more reliable data, the Branch measured the average duration of patient-stay by means of an “activity index.” This index was the ratio of total patient days to the sum of hospital admissions and disposi- tions. Over a long period of time a num- ber twice the size of the activity index was considered a close approximation of the number of days that the average patient spent in a given hospital.7 A low activity 3 WD Cir 293, 11 Nov 43. 4 (1) An Rpt, 1943 and 44, Ft Bragg Sta Hosp. HD. (2) An Rpt, 1944, Surg 7th SvC. HD. (3) Memo, SG for CG ASF, 1 Sep 44, sub: Disposition of Inapt and Inadaptable. SG: 300.3. (4) Memo, Dep SG for ACofS G-l WDGS, 26 Sep 44, sub: WD Cir 370 (1944) II-EM. SG: 300.-5. (5) Memo, SG for CG ASF, 23 Mar 45, sub: Gen Hosp Program, ZI. SG: 322 “Hosp.” 5 (1) WD Cir 370, 12 Sep 44. (2) AR 615-368 and AR 615-369, 20Jul 44. (3) WD Cir 71,6 Mar 45. 6 (1) Memo, Dir NP Consultants Div SGO for Dir Resources Anal Div SGO, 27 Nov 44, sub: Discharge of EM. SG: 220.81 1-1. (2) An Rpt, 1944, Surg 7th SvC. HD. (3) An Rpts, 1945, Baxter Gen Hosp and Ft Bragg Sta Hosp. HD. 7 Draft article for ASF Monthly Progress Rpt, Sec 7, Health, entitled “The Disposition of Patients in Hospitals of Selected Size Groups [31 May 44].” HD: Resources Anal Div file, “Hosp.” 240 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR index was therefore an indication that a hospital was treating and disposing of patients promptly. Monthly announce- ments of hospitals’ activity indices kept before service command surgeons the im- portance of avoiding unnecessarily long patient-stays.8 This indirect pressure upon hospitals seemed insufficient after the patient load began to increase rapidly in the spring of 1945. In March, therefore, The Surgeon General urged general and convalescent hospital commanders, as well as service command surgeons, to ac- celerate dispositions.9 The following month he established tentative monthly quotas for the disposition of patients from convalescent hospitals.10 Meanwhile, dur- ing the preceding year and a half, atten- tion had been given to various individual factors which influenced the length of patient-stay. One of these was the transfer of patients between hospitals. Failure to transfer pa- tients promptly from station hospitals to better staffed and better equipped hospi- tals, after it had been determined that they needed a higher type of care than that afforded in station hospitals, retarded their recovery. On the other hand, unnecessary transfers of patients between hospitals of different types consumed the time of hos- pitals involved, put an extra load on over- burdened transportation facilities, and increased the time patients stayed on hos- pital rolls by causing repetitive physical examinations and more administrative paper work. Several steps were therefore taken to regulate the transfer of patients. In the fall of 1943 the Deputy Chief of Staff ruled that zone of interior patients need not be transferred from station to general hospitals merely because their in- juries or illnesses were of particular types, provided station hospitals were equipped and staffed to give them the care and treatment they needed.11 In the spring of 1944, when regional hospitals were au- thorized, a policy was established under which patients were to be transferred “without any more delay than is compati- ble with sound professional judgment” to the “nearest adequate medical installa- tions,” regardless of their type—whether regional, convalescent, or general hospi- tals—and regardless of the command under which they operated.12 To imple- ment this policy, both the Air Surgeon and The Surgeon General applied to re- gional hospitals the bed credit system which had been developed earlier to facili- tate the transfer of patients from station to general hospitals.13 Soon afterward The Surgeon General established the Medical Regulating Unit (mentioned elsewhere) to control the transfer to general hospitals of patients debarked at ports in the United States. This office, in turn, devised an elaborate system by which general and convalescent hospitals reported vacant beds and debarkation hospitals reported patients received, indicating by code their sex, rank, home address, and disability.14 Theoretically this system assured the trans- fer of patients directly to hospitals staffed 8 These letters are found in SG: 323.7-5 (each service command). 9 Ltr, CG ASF (SG) to CGs all SvCs attn SvC Surg, and to COs all Gen and Conv Hosps, 24 Mar 45, sub: Furlough and Disposition Policy. Off file, Gen Bliss’ Off SGO, “Med Clarification of Disposition Policy.” 10 Ltr, SG to CO Ft Story Conv Hosp, 12 Apr 45. Off file, Gen Bliss’ Off SGO, “Med Clarification of Disposition Policy.” 11 See above, p. 183. 12 WDGir 140, 11 Apr 44. 13 (1) See above, pp. 35, 184-85. (2) The Planning and Oprs of ZI Hosps, Tab B to Memo, Dir Hosp Div and Dir Resources Anal Div SGO thru Chief of Oprs Serv SGO for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. 14 See below, pp. 346-49. HOSPITAL BEDS IN THE ZONE OF INTERIOR 241 and equipped to care for their particular ills and injuries but it was not completely successful. A study by the Resources Analysis Divi- sion early in 1945 showed that forty-five out of fifty-nine general hospitals were re- ceiving patients who should have been sent to other medical installations. “Be- yond a doubt,” a report on the study con- tinued, “there are a large number of overseas patients being transferred from the debarkation hospitals to the general hospitals who need little or no further sur- gical or medical treatment and could equally as well be cared for in convalescent hospitals. These cases consume a large amount of time in the general hospitals in examination and working up plus all the administration detail and the time in- volved in disposition.” 15 Another factor which affected the length of stay in Army hospitals was the degree of recovery which patients were expected to attain before being discharged. Those re- turned to duty were expected to be able to do an effective day’s work as soon as they rejoined their outfits. To shorten the con- valescent phase of hospitalization, The Surgeon General emphasized during 1944 the reconditioning program initiated the year before. Although no statistical studies were made of the effect of this program on the average period of hospitalization, many hospital commanders believed that it was shortened.16 Patients who could not be reclaimed for military service could be transferred to Veterans Administration hospitals if they needed further care. In the early part of the war, it had been Surgeon General Magee’s policy to trans- fer such patients as soon as the Medical Department determined that they could not be restored to duty, thus shortening the time they stayed in Army hospitals.17 During 1943 public pressure upon the Army to keep patients for final treat- ment, along with the inability of Vet- erans Administration hospitals to accom- modate large numbers of them 18 caused a change in policy that tended to lengthen the period of patient-stay. In December 1943 Army hospitals began to keep all patients whose disabilities were incurred in line of duty, except those who were tuber- culous or psychotic, until their definitive treatment had been completed.19 As seri- ously wounded casualties began to fill hos- pital beds during 1944, this policy had to be clarified for it was difficult to know when the definitive treatment of those with chronic disabilities was completed. In the fall of that year it was announced that such patients would be kept in Army hos- pitals until they had reached the “maxi- mum degree of recovery.” 20 In the follow- ing December, the President confirmed this policy and broadened its application to include patients whose disabilities had not been incurred in line of duty.21 Hospi- tal commanders interpreted this directive “very broadly,” and by March 1945, as 15 Memo, J. S. Murtaugh [Resources Anal Div, SGO] for Dr [Eli] Ginzberg, 16 Mar 45, sub: Sum- mary of Replies to the Furlough and Disposition Study. Off file, Resources Anal Div, SGO. 16 Richard L. Loughlin, [History of] Recondition- ing [in the U.S. Army in World War II], (1946), pp. 198-208. HD. 17 (1) See above, pp. 129-30. (2) AR 615-360, C4, 16 Apr 43. 18 Ltr, Dep SG to Mr Donald C. Urquhart, Veter- ans of Foreign Wars of US, 24 Mar 44. SG; 220.- 811-1. 19 (1) WD AGO Form 026, prepared by Col Wil- liam B. Foster, MG, SGO, 15 Nov 43, sub: Request and Justification for Publication. AG: 220.8 (2 Jun 42) (2) Sec 2. (2) AR 615-360, C 16, 15 Dec 43. 20 (1) WD Cir 423, 27 Oct 44. (2) ASF Cir 374, 13 Nov 44. 21 Ltr, Franklin D. Roosevelt to SecWar, 4 Dec 44. HRS: Hq ASF Control Div, 705 “Cutback in Gen and Conv Fac.” 242 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR the patient-load neared its peak, The Sur- geon General concluded that they were holding patients longer than necessary.22 Two months later his Office attempted to define more precisely the term “maximum degree of recovery.” This term, it was ex- plained, referred to the point in a patient’s treatment when progress appeared to have leveled off and no further substantial im- provement could be anticipated. Patients reaching that point, even though they had not made full compensatory adjustment to disabilities, were not to be kept longer in Army hospitals.23 A third factor affecting the length of time patients stayed in hospitals was the efficiency with which hospital staffs made diagnoses and initiated treatment. In the fall of 1943 representatives of the Surgeon General’s Office and the ASF Control Division complained that hospitals were delaying diagnoses and treatment by hav- ing unnecessary laboratory work per- formed for each patient.24 At that time The Surgeon General urged hospitals to insist upon its elimination. A few months later he suggested that service command surgeons require hospitals to keep ward charts showing the duration of patient- stay, as a reminder that unnecessary pro- cedures should be avoided and requisite medical treatment given promptly. Some, and perhaps all, service commands ac- cepted this suggestion.25 A fourth factor affecting length of stay was the administrative work involved in disposition of patients, either by return to duty or by separation from the service. Their return to units or organizations from which they entered hospitals created no problem, but the reassignment of others who were physically unqualified for duty with their former units or whose units had gone overseas was fraught with delays. Reassignment was primarily an Army per- sonnel procedure over which the Medical Department had no control. It was compli- cated by the fact that patients belonged to different major commands (Ground, Serv- ice, and Air Forces), were qualified for different types of duty (limited or full duty), came from different areas (theaters of operations or the zone of interior), and were of separate ranks (commissioned or enlisted). Because of these complications, directives governing the reassignment of men and women who had been hospital- ized were numerous, frequently changed, often obscure in meaning, and sometimes in conflict with one another. Attempts were made to correct this situation, but the general problem so far as it pertained to Ground and Service Forces personnel remained unsolved throughout the war.26 The Air Forces, on the other hand, adopted a system of assignment in the fall of 1944 that was simple and effective. AAF headquarters placed liaison officers in some AAF regional hospitals and, with the concurrence of ASF headquarters, in each general and ASF regional hospital. 22 Memo, SG for CG ASF, 23 Mar 45, sub: Gen Hosp Program, ZI. SG: 322 “Hosp.” 23 Ltr, SG to CGs all SvCs attn COs Hosp Ctrs, Gen Hosps, and Conv Hosps, 28 May 45, sub: Med Clari- fication of Disposition Policy. HD. 24 (1) Rpt of SGs Pers Bd, 3 Nov 43. HD. (2) Memo, Dr Eli Ginzberg, ASF Control Div for Chief Oprs Serv SGO thru Dir Control Div ASF, 30 Nov 43, sub: Surv of Gen Hosps. SG: 333.1-1. 25 (1) SG Ltr 193, 30 Nov 43. (2) Ltr, SG (init A. H. S[chwichtenberg]) to Surg 2d SvC, 8 Feb 44, sub: Prompt Prof and Admin Practice in Army Hosps. SG: 705 (2d SvC)AA. Similar letters were sent to other service command surgeons. (3) Ltr, CG 5th SvC (Asst SvC Surg) to SG, 30 Mar 44, sub: Prompt Prof and Admin Practice in Army Hosps. SG: 705 (5th SvC)AA. (4) An Rpt, 1944, 2d SvC Surg. HD. 26 (1) Mins, SvC Conf, Ft Leonard Wood, Mo, 27- 29 Jul 44, p. 17. HD. (2) Memo, SG for CG ASF, 14 Mar 45, sub; Improvement in Hosp Admin Proce- dures. SG: 300.7. (3) History of Control Division, ASF, 1942-45, App, p. 199. HOSPITAL BEDS IN THE ZONE OF INTERIOR 243 These officers acted as representatives of the commanding general, Army Air Forces, reassigning both commissioned and enlisted personnel of the Air Forces. Subsequently it was reported that they re- turned flying officers to duty in the Fourth Air Force in 10 percent of the time formerly required.27 Aside from the necessity of securing reassignments, there was another cause for delay in returning patients to duty: the administrative procedure for the physical reclassification of officers. In July 1943 the General Staff directed that officers found by hospital disposition boards to be per- manently incapacitated for full military service should appear before Army retir- ing boards instead of being returned to duty in limited service assignments.28 This meant that such an officer had to be kept in a hospital while its commander for- warded recommendations of his disposi- tion board to service command headquar- ters; the service commander issued orders for the appearance of the officer before a retiring board; the board assembled and considered the case, and sent its findings to Washington for review by The Surgeon General, The Adjutant General, and the Secretary of War’s Separation Board; and The Adjutant General issued orders for the officer’s disposition. In the fall of 1944 the Surgeon General’s Office, ASF headquar- ters, and the Adjutant General’s Office attempted to find a way to avoid keeping such officers in hospitals after their treat- ment had been completed. The Adjutant General proposed returning them to their previous stations or to replacement pools after appearance before retiring boards, to await there the decision of agencies in Washington.29 The ASF proposal, which went further than this, was approved by the General Staff. On 14 October 1944 a War Department circular authorized hos- pital and station commanders to return to duty officers recommended for limited service by disposition boards, without re- ferring them, except in a few cases, to retiring boards.30 This change in proce- dure reduced the length of stay in hospi- tals of officers in this category to such an extent that it saved, according to the esti- mate of ASF headquarters, 1,000 hospital beds annually.31 Improvements in Disability Discharge and Retirement Procedures Officers and men whose physical dis- abilities prohibited return to duty were either retired or discharged from the serv- ice. Since both retirement and discharge for disability were personnel as well as medical administrative procedures, they involved agencies other than the Medical Department. Their simplification was therefore a complicated process and some- 27 (1) A History of Medical Administration and Practice in the Fourth Air Force (1945), vol. I, pp. 79- 81. HD; TAS. (2) Ltr, CG AAF to GG ASF, 25 Aug 44, sub: Disposition of AAF Pnts in Gen Hosps and Certain ASF Hosps. AG: 705(25 Aug 44)(1). (3) ASF Cir 296, 9 Sep 44. (4) AAF Ltr 25-1,21 Sep 44, sub: AAF Liaison with Hosp. SG: 211 (Surg, Flight). (5) An Rpts, 1944, Fitzsimons, Thayer, and O’Reilly Gen Hosps. HD. 28 Rad, ACofS G-l WDGS to SvC Gomdrs, Retir- ing Bds, and all Named Gen Hosps, 10 Jul 43. SG; 334.6-1 Retiring Bds. 29 Draft of WD Gir, incl to T/S APGO-S 210.85 (6 Sep 44), TAG to SG, 8 Sep 44, sub; Disposition of Offs Appearing before Retirement Bds, with 1st ind, SG to TAG, 24 Oct 44. SG: 300.5 (WD Gir). 30 (1) Memo, GG ASF for ACofS G-l WDGS, 25 Sep 44, sub: Physical Reclassification of Offs. AG; 210.85 (25 Sep 44)(2). (2) DF WDGAP 210.01, ACofS G-l WDGS to TAG, 7 Oct 44, same sub. Same file. (3) WD Cir 403, 14 Oct 44. 31 Rpt, Economies Effected through Procedures Studies Made by or jointly with Control Div ASF, 13 Apr 45. HRS: Hq ASF Control Div file, “Est Admin Savings Resulting from Procedural Revisions.” 244 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR times slow, but for the Medical Depart- ment it was important because any delay in either procedure wasted beds by length- ening the stay of patients in hospitals. Despite earlier attempts to remove causes for delays, the disability discharge procedure took more time than was con- sidered necessary and in the fall of 1943 32 both the Surgeon General’s Office and ASF headquarters began studies to sim- plify and standardize it. Because its Con- trol Division was engaged in a more gen- eral study of Army administrative proce- dures, ASF headquarters directed The Surgeon General to discontinue his study. The ASF Control Division proceeded thereafter, with assistance from the Sur- geon General’s Office, to develop and test a revised procedure for disability dis- charges.33 In March 1944 this procedure was published in a tentative manual and each service command was directed to install it in one general and one station hospital for further testing. Reports from such tests were favorable, and on 24 July 1944 ASF directed all of its hospitals to begin using the new procedure. Six months later a War Department manual made it official for use in hospitals of the Air Forces as well as of the Service Forces.34 The new procedure for disability dis- charges covered actions taken within hos- pitals themselves, since measures adopted earlier had reduced administrative actions required by headquarters other than hos- pitals.35 This goal was more completely achieved during 1944 when additional post commanders delegated to hospital commanders their functions relative to dis- ability discharges, and the War Depart- ment delegated to commanders of regional and convalescent hospitals, as it had earlier to those of general hospitals, authority to grant discharges without reference to higher headquarters.36 Under the new procedure, administrative actions within hospitals were simplified and speeded up. Hospital commanders were permitted to request records of former physical exami- nations and medical treatments from the Adjutant General’s Office and from other hospitals as soon as ward officers made a diagnosis indicating eventual disability discharge, rather than after completion of treatment. This move was expected to eliminate delays in the consideration of cases by CDD (Certificate of Disability for Discharge) boards. To reduce the work of these boards and of all officers who par- ticipated in the procedure, paper work required for disability discharges was sim- plified. Separate forms and letters previ- 32 (1) Memo, Dr Eli Ginzberg, Control Div ASF for Chief Oprs Serv SCO thru Dir Control Div ASF, 30 Nov 43, sub; Surv of Gen Hosps. SC: 333.1-1. (2) Notes on Visit to McCloskey, O’Reilly, and Percy Jones Gen Hosps, 11 Dec 43, by Col Tracy S. Voor- hees, Control Div SCO. Same file. 33 (1) Memo, SC (Control Div) for Dir Control Div ASF, 29 Oct 43, sub: Delays in Discharging Pnts from Hosps. (2) Memo, SC (Control Div) for CG Army Med Ctr, 29 Oct 43, sub: Delays in CDD Pro- cedure. (3) Memo, CG ASF (Control Div) for SC attn Dir Control Div, 5 Nov 43, sub: Delays in Dis- charging Pnts from Hosps. (4) Memo, Act Dir Con- trol Div SCO for Brig Gen Edward S. Greenbaum, Off of UnderSecWar, 16 Feb 44, sub: Improvements in CDD Procedures. All in SC: 220.81 1-1. (5) An Rpt, FY 1944, Control Div SCO. HD. 34 (1) History of Control Division, ASF, 1942-1945, App, pp. 345-46. HD. (2) Memo, CG ASF for CG 1st SvC, 17 Mar 44, sub: Estab of Pilot Instl Covering Discharges and Release from AD. SC; 220.81 1-1. Similar letters were sent to each service command. (3) Draft of Tentative Procedures—Discharge and Re- lease from AD, Hq ASF, 5 Mar 44. AG; 220.8. (4) ASF Gir 217, 13 Jul 44. (5) TM 12-235, Enl Pers— Discharge and Release from AD (Other than at Sep- aration Gtrs), 1 Jan 45. 35 See above, pp. 124-30. 36 (1) AR 615-360, C 19, 17 Mar 44. (2) An Rpts, 1944, Fts Jackson, Bragg, and Cp Shelby Regional Hosps. HD. (3) WD Memo 615-44, 17 Aug 44, sub; Discharge Auth. (4) AR 615-360, 20 Jul 44, and C 1, 1 Feb 45. HOSPITAL BEDS IN THE ZONE OF INTERIOR 245 ously used were eliminated or consoli- dated, and copies of different forms and the number of signatures required on them were limited. All forms were set up accord- ing to standard typewriter spacing to facil- itate preparation and, in some instances, rubber stamp entries were authorized.37 To insure speedy, well co-ordinated action by all hospital officers concerned with dis- charges, a time schedule was established. It listed the actions taken by each officer on the days following the admission of patients to hospitals, the day before the CDD board meeting, the day of the meet- ing, and the three following days. Finally, the manual on the discharge procedure showed graphically each step in a dis- ability discharge. Except in procuring adequate supplies of new forms, hospitals encountered little difficulty in installing the new procedure. Their reaction was almost immediately favorable. For example, by the end of 1944 one of them reported that disability discharges were “no longer a matter of concern.”38 The Surgeon General’s Office likewise was pleased with the new proce- dure and with the saving in hospital beds which it produced.39 According to an esti- mate of the ASF Control Division in April 1945, this saving amounted to an average of seventeen days for each disability dis- charge and to a total of 6,205,000 hospital bed-days (the equivalent of seventeen 1,000-bed hospitals) annually.40 As in the case of disability discharges for enlisted men, several agencies became concerned in the fall of 1943 about the time used in retiring officers for disability. Among them were the Adjutant General’s Office, the Surgeon General’s Office, and ASF headquarters.41 During the next two years they worked together to speed the retirement process and thereby to shorten the period of hospitalization of officers dis- abled for military duty. One method was to shorten the time that elapsed between completion of an officer’s treatment and his appearance before a retiring board. In the middle of 1943 the procedure for get- ting an officer before a retiring board was complicated. After completion of treat- ment, his case was reviewed by a hospital disposition board. If the board recom- mended retirement, its recommendation was sent to higher headquarters, such as that of a service command, for review. If that headquarters approved the recom- mendation, it ordered the officer to go before a retiring board. At that point, the hospital requested his personnel records from the Adjutant General’s Office. After they arrived, the retiring board could con- sider the officer’s case. In the fall and win- ter of 1943 steps were taken to get records 37 (1) TM 12-235, Enl Pers—Discharge and Re- lease from AD (Other than at Separation Ctrs), 1 Jan 45. (2) History of Control Division, ASF, 1942-45, pp. 183-86, and App, pp. 345-46. HD. 38 An Rpt, 1944, O’Reilly Gen Hosp. HD. Letters from hospitals reporting on the new procedure, dated May-June 1944, are filed in HRS: Hq ASF Control Div file, “Disability Discharge Corresp.” See also: An Rpts, 1944, Fts Jackson and Bragg Regional Hosps and Ashford Gen Hosp. HD. 39 An Rpt, FY 1944, Control Div SCO, and An Rpt, FY 1945, Hosp and Dom Oprs SCO. HD. 40 Rpt, Economies Effected through Procedures Studies Made by or jointly with Control Div ASF, 13 Apr 45. HRS: Flq ASF Control Div file, “Est Admin Savings Resulting from Procedural Revisions.” 41 (1) T/S, Dir Control Div AGO to Chief Insp and Investigation Br AGO, 28 Aug 43, sub; Retirement Procedures Affecting Offs. AG: 210.85 (12-17-42)(1). (2) Memo, SG for Gen Malin Craig, Pres Army Re- tiring Bd, 30 Aug 43. SG: 334.6-1. (3) Memo, Dir Control Div SGO for Brig Gen Charles C. Hillman, SGO, 8 Sep 43, sub; Retiring Bd Procedures. Same file. (4) Memo, Lt Col Basil C. MacLean, SGO for Gen [Raymond W.] Bliss thru Col A. H. Schwichten- berg, 6 Nov 43, sub: Observations Based on Recent Visits to Gen Hosps. Off files, Gen Bliss’ Off SGO, “Util of MCs in ZI” (19) #1. 246 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR from the Adjutant General’s Office at an earlier point in the proceedings. In Sep- tember, on The Surgeon General’s recom- mendation, the General Staff authorized hospitals to request records of officers as soon as disposition boards recommended their appearance before retiring boards.42 Later, on recommendation of the ASF Control Division, the Staff permitted hos- pitals to request these records as soon as it became obvious that officers would be considered for retirement, even though their cases had not been reviewed by dis- position boards.43 In the latter half of 1944 another cause for delay was eliminated when the Staff authorized hospital com- manders to order officers to appear before retiring boards without reference to higher- headquarters.44 Another method of speeding the retire- ment of officers was to prevent the devel- opment of backlogs of work for retiring boards. This could be done, in part at least, by increasing the number of such boards. Until the middle of 1943 retiring boards were few in number and could be appointed only by the Secretary of War,45 In June of that year the Secretary dele- gated appointment authority to command- ing generals of service commands and directed them to establish retiring boards at all general hospitals. Four months later the commanding general of the Air Forces, receiving similar authority, was directed to set up a retiring board at each AAF convalescent center.46 In the middle of 1944 the right to have retiring boards was extended to all convalescent and regional hospitals.47 Later, in October 1944, the number of cases referred to such boards was limited when, in connection with the movement to shorten the period of hospi- talization of officers being physically re- classified for limited duty only, retiring boards were relieved of the consideration of such cases.48 An additional way of speeding officer retirements was to reduce the paper work of retiring boards. In the latter part of 1944 the ASF Control Division developed a standard form for such boards to use in reporting their proceedings.49 Following the success of the new manual on disabil- ity-discharge procedures, the same Divi- sion developed and published in 1945 a technical manual on the retirement and reclassification of officers.50 This manual, like that on the disability-discharge pro- cedure, gave detailed instructions in dia- grammatic and other explanatory forms on the completion of all administrative actions in the retirement process and established a time schedule to be followed by officers concerned. As a result, accord- ing to ASF headquarters, the period of hospitalization of officers awaiting disabil- 42 (1) Memo SPMCH 300.3-1, Exec Off SCO for Publication Div AGO thru Procedure Br SGO, 7 Aug 43, sub: Proposed Change in AR 605-250. AG: 210.- 85 (12-17-42)(1). (2) AR 605-250, C 1, 17 Sep 43. 43 (1) Memo, Dir Control Div ASF for TAG, 18 Dec 43, sub: Request for Publication. AG: 210.85 (12- 17-42)(l). (2) AR 605-250, G 5, 6 Jan 44. 44 (1) T/S, Chief Insp and Investigation Br AGO to Dir Control Div AGO, 26 Jul 44, sub: Reasgmt of Pers Returned to Duty from Hosp. AG: 705 (5 Jul 44). (2) WD Cir 403, 14 Oct 44. 45 AR 605-250, 1 Jun 43 and 28 Mar 44. 46 WD Memo W605-28-43, 17 Jun 43, and WD Memo W605-41-43, 19 Oct 43, sub; Delegation of Auth to Appoint Retiring Bds. SG: 334.6-1. 47 (1) AR 605-250, C 1, 22 Jun 44. (2) Mins, SvG Conf, Ft Leonard Wood, Mo, 27-29 Jul 44. HD. 48 See above, p. 243. 49 Memo, CG ASF (Dir Control Div ASF) for SG, 9 Oct 44, sub: Form for the Proceedings of Army Re- tiring Bds. SG; 315 “Gen.” 50 (1) Draft of Proposed WD Technical Manual, TM 12-245, Physical Reclassification and Retirement of Offs, 1 Jun 45. Off file, Physical Standards Div, SGO. (2) Tentative WD Technical Manual, TM 12- 245, Physical Reclassification, Retirement, and Re- tirement Benefits for Offs, 1 Oct 45. Same file. HOSPITAL BEDS IN THE ZONE OF INTERIOR 247 ity retirements was reduced enough to save 4,700 beds annually.51 The simplification and standardization of procedures for disability discharges and retirements were the culmination of efforts begun early in the war to limit the occu- pancy of hospital beds to persons actually needing them. Earlier measures to reform these procedures affected actions taken outside hospitals but were a necessary foundation for the later ones which were mainly intended to improve action within the hospitals themselves. Other efforts to restrict patients in hospitals to those need- ing medical and surgical treatment were less successful. Little if anything was done to screen patients by physical examination before admission to hospitals. The reas- signment of those returning to duty con- tinued to cause difficulty and delays in disposition. And the policy of giving all patients “maximum hospitalization,” whether their disabilities had been in- curred in line of duty or not, tended to lengthen the average period of hospitaliza- tion and hence to increase the occupancy of beds by men who could be of no further service to the Army. 51 History of Control Division, ASF, 1942-45, App. pp. 481-83. HD. CHAPTER XIV Changes in Size and Make-Up of Staffs of Zone of Interior Hospitals Changes in policies and procedures af- fecting the occupancy of beds resulted in part from limitations upon the amount of personnel available for the hospitals. One such limitation was a definite requirement that hospitals get along on proportionately smaller staffs than accustomed to. Al- though the Manpower Board and ASF headquarters were chiefly responsible for this development, the Surgeon General’s Office participated indirectly. Established in March 1943 to advise the Chief of Staff on personnel matters,1 the Manpower Board analyzed the functions of hospitals in the United States, as it did those of other installations, and developed “yard- sticks” by which to measure their person- nel requirements.2 Using these yardsticks, the Board estimated the total amount of military and civilian personnel which ASF installations needed, and the General Staff normally accepted the Board’s esti- mates in making personnel authorizations. ASF headquarters then subdivided its quota among service commands. Service commanders in turn authorized person- nel for subordinate installations which then took similar action.3 Under this sys- tem, despite its nominally advisory capac- ity the Manpower Board exercised a rigid control over the personnel which the Serv- ice Forces received, and subordinate com- mands might or might not authorize as much for hospitals as the Manpower Board’s yardsticks showed they needed.4 To provide a guide for subordinate com- mands in manning hospitals, and perhaps to influence service commanders in mak- ing authorizations, the Surgeon General’s Office developed manning tables for gen- eral, regional, and station hospitals of various sizes and obtained sanction for them in a War Department circular issued in the spring of 1944.5 They agreed gener- 1 (1) Memo W600-27-43, 1 1 Mar 43, sub: WD Manpower Bd. (2) Ltr, CofSA to CG SOS, 12 Mar 43, same sub. Both in SG; 322.7-1 (Bds, etc.). 2 (1) WDMB Yardstick No 7 for Measuring Pers Reqmts of Named Gen Hosps. SG: 323.7-5. (2) Rpt, SGO Bd of Offs on the Util of MG Offs, 19 Oct 43. Off file, Gen Bliss’ Off SGO, “Util of MGs in ZI” (19)# 1- 3 (1) History of Control Division, ASF, 1942-45, pp. 31-33. HD. (2) ASF Cir 39, 11 Jun 43. (3) 1st ind, CG ASF to SG, n d, on Memo SPMDC 320.2 (2d SvC)AA, SG for CG ASF, 10 Apr 45, sub: Strength Auth, MD. HRS: ASF SPGA 320.2 “Med.” 4 For example, see Diary, Hosp Div SGO, 28 Sep 44 and 16 Mar 45. HD; 024.7-5. 5 (1) Memo, Gilbert W. Beebe, Control Div SGO for Col Tracy S. Voorhees, Control Div SGO, 31 Oct 43. SG: 632.-2. (2) Memo SPMCH 300.5-5, SG for CofS ASF, 19 Apr 44, sub: Pers Strength Tables for Med Instls in ZI. AG: 320.3 (18 Apr 44)(1). (3) WD Cir 209, 26 May 44. STAFFS OF ZONE OF INTERIOR HOSPITALS 249 ally with the Manpower Board’s yard- sticks and with recommendations made by the Inspector General’s Office. While they were not compulsory they served as guides supplied by the Medical Depart- ment for the reduction of hospital staffs.6 General Nature of Changes The general reduction made in hospital staffs can be illustrated by changes in the ratio of employees to beds. In July 1943 the average number of employees (mili- tary and civilian) per 100 beds in general hospitals was 94. At that time 58.6 percent of all beds in general hospitals were occu- pied. Therefore the number of employees per 100 occupied beds was 160. By July 1944 the average number of employees per 100 beds in all general hospitals had dropped to 68.6. At that time, however, only 42 percent of the beds were occupied, and therefore the number of employees per 100 occupied beds was 160—the same as a year before. About a year later (June 1945), when 81.4 percent of all general hospital beds were occupied and the num- ber of patients on the rolls of general hos- pitals (those absent from hospitals on leave or furlough as well as those occupying beds) was 122 percent of their bed capac- ities, the average number of employees per 100 beds was 71.1, but the average per 100 occupied beds was only 87. Thus, by the middle of 1945 the staffs of Army gen- eral hospitals in the United States had been reduced to the point where they had roughly only about half as many people to care for patients as in former years.7 Another general change in hospital staffs during the latter half of the war was the widespread substitution of civilians, Wacs, and limited service personnel for the enlisted men, officers, and nurses who were taken out of zone of interior hospitals for overseas assignments. This change re- sulted from a War Department policy governing the use of personnel by the Service Forces, reiterated by ASF head- quarters in June 1943. In general, men qualified for overseas service were to be released as rapidly as possible from assign- ment to all zone of interior installations. In replacing them commanders were not to assign men to positions that could be filled by women; they were not to assign military persons, male or female, to those that could be filled by civilians; and they were not to assign officers to duties that could be performed by enlisted persons or civilians.8 Compliance with this policy had two effects upon hospital staffs. In the first place, as officers, nurses, and men were withdrawn from hospitals for over- seas service, hospital staffs were subject to a continuous personnel turnover. For ex- ample, during 1944 Birmingham General Hospital gained 53 Medical Corps officers, but lost 33; it gained 177 nurses, but lost 89; and it gained 758 enlisted men, but lost 416.9 Redeployment following V-E Day and demobilization following V-J 6 (1) Memo, SG for DepGofSA thru GG ASF, 10 May 44, sub: Pers Strength Tables. . . . (2) Memo, WOMB for ACofS G-4 WDGS, 25 Apr 44, sub: Anal of Proposed Strength Tables. . . . Both in AG: 320.2 (18 Apr 44)(1). 7 (1) Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div, SGO. (2) Statistical Health Rpts. Off file, Med Statistics Div, SGO. In 1939 civilian hospitals in the United States had an average of 83 employees per 100 beds and 121 em- ployees per 100 patients. See Warren P. Morrill, “Ratio of Personnel to Patients,” Hospitals (The Jour- nal of the American Hospital Association), XIV (1940), pp. 47-49. 8 ASF Cir 39, 11 Jun 43. 9 An Rpt, 1944, Birmingham Gen Hosp. See also An Rpts, 1944 and 45, Ashford, Wakeman, Baker, and Lovell Gen Hosps and Waltham, Ft Geo. G. Meade, Cps Bowie, Crowder, and Shelby Regional Hosps. HD. 304244 0—55 18 250 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Day gave impetus to this turnover. Sec- ondly, as hospitals replaced persons quali- fied for overseas service with those in other categories, their staffs gradually became heterogeneous mixtures of doctors, admin- istrative officers, Army nurses, civilian nurses, paid nurses’ aides, voluntary nurses’ aides, general and limited service men, Wacs, skilled and unskilled civilians, and prisoners of war. Some of the prob- lems involved in the reduction, turnover, and replacement of personnel in particu- lar categories will now be considered. Wider Use of Administrative Officers Medical Corps officers available for as- signment to zone of interior hospitals were limited in number. According to manning tables, the proper ratio of physicians to beds ranged from 2.5 per 100 in a 1,000- bed general hospital to 2 per 100 in a 4,000-bed installation. During 1944 the actual average ratio for all general hos- pitals was approximately 2.6 per 100 beds. The next year, with the expansion of the hospital system, that ratio dropped to about 2.3 per 100 and remained there until November 1945.10 Hospital com- manders apparently accepted the fact that additional doctors were not available, for they complained about shortages during this period less than earlier. In a few in- stances hospital commanders and service command surgeons reported that the quality of professional care declined. In others they called attention to the need for more specialists, such as neuropsychi- atrists, orthopedic surgeons, and neuro- surgeons.11 More frequently, they com- plained about constant changes in pro- fessional staffs and about the inferior qual- ity of replacements received.12 Despite these complaints, there seem to have been enough Medical Corps officers to care adequately for all patients provided they were relieved of administrative work and permitted to devote full time and atten- tion to professional activities.13 The chief method of relieving physi- cians of administrative work was the more extensive use of Medical Administrative Corps officers. It will be recalled that sub- stitution of these for Medical Corps offi- cers in strictly administrative positions had begun during the early war years, but had not reached widespread proportions. In the fall of 1943 a strict limitation upon the number of Army physicians combined with an increasing supply of Medical Ad- ministrative Corps officers to suggest to both the Surgeon General’s Office and the medical officer on The Inspector Gen- eral’s staff a wider use of administrative officers, not only in administrative work unconnected with medical practice but also in jobs having semiprofessional as- pects.14 In November 1943, therefore, The Surgeon General proposed that Medical Administrative Corps officers be used throughout the Army in many positions 10 Tables on basic data and ratios in gen hosps. Off file. Resources Anal Div SGO. 11 An Rpts, 1944, 2d, 4th, 7th, and 9th SvC Surgs; An Rpts, 1945, 5th and 7th SvC Surgs; An Rpt, 1944, Ashburn Gen Hosp. HD. 12 (1) An Rpts, 1944, 4th and 5th SvC Surgs; An Rpt, 1944, Ft Benning Regional Hosp; An Rpts, 1945, 1st, 4th, 5th, and 9th SvC Surgs; An Rpts, 1945, Beaumont Gen Hosp, Ft Bragg and Cp Lee Regional Hosps. HD. (2) Mins, Conf of Hosp Comdrs, 7th SvC, 22 Aug 45. HD; 337. 13 (1) Memo, Act IG for CG ASF, 7 Feb and 15 Mar 45, sub: Med Pers and Hosp Fac in ZI. IG: 333.9-Med Pers (2). (2) Memo WDSIG 333.9-Hosp Fac (2), Act IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (3) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45. HD; 337. 14 (1) Mins, Mtg of Bd of Offs to Study Util of MC Offs, 17 Sep 43. (2) Ltr IG 333.0-Med Pers, IG to DepCofSA, 13 Jan 44, sub; Util of Med Off Pers in ZI Instls. Both in Off file, Gen Bliss’ Off SGO, “Util of MCs in ZI” (19)# 1 and (20)#2. STAFFS OF ZONE OF INTERIOR HOSPITALS 251 previously held by doctors, such as bat- talion surgeons’ assistants in the field and registrars in hospitals.15 The General Staff approved this proposal.16 In May 1944 this policy was reflected in hospital manning tables prepared by the Surgeon General’s Office.17 The demand for Medical Administra- tive Corps officers to fill positions assigned to them under the new policy created a temporary shortage in the latter part of 1944. Gradually, as the supply of such of- ficers increased they took over all custo- mary administrative positions in hospitals in the zone of interior, except those of executive officer and commanding officer, as well as new positions established to handle such additional wartime functions as legal assistance, personal affairs, voca- tional counseling, and reconditioning. In addition, during 1944 and 1945 some hos- pital commanders appointed Medical Ad- ministrative Corps officers as assistants to doctors to relieve them of duties not di- rectly connected with the treatment of patients. In such positions, Medical Ad- ministrative Corps officers assumed re- sponsibility for all property in hospital wards, for the cleanliness of wards, and for the discipline of patients; granted passes, leaves, and furloughs to patients; and in some instances assigned and super- vised the work of enlisted and civilian ward employees. Thus, by the end of the war Medical Administrative Corps offi- cers, whose use had been almost negligible in 1942, had become an important part of Army hospital staffs.18 Alleviation of the “Shortage” of Army Nurses During 1944 and the early part of 1945 hospital commanders and service com- mand surgeons complained loudly of an “acute shortage” of Army nurses; but by the middle of 1945, they reported, the shortage had been eliminated and there were plenty of nurses for the rest of the year.19 During the first four months of 1944 (for which figures are available) the average number of beds per Army nurse in general hospitals ranged from 21.2 to 23.8, but the average number of patients per Army nurse was between 10.1 and 13.7. In June 1945, when the peak patient load was reached, the average number of beds per nurse in general hospitals was 13.7, but the average number of occupied beds per nurse (11.2) remained about the same as the year before.20 If one con- siders the general situation, and that only in terms of the ratio of occupied beds to nurses, there seems to have been no more reason for complaint in 1944 than later when hospitals reported that the shortage had been eliminated. At any rate, the validity of complaints made in 1944 was openly questioned by the commander of the Fifth Service Command.21 15 Memo SPMCT 353.-1, SG for CG ASF, 25 Nov 43, sub; Conservation of MG Offs. AG: 320.2(10-30- 41 )(2) T/Os. 16 DF WDGCT 322(25 Nov 43), ACofS G-3 WDGS to TAG, 1 Mar 44, sub: Conservation of MG Offs. AG; 320.3(10-30-41)(2) T/Os. 17 WD Cir 209, 26 May 44. 18 An Rpts, 1944, 5th and 9th SvC Surgs; An Rpts, 1944, Baker, Beaumont, Birmingham, O’Reilly, and Wakeman Gen Hosps and Gps Barkeley, Shelby and Ft McClellan Regional Hosps; An Rpt, 1945, 5th SvC Surg; An Rpts, 1945, Birmingham, Crile, and Lovell Gen Hosps. HD. 19 An Rpts, 1944, 2d, 3d, 4th, 5th, and 9th SvC Surgs; An Rpts, 1945, 2d, 5th, 7th, and 9th SvC Surgs; An Rpts, 1944 and 45, Ashford, Fitzsimons, Baker, Halloran, O’Reilly, Baxter, Beaumont, Lovell, Bir- mingham, and Wakeman Gen Hosps and Waltham, Gps Barkeley, Crowder, and Shelby, and Ft McClel- lan Regional Hosps. HD. 20 Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div SGO. See Charts 8, 9, and 10, and Table 13. 21 Mins, 6th Gonf of SvC Gomdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 202-03. HD: 337. 252 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Hospital commanders may have been complaining about a potential rather than an actual shortage of nurses, but whether potential or actual there were reasons for their belief that it was serious. In the first place, the authorized ratio of nurses to beds during 1944 was lower than that to which hospitals had been accustomed. Early that year the Deputy Chief of Staff of the Army ordered it reduced from one for every ten beds to one for every fifteen.22 Next, the number of nurses actually as- signed to hospitals during 1944 was often lower than the number authorized23 and there was thus a shortage of nurses to fill authorized quotas. If hospitals had been called upon to operate at full capacity at that time, they might have encountered serious difficulties. Furthermore, at the time when hospitals were required to ad- just to lower ratios of nurses, their enlisted staffs were reduced also and some of their trained technicians were withdrawn for overseas service.24 This situation perhaps contributed to a feeling on the part of nurses themselves that they were short- handed and overworked, a feeling possi- bly heightened by the fact that nurses had to devote attention to new activities, such as the educational and physical recondi- tioning programs, that were being intro- duced during 1944.25 Finally, the continu- ous turnover of personnel interfered with the achievement of stable, well-organized staffs to operate hospital wards. Whatever the reason, there was a widespread belief in Army hospitals during 1944 and the early part of 1945 that there was an “acute shortage” of nurses; and the Medi- cal Department, from the Surgeon Gen- eral’s Office down, tried to alleviate that condition.26 A number of measures were adopted to insure an adequate nursing service for the Army’s patients. Some, such as the elimi- nation of inessential nursing records and the concentration of patients requiring continuous nursing care in as few wards as possible, were administrative."7 Others, such as the employment of civilian regis- tered nurses and senior student nurses, were designed to supplement the profes- sional nursing service.28 By April 1945 there were in general hospitals more than 2,000 cadet nurses and more than 1,000 civilian nurses.29 A measure that was pro- 22 (1) DF WDGAP 320.21, ACofS G-l WDGS to GG ASF and SG, 8 Jan 44, sub: Nurse Pers Reqmts. HD: 211. (2) Memo, SG for DepCofSA thru CG ASF, 10 May 44, sub: Pers Strength Tables for Med Instls in ZI. AG; 320.2(18 Apr 44)(1). (3) WD Cir 209, 26 May 44. 23 For example, see Conf, Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44. HD: 337. 24 See below, pp. 253-56. 25 An Rpts, 1944 and 45, Birmingham, Lovell, Wakeman, and Baker Gen Hosps. HD. 26 Florence A. Blanchfield and Mary W. Standlee, Organized Nursing and the Army in Three Wars (1950) (cited hereafter as Blanchfield and Standlee, Organized Nursing) gives a full discussion of the nursing “shortage” in the winter of 1944-45. In gen- eral, the authors indicate that the Medical Depart- ment’s estimate of nurse requirements was unrealis- tically high. In an interview on 20 November 1951 General Kirk stated that the Medical Department was “always short” of nurses until a draft was pro- posed in the winter of 1944-45. (HD: 314 Corre- spondence on MS) V. The question of whether or not there was a shortage of nurses in zone of interior hos- pitals was only part of a larger question of a shortage of nurses for use in theaters of operations as well as in the zone of interior. This question will be discussed more fully in John H. McMinn and Max Levin, Per- sonnel (MS for companion vol. in Medical Dept, series), HD. 27 (1) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 128. HD: 337. (2) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 191-93. Same file. (3) An Rpt, 1944, O’Reilly Gen Hosp. HD. 28 An Rpts, 1944, 2d, 3d, 4th, 5th, and 9th SvC Surgs; An Rpts, 1944, Fitzsimons, Halloran, O’Reilly, Birmingham, and Baxter Gen Hosps, and Waltham, Cps Shelby and Crowder Regional Hosps. HD. 29 Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div SGO. STAFFS OF ZONE OF INTERIOR HOSPITALS 253 posed, but not adopted, was a draft of nurses.30 Still another measure was the increased employment of ancillary per- sonnel to relieve nurses of nonprofessional duties in the care of patients. During 1944 and 1945 hospitals hired civilian nurses’ aides and ward orderlies, sought the serv- ices of volunteer Red Cross nurses’ aides, and used both enlisted men and Wacs, as they were available, to assist nurses in the care of patients.31 Greater Use of Limited Service Men Along with measures affecting the allot- ment of officers and nurses to hospitals, there were changes in the type of enlisted men employed during 1944 and 1945.32 The existing policy of reassigning general service men from zone of interior installa- tions to overseas units was made stricter and applied more widely during 1944 than before. In January ASF headquar- ters began a drive to have all general service men, except those who were more than thirty-five years old, those who had already served overseas, those who had had less than one year of Army service, and those who were considered to be in certain “key” categories, released from its installations by June; later, October.33 This drive threatened to strip hospitals of even their trained technicians. In order to prevent this, the Surgeon General’s Office got the Military Personnel Division of ASF headquarters to consider such men as dental laboratory technicians, meat and dairy inspectors, pharmacists, X-ray technicians, reconditioning instructors, medical technicians, surgical technicians, and laboratory technicians as being in “key” categories.34 In July 1944 ASF headquarters announced that even “key” technicians, if physically qualified for overseas service, would be taken out of zone of interior installations as soon as re- placements were available.35 Service com- mands interpreted these directives differ- ently, and some pulled “key” men out of hospitals without thought of the availabil- ity of properly trained replacements.36 To recover for the Medical Department some of the technicians improperly transferred as well as those misassigned initially to the Ground Forces, the Surgeon General’s Office succeeded in getting orders pub- lished during 1944 and 1945 requiring their retransfer to Medical Department units and installations. These actions saved enough technicians, so the Enlisted Personnel Branch of the Surgeon Gen- eral’s Office reported at the end of 1944, to man all hospitals properly,37 but not all 30 Blanchfield and Standlee, Organized Nursing, pp. 551-95. 31 An Rpts, 1944 and 45, 2d, 3d, and 9th SvC Surgs; An Rpts, 1944, Deshon, Halloran, O’Reilly, Baker, Fitzsimons, Baxter, Wakeman, Birmingham, and Lovell Gen Hosps. HD. 32 For example, see An Rpts, 1944 and 45, Fts Bragg and Knox, Cps Barkeley and Lee Regional Hosps, and Baxter, Beaumont, Halloran, Schick, and Wakeman Gen Hosps. HD. See also McMinn and Levin, op. cit. 33 (1) ASF Cir 26, 24 Jan 44. (2) Quarterly Rpt, 3d Qtr 1944, Enl Pers Br, Mil Pers Div SGO. HD. 34 (1) ASF Cir 193, 26 Jun 44. (2) WD Memo W615-44, 29 May 44, sub: Critically Needed Special- ists. HD. (3) Quarterly Rpt, 3d Qtr 1944, Enl Pers Br Mil Pers Div SGO. HD. (4) Mins, Conf of Post Surgs and GOs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 194. HD: 337. 35 ASF Cir 239, 29Jul 44. 36 (1) Ltr, Gapt Luther F. Dunlop, QMC, Hosp Div SGO to HD SGO, 4 Jul 44, sub: Summary of Civ Situation in Sta and Gen Hosps during the Past Few Months. HD; 230.-1 “Civ Pers (Gen).” (2) Quarter- ly Rpt, 4th Qtr 1944, Enl Pers Br Mil Pers Div SGO. HD. (3) An Rpts, Ft Bragg Regional Hosp and Beau- mont Gen Hosp. HD. 37 Quarterly Rpt, 3d and 4th Qtr 1944 and 2d Qtr 1945, Enl Pers Br Mil Pers Div SGO, and An Rpts, 1944, Baxter and Schick Gen Hosps. HD. pp. 551-95. 254 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR commanders were satisfied with saving technicians. Some complained loudly about the loss of certain clerical em- ployees, such as those occupying the posi- tion of sergeant major, whom they consid- ered also as “key” persons.38 One reason that hospital commanders complained about the loss of general serv- ice men was that they encountered per- sonnel-management problems in using civilians, Wacs, and limited service men to replace them.39 As a rule, limited service men assigned to hospitals came either from nonmedical units in the United States or from organizations overseas. Many were not trained for work in hospi- tals and had to be oriented and trained on the job, even in clerical positions. Some felt that they had already contributed their share toward winning the war and wished to be discharged from the Army. Others were psychoneurotic and their job- assignments had to be made with caution. Still others had mental limitations which made it difficult for them to absorb job- training. Many were physically handi- capped and could not do heavy work. These restrictions on the use of limited service men complicated the problem of staffing hospitals.40 Furthermore, the as- signment of such men to hospitals often created morale problems. Under the ASF personnel-control system, each hospital was authorized a specific number of non- commissioned officers. So long as it had that number it could make no promo- tions.41 Many limited service men as- signed to hospitals held noncommissioned- officer grades which they had earned in nonmedical units. They were usually not qualified, either by experience or by train- ing, to hold such grades in hospitals. When required to do work which they considered beneath the dignity of their grades, they became resentful. Moreover, their mere presence prevented the promo- tion of other men who, by reason of quali- fications and jobs held, deserved to be noncommissioned officers. Lack of oppor- tunities for promotion lowered the morale of these men.42 Hospital commanders were powerless to correct this situation, and the Surgeon General’s Office tackled it. Hoping to solve the dual problem of having men with proper job qualifications assigned as replacements and of promoting men who deserved noncommissioned-officer grades, that Office in 1944 prepared tables of or- ganization for zone of interior hospitals, showing job specifications and correspond- ing grades.43 These tables were not pub- lished in 1944. In January 1945, after the problem of grades for enlisted men was made more acute by the proposal to as- sign WAG companies to hospitals,44 Sur- geon General Kirk appealed to the Secre- 38 For example, see remarks of hospital command- ers in the following: (1) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, pp. 204 and 209. HD: 337. (2) An Rpt, 1944, Ashford Gen Hosp. HD. 39 In the middle of 1943 the Army abolished the term “limited service” but continued to classify men as qualified or not qualified for overseas service. Un- officially men not qualified for overseas service con- tinued to be called limited service men. 40 An Rpts, 1944, 2d, 4th, 5th, 7th, and 9th SvC Surgs; An Rpts, 1944, Halloran, Beaumont, Wake- man, Baxter, Baker, Ashford, and Birmingham Gen Hosps and Cps Barkeley, Lee, and Ft Knox Regional Hosps. HD. 41 ASF Cir 39, 11 Jun 43. 42 (1) An Rpt, 1943, 2d SvC Surg; and An Rpts, 1944, Wakeman and Birmingham Gen Hosps. HD. (2) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, p. 190. HD; 337. 43 An Rpt, FY 1944, Enl Pers Br Mil Pers Div SGO. HD. 44 See below, pp. 256-59. STAFFS OF ZONE OF INTERIOR HOSPITALS 255 tary of War to approve the table-of-organ- ization method of manning hospitals in the zone of interior.45 The Secretary ap- proved this proposal in principle, and the Surgeon General’s Office revised the tables it had prepared in 1944.46 During the following six months, the latter at- tempted to have them published. For some reason, perhaps simply red tape, this was not done and the problem of job qualifications and grades remained un- solved in ASF hospitals.47 Replacement of Military by Civilian Employees Although limited service men were au- thorized as replacements for men physi- cally qualified for overseas service, chief emphasis of War Department policy re- garding nonprofessional personnel was on the use of civilians to replace military em- ployees, whether general service men, limited service men, or enlisted women. Beginning in 1943 civilians were used ac- tually to replace enlisted men, rather than to supplement them. Under the ASF per- sonnel-control system established in June of that year, hospitals had personnel ceil- ings which they could not exceed, and as they employed additional civilians they had to release proportionate numbers of enlisted men.48 The War Department’s goal during 1944 and 1945 was to replace military personnel with civilians up to about half the total force.49 This goal — one to which Surgeon General Magee had objected vigorously in the fall of 1940 l0— was approached, though not reached, dur- ing the later war years. In June 1944 ASF station and regional hospitals employed 33,023 enlisted men and women, but only 19,469 civilians, exclusive of registered nurses—a ratio of approximately 17 mili- tary to 10 civilian employees. During the following year civilians replaced en- listed persons at such a rate that in June 1945 such hospitals had 17,673 enlisted men and women and 11,703 civilians— approximately 10 civilians for every 15 enlisted men and women.51 General hos- pitals used civilian employees in greater proportion. In March 1944 the ratio of en- listed to civilian workers in all general hospitals was about 10 to 10.5, for there were 28,060 enlisted men and women and 29,546 civilians employed in those in- stallations. About a year later, when gen- eral hospitals employed 40,659 enlisted and 45,793 civilian workers, the ratio had changed to about 10 enlisted persons to 11 civilians.52 In replacing military with civilian em- ployees, hospitals encountered difficulties, 45 Memo SPMDA 322.05, SG for SecWar, 10 Jan 45, sub; Med Mission Reappraised. HRS: G-4 file, “Hosp, vol. II.” It should be noted that this was a reversal of The Surgeon General’s traditional oppo- sition to staffing zone of interior hospitals according to tables of organization. 46 (1) DF WDGAP 321 Med, ACofS G-l WDGS for ACofS G-4 WDGS, 29 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, “Hosp, vol. II.” (2) Diary, Hosp Div SGO, 3 1 Jan 45. HD: 024.7-3. (3) Quarterly Rpt, 1st Qtr 1945, Enl Pers Br Mil Pers Div SGO. HD. (4) Unsigned Memo for Record, 22 Feb 45. SG: 320.3 “(T/O) Jan-Mar 45.” 47 (1) Memo, Dir Resources Anal Div SGO for Gen Bliss, 20 Jun 45, sub; Pers Guides. HD; Resources Anal Div file, “Hosp.” (2) 2d ind, Dep SG to CG ASF, 14 Jul 45, on basic not located. Same file. 48 ASF Cir 39, 11 Jun 43. 49 Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, pp. 197, 207, and 208; and Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 193-94. HD: 337. 50 See above, pp. 31-32. 51 Tables on basic data and ratios for sta, regional, POW, and conv hosps. Off file, Resources Anal Div SGO. 52 Tables on basic data and ratios for gen hosps. Off file, Resources Anal Div SGO. 256 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR as they had earlier.53 They still had trouble recruiting civilians in sufficient numbers, maintaining stable civilian-personnel forces, and using women and elderly or partially disabled men. They had to hire civilians who were not qualified for jobs they were to hold, and train them after- ward. For example, hospitals in the Fourth Service Command trained civil- ians as apprentice dietitians, dental as- sistants, dental mechanics, laboratory helpers, X-ray technicians, guards, fire- fighters, telephone operators, steamfitters, refrigeration and air-conditioning me- chanics, laundry operators, ward attend- ants, mess attendants, orthopedic shoe mechanics, cooks, and meatcutters. Fur- thermore, particularly in wards, hospital commanders confronted the difficulty of replacing enlisted men who worked twelve hours a day with civilians who worked only eight. Hoping to solve this problem, The Surgeon General asked for replace- ments on a basis of three civilians for two enlisted men. Some service commands followed this practice, but the War De- partment Manpower Board disapproved it and recommended allotments of civilian replacements for enlisted men on a one- for-one basis.54 Hospitals then used split shifts for civilian employees and made other changes in work schedules, in order to have sufficient numbers on duty dur- ing the hours when work was heavy. Other difficulties for hospital commanders resulted from their lack of control over civilians, who often failed to show up for work, refused to work on night shifts, and, because of civil service regulations, could not be moved from one job to another to meet emergency needs. In such instances it was necessary to assign enlisted per- sonnel to fill the vacancies. Finally, hos- pitals began to employ a different type of civilian during the later war years—paid nurses’ aides—who, although not numer- ous, often created morale problems among enlisted Wacs by their mere presence.55 Use of Wacs in Army Hospitals Although the Medical Department had begun to use Wacs56 in hospitals earlier, by the middle of 1943 their number was small in proportion to that of enlisted men and civilians. Apparently WAG headquar- ters could not supply more, for in January 53 See above, pp. 33, 135. This paragraph is based in general upon the following: An Rpts, 1944, Surgs 4th, 5th, 7th, and 9th SvCs, and 1945, 2d and 5th SvCs; and An Rpts, 1944 and 45, Brooke, Halloran, O'Reilly, Ashford, Baker, Birmingham, Wakeman, Baxter, Beaumont, Ashburn, and Battey Gen Hosps and Regional Hosps, Cps Shelby, Polk, Lee and Crowder, Scott and Keesler Fids, and Fts Bragg, Knox, and Meade, all in HD; and Ltr, Capt Luther F. Dunlop, QMG, Hosp Div SGO to HD SGO, 4 Jul 44, sub: Summary of Civ Situation in Sta and Gen Hosps during Past Few Months, in HD: 230.-1 “Civ Pers (Gen).” 54 (1) Memo, WDMB for ACofS G-3 WDGS, 25 Apr 44, sub; Anal of Proposed Strength Tables for Med Instls in ZI. (2) Memo, SG for DepCofSA thru CG ASF, 3 May 44, same sub. (3) Memo WDSMB 323.3 (Hosp), WDMB for CofSA, n d, sub: WD Cir 209, 1944. (4) Memo SPMDM 300.5, SG for ACofS G-l WDGS, 17 Feb 45, same sub. (5) Memo WDGSA 200.3 (3 Mar 45), Asst DepCofSA for ACofS G-l WDGS, 7 Mar 45, same sub. All in AG; 320.2 (18 Apr 44)(1). (6) WD Cir 87, 19 Mar 45. (7) Mins, Gonf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 199. HD: 337. 55 ASF Cir 226, 20 Jul 44. The best discussion avail- able of the employment of civilian nurses’ aides in Army hospitals is in Blanchfield and Standlee, Or- ganized Nursing, pp. 487-89, 492-93, 568. 56 The Women’s Army Corps (WAG) was author- ized by Congress to supersede the WAAG on 1 July 1943. For a general discussion of the use of Wacs by the Medical Department see McMinn and Levin, op. cit., and Mattie E. Treadwell, The Women’s Army Corps (Washington, 1954), Chap XIX, in UNITED STATES ARMY IN WORLD WAR II. STAFFS OF ZONE OF INTERIOR HOSPITALS 257 1944 The Surgeon General’s Hospital Administration Division reported that many unfilled requisitions were on hand.57 As the withdrawal of general service men from zone of interior hospitals and the lack of sufficient nurses to fill authorized quotas increased the need of hospitals for ancil- lary personnel, The Surgeon General ap- proved the use of Wacs and of both volun- tary and paid nurses’ aides. During 1944 and 1945 special recruiting campaigns were conducted both by WAC headquar- ters for additional Wacs and by the Red Cross for civilian nurses’ aides. By the spring of 1945 a surplus of Wacs had been recruited for the Medical Department.58 In order to use all of them, and at the same time to offset the shorter hours which Wacs were by then authorized to work, The Surgeon General requested their allotment to replace enlisted men in a ratio of three Wacs for two men. The Staff refused this request, and some of the Wacs recruited for the Medical Department had to be transferred to other assignments.59 As hospitals began to use more Wacs, a controversy developed over policies gov- erning their employment. Basically, it sprang from the question of whether Wacs were to be considered primarily as women or as enlisted personnel. The director of the Women’s Army Corps placed more emphasis on their sex than on their en- listed status. Interested in their welfare and in the success of recruiting programs, she wanted Wacs to work shorter hours than was customary for enlisted men assigned to ward duties, to be used only as technicians and not as ward orderlies or kitchen workers, and to be given grades commensurate with technical duties per- formed.60 Aware of difficulties which hos- pital commanders encountered in man- rung installations in compliance with War Department policies, The Surgeon Gen- eral wished to give them as much flexibil- ity as possible in the employment of mili- tary personnel. Therefore, he emphasized the enlisted status of Wacs and insisted that they should not be given preferential treatment, just because they were women, in jobs, work-hours, or grades.61 This atti- tude, along with the kind of jobs to which some Wacs in hospitals were assigned, laid the Medical Department open to the accu- sation in the fall of 1944 that it side- stepped recruiting promises.62 In the winter of 1944-45 The Surgeon General almost lost out in the controversy over policies on Wac employment. In December 1944 G-l ruled that Wacs should work the same hours as nurses 57 (1) Tables on basic data and ratios of gen, re- gional, sta, and conv hosps. Off file, Resources Anal Div SGO. (2) Diary, Hosp Admin Div, 25 Jan 44. HD: 024.7-3. 58 (1) Treadwell, op. cit., Gh. XIX, gives from the WAG viewpoint a full discussion of both the recruit- ing of Wacs for, and their use by, the Medical De- partment. (2) Blanchfield and Standlee, Organized Nursing, pp. 489-93, have a discussion of the nurses’ aide recruiting campaign. 59 (1) Ltr, SG to CG ASF attn Dir Mil Pers Div, 23 May 45, sub: Asgmt of MD Enl Pers (WAG). SG: 322.5-1 (WAG) 1945. (2) Ltr, SG to CG ASF attn Dir Mil Pers Div, 23Jun 45, sub: Tng of Enl Pers (WAG). Same file. (3) Quarterly Rpts, 2d and 3d Qtrs (1 Jun and 1 Oct) 1945, Enl Pers Br Mil Pers Div SGO. HD. 60 Ltr WDWAC 720 (29 Jun 44), Dir WAG to CG ASF, 29 Jun 44, sub: WAG Duties on KP Detail and Hosp Orderly Asgmt. AG: 220.3 “WAC(29 Jun 44) (2).” 61 (1) T/S, SG to ACofS G-l WDGS, 31 Oct 44, sub: WAG Pers Asgd to Hosp Duties. AG; 220.3 “WAG (29 Jun 44)(2).” (2) Memo, Dir Tng Div SGO for Chief Prof Admin Serv SGO, 22 Nov 44. HD: 353 “WAG Gen.” 62 (1) T/S SPGAM/322.5 WAC(6 Sep 44)-97, CG ASF to ACofS G-l WDGS, 12 Sep 44, sub: WAG Duties on KP Detail and Hosp Orderly Asgmts. AG: 220.3 “WAC(29 Jun 44)(2).” (2) Blanchfield and Standlee, Organized Nursing, p. 494. 258 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR (normally less than those of enlisted men employed in wards).63 The following month the Chief of Staff, in approving a recruiting program for Wacs for the Medi- cal Department, directed that WAC table- of-organization or table-of-distribution companies should be organized for general hospitals. The table of distribution that was adopted listed only technical jobs, except for company administrative work, and contained no grades lower than that of technician fifth grade (the equivalent of corporal).64 If the wishes of the WAC direc- tor had been followed, all of the Wacs already serving in hospitals under the bulk- allotment system would have been either assigned to these companies or transferred from hospitals. Either action would have deprived hospitals of the use of Wacs as ward orderlies, drivers, clerks, cooks, and bakers. The Surgeon General objected to such an arrangement and the General Staff then agreed that general hospitals might retain some Wacs, without assigning them to table-of-distribution companies, for use in nontechnical jobs.65 After V-J Day WAC companies were disbanded and the Medical Department returned to the former system of employing enlisted wom- en, along with enlisted men, as part of its bulk allotment of military personnel. As hospital commanders employed greater numbers of Wacs, some reported that they could be used in all departments on almost every type of job, but others believed that Wacs could not replace en- listed men on a one-for-one basis in the wards and kitchens of hospitals, where the work was heavy and the hours long.66 To keep enough men in such places for heavy work, the General Staff approved The Surgeon General’s proposal that the num- ber of enlisted women assigned to wards and diet kitchens should not exceed 40 percent of the total enlisted staff.'" While some hospital commanders re- sented limitations upon their authority to select the jobs and set the duty-hours of Wacs, the most common problem in em- ploying them was one of morale. Nurses rarely thought of enlisted women in terms of the nursing service and objected to their assumption of many professional nursing duties.08 Because of misleading recruiting publicity, Wacs came to expect more op- portunities in the nursing care of patients than was warranted, and many were dis- illusioned and disappointed when they found their actual jobs less glamorous than had been depicted.69 Enlisted men re- sented the preferential treatment which Wacs received in the matters of rank and working conditions. Wacs in turn resented 63 DF WDGAP 220.3 WAG, ACofS G-l WDGS to SG thru CG ASF, 26 Dec 44, sub: WAG Pers Asgd to Hosp Duties. AG: 220.3 “WAG (29 Jun)(2).” 64 T/D 8-1037, WAG Hosp Co (ZI), 17 Feb 45. SG: 322.5-1 (WAG) 1945. 65 (1) Mins, Mtg Held in Off of Dir WAG, 9 Mar 45. SG; 322.5-1 (WAG) 1945. (2) Memo, Act Chief Pers Serv SGO for SG, 14 Mar 45, sub: WAG Re- cruiting Program for T/D Co at Named Gen hosps. Same file. (3) Memo, Lt Col E. R. Whitehurst for Dir Tng Div SGO, 18 Jul 45. Same file. (4) Quarter- ly Rpt, 1st and 2d Qtrs, 1945, Enl Pers Br Mil Pers Div SGO. HD. 66 (1) An Rpts, 1944 and 45, Lovell, Wakeman, Baker, Percy Jones, Baxter, Birmingham, Beaumont, Ashford, and Crile Gen Hosps, and Waltham, Ft. Knox, and Cps Polk and Barkeley Regional Hosps; and Quarterly Rpt, 3d Qtr (2 Oct 44) 1944, Enl Pers Br Mil Pers Div SGO. HD. (2) Weekly Summary of Daily Diaries, Hosp and Dom Oprs SGO, 14 Jul 45. HD; 024.7-3. 67 (1) Memo SPMCQ 300.5( WD Cir), SG for Dir Publication Div AGO thru CG ASF and ACofS G-l WDGS, 31 Jan 45, sub: Proposed WD Cir. . . . AG: 220.3 “WAG (29 Jun 44)(2).” (2) WD Cir 7 1, 6 Mar 45. 68 Blanchfield and Standlee, Organized Nursing, pp. 487, 594. 69 Treadwell, op. cit., Ch. XIX, and Blanchfield and Standlee, Organized Nursing, p. 487. STAFFS OF ZONE OF INTERIOR HOSPITALS 259 preferential treatment accorded civilian nurses and nurses’ aides.70 Despite these difficulties, Wacs became valuable and integral parts of hospital staffs by the end of the war.71 Use of Prisoners of War in Army Hospitals A final category of personnel which proved advantageous in the operation of hospitals in the United States was prisoners of war. Hospitals began to use them during 1944 and by the end of the year some gen- eral hospitals employed as many as two or three hundred each. They continued to be used until their repatriation in 1945. Nor- mally, prisoners of war were not used in wards in the care of patients. The most common place for their employment was in kitchens and messes and on buildings and grounds. In some hospitals they served also in warehouses, motor pools, laun- dries, post exchanges, and orthopedic shops. Some prisoners had skilled trades and others were skilled technicians. Hos- pital commanders used them, when desir- able, on jobs for which they had been trained. Generally, prisoners of war seem to have been an industrious, easily man- aged lot, who did their work efficiently and well so long as they were properly supervised.72 The record of the Medical Department’s experience in manning hospitals leads to two conclusions. In the first place, during the earliest part of the war Army hospitals had larger staffs than they actually needed to maintain a satisfactory standard of care, for the Surgeon General’s Office itself was agreeable to some reductions in 1944 when necessity required them. It is a moot point whether or not the reductions required by policies and practices of the War Depart- ment Manpower Board and ASF head- quarters were too great. In the second place, experience showed that hospitals could be operated with a lower ratio of doctors and able-bodied enlisted men to total hospital staffs than had been thought possible. The Surgeon General’s Office resisted the substitution of Medical Ad- ministrative Corps officers for doctors in administrative positions as well as the sub- stitution of civilians, limited service en- listed men, and Wacs for able-bodied enlisted men; but when necessity or direc- tives from higher authority compelled these steps to be taken experience proved that they were not disastrous. This is not to say that the practice of reducing the staffs of hospitals and of sub- stituting personnel of various kinds for able-bodied enlisted men had no adverse effect upon hospital operations. On the contrary, as shown above, changes in per- sonnel created serious problems for hospi- tal commanders. Furthermore, opinion differed about the effect of those changes upon the quality of professional care. Many hospital commanders reported that 70 (1) Draft Ltr, SG to CG ASF, 23 Jul 45, sub: Dis- cipline and Morale of ASF Trps. (2) Memo, Con- sultant Women’s Health and Welfare Unit SGO for Chief Pers Serv SGO, 28 Jul 45, sub: Use of WAG in Army Med Instls. Both in SG: 322.5-1 (WAG). 71 (1) Rpt, Subcmtee on Employment of Mil Med Resources to the Exec Sec, Cmtee on Med and Hosp Serv of the Armed Forces, 25 May 48, p. 542. HD. (2) Memo, Dep Dir Educ and Tng Div SGO for Spec Planning Div SGO, 17 Apr 46, sub: Wacs in Postwar Mil Estab. HD: 353 “WAG Gen.” 72 (1) An Rpts, 1944, Percyjones, Ashford, Baker, Letterman, and Halloran Gen Hosps, and Cp Barke- ley and Ft McClellan Regional Hosps; and An Rpts, 1945, Birmingham, Lovell, Baker, Baxter, and Ash- ford Gen Hosps and Waltham and Gp Shelby Re- gional Hosps. HD. (2) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, p. 192. HD: 337. 260 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR they continued to maintain high stand- ards; but some, as well as certain service command surgeons and indeed the chief of the Surgeon General’s Hospital Divi- sion, believed that medical care suffered as a result of changes in both the quality and quantity of personnel assigned to hospital staffs.73 On the other hand, a group of non- medical officers who investigated com- plaints of the hospital commander at Fort Jackson (South Carolina) during the spring of 1944 believed that many hospital commanders became “panicky” when faced with changes in their staffs and that most of their problems were capable of solution through “determined and efficient personnel management.” 74 Certainly the problems of hospital commanders would have been fewer and the possibility of ad- verse effects upon professional care less if changes eventually made in hospital staffs, as well as measures to improve personnel management in hospitals, had been initi- ated early in the war by the Medical Department itself. 73 (1) See above, pp. 249-59. (2) Interv, MD His- torians with Brig Gen Albert H. Schwichtenberg, 29 Apr 52. HD: 000.71. 74 Proceedings, Bd of Offs Held at Ft Jackson, SC, 1-4 May 44, Pursuant to Verbal Orders CG [ASF]. HRS; SPGA/320.2 Med. CHAPTER XV Improvements in the Internal Organization and Administra- tion of Hospitals in the United States In the latter half of the war, reductions in the staffs of hospitals and changes in their make-up made more imperative than formerly the improvement of hospi- tal organization and administration. It will be recalled that the Wadhams Com- mittee had recommended such action as early as November 1942 and as a result The Surgeon General had brought into his Office in the spring of 1943 an experi- enced hospital administrator, Lt. Col. Basil C. MacLean. In his opinion pre- liminary studies confirmed the need for improvement.1 Moreover, as the Army’s manpower shortage became serious in the fall of 1943, ASF headquarters began a general program for the more efficient use of personnel. Extending to all technical and supply services, including the Medical Department, it comprehended the stand- ardization of organization, the elimination of nonessential activities and records, the simplification of work methods, and the improvement of administrative proce- dures,2 As a part of this program and of efforts to shorten periods of patient-stay in hospitals, the ASF Control Division and the Surgeon General’s Office began work in the fall of 1943 on the simplification and standardization of the disability-dis- charge procedure, already discussed. By the following January, General Somervell informed Surgeon General Kirk that he considered improvement of hospital ad- ministration one of the Medical Depart- ment’s major problems. About a month later, at a service command conference in Dallas, Tex., he directed the chief of the Surgeon General’s Operations Service, Brig. Gen. Raymond W. Bliss, to “under- take to be the lead-off man in a study of 1 (1) Memo, Lt Col Basil C. MacLean, SCO, for Brig Gen Raymond W. Bliss thru Col A[lbert] H. Schwichtenberg, 6 Nov 43, sub: Observations Based on Recent Visits ... to Nine Gen Hosps. Off files, Gen Bliss’ OffSGO, “Util of MCs in ZI” (19)# 1. (2) Memo, MacLean for Bliss thru Schwichtenberg, 2 Feb 44, sub; More Efficient Util of Army Hosp Fac. Off files, Gen Bliss’ Off SGO, “Util of Army Hosp Fac.” 2 History of Control Division, ASF, 1942-45, pp. 31-55, 160-66, 182-83. HD. 262 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR the simplification of this Medical Depart- ment paper-work.” 3 Simplification of Administrative Procedures A basis for the study directed by Gen- eral Somervell was laid during the spring of 1944. Work on the disability-discharge procedure had already demonstrated the value of simplification and standardiza- tion and about a week before the Dallas conference the Surgeon General’s Hospi- tal Division had asked his Control Divi- sion to review hospital administrative procedures generally. The latter Division called for assistance upon the ASF Con- trol Division, which had had experience and which had personnel qualified in such matters. In April 1944 these Divisions, as- sisted by service command control divi- sions, surveyed records and procedures used at Schick, O’Reilly, and Halloran General Hospitals and outlined a broad program for succeeding months. Studies were to be made to simplify hospital organization, hospital admissions, ward administration, fiscal procedures, mess management, hospital statistics, nursing administration procedures, personnel of- fice procedures, information office proce- dures, and hospital dispositions. To pre- vent swamping hospitals with revised but imperfect procedures, the Hospital and Control Divisions of the Surgeon Gen- eral’s Office insisted that each revised procedure should be approved by profes- sional consultants of that Office and tested in selected hospitals before general adop- tion. To avoid unnecessary delays in their use, procedures were to be studied sepa- rately and, when revised and tested, were to be issued as parts of a loose-leaf manual on hospital administration.4 Several difficulties were encountered in carrying out this program. Short of per- sonnel because it had reduced its own staff as an example to others, the Surgeon Gen- eral’s Control Division had only one officer who could devote his full time to that work. The Division also lacked personnel qualified by training and experience to make procedural studies and to draft pro- cedural manuals in the form desired by ASF headquarters. Furthermore, its di- rector was absent on special overseas mis- sions during much of 1944 and work on the program suffered from his absence. To overcome some of these difficulties, the Surgeon General’s Office temporarily bor- rowed personnel from the ASF Control Division, from Army hospitals, and from other installations. Even so, the ASF Con- trol Division considered progress on the program unsatisfactory and threatened, early in 1945, to take over its completion. The Surgeon General prevented such action, but friction between his Office and the ASF Control Division continued.5 As a result of these difficulties, and of delays 3 (1) Memo, Lt Gen Brehon B. Somervell, CG ASF for SG, 18 Jan 44. HRS; Hq ASF Somervell files, “SG 1944.” (2) Mins, ASF Conf of CGs of SvCs, Dallas, Tex., 17-19 Feb 44. HD: 337. 4 (1) Memo, Act Dir Control Div SGO for Dir Con- trol Div ASF, 10 Feb 44, sub: Proposed Study of Admin Procedures and Records Used in Gen Hosps. SG: 323.7-5 (Gen Hosp). (2) Memo, Dep SG for CG ASF attn Dir Control Div ASF, 14 Mar 45, sub: Im- provement of Hosp Admin Procedures. SG: 300.7. (3) History of Control Division, ASF, 1942-45, App, pp. 357-59. HD. 5 (1) Memo, Maj J. B. Joynt, Control Div ASF for Col A. G. Erpf, Control Div ASF, 18 Dec 44, sub: Problems on Hosp Manual. (2) Memo, Col A. G. Erpf, Control Div ASF for Col O. A. Gottschalk, Con- trol Div ASF, 18 Dec 44, sub: Control Div SGO. (3) Memo SPMCQ 300.7, Dep SG for CG ASF attn Dir Control Div ASF, 14 Mar 45, sub: Improvement in Hosp Admin Procedures. (4) Memo, Col A. G. Erpf for Col O. A. Gottschalk, 17 Mar 45. All in HRS: Hq ASF Control Div file, “SGO.” (5) Memo, Act Dir Control Div ASF for Act CofS ASF, 5 Apr 45, sub: INTERNAL ORGANIZATION AND ADMINISTRATION 263 inherent in testing revised procedures be- fore adopting them for general use, only one chapter of the projected manual— that on hospital admissions—-was pub- lished before the peak patient load was reached in the United States. Other re- vised procedures—those for linen control, disability discharges, and disability retire- ments—were published in separate man- uals or circulars before that date. The hospital admissions procedure can be used to illustrate both the manner in which new procedures were developed and the methods used to simplify hospital paper work. The Control Division of the Surgeon General’s Office, in consultation with the Hospital Division, developed a tentative procedure for the admission of patients, and, along with it, the forms to be used. Before these forms were pub- lished, they were approved by the ASF Control Division, the Air Surgeon’s Office, the Surgeon General’s Control, Profes- sional Services, Hospital, and Medical Statistics Divisions, and the Adjutant General’s Methods Management Branch.6 The new procedure was then given a pre- liminary trial in three hospitals—two of the Service Forces and one of the Air Forces.7 After they had commented on its advantages and disadvantages, it was re- vised and published in a tentative manual of hospital procedures.8 Soon afterward, the Surgeon General’s Office called a con- ference in Washington to explain the new procedure to representatives of various hospitals.9 Selected hospitals, serving as pilot installations, then began to use the procedure and to teach representatives from other hospitals how to employ it.10 Finally, early in 1945, the new procedure was published in final form as a chapter of the new manual on hospital adminis- tration (TM 8-262), and by the middle of that year almost all hospitals with as many as ten admissions a day had begun to adopt it.11 While the revised procedure covered in somewhat greater detail than did the old one the various steps taken in the admis- sion of patients, its greatest significance lay in changes in hospital admission rec- ords and their preparation. Two basic forms were prepared for the admission of patients to hospitals: the clinical record brief and the medical report card. In ad- dition, other records such as deposit slips for patients’ funds and locator cards for use by interested groups in hospitals were prepared to meet local needs only. Under 6 (1) Diary, Hosp Div SGO, 12 and 14 Jun 44. HD; 024.7-3. (2) Ltrs, SG to Chief Forms Design and Standardization Sec Methods Management Br Con- trol Div ASF, 13 Jul 44, sub: Revision of MD Form 52 and Revision of WD MD Form 55A. SG: 315. 7 (1) Memo, Capt H. S. Press, SGO for Mr W. A. Archibald, SGO, 30 Jun 44, sub: Progress of Hosp Procedures Simplification Project. SG: 323.7-5 (Gen Hosp). 8 Manual of Hosp Procedures (Tentative), pre- pared by SGO Control Div, 1 Sep 44. HD. 9 Ltr, CO Regional Hosp Cp Swift to GG 8th SvC attn SvC Surg, 1 Oct 44, sub: Rpt of Hosp Admin Procedure Conf Held in Washington, 25 Sep 44. SG; 337.-1. 10 For example, see: An Rpts, 1944, Schick Gen Hosp, and Ft Jackson and Cp Swift Regional Hosps. HD. 11 (1) Memo SPMCQ, 300.7, SG for CG ASF, 14 Mar 45, sub: Improvement in Hosp Admission Pro- cedures. HRS: Hq ASF Control Div file, “SGO.” (2) An Rpt, FY 1945, Control Div SGO. HD. (3) TM 8-262, Admin of Fixed Hosps, ZI, Ch II, Hosp Admissions, 1 Feb 45. Status of Hosp Admin Procedures. SG; 323.3 (Hosp). (6) Memo, CG ASF for SG, 7 Apr 45, same sub. Same file. (7) Memo, SG for Act CofS ASF, 12 Apr 45, same sub. Same file. (8) Memo, Dir Control Div [SGO] for Dir HD [SGO], 23 Jun 45, sub: An Rpt of Control Div for FY 1945. HD; 3 19. l-2-(Control Div, SGO) FY 1945. The reason that Colonel Mac- Lean took little or no part in the development of sim- plified administrative procedures, and left the Sur- geon General’s Office in the fall of 1944, is not clear to the writer. 264 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR the old procedure the two basic forms had to be typed in separate operations, for even though much information was com- mon to them both, such as the patient’s name, rank, serial number, organization, age, race, length of service, etc., those forms were blocked off differently. Other records had to be made up separately also, many by offices needing information found either on the clinical record brief or on the hospital’s daily admission and disposition sheet. Under the revised procedure, all forms containing common information were blocked off alike and a mimeograph duplicator was used to transfer that in- formation to as many copies as needed throughout the hospital. Thus one typing replaced fifteen or twenty under the old system. The chapter on the new admis- sions procedure illustrated each of these forms and gave detailed instructions for their preparation and distribution. In the opinion of the Surgeon General’s Office, the new procedure speeded up the ad- mission of patients, eliminated the du- plication of records, supplied operating units of hospitals with information they had not formerly received, and saved in the hospitals where adopted a total of about 3,333 man-days of work per week.12 Hospital commanders encountered only minor difficulties in installing the new procedure and, with few exceptions, con- sidered it an improvement over the old one.13 As in the development of the admissions procedure which saved work for adminis- trative officers, the Surgeon General’s Office was equally interested in proce- dures that would relieve ward officers of administrative details in order to permit them to devote more time to professional work. One of the procedures developed during 1944, that for the control and dis- tribution of hospital linens, was designed for this purpose. Developed in a manner similar to the hospital admissions proce- dure, the linen control procedure was published in December 1944 in an ASF circular rather than as a chapter of the hospital-administration manual.14 Under the old procedure physicians were charged with the linen used in wards and clinics. In order to avoid being “caught short,” they required ward personnel to count soiled linen as it left the ward and clean linen as it was returned. Furthermore, they required periodic inventories and some tended to hoard linen unnecessarily. Ad- ditional linen-counts were made at inter- mediate storage points and at hospital laundries. Under the new procedure each hospital had a linen officer who was re- sponsible for all linen used. All counts of linen in wards and intermediate stations were eliminated; and linen officers, rather than ward officers, made periodic inven- tories. According to some hospitals, a dis- advantage of this procedure was an excessive loss of linens. This was com- pensated for, in the opinion of the Sur- geon General’s Office and many hospital commanders, by the saving of about 1,250 man-days of work per month and 12 (1) TM 8-262, Admin of Fixed Hosp, ZI, Ch II, Hosp Admissions, 1 Feb 45. (2) An Rpt, FY 1945, Control Div SCO; and An Rpt, FY 1945, Hosp and Dorn Oprs SCO. HD. 13 For example see: An Rpts, 1944, Baxter and Fitzsimons Gen Hosps; An Rpt, 1945, Birmingham Gen Hosp; An Rpts, 1944, Cps Crowder and Swift, and Ft Jackson Regional Hosps; An Rpts, 1945, Cp Wolters and Ft Bragg Regional Hosps. HD. 14 (1) ASF Memo for Record, 11 Nov 44. AG: 427 (11 Nov 44) (2). (2) Ltr SPMCH 300.5 (ASF Cir), SG to AG, 30 Nov 44, sub: Proposed ASF Cir on Linen Control and Distribution Systems. Same file. (3) Rpt of Economies Effected through Procedures Studies Made by or jointly with Control Div ASF, 13 Apr 45. HRS: Flq ASF Control Div file, “Est Admin Savings Resulting from Procedural Revisions.” (4) ASF Cir 395, 2 Dec 44. INTERNAL ORGANIZATION AND ADMINISTRATION 265 tile relief of doctors of administrative de- tails. It was also reported that the new procedure decreased the hoarding of linen and speeded up its distribution to places where needed.15 The use of dictaphones in hospitals was not called for by manuals or circulars, but nevertheless constituted an important change in the method of preparing clinical records. Lack of enough medical stenog- raphers in hospitals, as a result of the civilian labor shortage and of hospital personnel ceilings, made it necessary dur- ing 1943 for doctors themselves to prepare clinical records, sometimes in longhand. To relieve them of such a time-consuming process, hospitals began early in 1944 to acquire dictaphones. At convenient times doctors recorded on these machines con- sultation reports, progress notes, case his- tories, and final summaries. Clerks or- ganized in central pools then transcribed the information recorded. This system of preparing clinical records permitted doc- tors to keep more complete and more legible records and to devote more atten- tion to care of patients. It also contributed to the more efficient use of clerical per- sonnel. Finally, by enabling doctors to keep clinical records up to date it helped to speed the disposition of patients and to shorten their period of hospitalization.16 The simplification of other administra- tive procedures was not completed before the peak patient load was reached, but work on the program continued during the winter of 1944 and the spring of 1945. Beginning in July 1945 chapters in the hospital-administration manual were pub- lished on the following subjects: Patients’ Funds and Valuables (1 July 1945); Hos- pital Organization (1 July 1945); Ward Administration (1 October 1945 and 15 February 1946); Accounting Procedures for Hospital Funds (1 October 1945); Mess Administration (15 November 1945); Personnel Administration (28 De- cember 1945 and 15 February 1946); Clinical Procedures (15 February 1946); and Supply Procedures (1 March 1946).17 Work-Measurement and Work-Simplification Programs Delay in completing the manual on hospital administration did not interfere with the simplification of administrative procedures and work methods by hospitals themselves. As part of its program for efficient personnel utilization, early in 1943 ASF headquarters began to require subordinate installations to set up pro- grams of “work simplification” and “work measurement.” Work simplification was the process of reducing the jobs of indi- vidual workers, or the operations of groups of workers, to their simplest forms and eliminating from them all lost motion. Work measurement was the determina- tion by various standards of the number of employees required for certain jobs or operations.18 During 1944 and 1945 hos- 15 (1) An Rpt, FY 1945, Hosp and Dom Oprs SGO; An Rpts, 1944, Lawson, Thayer, Oliver, and Ash- burn Gen Hosps, and AAF Regional Hosp Keesler Fid; An Rpts, 1945, Birmingham and Lovell Gen Hosps, and Surg 7th SvC. HD. (2) Mins, Hosp Comdrs Conf, 7th SvC, 22 Aug 45. HD: 337. 16 (1) Excerpts from rpts of various hosps on the use of dictaphones, Jun-Jul 44. SG: 413.51. (2) An Rpts, 1944, Ashburn, Deshon, Beaumont, Baxter, and Bir- mingham Gen Hosps, and Regional Hosps at Fts McClellan and Meade, Maxwell and Scott Fids, and Cps Shelby, Barkeley, Swift, and Crowder. HD. 17 (1) TM 8-262, Admin of Fixed Hosps, ZI, dates listed. (2) An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD. 18 (1) History of Control Division, ASF, 1942-45, pp. 160-63; App, pp. 141-44 and 151-53. HD. (2) Memo, GG SOS for Dir Staff Divs, Cs of Sup and Admin Servs, CGs all SvCs, 1 Mar 43, sub: Work Simplification. SG: 024.-1. 304244 0—55 19 266 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR pital control officers appointed as a result of ASF headquarters’ emphasis upon management techniques (or administra- tive engineering) conducted work-meas- urement and work-simplification studies and proposed changes to save time and personnel in a multiplicity of functions and activities.19 For example, a survey of ward attendants’ duties at Walter Reed General Hospital in the spring of 1944 showed that attendants spent 20 percent of their time in off-the-ward errands. To correct that situation a delivery service staffed with twenty people was set up, and forty ward attendants were released.20 Another hospital, Thayer General Hos- pital, made changes in its system of trash collection that saved 200 man-hours per month. At still another Ashford General Hospital, a reallocation of individual duties and a rearrangement of office and desk space in the registrar’s office per- mitted the completion in 1944 of 4,911 more work-units in 9,600 fewer work- hours than in the year before. Seventeen work-measurement and work-simplifica- tion studies made at Newton D. Baker General Hospital during 1944 resulted in the saving of 2,844 man-hours per month. Other hospitals reported similar sav- ings from local changes.21 In this way, hospitals adjusted their operations to performance by reduced staffs and man- agement control became an established function in all large Army hospitals.22 Additional Activities and Their Place in the Organizational Structure of Hospitals In the latter half of the war new pro- fessional and administrative activities were added to Army hospitals. When con- valescent reconditioning was established as an Army program, hospital command- ers placed that activity in a variety of locations in their organizational struc- tures; but by February 1944 the Surgeon General’s Office concluded that recondi- tioning should be considered as a profes- sional service on a par with medical and surgical services. The next month, with the approval of ASF headquarters, the chief of The Surgeon General’s Recondi- tioning Division announced this decision as policy at a conference of reconditioning officers at Schick General Hospital.23 Two other changes occurred in the professional services during 1943 and 1944. Gradually hospitals began to list nursing as a profes- sional rather than an administrative serv- ice and to show neuropsychiatry as an independent service rather than as a sec- tion of the medical service.24 19 In an interview on 20 November 1951 General Kirk stated that he thought too much emphasis had been placed upon the “workload business.” In his opinion workload studies were expensive and “did not pay more than ten cents on the dollar.” HD: 314 (Correspondence MS)V. 20 Work Simplification Rpt, 8 Apr 44, sub: Delivery Serv, Walter Reed Gen Hosp. SG: 323.7-5(Walter Reed GH)K. 21 An Rpts, 1944, Thayer, Ashford, Newton D. Baker, O’Reilly, Kennedy, Baxter, Schick, and Bir- mingham Gen Hosps; An Rpts, 1945, Crile and Bat- tey Gen Hosps. HD. 22 (1) Memo, Dir Control Div SGO for Dir HD SGO, 23 Jun 45, sub: An Rpt of Control Div for FY 1945. HD: 319.1-2 (Control Div, SGO) FY 1945. (2) SG Cir 119, 15 Sep 50, sub: Orgn of US Army Hosps Designated as Class II Instls or Activities, provided for a management office in each Army hospital desig- nated as a Class II installation or activity (that is, gen- eral hospitals operating in 1950 under the direct con- trol of SGO). 23 (1) An Rpts, 1944, Baxter, Finney, Crile, Law- son, Vaughan, and Fletcher Gen Hosps. HD. (2) Ltr, Act SG to CG ASF, 15 Mar 44, sub: Orgn Chart, Re- conditioning Program, with 1st ind, GG ASF to SG, 17 Mar 44.Off file, Physical Med Consultants Div SGO, “Reconditioning, Gen (Policy).” (3) An Rpt, Reconditioning Conf, Schick Gen Hosp, 21-22 Mar 44y p. 17. HD; 353.9 Schick Gen Hosp. 24 See annual reports of hospitals on file in HD. INTERNAL ORGANIZATION AND ADMINISTRATION 267 Additional administrative activities in hospitals came largely as a result of their introduction generally in ASF installa- tions. Revision of the ASF organization manual in December 1943 caused addi- tion of control officers to serve as staff ad- visers on administrative, procedural, and management problems.25 About the same time authority was granted all ASF instal- lations having a strength of 2,000 or more to appoint special services officers to con- duct athletics and recreation programs and orientation officers (later called infor- mation and education officers) to conduct information and education programs.26 In February 1944 ASF headquarters directed the establishment on each of its posts of a personal affairs division to assist soldiers in handling their personal affairs.27 In the following December the War Department directed separation centers and many hos- pitals (those separating from the service one hundred or more persons monthly) to set up classification and counseling units to assist soldiers in planning their return to civilian life.28 General hospitals with few exceptions and regional hospitals in some instances came within the purview of these directives and acted accordingly. These new activities—special services, in- formation and education, personal affairs, and classification and counseling—were to be known later as “welfare services” or as “individual services.” Effect on Hospitals of the ASF Standard Plan for Post Organization The general program of ASF headquar- ters to standardize organization through- out the Service Forces continued, as it had earlier, to influence the organization of general hospitals.29 In December 1943 the standard plan for the organization of ASF posts was revised. At that time a control officer and a post inspector general were added to form, along with the existing public relations officer, the commanding officer’s immediate staff. Furthermore, the seven functional divisions which previ- ously comprised all post activities were replaced by seven administrative and seven technical staff units. To make this change, the erstwhile Administrative Divi- sion, a functional division which had in- cluded the adjutant, judge advocate, and fiscal officer, was abolished and its officials were listed among the seven administra- tive staff units. Certain technical services— quartermaster, ordnance, chemical war- fare, signal, and transportation—were relieved from their former subordination to the Supply Division and were estab- lished as independent technical staff units. Medical and engineer activities, consid- ered as functional divisions under the old plan, now became technical staff units. All welfare activities continued, under the new post plan, to be grouped under the Personnel Division.50 General hospitals attempted to adjust themselves to the new organizational plan for ASF posts as they had to its predeces- sor. In each hospital, professional services and some administrative units peculiar to hospitals, such as the registrar’s office and the dietetics division, had to be added to the units included in the standard ASF plan. In the administrative field, hospitals made adjustments in various ways. Baxter 25 For example, see An Rpts, 1944, Baxter, Wood- row Wilson, Schick, and Mayo Gen Hosp. HD. 26 (1) ASF Cir 127, 20 Nov 43. (2) WD Cir 360, 5 Sep 44. 27 ASF Cir 31, 7 Feb 44. 28 WD Cir 486, 29 Dec 44. 29 See above, p. 123. 30 ASF Manual M 301, Pt IV, Rev 2, 15 Dec 43. Also see above, Chart 13. 268 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR General Hospital, for example, followed the ASF plan carefully, at least in its or- ganization chart, and only added to the post organization a reconditioning divi- sion, a medical supply office, a medical detachment, and a professional division that included the professional services and such administrative units as the registrar’s and dietitian’s offices. Mayo General Hos- pital adhered less strictly to the ASF plan. Although it had most of the officers which that plan called for, it placed many who were supposed to be grouped under an intermediate supervisor, such as special services and personal affairs officers, in a direct relationship with the commanding officer.31 (Chart 12) Hospitals that thus multiplied the number of officers report- ing directly to the commander violated one of the ASF principles of organization, namely, that the number of such officers should be kept as small as possible.32 Sev- eral hospitals on the other hand followed that principle (and incidentally a recom- mendation made by the Wadhams Com- mittee in the fall of 1942) by combining their administrative services under a single director and their professional services under another.33 In February 1945 the commanding officer of Darnall General Hospital suggested that this grouping of professional and administrative services under separate directors, who in turn were responsible to the commanding officer, might be followed with advantage by all other hospitals.34 Two other changes were considered de- sirable to make the ASF post organization applicable to all hosiptals. Officers in the Third Service Command headquarters and in the Surgeon General’s Office, as well as some hospital commanders, be- lieved that technical service officers with only minor functions in hospitals, such as those of the Chemical Warfare Service, Ordnance Department, and Transporta- tion Corps, should be either eliminated or subordinated—as they had been under the previous ASF post organization—to a director of supply.35 Conversely, because officers concerned with the individual welfare of soldiers (special services, per- sonal affairs, information and education, and classification and counseling officers) assumed more importance in hospitals than in other installations, some hospital commanders and service command sur- geons felt that they should be grouped together under a director of individual services rather than under the director of personnel.36 Emergence of Standard Plans for Hospitals Early in May 1944 the Surgeon Gen- eral’s Office announced that it was plan- ning to publish a standard plan for the organization of general hospitals, but its development was delayed because of shortage of personnel in the Control Divi- 31 See annual reports of hospitals named. HD 32 ASF Manual M 301, 15 Aug 44, Pt I, Sec 103.02, sub: Principles of Orgn. 33 (1) An Rpts, 1944, Cp Barkeley and Scott Fid Regional Hosps. HD. (2) 1st ind, CO Staten Island Area Sta Hosp to CG 2d SvC attn SvC Surg, 3 Mar 45, on Ltr, GG 2d SvC (Surg) to CO Staten Island Area Sta Hosp, 24 Feb 45, sub: Orgn Chart. HD: 323 “Hosp Orgn.” 34 Ltr, CO Darnall Gen Hosp to CG 5th SvC attn SvC Surg, 22 Feb 45, sub; Standard Orgn Charts of Gen, Regional, and Sta Hosps, with inch HD: 323 “Hosp Orgn.” 35 (1) Orgn Chart prepared by 3d SvC Hq, [1944]. HD: 323 “Hosp Orgn.” (2) Interv, MD Flistorian with Dr. H. A. Press, formerly of SCO Control Div, 1944-45, 9 Oct 50. HD; 000.71. (3) An Rpts, 1944, Mayo, Valley Forge, Ashburn, and Baker Gen Hosp. HD. 36 Ltrs from 4th and 5th SvC Surgs, and COs of Darnall, Nichols, O’Reilly, and Schick Gen Hosps. HD; 323 “Hosp Orgn.” DIRECTOR 0F| DIETETICS | E E N T UROLOGY VASCULAR SURGERY ORTHOPEDIC SURGERY STORAGE I a ISSUE I SURGICAL SERVICE POST MEDICALl INSPECTOR | VETERINARY OFFICER I MESS * I I | MESS **2. | GENERAL SURGERY PHYSICAL THERAPY NEUROSURGERY ANESTHESIA LEGAL [assistance! PHARMACY HOSPITAL INSPECTOR PERSONAL AFFAIRS |PROVOST I MARSHAL Chart 12—Organization of Mayo General Hospital, 1944 SECURITY 6 INTELLIGENCE POST ENGINEER military: POLICE | OUTPATIENT SERVICE CONTROL OFFICER I ADMISSION Si disposition! EXCHANGE OFFICER | DETACHMENTl OF PATIENTS I PATIENTS I EFFECTS LABORATORY SERVICE COMMANDING OFFICER REGISTRAR [evacuation SECTION [PATIENTS FUND EXECUTIVE OFFICER EDUCATIONAL RECON. INFORMATION 8 EDUCATION SEPARATION CLASSIFICA- TION OFFICER RECONDITIONING SERVICE PLANS a TRAINING PHYSICAL RECON. OCCUPATIONAL THERAPY CIVILIAN PERSONNEL O u Q: z O 2 o ° o a- WAC [detachment] ORDNANCE OFFICER DENTAL SERVICE MILITARY PERSONNEL SPECIAL SERVICES HO. CO. 3613 SCU CADET NURSE TRAINING PUBLIC RELATIONS THEATER CWS OFFICER NURSING SERVICE INVESTIGATING a AUDITING OFFICER U. O o a. F" Q. 03 £cn Q LIBRARY X-RAY SERVICE FINANCE a FISCAL OFFICE MSO LINEN EXCHANGE NEUROLOGY DERMATOLOGY COMMUNICABLE DISEASES POST JUDGE ADVOCATE CHAPLAIN MEDICAL SERVICE Q M ADJUTANT SIGNAL OFFICER POSTAL OFFICER VASCULAR GENERAL MEDICINE CARDIOLOGY 270 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR sion and priority given to procedures for disability discharges and hospital admis- sions.37 Meanwhile, the surgeon of the Fourth Service Command worked out a standard plan for the organization of hos- pitals under his supervision.38 Then, in June and July 1944 the surgeon and the control officer of the Third Service Com- mand, with assistance from the Surgeon General’s Office, developed a standard plan for hospitals in that Command. After it had been tested for about six months, The Surgeon General submitted it for comment in February 1945 to other serv- ice commands. On the basis of their sug- gestions, he made minor changes in the Third Service Command plan and adopted it as standard for general, re- gional, and station hospitals.39 It was pub- lished in July 1945 as a chapter of the manual on hospital administration.40 The Surgeon General’s Office also worked dur- ing this period on the organization of con- valescent hospitals and hospital centers. Tentative plans were published in 1944 and 1945. The final plan for convalescent hospitals was published in December 1945, but that for hospital centers re- mained unpublished because they began to close before it was completed.41 During the movement to standardize hospital organization, the merits of such a step were freely discussed. Hospital com- manders generally and service command surgeons in some instances raised argu- ments against inflexible standardization. One feared that it would crystallize hospi- tal organization, increasing efficiency in the operation of some installations but prohibiting imaginative and capable com- manders from making valuable innova- tions in others.42 Some felt that standard- ization would prevent hospital command- ers from adjusting to local conditions. For example, hospitals giving little outpatient care might not need to establish separate outpatient services. Others believed that commanders needed freedom to fit their organizations to the personalities of offi- cers assigned to them. An eye, ear, nose, and throat specialist of intense individual- ism and higher rank than a chief of surgi- cal service, for instance, could hardly be successfully subordinated, in an EENT section, to the latter.43 On the other hand, there was some feeling that men should be fitted to jobs, not jobs to men, and that the standardization of organization would help to solve problems raised by clashing personalities. The most telling arguments in favor of standardization were that it was the first step toward the simplification and standardization of administrative procedures, that it facilitated the measure- ment of work and of personnel require- 37 (1) Rad, SG to GG 4th SvC attn SvC Surg, 3 Mar 44. SG: 323.7-5(4th SvC)AA. (2) Edward J. Morgan and Donald O. Wagner, The Organization of the Medical Department in the Zone of the Interior (1946), p. 145. HD. (3) Interv, MD Historian with Dr. Press, 9 Oct 50. HD: 000.71. 38 (1) Rad, SG to CG 4th SvC attn SvC Surg, 3 Mar 44. SG: 323.7-5(4th GA)AA. (2) 1st ind, CG 4th SvC (Surg) to SG, 9 Mar 45, on Ltr SPMCH 323.3 (4th SvC)AA, SG to CG 4th SvC attn SvC Surg, 16 Feb 45, sub: Standard Orgn Charts of Gen, Regional, and Sta Hosps. HD: 323 “Hosp Orgn.” 39 (1) Ltr 323.3 (1st SvC)AA, SG to CG 1st SvC attn SvC Surg, 16 Feb 45, sub: Standard Orgn Charts of Gen, Regional, and Sta Hosps. Identical letters were sent to all service commands; these letters, with their replies, are on file in HD: 323 “Hosp Orgn.” (2) Status of Procedures being Developed in SGO, [Apr 45]. HD. 40 TM 8-262, Ch. I, Hosp Orgn, 1 Jul 45. 41 (1) ASF Cirs 419, 22 Dec 44; 135, 16 Apr 45; and 445, 14 Dec 45. (2) Morgan and Wagner, op. cit., p. 162. 42 1st ind, CG 7th SvC (Surg) to SG, 8 Mar 45, on Ltr 323.3 (7th SvC)AA, SG to CG 7th SvC attn SvC Surg, 16 Feb 45, sub: Standard Orgn Charts of Gen, Regional, and Sta Hosps. HD: 323 “Hosp Orgn.” 43 Letters from hospital commanders and service command surgeons expressing these opinions are on file, HD: 323 “Hosp Orgn.” INTERNAL ORGANIZATION AND ADMINISTRATION 271 ments, and that it promoted manpower economy.44 At any rate, both the Surgeon General’s Office and ASF headquarters were committed to standardization of hos- pital organization by the winter of 1944. That they did not insist on inflexibility was demonstrated by a proviso that hospi- tal commanders might deviate from the standard plan if their respective service commanders approved.45 Details of the Medical Department’s Standard Plans The standard plan for the organization of general hospitals, published in July 1945, resembled the ASF plan for post organization and reflected the experience of hospitals in making adjustments to it. In both plans, the commander’s immedi- ate staff included public relations officers, control officers, and inspectors (called in- spectors general on posts and medical inspectors in hospitals). General hospitals, according to the standard plan, were to have six of the seven administrative staff divisions of posts. The seventh, training, was to be subordinated to the personnel division. In addition, they were to have four administrative staff units not called for in the post organization plan. These were the station complement (medical de- tachment), the dietetics division, the vet- erinarian’s office (for food inspection), and the registrar’s office. The plan for hospi- tals had no technical staff divisions as such. Some, such as ordnance and chemi- cal warfare, were eliminated completely; others, such as quartermaster and trans- portation, were subordinated to the sup- ply division; and another, the engineer, was placed on the administrative staff. The welfare services, despite the wishes of hospital commanders, were left subordi- nated to the personnel division. The plan for hospital organization naturally in- cluded professional services. There were nine in general hospitals, including the reconditioning service, the neuropsychi- atric service, and the nursing service. In this field hospital commanders were left with more latitude than in the adminis- trative because, the manual stated, the professional services “function solely in a professional manner and are subject to constant variation by reason of changes in types of patients treated.” The standard plan for regional and station hospitals re- sembled that for general hospitals. The chief differences were that administrative and technical units which existed as parts of post and general hospital organizations were eliminated and the neuropsychiatric service was subordinated, as a section, to the medical service.46 (Chart 13) Publication of the standard plan for the organization of general, regional, and sta- tion hospitals had little appreciable effect upon their organization.47 The chief rea- son, perhaps, was that the plan itself reflected experiences of hospitals in con- forming with ASF directives on organiza- tion.48 Nevertheless it officially sanctioned their conformity and provided them with a detailed statement of the functions of all major units within hospitals. Undoubtedly its value would have been greater if pub- 44 Ltr, SG to CG 1st SvC attn SvG Surg, 16 Feb 45, sub: Standard Orgn Charts of Gen, Regional, and Sta Hosps, with 1st ind and inch HD: 323 “Hosp Orgn.” 45 TM 8-262, Gh. I, Sec I, 1 Jul 45. 46 TM 8-262, Gh. I, 1 Jul 45. 47 Morgan and Wagner, op. cit., pp. 147-51, arrive at this conclusion after examining the data on organ- ization given in the annual reports of 14 general and 19 regional hospitals for 1944 and 1945. 48 Interv, MD Historian with Dr. Press, 9 Oct 50. HD: 000.71. Chart 13—Comparison of Standard Plans for Organization of ASF Posts and ASF General Hospitals, 1945 COMMANDING OFFICER PUBLIC RELATIONS OFFICER EXECUTIVE OFFICER CONTROL OFFICER INSPECTOR GENERAL POST ADJUTANT POST JUDGE ADVOCATE PERSONNEL DIVISION MILITARY TRAINING DIVISION SECURITY a | INTELLIGENCE DIVISION | SUPPLY DIVISION FISCAL DIVISION REGISTRAR STATION COMPLEMENT DIETETICS DIVISION VETERINARIAN MILITARY PERSONNEL CIVILIAN PERSONNEL DETACHMENT OF PATIENTS ADMISSION 8 DISPOSITION BRANCH ARMY EXCHANGE ATHLETICS 8 RECREATION PURCHASES SALVAGE 8 REDISTRIBUTION INFORMATION 8 EDUCATION POST CHAPLAIN PROPERTY PERSONAL AFFAIRS POST ORDNANCE OFFICER POST CHEMICAL WARFARE OFFICER POST SIGNAL OFFICER POST TRANSPORTATION OFFICER POST QUARTER- MASTER POST ENGINEER POST SURGEON OUTPATIENT SERVICE MEDICAL SERVICE DENTAL SERVICE SURGICAL SERVICE X-RAY SERVICE N P SERVICE IreconditioningI 1 SERVICE | NURSING SERVICE lLABORATORY 1 SERVICE STANDARD ORGANIZATION FOR ASF POSTS, PRESCRIBED 15 JUN 45. RETAINED IN STANDARD ORGANIZATION FOR ASF GENERAL HOSPITALS, PRESCRIBED I JUL 45. ADDED TO STANDARD ORGANIZATION FOR ASF GENERAL HOSPITALS. INTERNAL ORGANIZATION AND ADMINISTRATION 273 lished four years earlier, at a time when new hospitals were beginning to open with staccato rapidity.49 The development of standard organiza- tional plans for convalescent hospitals and hospital centers came even later than for general hospitals and was therefore of less value. Having only limited amounts of personnel and no guides for organization, ASF convalescent hospitals were organ- ized by their commanding officers to fit individual circumstances. Consequently they differed from one another in many respects. Convalescent hospitals that were separate installations attempted generally to organize administrative activities ac- cording to the standard ASF post plan.50 Those that operated in conjunction with general hospitals depended upon the lat- ter for some administrative services and organized for the rest as the personnel assigned to them permitted.51 Gradually a common feature began to emerge. It was the establishment of a reconditioning sec- tion and the grouping of patients into companies, battalions, and/or regiments for administration and supervision.52 In the winter of 1944, when additional em- phasis was placed upon the convalescent program, the Surgeon General’s Office developed and published a guide 53 which left the organization of administrative activities of convalescent hospitals almost entirely to the discretion of their com- manders. The result was that, as they re- ceived more patients and operating per- sonnel, some set up administrative offices that duplicated, or at least paralleled, those of the general hospitals located near by 54 Xhe guide showed in more detail the organization of convalescent activities. They were to be grouped in three divi- sions; a receiving division, an infirmary division, and a reconditioning division. The infirmary division was not to be estab- lished in convalescent hospitals located near general hospitals. The reconditioning division was to have a twofold function; it was to exercise command over patients who were to be organized in three battal- ions (neuropsychiatric, primary recondi- tioning, and advanced reconditioning), and it was to conduct the convalescent training program. This program was to include occupational therapy, physical re- conditioning, educational reconditioning, and classification and counseling. The plan served as a guide to convalescent hospitals that remained separate installa- tions during 1945, and it was used to some extent, particularly for the organization of convalescent activities, by those that be- came parts of hospital centers in the spring of that year. That hospitals considered it as a guide only is indicated by differences 49 The plan of 1945 for general hospitals remained in force for five years. The Surgeon General’s Office then published, on 15 September 1950, a new stand- ard plan for their organization. It is of interest that this plan called for fewer major units within a hos- pital and charged two officers, the executive officer and the deputy commanding officer, with the co-or- dination, if not the supervision, of the administrative and professional services respectively. SG Cir 119, 15 Sep 50, sub: Orgn of US Army Hosps Designated as Class II Instls or Activities. 50 An Rpts, 1944, Mitchell Conv Hosp and Surg 4th SvC. HD. 51 (1) An Rpts, 1944, Madigan and Percy Jones Gen and Conv Hosps. HD. (2) An Rpts, 1945, Brooke and Wakeman Hosp Ctrs, have reference to 1944 orgn. HD. 52 An Rpts, 1944, Wakeman and Lovell Gen and Conv Hosps, and Cp Carson Conv Hosp. HD. 53 ASF Cir 419, 22 Dec 44, Pt II, Conv Hosp—Re- vised Program. 54 An Rpts, 1945, Percy Jones, Wakeman, and Cps Butner and Carson Hosp Ctrs. HD. These reports have discussions of organization of convalescent and general hospitals before they were combined to form centers. Chart 14—Standard Plan for Organization of ASF Convalescent Hospitals, 1945 U S, EMPLOYMENT SERVICE RED CROSS VETERANS ADMINISTRATION U,S. CIVIL SERV. COM. SELECTIVE SERVICE COMMANDING OFFICER EXECUTIVE OFFICER MEDICAL INSPECTOR CONTROL OFFICER PUBLIC RELATIONS OFFICER ADJUTANT JUDGE ADVOCATE FISCAL DIVISION STATION COMPLE- MENT personnel! DIVISION I AUTHOR- IZATION OFFICER DIETETICS DIVISION SUPPLY DIVISION VETERI- NARIAN engineer! SECURITY 8 INTELLIGENCE DIVISION REGISTRAR! POSTAL BRANCH AUDIT BRANCH PERSONAL AFFAIRS BRANCH PURCHASES BRANCH MANAGEMENT BRANCH DETACHMENT OF PATIENTS OFFICE SERVICE BRANCH BUDGET 8 ACCOUNTS BRANCH INFORMATION 8 EDUCATION BRANCH SALVAGE 8 REDISTRIBUTION BRANCH FIRE PREVENTION BRANCH ADMISSION 8 DISPOSITION BRANCH PUBLICATIONS BRANCH SPECIAL FINAN- CIAL SERVICES BRANCH MILITARY PERSONNEL BRANCH QUARTERMASTER BRANCH MAINTENANCE 8 REPAIR BRANCH RECEIPTS 8 DISBURSEMENTS BRANCH CIVILLIAN PERSONNEL BRANCH SIGNAL BRANCH UTILITIES BRANCH SPECIAL SERVICES BRANCH PROPERTY BRANCH CHAPLAINS BRANCH TRAINING BRANCH TRANSPORTATION BRANCH RECEIVING 8 DISPOSITION DIVISION INFIRMARY DIVISION RECEIVING COMPANY DISPOSITION COMPANY MEDICAL SERVICE SURGICAL SERVICE DENTAL SERVICE RECONDITIONING SERVICE FIRST CONVALESCENT REGIMENT (N.R) SECOND CONVALESCENT REGIMENT (MED) THIRD CONVALESCENT REGIMENT(SURG-) OFFICER PATIENTS COMPANY PHYSICAL RECONDITIONING SECTION 1st BATTALION I St BATTALION 2d BATTALION 1st BATTALION EDUCATIONAL RECONDITIONING SECTION 2d BATTALION 3d BATTALION 4 th BATTALION 2d BATTALION OCCUPATIONAL THERAPY SECTION 3d BATTALION 3d BATTALION CLASSIFICATION S COUNSELING SECTION 4th BATTALION 4th BATTALION INTERNAL ORGANIZATION AND ADMINISTRATION 275 that continued to exist in the organization of different installations.55 At the end of 1945 a second plan for the organization of convalescent hospitals was developed by the Surgeon General’s Office and published by ASF headquarters.56 A combination of the old plan for convales- cent hospitals and the new standard plan for general hospitals, it showed the admin- istrative organization of convalescent hos- pitals in more detail than did the old one. The immediate staff of the commanding officer and the administrative staff units of convalescent hospitals were to be essen- tially the same as those prescribed for gen- eral hospitals. The convalescent services were to be similar to those called for by the 1944 guide for convalescent hospitals. The most important change was the sepa- ration of the reconditioning, or convales- cent training, program from the adminis- tration of companies of patients. The chief of the reconditioning service was to have charge of the former, while the hospital commander was to supervise directly the commanders of the 1st convalescent regi- ment (neuropsychiatric), 2d convalescent regiment (medical), and 3d convalescent regiment (surgical). Publication of this plan after convalescent hospitals had already begun to close undoubtedly lim- ited its effect upon the organization of such installations. (Chart 14) The establishment of hospital centers in the spring of 1945 was expected to elimi- nate duplication of administrative activi- ties involved in the operation at the same location of both convalescent and general hospitals. The Surgeon General’s Office expected that administrative functions common to both would be centralized under center headquarters, but a guide for the organization of hospital centers published in April 1945 was sufficiently general to leave to local commanders the decision as to how much centralization there would be.57 For that reason, and be- cause of differences among hospital cen- ters—some being located on posts with other activities and some constituting posts in themselves—centers varied in organiza- tion from one to another.58 Two extremes were represented by the Percy Jones Hos- pital Center and the Wakeman Hospital Center. (Chart 15) The former, a post it- self, had operating as well as supervisory functions, and administrative activities common to both the general and conva- lescent hospitals assigned to it were per- formed by center headquarters.59 Wake- man, on the other hand, was located on a post with other Army activities that were nonmedical in character. Post headquar- ters furnished some administrative services for both the general and convalescent hos- pitals; each hospital performed the others itself; and center headquarters served in a supervisory, not an operational, capacity.60 In the hope of achieving a measure of uniformity in the organization of hospital centers, the Surgeon General’s Office in July 1945 sent out the Percy Jones plan for comment by hospital center commanders 55 (1) An Rpts, 1945, Welch and Cp Upton Conv Hosps. HD. (2) Orgn and Functional Charts, Percy Jones Hosp Ctr, 24 Apr 45; Orgn and Functional Charts, Brooke Hosp Ctr, 16 Aug 45; Orgn and Func- tions, Cp Edwards, Mass, Embracing the Post and the Hosp Ctr, 20 Aug 45; Orgn and Functional Man- ual, Cp Carson Hosp Ctr, 31 Jul 45. HD: 323 “Hosp Orgn.” 56 ASF Cir 445, 14 Dec 45, Pt II—Conv Hosp — Revised Program. 57 (1) See above, pp. 198-99. (2) WD Cir 105, 4 Apr 45. (3) ASF Cir 135, 16 Apr 45. 58 Morgan and Wagner, op. cit., pp. 163-64. 59 An Rpt, 1945, Percy Jones Hosp Ctr. HD. 6H 2d ind, CO Wakeman Hosp Ctr to CG 5th SvC attn SvC Surg, 18 Jul 45, and 3d ind, Surg 5th SvC to SG, 9 Aug 45, on Ltr, SG to CG 5th SvC attn SvC Surg, 9 July 45, sub: Standard Orgn Charts for Hosps. SG: 323.3(5th SvC)AA. Chart IS—Organization of Percy Jones Hospital Center, 1945 POST INSPECTOR COMMANDING GENERAL EXECUTIVE OFFICER CONTROL OFFICER PUBLIC RELATIONS OFFICER DIRECTOR OF PERSONNEL SECURITY AND INTELLIGENCE DIVISION DIRECTOR OF INDIVIDUAL SERVICES HEADQUARTERS COMMANDANT DIRECTOR OF TRAINING DIRECTOR OF SUPPLY MILITARY PERSONNEL PERSONNEL a RECORDS BRANCH INTELLIGENCE BRANCH LEGAL ASSISTANCE BRANCH HQ a HO CO PJ H C MILITARY TRAINING BRANCH PROVOST MARSHAL BRANCH ho a sv co PJCH MEDICAL DEPT SCHOOLS PERSONNEL CONTROL BRANCH SAFETY BRANCH SPECIAL SERVICES BRANCH 25th WAC HOSP. CO INFORMATION AND EDUCATION BRANCH RECEIVING AND DISCHARGE COMPANY CHAPLAIN 56th WAC HOSP. CO CIVILIAN PERSONNEL BRANCH PERSONAL AFFAIRS BRANCH 109th WAC HOSP. CO ADDRESSOGRAPH UNIT SOLDIERS SAVINGS PROGRAM OFFICER HQ B SV CO PJ C H 3 47™ ASF BAND FISCAL DIRECTOR POST JUDGE ADVOCATE POST ADJUTANT 4 5 4th ASF BAND DISBURSING OFFICER POSTAL OFFICER WAC DET DIRECTOR OF DIETETICS REGISTRAR POST ENGINEER POST QUARTERMASTER POST MEDICAL SUPPLY OFFICER POST SIGNAL OFFICER POST ORDNANCE OFFICER POST TRANSPORTATION OFFICER POST SURGEON CHIEF OF DENTAL SERVICES DIRECTOR OF PROFESSIONAL SERVICES POST CHEMICAL WARFARE OFFICER POST VETERINARIAN MEDICAL INSPECTION BRANCH ADMINISTRATIVE SERVICE CONVALESCENT HOSPITAL W K KELLOGG ANNEX GENERAL HOSPITAL WITH ANNEX RECONDITIONING SERVICE OFFICERS BN ADMINISTRATIVE SERVICE FIRST REGIMENT SECOND REGIMENT RECONDITIONING SERVICE MEDICAL SERVICE A ISt BN BN 3<* BN A B |8t BN 2d BN 3d BN MEDICAL SERVICE NEUROPSYCHIATRIC SERVICE T 4th BN 5th BN c 4*’’ BN 5th BN NURSING SERVICE SURGICAL SERVICE C 0 SURGICAL SERVICE DENTAL SERVICE D E DENTAL SERVICE Chart 16—Standard Plan for Organization of a Hospital Center (ZI), 1945 RED CROSS U.S.EMPL.SERV. VET. ADMIN. U.S.CIVIL SERV. SEL.SERV. COMMANDING OFFICER EXECUTIVE OFFICER MEDICAL INSPECTOR CONTROL OFFICER PUBLIC RELATIONS OFFICER DIRECTOR OF DENTAL SERVICE DIRECTOR OF PROFESSIONAL SERVICES DIRECTOR OF NURSING SERVICE RECONDITIONING COUNCIL DIETETICS DIVISION SEC. 8 INTELL. DIVISION STATION COMPLEMENT JUDGE ADVOCATE VETERINARIAN ADJUTANT SUPPLY DIVISION FISCAL DIVISION PERSONNEL DIVISION REGISTRAR ENGINEER OFFICE SERVICE BRANCH PURCHASES BRANCH SIGNAL BRANCH BUDGET a ACCOUNTS BRANCH UTILITIES BRANCH MILITARY PERSONNEL BRANCH CIVILIAN PERSONNEL BRANCH CUSTODIAN PATIENTS FUND INFORMA - TION BRANCH TRANSPOR- TATION BRANCH QUARTER- MASTER BRANCH AUDIT BRANCH MANAGE- MENT BRANCH PERSONNEL CONTROL BRANCH TRAINING BRANCH DETACHMENT OF PATIENTS POSTAL BRANCH LINEN SUPPLY BRANCH PROPERTY BRANCH RECEIPT a DISBURSE- MENTS BRANCH FIRE PREVENTION BRANCH CHAPLAINS BRANCH PERSONAL AFFAIRS BRANCH ADMISSION 8 DISPOSITION ' BRANCH PUBLICATION BRANCH SALVAGE 8 REOISTRI - BUTION BRANCH SPECIAL FINANCIAL SERVICES BRANCH MAINTENANCE 8 REPAIR BRANCH INFORMA- TION a EDUCATION BRANCH SPECIAL SERVICES BRANCH GENERAL HOSPITAL CONVALESCENT HOSPITAL 278 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR and service command surgeons.61 Follow- ing receipt of their replies, that Office by the beginning of 1946 developed a stand- ard plan for the organization of hospital centers. Although never published, it was significant because it represented The Surgeon General’s idea of what the organ- ization of a hospital center should be. Of prime importance was the fact that center headquarters was to be operational and was to perform for general and convales- cent hospitals the administrative services that were common to both. Hence, the center commander’s immediate staff and the administrative staff divisions of hospi- tal centers were to be essentially the same as those found in both general and con- valescent hospital organization charts. To assist a center commander in supervising and co-ordinating the professional activi- ties of hospitals under his control, his immediate staff was to contain a director of dental services, a director of professional services, and a director of nursing services. General and convalescent hospitals, minus the staff and administrative divisions of center headquarters, were to be under separate commanders, each of whom re- ported directly to the center commander and had an administrative assistant to provide the few administrative activities that could not be concentrated under center headquarters.62 (See Charts 15, 16.) A significant feature of the hospital organization plans just discussed was their attempted conformity with the standard plan for the organization of ASF posts. While there were perhaps enough similar- ities between the functions of posts and those of hospitals to warrant such con- formity, one may question whether it was altogether desirable or would have been required if standard plans emphasizing the peculiar functions of medical installa- tions had been issued earlier. Certainly the Medical Department would have benefited from having such plans avail- able when the hospital expansion program first began. Moreover, they would have made easier the task of simplifying and standardizing hospital administrative pro- cedures. While accomplishments in this field were substantial, it was unfortunate that they came so late in the war. Offset- ting this delay, perhaps, was the fact that management control became an estab- lished function in all large Army hospitals by the end of the war. 61 For example, see: Ltr, SG to CG 9th SvC attn SvC Surg, 9 Jul 45, sub: Standard Orgn Charts for Hosps. SG; 323.3 (9th SvC)AA. Similar letters were sent to other service commands. 62 Morgan and Wagner, op. cit., pp, 156-64. CHAPTER XVI Changes in the Organization and Equipment of Hospital Units Prepared for Overseas Service Since hospitals operating in overseas theaters were less subject to The Surgeon General’s authority than those in the zone of interior, they were largely unaffected by the movement, discussed in the fore- going chapter, to standardize organiza- tion and simplify administrative proce- dures. Nevertheless, certain changes in their organization and equipment were made before they left the United States. Changes in organization were primarily of two types: the creation of units that would supply larger numbers of beds without corresponding increases in per- sonnel and the reduction of personnel authorized for hospitals of different types. Trend Toward Use of Larger Units One method of supplying greater num- bers of beds to theaters without propor- tionately increasing the number of per- sonnel was to emphasize the use of larger hospital units.1 Tables of organization for various sizes of station hospitals, ranging in capacity to 900 beds, had been devel- oped during the early war years; but until the middle of 1944 a general hospital of only one size (1,000-bed capacity) was authorized. During the winter of 1943-44 the Technical Division of the Surgeon General’s Office developed tables of or- ganization, published in July 1944, for 1,500- and 2,000-bed general hospitals.2 Another method of supplying more beds with limited amounts of personnel—the use of convalescent facilities to receive the convalescent patients of general hospi- tals—was employed successfully in the United States and needed to be extended, in the opinion of the Surgeon General’s Office, to theaters of operations. Tables of organization for 1,000-bed convalescent camps and 3,000-bed convalescent cen- ters were developed, but the General Staff would not include such units in the troop basis without requests from theaters. The latter were reluctant to requisition them because their capacities counted against fixed-bed quotas while their staffs were meager as compared to those of general 1 See above, pp. 218-19. 2 (1) T/O&E 8-550, Gen Hosp, 3 Jul 44. (2) An Rpt, Tec Div Oprs Serv SGO, FY 1945. HD. 280 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR hospitals with equal numbers of beds.3 As a result, such units were not used widely, only four of each being activated in thea- ters and none in the United States. In- stead, theaters requisitioned station and general hospital units to meet authorized quotas of beds and established convales- cent facilities with personnel available from other sources.4 Cuts in Personnel of Hospital Units As in zone of interior hospitals, reduc- tions were made in the staffs of numbered hospitals. In compliance with a G-l di- rective, the Surgeon General’s Office in March 1944 reduced the ratio of nurses in station and general hospital units from 1 for every 9 or 10 beds to 1 for every 12. Thus the number authorized for a 1,000- bed general hospital was lowered from 105 to 83 and for a 750-bed station hospi- tal from 75 to 63.5 Also in March, in con- sonance with the general policy of replac- ing physicians with administrative officers wherever possible, a War Department cir- cular directed that both the executive of- ficers and registrars of station and general hospitals should be Medical Administra- tive Corps officers. The Surgeon General protested that executive officers, who served as commanding officers in the ab- sence of their superiors, needed profes- sional training in medicine, and subse- quently the General Staff amended the announced policy to permit Medical Corps officers to continue serving as exec- utive officers of general hospitals.6 Mean- while, the Surgeon General’s Office was revising the tables of organization of both station and general hospitals, in order to reduce the number of Medical Corps offi- cers and to increase the number of Med- ical Administrative Corps officers author- ized for such units.7 In July 1944 the num- ber of physicians in a 1,000-bed general hospital was reduced from 37 to 32. Three months later the number of Medical Corps officers in station hospitals was also reduced, that for a 250-bed station hospi- tal, for example, dropping from 13 to 10 and for a 750-bed station hospital from 23 to 20. At the same time, the number of Medical Administrative Corps officers assigned to these units was increased, the number in a 1,000-bed general hospital rising from 7 to 10 and in a 750-bed sta- tion hospital from 10 to 12.8 No significant 3 (1) Memo, SG for Dir Mil Pers Div ASF, 4 Aug 43, sub: Conv Cps. SG; 322.15-1. (2) T/O&E 8-595, Conv Cps (1,000-bed), 12 Jun 44. (3) T/O&E 8-59IT, Conv Ctr (3,000-bed), 12 Jun 44. (4) Interv MD Historian with Col Arthur B. Welsh, 27 Dec 50. HD: 000.7 1. (5) Telewriter conv between Surg ETO and SG, 22 Oct 43. SG: 337.-1. 4 An Rpt, MOOD SGO, FY 1945. HD. 5 (1) DF WDGAP 320.21, ACofS G-l WDGS to MPD ASF and SG, 8 Jan 44, sub; Nurse Pers Reqmts. HD: 211 (Nurse Reqmts). (2) T/O 8-550, Gen Hosp, C 3, 4 Mar 44. (3) T/O 8-560, Sta Hosp, C 3, 4 Mar 44. 6 (1) WD Cirs 99, 9 Mar; 122, 28 Mar; and 152, 17 Apr 44. (2) Memo WDGCT 320.3 (11 Mar 44), ACofS G-3 WDGS for CG ASF, 25 Mar 44, sub: T/O&E 8-500 and T/O&E 8-550, with 4 inds. SG: 320.3-1. 7 Ltr, SG to CG ASF, 17 Mar 44, sub: Revision of T/O&E 8-560, Sta FIosp, and Revision of T/O&E 8-550, Gen Hosp. SG: 320.3-1. 8 (1) T/O 8-550, Gen Hosp, 1 Apr 42; C-2, 5 Oct 42; and T/O&E 8-550, Gen Hosp, 3 Jul 44. (2) T/O 8-560, Sta Hosp, 22 Jul 42, and T/O&E 8-560, Sta Hosp, 28 Oct 44. In 1948 the wartime chief of the Surgeon General’s Mobilization and Overseas Opera- tions Division stated that these cuts of Medical Corps officers had been too great. (Ltr, Col Arthur B. Welsh, MG, USA, 19 Apr 48, quoted in Rpt, Sub- cmtee on Employment of Med Resources, “Use of Med Resources,” Cmtee on Med and Hosp Serv of Armed Forces, Off SecDef, 25 May 48. HD.) Several years later the number of Medical Corps officers in a 1,000-bed general hospital unit was further reduced to 28. (T/O&E 8-551, Gen Hosp, 3 Jul 50.) This final cut in physicians in general hospital units after the war represented a reduction of over 50 percent in the number of doctors authorized for a 1,000-bed general hospital in 1940. HOSPITAL UNITS PREPARED FOR OVERSEAS SERVICE 281 reductions were made in the latter half of the war in the number of Medical Corps officers or nurses authorized for evacua- tion hospitals.9 In the spring of 1944 the General Staff directed reductions in the number of en- listed men in hospital units, as well as in those of units of other technical services.10 The Technical Division of the Surgeon General’s Office complied with this direc- tive by reducing in the table of organiza- tion of general hospitals the number of men who performed housekeeping func- tions. It overcompensated for that reduc- tion by providing for the attachment to hospitals of personnel from other technical services.11 This meant that the number of enlisted men authorized for assignment to a 1,000-bed general hospital was reduced from 500 to 450, but that additional men could be supplied by attaching teams from nonmedical services, such as a Signal Corps team to operate communications systems and a Military Police team to sup- ply interior and exterior guards.12 Subse- quently, in the fall of 1944 cuts were made also in the number of enlisted men au- thorized for station hospital units but, as in the case of general hospitals, provision was made for the attachment of teams of men from other technical services.13 While this change did not necessarily mean that the total number of men working in and around a hospital plant was always re- duced, it actually had that effect in many instances because some theater com- manders did not approve the use of the teams authorized by the War Department and desired by theater surgeons. As a re- sult, the change was unpopular with many Medical Department officers, espe- cially those in theaters who wished the personnel needed to perform station serv- ices for hospitals to be organic elements of hospital units and not dependent upon decisions and actions of theater staff offi- cers. In this connection, it is significant that the chief complaint which theater Medical Department officers made about cuts in both enlisted and commissioned personnel in hospital units was not that they would endanger the care of patients but that they would reduce the ability of hospitals to expand beyond table-of-or- ganization capacities.14 Another change designed to save per- sonnel was made in the organization of the hospital-center unit. This unit, in- tended to operate a 1,000-bed convales- cent camp and to perform certain admin- istrative services common to all hospitals in a center, was authorized 29 officers, 4 warrant officers, 1 nurse, and 255 enlisted “Compare T/O&E 8-581, Evac Hosp, Semimo- bile, dated 26 Jul 43 with that dated 25 Mar 44, and T/O 8-580, Evac Hosp, 23 Apr 43, with T/O&E 8-580, Evac Hosp, 31 Jan 45. 10 Memo, Dir Tec Div SCO for Chief Oprs Serv SCO, 17 Apr 44, sub: T/O&E 8-550, Gen Hosp. SG: 320.3-1. 11 Memo, Dir Tec Div SGO for SG thru Chief Oprs Serv, 20 Apr 44, with inch SG: 320.3-1. 12 (1) T/O 8-550, Gen Hosp, C 4, f6 May 44. (2) WD Gir 256, 16 Oct 43. 13 Ltr, SG to CG ASF, 21 Jul 44, sub: Revision to T/O&E 8-550, Sta Hosp. SG: 320.3-1. Compare T/O&E 8-560, Sta Hosp, 28 Oct 44, with T/O 8-560, Sta Hosp, 22 Jul 42. 14 (1) Memo, Off Chief Surg Hq ETO for SG, 14 Jul 44, sub: Difficulties Presently Being Encountered in the Med Serv, ETO. HD: MOOD “ETO.” (2) Memo, Dep Chief Plans and Oprs SGO for Dir Tec Div SGO, 21 Sep 44, with routing slip. SG: 320.3-1. (3) Ltr AG 320.3(14 Aug 44) OP-I-WDGCT-M, TAG to COs and CGs in TofOpns, 28 Nov 44, sub: Revised T/O&E 8-560, Sta Hosp. SG: 320.3-1. (4) Memo, Plans and Oprs MTO for Maj Gen [Morrison C.] Stayer, 25 Dec 44, sub: Memo for Dir Hosp Div SGO, 31 Oct 44, with inch SG: 320.3 “T/Os Apr- Jun 45.” (5) Memo, Dep Dir MOOD SGO for Insp Br SGO, 14 Aug 45, sub: Comments on Rpt by Col [Floyd L.] Wergeland and Lt Col Moorhead ref their visit to SWPA and POA. HD: MOOD “Pacific.” (6) Rpt, Gen Bd USFET, “Orgn and Equip of Med Units,” Study No 89. HD: 334 (ETO). 304244 0—55 20 282 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR men until the early part of 1944.15 During that year the belief developed that no sav- ing in personnel was gained by concen- trating hospitals and then providing them with increased overhead personnel.16 Fur- thermore, separate tables of organization had been developed for convalescent camps and convalescent centers. The old table of organization for hospital centers, in consequence, was superseded in April 1944 and a hospital center headquarters, consisting of 7 officers, 1 warrant officer, 1 nurse, and 23 enlisted men, was author- ized.17 This headquarters was not ex- pected to operate a convalescent camp and it was to borrow any additional per- sonnel it needed for the performance of its functions from general hospitals located in the center. Only two of the hospital centers activated under the old table of organization were sent overseas. The other eight were inactivated and their personnel used in units of other types.18 Toward the end of the war, six hospital center headquarters were activated under the new table of organization in the Southwest Pacific and sixteen in the Euro- pean theater.19 New Hospital Units Although emphasis in the latter half of the war was less upon the development of new hospital units than upon the use — through improvisation, if necessary—of Medical Department units already avail- able, two new hospital units were devel- oped and a third was proposed. In response to a request from the chief sur- geon of the European theater for a hospi- tal that would specialize in the treatment of neuropsychiatric cases, the Surgeon General’s Office developed a table of or- ganization in the latter half of 1943 for a neuropsychiatric general hospital. It was published in October.20 The second hospi- tal developed was for use in forward areas. In the absence of small surgical hospitals that were highly mobile, the need to treat and hold near the front lines nontrans- portable casualties (those who could not be moved immediately without danger to their lives) was met throughout most of the war by improvisation. During 1945 the Ground Surgeon and surgeons of some forces in combat zones proposed publica- tion of a table of organization for a unit to meet this need. The Surgeon General op- posed this development, believing that the reinforcement of available units—such as platoons of held hospitals—with surgical teams met the need adequately and at the same time promoted flexibility in the use of scarce categories of officers. The former view finally prevailed and on 23 August 1945 a table of organization for a 60-bed mobile army surgical hospital was pub- lished.21 The third hospital, proposed but not developed, was also intended for use 15 T/O 8-540, Hosp Ctr, 1 Apr 42. 16 Speech, Med Hosp, Evac, and Sanitation, by Maj John S. Poe, MC, SGO, 11 Feb 44. HD: 322 (Hosp). 17 T/O&E 8-500, MD Serv Orgn, 23 Apr 44. 18 The 12th and 15th Hospital Centers were shipped to the European theater; the 9th, 10th, 11th, 16th, 17th, 18th, 19th, and 24th were inactivated. An Rpts. HD. 19 (1) Quarterly Rpts, 1945, 26th, 27th, 28th, 29th, 30th, and 31st Hosp Gtrs. HD. (2) An Rpts, 1945, 801st, 802d, 803d, 804th, 805th, 806th, 807th, 808th, 809th, 812th, 813th, 814th, 815th, 818th, 819th, and 820th Hosp Gtrs. HD. 20 (1) Telewriter conv, Surg ETO and SGO, 9 Aug and 22 Oct 43. SG: 337.-1. (2) Memo, CG ASF for AG, 26 Oct 43, sub: T/O&E 8-550S, Gen Hosp (1,000-bed) NP, ComZ, with Memo for Record. AG: 320.2 (13 Jul 43)(4). (3) T/O&E 8-550S, Gen Hosp, NP, 26 Oct 43. 21 (1) Memo, Lt Col C[lifton] F. Von Kann for AGofS G-4 WDGS, 11 Aug 45, sub: Conf Rpt, Pro- posed Mobile Army Surg Hosp, T/O&E 8-571. HRS; G-4 files, “Hosp, vol. IV.” (2) T/O&E 8-571, Mobile Army Surg Hosp, 23 Aug 45. Additional documents on this subject are on file in SG: 320.3. HOSPITAL UNITS PREPARED FOR OVERSEAS SERVICE 283 in forward areas. Both in theaters of oper- ations and in the Surgeon General’s Office there was a belief that a small hospital was needed near the front lines to treat neuropsychiatric casualties who could be salvaged for further duty. A table of organization for such a unit was never published and theaters met this need by improvisation.22 Changes in Supplies and Equipment During the latter part of the war changes occurred in both the medical and nonmedical equipment of hospitals. As a result of changes and improvements in pharmaceuticals and biologicals and of the accumulation of experience in the op- eration of hospitals under various sets of conditions in different parts of the world, the Surgeon General’s Office made three complete revisions and several partial re- visions of Medical Department equipment lists between the middle of 1943 and the end of 1945. Revision of these lists in- volved the selection of types and amounts of pharmaceuticals and biologicals, of sur- gical instruments and other operating room equipment, of X-ray and laboratory equipment, of ward equipment, and of other Medical Department items needed by hospitals of different types for the per- formance of their missions. These revi- sions, made by the Surgeon General’s Organization and Equipment Allowance Branch, were based on combat experience as revealed by reports of essential tech- nical medical data (ETMD’s), interviews with officers who served overseas, and in- spections of theater medical services; on changes in the size and personnel of units; and on the advice and recommendations of the Professional and Preventive Med- icine Services of the Surgeon General’s Office, the Army Medical Center, and the National Research Council. A significant administrative feature of these revisions was the consolidation and publication during 1944 and 1945 of equipment lists as parts of the medical section of the ASF supply catalog and their distribution by the Adjutant General’s Office. Until that time, such lists had been issued in mimeo- graph form by the Medical Department alone. Items added to them made avail- able to hospitals the newer drugs and biologicals and improved items of equip- ment developed during the war.23 Changes in the nonmedical equipment of hospital units revolved around the problem of supplying items of equipment necessary for station services, or house- keeping functions. The chief question was whether such equipment would be in- cluded in tables of equipment of hospitals, and therefore supplied automatically, or whether it would not be included, and supplied only when and if theater com- manders requested it. Types of nonmed- ical equipment which demanded the attention of the Surgeon General’s Office were those needed for such station services as laundries, electric lighting systems, and telephone communications systems. Inspections of theater medical services by Surgeon General Kirk and his chief of Professional Services in the middle of 1943 revealed what they considered to be in- adequate laundry service for hospitals in both the North African and Southwest 22 (1) Ltr, Surg Fifth Army to SG thru Surg MTOUSA, 22 Jun 45, sub: Mobile Med Hosp. SG: 320.3. (2) An Rpt, NP Consultants Div SGO, FY 1945. HD. 23 (1) History of Organization and Equipment Allowance Branch [SGO], 1939-44. HD. (2) An Rpt, Sup Serv SGO, FY 1944. HD. (3) An Rpt, Orgn and Equip Allowance Br Oprs Serv SGO, FY 1944. (4) An Rpt, Tec Div Oprs Serv SGO, FY 1945. Copies of the Equip Lists are on file, HD. 284 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Pacific theaters. In their opinion this re- sulted from lack of sufficient numbers of laundries and from the use of improper types of laundry equipment. On 5 June 1943 The Surgeon General informed ASF headquarters of the improvements he con- sidered necessary.24 As a result, the offices of The Quartermaster General and The Surgeon General collaborated in chang- ing washing formulae and laundry equip- ment to improve the quality of service which laundries afforded hospitals.25 The provision of adequate amounts of laundry equipment and of sufficient num- bers of laundry operators was more com- plicated. On 1 July 1943 The Quarter- master General informed ASF headquar- ters that there was sufficient laundry equipment in this country to meet the needs of theaters, provided the latter re- quested its shipment.26 Theater opinions of what constituted an adequate laundry service differed from The Surgeon Gen- eral’s, for theaters accepted lower stand- ards of service than he considered desir- able.27 He wished, therefore, to find some way to assure that sufficient laundry equipment and personnel would be shipped with each hospital unit. The di- rector of the ASF Planning Division, on the other hand, felt that theater command- ers, with the advice and help of their sur- geons, should determine the laundry services needed and request the War De- partment to supply the necessary equip- ment and personnel.28 The ASF view pre- vailed and in August 1943 theater com- manders were reminded of the necessity of planning in advance for the laundry serv- ice of hospitals but were informed that the War Department would not supply them with laundry equipment and personnel unless such were requested.29 During the following year, after the General Staff authorized the attachment of technical- service teams to units of other technical services, revised tables of organization and equipment of hospital units carried a statement that Quartermaster Corps laundry teams were authorized for attach- ment to hospitals when theater command- ers requested them.30 Although this served as a reminder to theater staffs that they had to make specific provisions for hospi- tal laundry services, it left to theaters con- siderable discretion in the matter and the Surgeon General’s Office continued its unsuccessful attempt to have laundry equipment and personnel made integral parts of numbered hospitals.31 24 (1) Ltr, SG to CG ASF, 5 Jun 43, sub: Laundry Fac in TofOpns. SG: 486.3. (2) Memo, Col R[obert] B. Skinner for the Record, 8 Jul 43, sub: Gen [Charles C. Hillman’s Trip to SWPA. Ground Med files, Chronological file (Gol Skinner). (3) Memo, SG for GG ASF, 10 Aug 43, sub: Interim Progress Rpt: Steps Taken During First Sixty Days Since Apmt as SG. SG: 024.-1. 25 Ltr, SG to CG ASF, 5 Jun 43, sub: Laundry Fac in TofOpns, with 1st, 2d, and 4th inds. SG: 486.3. 26 Memo SPAOG 331.5, Dir Oprs ASF for Dir Planning Div ASF, 23 Jun 43, sub: Laundries and Laundry Equip, with 1st ind. HD: Wilson files, “Day File, Jul 43.” 27 (1) Memo, Col Arthur B. Welsh, MG for Dep SG, 13 Aug 43, sub: Data for Gen Somervell. SG: 486.3. (2) Memo, Dep SG for CG ASF, 16 Aug 43, sub: Interim Progress Rpt. HRS; ASF Control Div, 319.1 “SGs Interim Rpt, G-56.” 28 (1) Memo, Col Arthur B. Welsh, MG for Dep SG, 1 Jul 43, sub: Laundry for Overseas Hosps. SG: 331.5. (2) Memo, Majjohn S. Poe for Col [Howard T.] Wickert, 16 Jul 43. SG: 414.4-5. (3) Historical Record, Laundry Section, Hospital Division [SGO], 1 July 1944, p. 18. HD: 024. 29 Memo SPOPP 008, CG ASF for TAG, 3 Aug 43, sub: Aux Fac for Fixed Hosps. SG: 632.-1. 30 (1) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (2) T/O&E 8-550, Gen Hosp, 3 Jul 44. (3) T/O&E 8-560, Sta Hosp, 28 Oct 44. (4) T/O&E 8-580, Evac Hosp (750-bed), 31 Jan 45. 31 Ltr, SG to CG ASF attn Dir Mob Div, 10 May 45, sub: Tables of Orgn and Equip. SG: 320.3. Suc- cess came after the war. For example, see T/O&E 8-566, Sta Hosp, 500-bed, ComZ, and T/O&E 8-551, Gen Hosp, 1,000-bed, ComZ. Reviewing the experi- HOSPITAL UNITS PREPARED FOR OVERSEAS SERVICE 285 A similar problem arose in connection with electric lighting equipment. The Sur- geon General’s Office recommended that such equipment, including electric gen- erators, should be specifically listed in tables of equipment of hospital units to in- sure its being provided for each.32 During 1944 and 1945 this action was taken for field and evacuation hospital units; but electric lighting equipment was not in- cluded during the war in tables of equip- ment for general and station hospitals, convalescent hospitals, and convalescent camps and centers. Instead, a War De- partment memorandum placed upon the Chief of Engineers responsibility for fur- nishing electric lighting equipment, in- cluding generators, to such units when they received orders to move to theaters.33 At the beginning of the war the table of basic allowances for the Medical Depart- ment authorized telephone and switch- board equipment for the 750-bed evacua- tion hospital only. During the early part of the war, the tables for general and con- valescent hospitals were revised to include that equipment. Similar action was taken for station and 400-bed evacuation hospi- tals during the latter part of the war.34 Other significant changes in the equip- ment of hospital units were additions of tool chests of various sorts. Experience showed that hospital personnel in many instances had to perform much mainte- nance work and that the number of tool chests previously provided was insuffi- cient. Consequently, in successive revi- sions of tables of equipment of hospital units there were added tool chests for carpenters, refrigeration mechanics, elec- tricians, plumbers, automobile mechanics, and the like.35 32 An Rpt, Tec Div Oprs Serv SGO, FY 1945. HD. 33 (1) T/O&E 8-510, Fid Hosp, G 3, 24 Mar 44. (2) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (3) T/O&E 8-580, Evac Hosp (750-bed), 3 1 Jan 45. (4) WD Memo W 100-44, 9 May 44. HD: 412.-1. (5) WD Memo 100-45, 31 Mar 45. AG: 412 (5 May 44)(1). 34 (1) T/BA 8, MD, 1 Oct 41. (2) T/BA 8, MD, 15 Jul 42; C 1, 29 Aug 42. (3) T/O&E 8-560, Sta Hosp, 28 Oct 44. (4) An Rpt, Strategic and Logistic Plan- ning Sec MOOD SGO, 5 Jun 45 (HD), stated that switchboards and communications equipment had been provided for 400-bed evacuation hospitals. How- ever, a search of the T/O&E for this hospital does not disclose such authorization until publication of T/O&E 8-581 on 11 January 1949. 35 For example, see (1) T/E 8-560, Sta Hosp, 28 Dec 43. (2) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (3) T/O&E 8-510, Fid Hosp, 31 Mar 44. (4) T/O&E 8-550, Gen Hosp, 3 Jul 44. (5) T/O&E 8-560, Sta Hosp, 28 Oct 44. (6) T/O&E 8-580, Evac Hosp (750-bed), 31 Jan 45. ences of World War II several years after its end, the former chief of the Surgeon General’s Mobilization and Overseas Operations Division pointed out the failure to solve this problem. (Extract from Ltr, Col Arthur B. Welsh, MG, 19 Apr 48, quoted in “Use of Med Resources,” Rpt by Subcmtee on Employment of Mil Med Resources to Hawley Bd, 25 May 48, p. 346. HD: 334.) CHAPTER XVII Hospital Construction and Maintenance Emphasis in the Medical Department construction program in the United States in the latter part of the war was on ex- panding and improving existing hospital plants rather than on the construction or acquisition of new ones. It will be recalled that ASF headquarters considered the hospital construction program substan- tially complete by the middle of 1943. At that time forty general hospitals were in operation and eighteen others were under construction. Afterwards, only eight addi- tional general hospitals were authorized, and they were located in buildings which the Army already had. Moreover, the clo- sure of station hospitals as troops moved overseas made it unnecessary, except in a few instances, either to build or to acquire new station hospital plants.1 Despite this apparent completion of the hospital build- ing program, there was feverish construc- tion activity at many Medical Depart- ment installations. Mounting bed require- ments in the first half of 1945 made it nec- essary to provide housing in general and convalescent hospitals for additional beds equal in number to 80 percent of those accumulated in general hospitals during the previous four years. Changes in con- cepts of patient treatment, patient welfare, and hospital administration created needs for facilities not available in hospital plants already built. Finally, The Surgeon General took advantage of the passing of the initial phase of the Army’s construc- tion program and of the increasing avail- ability of scarce materials to press for im- provements and refinements in existing plants in order to bring them up to the standards of peacetime civilian hospitals. In expanding and improving hospital plants, The Surgeon General continued to have only partial responsibility and au- thority. He was dependent upon ASF headquarters for approval of all majof projects and upon the Engineers for all construction work. They, in turn, contin- ued to be subject to decisions and policies made by the General Staff. The Surgeon General’s Hospital Construction Branch developed general programs and standard criteria for hospital expansions and im- provements, and insisted, as before, upon an opportunity to approve or disapprove construction which changed either the capacities of hospital plants or the primary professional functions of any of their build- ings. In general, that Branch tended to rely more than before on service command surgeons and ASF hospital commanders 1 (1) Memo, Chief Cons Br SCO for HD SCO, 1 Nov 46, sub: Record of Expansion and Contraction, Hosps, ZI, and Hosp Ships. HD: 632. (2) See Table 14. HOSPITAL CONSTRUCTION AND MAINTENANCE 287 for assistance in planning and initiating programs for expansions, additions, and improvements. There were several rea- sons for this development. The expansion of existing hospital plants required in- dividual attention and planning in order to make maximum use of available hous- ing and to fit additional facilities into plants already constructed. Furthermore, many hospital commanders showed that they could secure additional facilities as gifts from civilian groups without assist- ance from the War Department. Finally, under prevailing War Department con- struction policies, requests for all but major construction projects had to be initiated in the field and not in the offices of the chiefs of technical services in Wash- ington.2 Over Air Forces hospital con- struction the Surgeon General’s Office exercised less supervision than it had dur- ing the early part of the war. Complying with a request of the Air Surgeon and re- flecting perhaps the growing independ- ence of the Air Forces, The Surgeon General on 22 January 1944 delegated to the Air Surgeon authority to act as his representative in that field.3 Providing Housing for Additional Beds in General and Convalescent Hospitals in the United States The primary method of obtaining housing for additional beds was to use existing buildings, whether for newly established hospitals or the expansion of those already in operation. This method was adopted because of restrictions on new construction imposed by ASF head- quarters under policies of the General Staff.4 When ASF approved the estab- lishment of convalescent annexes for gen- eral hospitals in June 1943, it announced that new construction, except for gymna- siums, was not authorized. Existing Army housing or leased civilian buildings were to be used instead.5 During 1943, 1944, and 1945, on The Surgeon General’s recommendation the Service Forces acquired through lease or transfer eighteen pieces of real estate, in- cluding schools, hotels, and National Youth Administration buildings, with enough space to house beds for 9,322 con- valescent patients at a number of general hospitals. Other general hospitals estab- lished annexes in vacant Army buildings located near by.6 After approving the establishment of convalescent centers for 25,000 patients early in 1944, ASF head- quarters turned over to the Medical De- partment vacant barracks on Army posts. Meanwhile, the Air Forces followed the same procedure in setting up convalescent hospitals.7 In most instances existing buildings were used during 1944 without - WDCir 58, 19 Dec 43. 3 (1) Memo, Dep Air Surg for Chief Hosp Admin Div SCO, 14 Oct 43, sub: Processing of Recomds for AAF Hosp Cons, Maintenance, and Repair. SG: 632.-1. (2) Ltr, CG AAF (Air Surg) to SG, 10 Jan 44, sub: Delegation of Auth to CG AAF, the Air Surg, for Operational Control at AAF Hosp, with 1st ind, SG to CG AAF thru CG ASF, 22 Jan 44. SG; 323.7-5. 4 ASF Girs 78, 18 Mar 44; 178, 13Jun44;and 168, 11 May 45. 5 1st ind SPRMC 322 (18 Jun 43), CG ASF to SG, 22 Jun 43, sub: Conv Ctrs, on unknown basic ltr. SG: 632.-1. 6 (1) Ltr, SG to COs of Gen Hosps, 3 Aug 43, sub: Estab of Conv Retraining Unit. SG: 632.-1. (2) Memo, SG for Reqmts Div ASF, 3 Sep 43, sub: Conv Fac. Off file, Gen Bliss’ Off SGO, “Med Clarification of Disposition Policy.” (3) Diary, Hosp Cons Br SGO, 13 Mar, 4 Apr, and 18 Aug 44. HD: 024.7-3. (4) Memo, Chief Cons Br SGO for HD SGO, 1 Nov 46, sub: Record of Expansion and Contraction, Hosps, ZI, and Hosp Ships. HD: 632. 7 (1) Memo SPMOC 532 (3 Jun 44), CG ASF for SG, 29 Jun 44, sub: Housing Fac for Convs. Off file, Gen Bliss’ Off SGO, “Med Clarification of Disposi- tion Policy.” (2) AAF Memo 20-12, 18 Sep 43, sub: Orgn AAF Conv Ctrs. HD. 288 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR extensive alterations and with little addi- tional construction.8 The major hospital expansion program of the later war years came during the first six months of 1945, after G-4 ap- proved additional beds to meet the esti- mated peak load of patients. For this ex- pansion the War Department followed the same method—the use of existing buildings—but permitted more improve- ments and alterations than before. Both general and convalescent hospitals were expanded. Medical detachment barracks at general hospitals, which The Surgeon General early in the war had successfully insisted should be parts of hospital plants and of the same types and quality of con- struction, were converted into wards. Some convalescent annexes were made into wards and some nonhospital barracks were converted into housing for ambula- tory patients. Four station hospital plants supplemented by near-by barracks were converted into general hospitals. Several staging area hospitals were modified to serve as debarkation hospitals. And addi- tional barracks on posts where convales- cent hospitals were located were turned over to them. These changes involved chiefly improvements, already authorized late in 1944 for general and convalescent hospital plants, such as sealing inside walls, painting and reffooring, installing sprinkler systems and fire escapes in con- verted wards, and inclosing the covered walkways connecting those wards with the rest of the hospital plant. In general, the erection of new buildings was avoided but in some places no post housing was available for medical enlisted men and Wacs. In these instances theater-of-oper- ations-type barracks, along with buildings for detachment and company administra- tion, recreation, supply, and messing, were constructed to house the men dis- placed from hospital barracks and the Wacs sent to hospitals to help with in- creased patient loads.9 Initiation and completion of this pro- gram represented co-ordinated efforts of the Surgeon General’s Hospital Con- struction Branch, the Chief of Engineers’ Office, ASF headquarters, and their field officers. Even before G-4 authorized the additional beds, the Surgeon General’s Construction Branch collaborated with service command surgeons in making pre- liminary plans for hospital expansions, determining the number of additional beds that could be provided, and estab- lishing general criteria for conversion work.10 Meanwhile, the Chief of Engi- neers’ Office called upon division engi- neers, by telephone, for preliminary layout plans and cost estimates. As a re- sult, within forty-eight hours after that Office received a directive to proceed with the program, it authorized division engi- neers to begin work.11 To achieve speed in the expansion, ASF headquarters per- 8 (1) Tynes, Construction Branch. (2) Interv, MD Historian with Col Achilles L. Tynes, formerly Chief Hosp Cons Br SCO, 24 Apr 50. HD: 000.71. 9 (1) Ltr, SG to CofEngrs, 13 Jan 45, sub: Emer- gency Expansion of Gen Hosps. SG: 322 “Hosp.” (2) Memo SPMOC 632, CG ASF for CofEngrs, 22 Jan 45, sub: Prov of Add Hosp Fac for Gen Hosp Syst. CE: 683 Pt I. (3) Ltr, CofEngrs to Div Engrs, 2 Feb 45, same sub. SG: 632. (4) Engr Cons Directives, of various dates. Same file. (5) An Rpts, 1945, Birming- ham, Battey, and Cp Butner Gen Hosps, and Cp Carson Hosp Ctr. HD. 10 (1) Memo, Dir Hosp Div for Chief Hosp Cons Br, 19 Dec 44. SG; 632. (2) Memo, same for same, 6 Jan 45, sub: Ests of Cons Needs. Same file. (3) Off Memo, by Chief Hosp Cons Br, 12 Jan 45, sub: 6th SvC. Same file. (4) Ltr, SG to CofEngrs, sub: Emer- gency Expansion of Gen Hosps. SG: 322 “Hosp.” 11 1st ind CE SPEMT 683, CofEngrs to CG ASF thru SG, 22 Feb 45, on Memo SPMOC 600.1, CG ASF for CofEngrs and SG in turn, 7 Feb 45, sub: Conversion, New Cons, and Preferred Maintenance at Gen and Gonv Hosps. CE; 683 Pt I. HOSPITAL CONSTRUCTION AND MAINTENANCE 289 mitted The Surgeon General and the Chief of Engineers to make minor changes in the approved program, particularly in the number of beds for which housing was to be provided at each hospital.12 In turn, they delegated similar authority to local engineer and medical officers, and the Chief of Engineers directed division engi- neers to settle layout plans locally and to secure The Surgeon General’s approval by telephone.13 Finally, both the Chief of Engineers and ASF headquarters in- structed representatives in the field to co- operate fully with each other in pushing the program to completion.14 None of these measures would have been sufficient to assure the expansion of hospital housing capacity in time for the peak load if a solid foundation for it had not already been established. The exist- ence at hospital plants of barracks similar in type to ward buildings made their con- version to wards relatively simple. Fur- thermore, establishment of convalescent hospitals during 1944, without G-4 ap- proval and in the face of attempts of the Staff to reduce the number of general and convalescent beds, meant that a consider- able portion of the housing needed for the additional beds authorized in November 1944 and January 1945 had already been provided.15 Construction of Additional Facilities at Existing Hospital Plants In the latter half of the war the Medical Department also had to request addi- tional facilities that had not been planned when hospitals were built because the need for them had not been anticipated. The extension of specialization in general hospitals during 1944 and 1945 required additional clinical facilities. For example, vascular centers needed constant-temper- ature rooms; orthopedic centers needed brace shops, plaster and dressing rooms, and extra X-ray facilities; and centers for the deaf, acoustic clinics.16 Since the con- struction of such buildings could not nor- mally be classified as “major” projects, local hospital commanders had to submit formal requests for each. As a rule, the professional consultants of the Surgeon General’s Office worked closely with the Hospital Construction Branch and with hospital commanders, informing both of what was needed. For example, an ortho- pedic consultant recommended the con- struction of an orthopedic clinic at Fort George G. Meade (Maryland) Regional Hospital injune 1944, and a few months later an ophthalmology consultant rec- ommended an acrylic eye laboratory and an eye clinic for Dibble General Hospi- tal.17 Generally, the Medical Department encountered little if any opposition in se- curing the approval of the Engineers and ASF headquarters for the construction of special clinical buildings. Perhaps this cir- cumstance was due to the fact that their 12 Memo SPMOC 632, GG ASF for CofEngrs, 22 Jan 45, sub: Prov of Add Hosp Fac for the Gen Hosp Syst. GE: 683 Pt I. 13 Ltr, CofEngrs to Div Engrs, 2 Feb 45, sub: Prov of Add Hosp Fac for Gen Hosp Syst. SG: 632. 14 (1) Ltr cited above. (2) Ltr SPMOC 632, CG ASF to CGs SvCs, 3 Feb 45, sub: Prov of Add Hosp Fac for Gen Hosp Syst. AG: 323.3 (4 Sep 44)(1). 15 (1) See above, p. 202. (2) An Rpt, FY 1945, Hosp Cons Br SGO. HD. 16 (1) Memo, Capt A. W. Clark for Col A[lbert] H. Schwichtenberg, 1 Feb 45, sub: Constant-Tem- perature Rooms. SG: 632. (2) Memo, Col Leonard T. Peterson, Chief Orthopedic Br SGO for Dir Hosp Div SGO, 26 Mar 45, sub: Orthopedic Clinic. Same file. (3) Diary, Hosp Cons Br SGO, 29 Feb and 6 Mar 44. HD: 024.7-3. 17 (1) Ltr, Col Leonard T. Peterson to SG, 24 Jun 44, sub: Rpt of Visit to Ft George G. Meade Re- gional Hosp. HD: 333.-3. (2) Memo, Maj Middleton E. Randolph for SG, 27 Nov 44, sub: Rpt of Trip to Dibble Gen Hosp. HD; 333.-2. 290 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR use was so obviously a part of the profes- sional care of patients. In the case of other special buildings less evidently needed for professional care but appropriate to al- most all general hospitals, the Surgeon General’s Office had to request ASF head- quarters to establish a general policy per- mitting their construction. This occurred in the case of occupational therapy clinics, which were needed after The Surgeon General began to emphasize occupational therapy in all general hospitals, and in the case of neuropsychiatric social therapy clinics, which were needed after neuro- psychiatric centers were established in many general hospitals. In October 1943 ASF headquarters approved the construc- tion of occupational therapy clinics; about a year later, of neuropsychiatric social therapy clinics.18 The provision of special clinical facilities continued even after the Medical Department began to contract the general-convalescent hospital system. As late as September 1945, for example, when specialized centers were being re- located because some hospitals were being closed, the Surgeon General’s Office re- quested the construction of special build- ings for centers for rheumatic fever, deaf, paraplegic, neuropsychiatric, and plastic surgery patients in hospitals that were ex- pected to remain open for long periods of time.19 Development of the convalescent re- conditioning program called for additions to hospital plants which were generally authorized less readily than special clin- ical buildings. Among them were recre- ational facilities, such as theaters, gymna- siums, swimming pools, ball fields, and bowling alleys; instructional facilities, such as classrooms and prevocational training shops; and others that could be used for both recreational and education- al purposes, such as libraries and radio systems. In the second half of 1943, with the in- auguration of the reconditioning program and the growing belief that patients re- cuperated more rapidly if kept occupied physically and mentally to the maximum extent consistent with their degree of re- covery, hospital commanders began to re- quest appropriate facilities.20 At that time The Surgeon General was reluctant to support requests for “elaborate and costly” additions, such as swimming pools; but he urged the construction at general hospi- tals of buildings normally erected on Army posts, such as gymnasiums, librar- ies, and theaters.21 ASF headquarters ap- proved the construction of gymnasiums and theaters in June and December 1943, respectively.22 As materials became more plentiful and the prospective load of battle casual- 18 (1) Ltr, SG to CG ASF, 22 Oct 43, sub: Occupa- tional Therapy Instls, with 1st ind SPRMC 632 (22 Oct 43), CG ASF to CofEngrs thru SG, 26 Oct 43. SG: 632.1 (2) Memo, Dir Hosp Div SGO for Chief Hosp Cons Br SGO, 28 Nov 44, sub; Rooms for Visiting with Relatives at NP Ctrs, with 1st ind, Chief Hosp Cons Br SGO to Dir Hosp Div SGO, 30 Nov 44. SG: 632. (3) Ltr, SG to CofEngrs, 13 Dec 44, sub: NP Social and Occupational Therapy Bldg, with 4 inds. Same file. 19 Memo, Dep SG for CofEngrs, 11 Sep 45, sub; Engr Serv, Army—Project No 200 (Cons) Revised Estimates, FY 1946. SG: 632. 20 For example; (1) Diary, Hosp Cons Br SGO, 17 Feb and 28 Mar 44. HD: 024.7-3. (2) An Rpts, 1943, Baxter, Billings, Bushnell, Hoff, and Kennedy Gen Hosps. HD. (3) Memo, Chief Hosp Cons Br SGO for Chief Prof Serv SGO, 21 Apr 44. SG; 631. 21 (1) Memo, Brig Gen C[harles] G. Hillman, Chief Prof Serv SGO for Chief Hosp Admin Div SGO, 16 Dec 43, sub: Cons of Hosp Fac. SG: 631. (2) Memo, SG for Reqmts Div ASF, 5 May 43, sub: Recreational Fac in Army Hosps. Same file. 22 (1) 1st ind SPRMC 322 (18 Jun 43), GG ASF to SG, 22 Jun 43, sub: Gonv Gtrs, on unknown basic ltr. SG: 632.-1. (2) 1st ind, CG ASF to SG, 8 Dec 43, on Memo, SG for CG ASF, 22 Nov 43, sub: Theaters for Gen Hosps. SG: 631. HOSPITAL CONSTRUCTION AND MAINTENANCE 291 ties more imminent during 1944, The Surgeon General broadened his pro- gram.23 In that year the construction at general hospitals of libraries, swimming pools, and athletic fields was approved by ASF headquarters.24 Early in 1945, after the Reconditioning Consultant’s Division published an elaborate convalescent-re- conditioning program and the President gave it his blessing, The Surgeon General pressed for buildings and equipment of all types for use in that program. In Febru- ary 1945 ASF headquarters approved the installation of four-channel, program-dis- tribution (or radio) systems in general hospitals.25 Two months later the General Staff approved a construction program for convalescent hospitals which included shops for machine work, welding, auto- mobile repairs, woodwork, photography, electrical work, and the like; classrooms for general academic courses, business ad- ministration, and music appreciation; athletic facilities such as bowling alleys, stables, tennis courts, baseball and softball diamonds, archery ranges, golf courses, skeet ranges, and football fields; and thea- ters, libraries, clubhouses, and other recreational buildings.26 In securing eventual approval for such facilities, The Surgeon General encoun- tered difficulties and delays. ASF head- quarters would authorize only those which appeared necessary for the treat- ment and recovery of patients, and The Surgeon General therefore had to justify each request by explaining the therapeu- tic benefits additional facilities would afford.27 Furthermore, ASF tended to limit programs which it approved to gen- eral hospitals that were expected to re- main in operation during the postwar years.28 The Surgeon General agreed that extra facilities should be provided first for general hospitals in which overseas pa- tients were treated; but he wanted them later for regional and station hospitals also. He resisted attempts to limit recon- ditioning facilities to hospitals that would be used for the postwar period, arguing that they were needed for all patients of World War II, whether in hospitals that would be closed or in others that would be kept open after the war.29 ASF headquar- ters sometimes encountered difficulties in getting money appropriated for the extra construction which The Surgeon General wanted. For example, the opposition of the Bureau of the Budget to the appro- 23 For example, see: (1) Ltr, SG to CG ASF, 8 May 44, sub: Cons of Swimming Pools. SG: 631. (2) Memo, SPMC 631.-1, SG for Dir Spec Serv Div ASF, 10 May 44, sub: Bowling Alleys. Same file. (3) Diary, Hosp Cons Br SGO, 26 Feb 44. HD: 024.7-3. (4) Memo, SG for CofEngrs, 16 Mar 44, sub; Budget Def for Nurses Call Systs and Libraries for Army Hosps. SG: 632.-1. 24 (1) 1st ind SPMOC 632 (9 Sep 44), CG ASF to CofEngrs, 23 Sep 44, on DF G-4 2623, ACofS G-4 WDGS to CG ASF, 8 Sep 44, sub: Libraries for Army Gen Hosps. (2) 1st ind SPRMC 631 (8 May 44), CG ASF to SG, 16 May 44, on Ltr SPMCH, SG to CG ASF, 8 May 44, sub: Cons of Swimming Pools. (3) Memo, SPMOC 600.1 (21 Sep 44), CG ASF for CofEngrs, n d, sub; Outdoor Recreational Fac for Conv Soldiers at Gen and Conv Hosps. All in SG: 631. 25 3d ind SPRLR 413.45 (3 Feb 45), CG ASF to Chief Sig Off, 16 Feb 45, on Ltr, Dep SG to CG ASF, 3 Feb 45, sub: Funds for Instl of PA Systs in Gen Hosps. SG: 413.47. 26 Memo SPMOC 632 (29 Apr 45), CG ASF for CofEngrs, sub: Conv Hosps, with incl, Criteria for Providing and Maintaining Fac at AAF and ASF Conv Hosps. SG: 322 (Conv Hosp). 27 (1) Diary, Hosp Cons Br SGO, 8 Mar, 22 Apr, and 4 Sep 44. HD: 024.7-3. (2) Ltr, SG to CG ASF, 8 May 44, sub: Cons of Swimming Pools. SG: 631. (3) Memo SPMCH 632, SG for CG ASF, 8 Dec 44. Same file. 28 For example, see: 4th ind, CG ASF to SG, n d, on Ltr, SG to CG ASF, 8 May 44, sub: Cons of Swim- ming Pools. SG: 631. 29 Memo, SG for CG ASF, 18 Oct 44, sub: Cons of Swimming Pools at Gen Hosps, with 2d ind, Dep SG to CG ASF, 9 Nov 44. SG; 631. 292 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR priation of money for the building of libraries delayed that program for several months during 1944.30 In instances where lack of appropriated funds prevented ASF headquarters from approving additional construction or where those funds were sufficient to provide facilities for only a limited number of hospitals, ASF head- quarters and the Surgeon General’s Office approved, as a rule, the use of nonappro- priated funds to construct them.31 As a re- sult of that policy and of generous gifts by civilians, some hospitals got such addi- tions as swimming pools, bowling alleys, and radio systems before the use of War Department funds for such purposes was approved.32 Others were not so fortunate. Furthermore, because of delays in getting ASF and G-4 approval, some hospitals never got to use the extra facilities author- ized, for the war ended and their con- struction had to be canceled.33 Concurrently with the addition to hos- pitals of clinical and reconditioning facil- ities, the increase in administrative activ- ities and the development of new operational procedures created needs for additional or enlarged administrative buildings. During the early war years several hospitals had begun to operate central service systems similar to those found in large civilian hospitals.34 Such systems permitted the centralized mainte- nance, storage, preparation (including sterilization), and issuance of supplies and equipment which were used for certain diagnostic and therapeutic procedures in all wards but which were not needed in wards at all times. Among such items were those used for transfusion and intra- venous medication, wound dressing, spinal puncture, thoracentesis, catheter- ization, gastric lavage and gastroduodenal suction, and oxygen administration.35 In the last half of 1943 the Surgeon General’s Office developed standard operating pro- cedures for central service systems and prepared typical layouts for buildings to house them.36 By January 1944 it decided that all hospitals with capacities of 750 or more beds should have such systems.37 Their use would save both personnel and equipment, would achieve uniformity in sterilization techniques, and would insure the ready availability of all items needed 30 (1) Memo, WD Budget Off for ACofS G-4 WDGS, 18 Jul 44, sub: Libraries for Army Gen Hosps. SG; 631. (2) 1st ind SPMOC 632 (9 Sep 44), CG ASF to CofEngrs, 23 Sep 44, on DF G-4 2623, ACofS G-4 WDGS to CG ASF, 8 Sep 44, same sub. Same file. 31 For example, see: (1) Diary, Hosp Cons Br SGO, 16 and 19 Aug 44, 25 Nov 44, and 27 Jul 45. FID: 024.7-3. (2) 1st ind, CofEngrs to CG ASF, 21 Jun 44, on Memo SPRMG 631 (13 Jan 44), CG ASF for CofEngrs, 13 Jun 44, sub: Libraries at Gen Hosps. SG; 631. 32 (1) Memo, SG for CG ASF, 18 Oct 44, sub: Cons of Swimming Pools at Gen Hosps. SG; 631. (2) Com- ments by Col A. L. Tynes, Chief Hosp Cons Br SGO at Conf of SvC Surgs, 12 Dec 44. SG: 632. (3) Diary, Hosp Cons Br SGO, 29 Mar 45. SG: 024.7-3. (4) Ltr, Dep SG to CG ASF, 3 Feb 45, sub: Funds for Instl of PA Systs in Gen Hosps. SG: 413.47. 33 (1) Memo, Chief Hosp Cons Br SGO for Chief Oprs Serv SGO, 22 Aug 45, sub: Reduction of Cons Reqmts and Concurrent Changes in Budget. SG: 632. (2) Ltr SPMCH 632, SG to CG ASF, 17 Sep 45, sub: Cancellation and Reinstatement of Comd Cons Proj- ects, ZI Gen Hosps. CE: 632 (Hosp). (3) Memo, CofEngrs for CG ASF, 9 Oct 45. Same file. 34 An Rpt, 1941, Sta Hosp, Ft Bragg; and An Rpts, 1942, Percy Jones Gen Hosp and Sta Hosp Cp Butner. HD. 35 WD Memo W 40-44, 12 Apr 44, sub: Central Serv Syst in Army Hosps. SG: 300.6. 36 (1) Memo, Maj Michael E. DeBakey for Brig Gen C. C. Hillman, 20 Jul 43, sub: Central Serv. SG: 632.-1. (2) Memo, Chief Hosp Cons Br SGO for Dir Surg Div SGO, 21 Oct 43, sub; Central Serv Fac. Same file. 37 Memo, Maj Edwin M. Loye for Lt Col A. L. Tynes, 20 Jan 44, sub: Discussion of Central Serv . . . in Gen Hillman’s Off. . . . SG: 632.-1. HOSPITAL CONSTRUCTION AND MAINTENANCE 293 by doctors in wards.38 ASF headquarters therefore authorized the Engineers to pro- vide buildings for such services, either by new construction or by the alteration of existing buildings, wherever they were re- quested and justified by hospital com- manders.39 Thereafter, during 1944 and 1945 central service buildings were pro- vided for all general and regional hospi- tals.40 In getting other administrative build- ings, the Surgeon General’s Office was less successful. One fault with hospital plants already constructed was that they lacked rooms for clinical conferences.41 More- over, the addition to general hospitals of functions and activities not common in peacetime increased the need for more administrative space. Special services of- ficers, reconditioning officers, personal affairs officers, Veterans Administration representatives, and United States Em- ployment Service representatives often had to set up offices in wards, barracks, and storerooms. Consequently, on 28 July 1944 The Surgeon General requested the enlargement of hospital administrative buildings. Before granting approval, ASF headquarters required him to collaborate with the Chief of Engineers in a detailed study of office-space requirements.42 By the time it was completed in February 1945 the general-convalescent hospital ex- pansion program had increased even more the need for administrative space.43 On 3 April 1945 The Surgeon General again urged that it be authorized, and finally, on 25 April 1945, ASF headquar- ters instructed the Engineers and The Surgeon General to collaborate in plan- ning whatever construction was needed to bring existing hospital plants up to the standards set by their joint study.44 Sur- veys by service command surgeons of existing administrative space and of the additional amount required delayed the beginning of work on this program until hospitals began to close. It was then largely abandoned.45 Improvements in Existing Hospital Plants At the same time hospital plants were being expanded and improved to meet needs that had developed during the war, the Surgeon General’s Office was attempt- ing to correct constructional defects and to bring the Army’s hurriedly erected hos- pital buildings up to the standards of finish, appearance, and equipment of civilian institutions. During 1944 the re- flooring program was continued,46 and defects in hospital construction revealed by inspections made by the War Projects 38 Ltr, SG to CofEngrs, 21 Jan 44, sub: Central Serv Bldg at Cushing Gen Hosp. SG: 632 (Cushing GH)K. 39 Memo, CofEngrs for SG, 2 Feb 44, sub: Central Serv Bldgs at Gen Hosps. SG: 632.-1. 40 (1) An Rpt, FY 1944 and 1945, Hosp Cons Br SGO. HD. (2) Memo, SG for CofEngrs, 10 Mar 45. SG: 632. 41 1st ind, SG to CofEngrs, 7 Mar 44, on Ltr, CO McGuire Gen Hosp to SG, 10 Feb 44, sub: Cons of Add Clinic-Type Bldg. SG: 632.-1 (McGuire GH)K. 42 1st ind SPMOC 632 (31 Jul 44), CG ASF to CofEngrs, 3 Aug 44, and 2d ind, CofEngrs to SG, 7 Aug 44, on Ltr SPMCH 632, Dep SG to CG ASF, 28 Jul 44, sub: Admin Space in Gen FIosps. CE; 683 Pt I. 43 Ltr SPMCH 632, SG to CG ASF thru CofEngrs, 8 Jan 45, sub: Admin Space in Gen and Regional Hosps, with 1st ind, CofEngrs to CG ASF thru SG, 24 Feb 45. CE: 683 Pt I. 44 2d ind SPMCH 632, SG to CG ASF, 3 Apr 45, and 3d ind SPMOC 632 (3 Apr 45), CG ASF to CofEngrs thru SG, 25 Apr 45, on Ltr SPMCH 632, SG to CG ASF thru CofEngrs, 8 Jan 45, sub; Admin Space in Gen and Regional Hosps. CE: 683 Pt I. 45 Diary, Hosp Cons Br SGO, 18 Sep 45. HD: 024.7-3. 46 (1) See above, p. 96. (2) Diary, Hosp Cons Br SGO, 9 and 20 Jun 44. HD: 024.7-3. 294 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Unit of the Bureau of the Budget were corrected by the Engineers.47 In the opinion of the Surgeon General’s Hospital Construction Branch a broader program of more general application was needed. Therefore, late in the summer of 1944, when ASF headquarters began to plan for the improvement of Army installations that would be selected for postwar use,48 Surgeon General Kirk secured the per- sonal backing of General Somervell for a relaxation of the War Department’s policy of “Spartan simplicity” in order to permit higher maintenance standards for hos- pitals.49 About the same time, Congres- sional criticism of Army hospital construc- tion and maintenance apparently spurred ASF headquarters to more “aggressive ac- tion in increasing the maintenance pro- gram for hospitals.” 50 At any rate, during September and October 1944 the ASF Command Installation Branch and offices of The Surgeon General and the Chief of Engineers agreed upon a program for im- proving ASF hospitals. It included cover- ing floors in corridors and administrative buildings, as well as in wards and clinics, with linoleum over plywood; sealing ex- posed framing in corridors and nurses’ quarters; inclosing all corridors used by patients; painting both exteriors and in- teriors to conform to peacetime standards, including the use of pastel colors for in- teriors; replacement of “victory-grade” with standard hardware and fittings; and the planting and proper maintenance of lawns and grounds.51 In approving this program G-4 stipulated that it should be carried out only partially in hospitals that the Army would not retain after the war.52 ASF headquarters decided therefore to limit the program to general and con- valescent hospitals that would be retained in the postwar period and to delay its ex- tension to regional and station hospitals until a later time.53 The Surgeon General repeatedly protested against both the G-4 and ASF limitations, but was unsuccessful in getting them removed during the war.54 47 For example, see; (1) Ltr SPMCH 632, SG to CofEngrs, 19 Aug 44, sub: Transmittal of Comments on Sta Hosp Cons Rptd to SG by War Projects Unit, Bu of Budget. CE; 632 (Hosp)No. 1. (2) Memo, CofEngrs for SG, 12 Oct 44, sub: Comments on Gen Hosp Cons. Same file. (3) Ltr SPMCH 632, SG to CofEngrs, 25 Nov 44, sub: Transmittal of Comments on Army Hosp Cons Rptd to SG by War Projects Unit, Bu of Budget. Same file. (4) Ltr SPEMY 632, CofEngrs to SG, 18 Apr 45, sub: Comments on Army Hosp Cons. SG: 632. 48 1st ind SPMOC 600.1 (18 Aug 44), CG ASF to CofEngrs, 25 Aug 44, on unknown basic ltr. CE: 632. 49 Comments by Col A. L. Tynes, Chief Hosp Cons Br SCO at Conf of SvC Surgs, 12 Dec 44. SG; 632. 50 (1) Memo, Dir Plans and Oprs ASF for Dir Mob Div ASF, 17 Sep 44. HRS; Maj Gen LeRoy Lutes’ files, “Hosp and Evac, Jun 43-Dec 46.” (2) Memo, Chief Hosp Cons Br SCO for Dep SG, 2 Sep 44, sub; Comments Relative to Rptd Defects in Hosp Cons. SG: 632. (3) Investigations of the National War Effort, Report, Committee on Military Affairs, House of Repre- sentatives, 78th Cong, 2d sess, pursuant to H. Res. 30 (Washington, 1944). 51 (1) Memo, SG for CG ASF, 6 Sep 44, sub: Sug- gested Remedial Measures, Hosp Cons, ZI, in Tynes, Construction Branch. (2) Memo, CofEngrs for CG ASF, 18 Sep 44, sub: Preferred Maintenance for Post War Use Instls. CE: 632 (Hosp). (3) Memo, CofEngrs for CG ASF, 30 Sep 44, sub: Suggested Remedial Measures, Hosp Cons in ZI. CE: 600.18. (4) Memo, CofEngrs for CG ASF, 14 Oct 44, sub: Preferred Maintenance for Gen Hosps. Same file. (5) Diary, Hosp Cons Br SCO, 3 Oct 44. HD: 024.7-3. 52 DF WDGDS 4031, ACofS G-4 WDGS to CG ASF, 27 Oct 44, sub: Increased Maintenance at Gen and Conv Hosps. HRS: G-4 file, 600.3 (I). 53 Memo SPMOC 632, CG ASF for CofEngrs, 31 Oct 44, sub: Increased Maintenance at Gen and Conv Hosps, in Tynes, Construction Branch. 54 (1) Memo, Dep SG for CG ASF, 10 Nov 44, sub: Increased Maintenance at Gen and Conv Hosps, with 1st ind SPMOC 632 (10 Nov 44), CG ASF to SG, 16 Nov 44, in Tynes, Construction Branch. (2) Memo, SG for CofEngrs, 11 Jul 45, sub: Increased Standards of Maintenance at Regional Hosps, with 3d ind SPMOC 423.3 (1 Aug 45), CG ASF to CofEngrs, 10 Aug 45. SG: 323.3 (Hosp). HOSPITAL CONSTRUCTION AND MAINTENANCE 295 Finally, in June 1946, the General Staff sanctioned the program, within the limits of funds available, for regional and station hospitals to be kept for the postwar Army.55 Meanwhile, in March 1945, after representatives of G-4 suggested that the staging area hospitals being converted into debarkation hospitals should be “dressed-up” for the reception of return- ing war casualties, ASF headquarters authorized the application of the high- er standards of maintenance to those hospitals.56 Although improvement of general and ASF convalescent hospitals was author- ized in October 1944, it did not get started until early in 1945. Causes for delay dur- ing that period and later were numerous: the controversy over whether to limit the program to postwar hospitals; the tardi- ness of service commands, which under existing procedures had to initiate the re- quests for improvements; the time spent by the offices of The Surgeon General and the Chief of Engineers in deciding on colors of interior paint; the confusion in the field that arose from carrying on two projects at once—the improvements pro- gram and the hospital expansion pro- gram; the extension of the project to cover barracks and other buildings newly con- verted to hospital use; the effort to inter- fere as little as possible with the normal operation of the hospitals; and the hin- drance of winter weather to the planting of lawns and the painting of exteriors. In view of such factors the Engineers esti- mated in February 1945 that the main- tenance program would not be entirely completed until the end of 1945, but that the greater portion of it would be finished by the end ofjuly.57 Another aspect of the general move- ment to raise the standards of Army hos- pital plants was extension of the program of installing air-conditioning or ventilat- ing equipment and inauguration of a pro- gram of installing nurses’ call systems. The Surgeon General’s Office wanted the existing air-cooling program expanded. During the last six months of 1943 and the early part of 1944 the Hospital Con- struction Branch sought approval for the installation of air-conditioning equipment in the operating rooms of all gen-eral hos- pitals, whether they were located in areas with July temperatures above 75 degrees Fahrenheit or not, and in dental clinics in certain areas that had hot summers. It also requested that either mechanical- ventilating or evaporative-cooling equip- ment be permitted in some storerooms and in patients’ recreation buildings.58 A revision of policy by ASF headquarters in April 1944 permitted the installation of air-conditioning equipment in dental clinics in the South and of either mechani- cal-ventilating or evaporative-cooling 55 Ltr SPMCH 600.3, SG to CG ASF thru CofEngrs, 4 Jun 46, sub: Increased Maintenance at Regional and Sta Hosps, with 1st ind, CofEngrs to Dir SS&P WDGS, 19 Jun 46, and 2d ind, Dir SS&P WDGS to SG thru CofEngrs, 26 Jun 46. SG: 600.3. 56 (1) Memo SPMOC 632 (9 Mar 45), CG ASF for CofEngrs, 9 Mar 45, sub: Improvement of Debarka- tion Hosps. SG: 632. (2) Memo, Col L[loyd] E. Fel- lenz, GSC, G-4 Div for ACofS G-4 WDGS, 14 Mar 45, sub: Improvements at Debarkation Hosps. HRS: G-4 file, “Hosp and Evac Policy.” 57 Memo SPMOC 600.1, CG ASF for CofEngrs and SG in turn, 7 Feb 45, sub: Conversion, New Cons, and Preferred Maintenance at Gen and Conv Hosps, with 1st ind, CofEngrs to CG ASF thru SG, 22 Feb 45. CE; 683 Pt. I. 58 (1) Memo, SG to CG ASF, 28 Jul 43, sub: Venti- lative Treatment for Hosp Storehouses. (2) Memo, SG for CG ASF, 28 Aug 43, sub: Air Conditioning, Surgeries. (3) Memo, SG for CG ASF, 12 Oct 43, sub: Proposed Changes in WD Policy Governing Air Con- ditioning, Ventilation, and Cooling in ZI Hosps. (4) Memo, SG for CG ASF, 12 Feb 44, sub: Air Condi- tioning for Dental Clinics. All in SG: 673.-4. 296 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR equipment in patients’ recreation build- ings, but not in storehouses, in areas where the July temperatures exceeded 75 degrees Fahrenheit.59 Soon afterward, as the closure of station hospitals began to make equipment in those plants available for other uses, The Surgeon General again requested an extension of the program, and on 13 July 1944 ASF headquarters approved the installation of air-condition- ing equipment in operating rooms and of either air-conditioning or ventilating equipment in X-ray clinics and recovery wards of general and regional hospitals anywhere in the United States, regardless of average July temperatures. The in- stallation of such equipment in station hospitals was still limited to those located in southern areas of the country.60 As in the case earlier of air-cooling equipment, a shortage of critical materials delayed initiation of a nurses’ call-system program. During the winter of 1943-44 some hospitals nevertheless succeeded in procuring equipment and in having such systems installed with nonappropriated funds.61 When equipment became more plentiful in the spring of 1944, ASF head- quarters authorized the use of appropri- ated funds to install nurses’ call-systems in all general hospitals and to some extent in others.62 Because the amount of money set aside for this purpose was limited, The Surgeon General decided that, in general, only wards used for nonambulatory pa- tients would get the equipment and gen- eral hospitals would get it before regional hospitals.63 By March 1945 all general hospitals and all but thirty-one regional hospitals had had nurses’ call systems in- stalled. At that time ASF headquarters approved the Engineers’ request for suffi- cient additional funds to complete the in- stallation of such systems in all regional hospitals.64 Housing for Hospitals in Theaters of Operations In the middle of 1943 Surgeon General Kirk and his chief of Professional Services had the problem of housing for hospitals in theaters called forcibly to their atten- tion during visits to North Africa and the Southwest Pacific. According to plans at the beginning of the war, hospitals in the- aters of operations were to be housed in tents, in existing buildings wherever they were available, or in buildings erected by the Engineers with either native or im- ported building materials according to standard plans for theater-of-operations- type construction. None of these means of housing had proved universally satisfac- tory. In some areas, such as North Africa, tentage was too hot. In others, such as the Pacific, it not only was too hot but it mil- dewed, rotted, and disintegrated within 59 (1) Memo, CG ASF for SG, 14 Mar 44, sub: Pro- posed Revision of WD Memo W 100-4-43, with incl, draft of memo. SG: 300.6. (2) WD Cir 148, 14 Apr 44. 60 (1) Ltr, SG to CG ASF, 19 Jun 44, sub: Air Con- ditioning in Gen and Regional Hosps, with 2d ind, CG ASF to CofEngrs, 13 Jul 44. (2) OCE Cir Ltr 3457 (Repairs and Utilities No 10), 19 Dec 44, sub: Refrig- eration and Ventilation—Revision of Policy for Air- conditioning in Gen, Regional and Sta Hosps. Both in CE: 673. 61 Ltr, SG to CofEngrs, 16 Mar 44, sub: MD Cons Reqmts for FY 1945. SG: 632.-1. 62 Memo, CG ASF for SG, 1 Apr 44, referred to in 1st ind SPMCH 676, SG to CofEngrs, 26 Aug 44, on Memo, CofEngrs for SG, 23 Aug 44, sub; Nurses’ Sig- naling Fac. SG; 413.45. 63 1st ind SPMCH 676, SG to CofEngrs, 26 Aug 44, on Memo, CofEngrs for SG, 23 Aug 44, sub: Nurses’ Signaling Fac. SG: 413.45. 64 Memo, CofEngrs for CG ASF, 25 Mar 45, sub: Nurses’ Call Systs, with 1st ind SPMOC 676.1 (25 Mar 45), CG ASF to CofEngrs, 2 Apr 45. SG: 413.45. HOSPITAL CONSTRUCTION AND MAINTENANCE 297 about six months. In addition, the use of tentage made more difficult the control of mosquitoes in malarious areas. In some of the places where tentage was unsuitable for housing hospitals, there were no avail- able existing buildings. Moreover, the Medical Department often encountered difficulties in getting theater-of-operations- type housing constructed because of short- ages of lumber in theaters and of competi- tion for Engineer services with such high- priority projects as the construction of harbors, docks, piers, airstrips, and essen- tial roads. Beginning in the latter half of 1943 the Surgeon General’s Office turned its attention to these problems.65 The problem of modifying tentage so that interior temperatures were lowered was relatively simple to solve. Late in July 1943 representatives of The Surgeon General and The Quartermaster General found that the British used a fly with their tents.66 Suspended on poles above a tent, it provided shade for the tent roof and also retained an insulating layer of air, thereby reducing the temperature inside by about 20 degrees in the summer sun. After suitable tests, the Quartermaster Technical Committee in the summer of 1943 approved the use of flies with hospi- tal tents. Plans were then made to procure 30,000, and subsequently tent flies were included in revised tables of equipment for hospital units. Thus a large existing stock of hospital ward tentage was adapted to use in tropical climates of low humidity.67 Meanwhile the Quartermaster Corps had begun a more extensive project—the development of a new type of hospital tent. Called a sectional hospital tent, it had two distinguishing characteristics. A white liner made of cotton sheeting cov- ered the entire inside of the tent, lowering temperatures and promoting cleanliness. This tent was so constructed that a com- plete end section could be detached from the main body and additional center sec- tions added to extend its length as desired. It was standardized in July 1944 and, as tables of organization and equipment of hospital units were subsequently revised, was included as a replacement for ward tents with flies. Some were issued for over- seas use before the end of the war.68 The problem of providing housing in hot humid areas that had little lumber and no buildings was more difficult. Dur- ing the early part of the war the Southwest 65 (1) Memo, SG for CG ASF, 10 Aug 43, sub: In- terim Progress Rpt. SG: 024.-1. (2) An Rpt, Chief Surg SWPA, 1942. HD. (3) Ltr, Hq USASOS SWPA to CG ASF thru GG SWPA, 16 Sep 44, sub: Rpt of Trip to SWPA. . . . SG: 333.1-1 (Aust)F. (4) Ltr, SG to CG ASF, 28 Nov 44, Hosp Fac in TofOpns. HD: 632.-1 (Hosp Fac in POA). (5) Memo SPMCP 632 (Aust)F, SG for CG ASF, 29 Dec 44, sub: Hosp Cons, SWPA. HRS: ASF Hq Somervell files, “SG, 1944.” 66 The United States Army used flies with small tents but had made no provision for their use with the much larger hospital ward tents. Information supplied by Dr. Irving G. Cheslaw, Historian, OQMG. 67 (1) Memo SPOPI 424.1, Col Robert C. McDon- ald, MC, Chief Hosp and Evac Sec Planning Div Oprs ASF for Gen Lutes, 21 Jul 43, sub; Improve- ment in Tentage and Laundries for the MD. HD; Wilson files, “Day File, Jul 43.” (2) Inf note, W. D. Styer to Col Smith, ca. 17 Aug 43. HRS: ASF Control Div, 319.1 “SGs Interim Rpt, G-56.” (3) Memo, Col [Robert C.] McDonald for Col F. M. Smith, 17 Aug 43, sub: Shelter for Overseas Hosps. Same file. (4) Memo, Dep Dir Oprs ASF for CofS ASF, 31 Aug 43, sub; SGs Interim Progress Rpt, with 6 incls. Same file. (5) T/O&E 8-550, Gen Hosp, C 2, 16 May 44. (6) T/O&E 8-581, Evac Hosp SM (400-bed), 25 Mar 44. 68 (1) Erna Risch, The Quartermaster Corps: Organi- zation, Supply, and Services (Washington, 1953), p. 171, in UNITED STATES ARMY IN WORLD WAR II. (2) T/O&E 8-560, Sta Hosp, 28 Oct 44. (3) T/O&E 8-580, Evac Hosp, 31 Jan 45. (4) Informa- tion supplied informally by Dr. Risch on 30 Novem- ber 1953. 304244 0—55 21 298 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Pacific theater had developed plans for partially prefabricated buildings and had arranged with the Australians for their manufacture. Constructed of corrugated sheets of iron, floored with wood or con- crete, screened, and provided with wide overhanging eaves for protection against tropical rains, buildings of this type— called “Australian cowsheds”—had been satisfactory. By the middle of 1943, the demand for them threatened to exceed the Australian supply and the theater called upon the zone of interior to furnish prefab- ricated buildings to house 22,000 beds in 44 hospitals.69 As a result, the offices of The Surgeon General and the Chief of Engineers worked on improvements in plans for overseas hospitals and on the provision of prefabricated buildings.70 The term “prefabricated” was used loosely by both offices and apparently meant differ- ent things to different people, for in Sep- tember 1943 the Surgeon General’s Con- struction Division was surprised when it discovered that the Engineers were plan- ning precut but not prefabricated build- ings.71 The Surgeon General protested against the adoption of precut construc- tion, but because of the urgent need for hospital buildings in the Pacific, ASF headquarters, the Engineers reported, di- rected them to fill the theater’s requisi- tion.72 In conferences with representatives of the Surgeon General, the Chief of Engi- neers agreed that truly prefabricated steel buildings would be preferable to those of precut wood, but pointed to restrictions upon the use of steel as the major reason for not planning its use in hospital build- ings. The Surgeon General’s Office then prepared an urgent request to ASF head- quarters for steel, and the ASF Materiel and Production Division decided that, as a result of the cancellation of drum plate commitments, it could be supplied for buildings for twenty of the forty-four hos- pitals requested by the Pacific.7 * Subse- quently, the Surgeon General’s Office and the Engineers engaged in a revision of plans for the types, sizes, and internal arrangements of hospital buildings, to cor- rect defects that had been revealed by experience in using theater-of-operations- type construction in the Desert Training Center in the United States.74 The plans for precut hospital buildings developed by the Office of the Chief of Engineers failed to meet the approval of theater headquarters. In the first place, the Southwest Pacific theater believed that they would not solve the engineering problem, for to erect them would require more construction personnel than would 69 Office of the Chief Engineer, General Headquar- ters Army Forces, Pacific, Engineers in Theater Opera- tions, in ENGINEERS OF THE SOUTHWEST PACIFIC 1941-45, vol. I (1947), pp. 127-28. Refer- ence to a requisition dated 19 July 1943, which had not been located, is made in Ltr, CG USASOS SWPA to CG ASF thru CG USAFFE, 28 Apr 44, sub: Pre- fabricated Hosps. CE: 632 “Vol. 4.” 70 Memo, CofEngrs for SG, 19 Aug 43, sub; Pro- posed Plans for . . . Tropical Hosps . . . Prefabri- cated All Wood Bldgs, with 3 inds. SG; 632.-1 (Gen). 71 Memo, CofEngrs for SG, 23 Sep 43, sub: Prefab- ricated Tropical Hosps, with 1 ind and 3 incls. CE; 632 “Vol. 4.” 72 (1) Memo, CofEngrs for SG, 13 Oct 43, sub: Structures for Tropical Hosps. SG: 632.-1 (Gen). (2) Memo, Maj Edwin M. Loye, SGO for Lt Col A. L. Tynes, SGO, 15 Oct 43, sub: Mtg . . . Regarding Prefabricated Steel and Stock Precut Wood Hosp Bldgs. Same file. 73 (1) Ltr, Act SG to Mat Div SOS, 18 Oct 43, sub: Steel Hosp Bldgs. SG: 632.-1. (2) 1st ind, CG ASF to CofEngrs, 23 Oct 43, sub: Steel Hosp Bldgs, on unlo- cated basic Ltr. SG: MOOD “Pacific.” 74 (1) Memo, Chief Hosp Cons Br SGO for SG, 21 Feb 44, sub: Insp of TofOpns Type Hosp Facs in the G-AMA. SG: 632.-1. (2) Ltr, SG to CofEngrs, 24 Apr 44, sub: Modifications of TofOpns Specifications for Hosp Cons. Same file. (3) Rpt of Conf, CofEngrs to SG, 19 May 44. HD: 632.-1. HOSPITAL CONSTRUCTION AND MAINTENANCE 299 be available. In the second place, hospi- tals planned for precut construction were more elaborate than the theater thought necessary. For example, floor space per bed in wards was greater than in Austra- lian prefabricated buildings, services and utilities were considered excessive, and certain buildings such as fire stations, guardhouses, and quarters for officers and enlisted men were considered unnecessary. War experience in the Pacific had dic- tated austerity in hospital housing which the Surgeon General’s Office was unwill- ing to approve. The Southwest Pacific agreed to accept the hospital buildings being prepared for shipment from the United States “on the score of expedien- cy,” but requested that they be held until called for.75 Meanwhile, the Southwest Pacific continued to use “Australian cow- sheds” and the Central Pacific to use Quonset huts supplied by the Navy.76 When precut hospital buildings did arrive in the Pacific, theater headquarters found them, for the reasons expected, unsatisfac- tory.77 During the rest of 1944 and the early part of 1945 the Offices of The Sur- geon General and the Chief of Engineers continued attempts to provide prefabri- cated hospitals that would meet the needs of the Pacific, but the war ended before they could achieve success. 75 (1) Ltr, CG USASOS (SWPA) to CG ASF thru CG USAFFE, 28 Apr 44, sub: Prefabricated Hosps, with 7 inds. CE: 632 “Vol. 4.” (2) Ltr, SG to GofEngrs, 29 May 44, sub: Prefabricated Hosps. SG: 632.-1. (3) Memo, Chief Theater Br SGO for Col Welsh, 29 Sep 44, sub: Housing for Hosps. SG: MOOD “Pacific.” 76 (1) Memo, Chief Theater Br SGO for Col [Arthur B.] Welsh SGO, 13 Sep 44, sub: Housing for Hosps in SWPA. SG: MOOD “Pacific.” (2) Rad CM-IN-10289, CG USAFPOA to CG PE, Ft Mason, Calif, 8 Dec 44. SG; 632 “FIosp Misc 1944.” 77 (1) Memo, Chief Hosp Cons Br SGO for Dir Hosp Div SGO, 2 Sep 44. (2) Memo, Lt Col [Douglas B.] Kendrick, [Jr.] MG for SG, 2 Sep 44, sub: Rpt of Trip to SPA, SWPA, and CPA, 6 Jun-8 Aug 44. (3) Tel conv, Lt Col R. A. Lewis, OCE and Col Tynes, MC, SGO, 2 Sep 44, sub: Prefabricated Hosp Bldgs for Pacific Theater. All in SG: MOOD “Pacific.” (4) Ltr, CG Hq Island Gomd Saipan to CG POA, 17 Jan 45, sub: Deficiencies of Bks—Precut Ptbl Wood, for Hosp Usage, with 2 inds. CE: 632 (USAFPOA). CHAPTER XVIII Return to a Peacetime Basis With the war’s end, first in Europe and then in the Pacific, pressure to return to a peacetime basis was so great that hos- pital resources built up over a period of more than five years were liquidated in little over a year. This process was first completed in overseas theaters. Redeployment and Demobilization of Numbered Hospital Units The peak of hospital beds in overseas theaters was reached in May 1945, when there were in all theaters 343,975 fixed hospital beds and 85,975 mobile hospital beds. Of these, the greatest number were in the European theater, which at that time had 200,350 fixed beds and 58,200 mobile beds.1 With the approach of V-E Day, the War Department placed em- phasis upon evacuating as many patients as possible from both the European and Mediterranean theaters, in order to make full use of shipping space that would later be diverted to the Pacific and to free as many hospital units as possible for rede- ployment after the defeat of Germany.2 In April 1945 the 60-day evacuation pol- icy which Europe had been following on a defacto basis for several months was made official for both the European and Medi- terranean theaters.3 After V-E Day, as both troops and patients were moved out of these theaters, plans were made to ship some of their hospital units direct to the Pacific, some to the United States for later shipment to the Pacific, and some to the United States for inactivation.4 As a re- sult, by August 1945 the number of fixed beds in the European theater decreased to 141,850 and of mobile beds to 50,775.5 In that month it was possible to place both the European and Mediterranean theaters on an inactive basis—that is, to reduce their establishments to the require- ments of occupation forces. Their evacu- ation policies were therefore set at 120 days and their fixed-bed ratios at 4 per- cent.6 1 Statistics Branch, Control Division, Hq. ASF, Sta- tistical Review, World War II: A Summary of ASF Activi- ties (n d), App R, p. 243 (cited hereafter as Statistical Review, World War II). 2 (1) Ltr WDGDS 10303, Dep ACofS G-4 WDGS to CofSA, 17 Mar 45, sub: Evac of Pnts from ETO, with 3 incls. HRS: G-4 files, “Hosp, vol. III.” (2) Ca- blegram GM-OUT-65962, WD to Hq ComZ ETO, 10 Apr 45. Same file. (3) Memo, SG for ACofS G-4 WDGS, 11 Apr 45, sub: Evac Policy with Spec Ref to ETO. SG: 705. 3S/S WDGDS 11921, ACofS OPD WDGS to CofSA, 18 Apr 45, sub; Proposed Change in Evac Policy for ETO and MTO. HRS: G-4 files, “Hosp, vol. HI.” 4 (1) ASF Monthly Progress Rpt, Sec 7. Health, 30 Jun 45, p. 34. (2) ASF Monthly Progress Rpt, Sec 7, Health, 31 Jul 45, p. 29. 5 Statistical Review, World War II, App R, p. 243. 6 (1) Rad CM-IN-19035 (19 Jul 45), TERMINAL to WD, 19 Jul 45. SG: 705. (2) Memo, Lt Col E[dward] C. Spaulding, GSC for ACofS G-4 WDGS, 27 Jul 45, sub: Reduction of Fixed Hosp Bed Basis in ETO. HRS: G-4 files, “Hosp, vol. IV.” (3) Memo, SG for ACofS G-4 WDGS, 10 Sep 45, sub; Recom- mended Reduction in Fixed Beds in ETO and MTO to 4 percent. SG: 632.2. (4) Rad CM-OUT-63 182, WAR to CG ETO and MTO, 12 Sep 45. HRS: G-4 files, “Hosp, vol. IV.” (5) Memo SPOPP 370.05, Act Dir Plans and Oprs ASF for SG and CofT, 24 Jul 45, sub: Evac Policy ETO. SG; MOOD “ETO.” (6) Rad GM-OUT-46451 (Aug 45), COMGENSERV to CG USAF MTO, 8 Aug 45. SG: 705. RETURN TO A PEACETIME BASIS 301 With redeployment, the number of fixed and mobile beds in the Southwest Pacific increased from 67,250 in May 1945 to 82,700 in August 1945. Mean- while, the number of beds in other areas of the Pacific declined from 37,600 to 32,- 700.7 The surrender ofjapan in August heralded a cancellation of the shipment of further hospital units to the Pacific8 and a repetition of the process that had been followed in Europe of clearing hospitals of patients by evacuating them to the United States. Early in August, the War Department directed the Pacific—which in April had been placed under a single command—to use all evacuation facilities available, reducing the evacuation policy to 60 days if necessary.9 The next month it was possible to plan to place that area on an inactive basis. The War Depart- ment therefore directed it to return to a 120-day policy effective 1 December 1945 and to comment on a proposed reduction of its bed ratios to 4.8 percent.10 Before this reduction was actually made, the Sur- geon General’s Office and the General Staff turned to re-examining the needs of all theaters. By the end of October 1945 the num- ber of beds in fixed hospitals in theaters of operations had been reduced, through the inactivation of some units in theaters and the return of others to the United States, from a peak of 343,975 in May 1945 to 236,050.“ This reduction was not great enough to return physicians, den- tists, and nurses to civilian life as rapidly as the public and the Congress desired, and in November 1945 both the Secretary of War and the Chief of Staff of the Army took personal interest in speeding that process. Consequently, G-l called a con- ference of representatives of other General Staff divisions, of AAF, AGE, and ASF headquarters, and of the Surgeon Gen- eral’s Office. At this conference it was agreed that the Surgeon General’s Office would make studies of the requirements of various theaters for beds during demobi- lization and would submit recommenda- tions for changes in authorized ratios.12 During November and December 1945 such studies were completed and the Gen- eral Staff requested theaters to comment on the proposals of The Surgeon General. Aside from a recommendation that the authorized bed ratio of each theater be re- duced, his most important proposal was the application of that ratio to beds not only in fixed hospitals but also in mobile hospital units that retained professional staffs of physicians, dentists, and nurses. The reason that The Surgeon General now proposed what he had protested against in August 1943—that is, the use of a single ratio for authorizing beds in both fixed and mobile hospitals—was that the need for mobile hospitals to support troops in combat had vanished with the cessation of hostilities. The only possible excuse for a theater’s keeping professional staffs in the mobile units left there was to use these units as fixed hospitals. The Sur- geon General’s proposals were approved and as a result of studies by his Office and 7 Statistical Review, World War II, App R, p. 243. 8 ASF Monthly Progress Rpt, Sec 7, Health, 31 Aug 45, p. 13. HD. 9 Memo, C. M. Ankcorn for ACofS G-4 WDGS, 10 Aug 45, sub: Evac from Pacific Theater. HRS: G-4 files, “Hosp, vol. IV.” 10 (1) Memo, Dir MOOD SGO for Record, 24 Sep 45. SG: MOOD “Pacific.” (2) Rad CM-OUT-70899 (Sep 45), WARGFOUR to CINCAFPAC, 27 Sep 45. SG: 705. (3) Rad CM-IN-2145, CINCAFPAC to WD, 4 Oct 45. HRS: G-4 files, “Hosp, vol. IV.” 11 Statistical Health Rpts. Off file, Health Rpts Br Med Statistics Div, SGO. 12 Memo, Lt Col Johnnie R. Dyer, GSC for ACofS G-4 WDGS, 26 Nov 45, sub: Delays in Discharge of Doctors and Dentists. HRS: G-4 files, “Hosp, vol. IV.” 302 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR of comments by theaters, the General Staff in December 1945 authorized a bed ratio of 4 percent for all theaters except the American, which was to continue on a 3 percent basis.13 In consequence, the number of beds in fixed hospitals and pro- fessionally staffed mobile hospitals de- creased rapidly until by the end of May 1946 there were only 42,100 such beds in all theaters.14 Contraction of the fjone of Interior Hospital System Soon after V-E Day G-4 began to put considerable pressure upon ASF, and that headquarters in turn upon the Surgeon General’s Office, to estimate general and convalescent hospital requirements in the United States through the first quarter of 1946 and to make plans to reduce the number of beds accordingly.15 Emphasis was placed upon planning for the con- traction of the general-convalescent hos- pital system because the reduction and closure of station and regional hospitals, dependent primarily upon the reduction and closure of posts where they were lo- cated, had already begun and would con- tinue under established procedures. After V-E Day, G-4 called for revised estimates of requirements and The Surgeon Gen- eral projected forward to the end of 1946 his plans for shrinking the general-con- valescent hospital system.16 In estimating bed requirements at this time, there still were uncertainties to con- tend with. Before V-J Day the number of battle casualties that would occur and the number of patients to be evacuated monthly from the Pacific were of course unknown. In addition, there was uncer- tainty about the amount and rate of rede- ployment of troops to the Pacific through the United States and the speed with which German prisoners of war would be repatriated.17 After V-J Day some of these difficulties vanished but additional factors appeared. Among them were the rate at which the Army would be demobilized; the time required to treat patients for sec- ondary diagnoses; the number of soldiers that would be found at separation centers to need hospitalization, especially for tu- berculosis and deafness, before their dis- charge from the Army; and delays that the shortage of specialists might occasion in the disposition of patients already under treatment, particularly plastic sur- gery and amputation cases.18 In view of these uncertainties and diffi- culties, the Resources Analysis Division of the Surgeon General’s Office presented to G-4 “conservative” estimates of the num- ber of beds that could be eliminated each quarter, in order to protect the Medical Department against the possibility of hav- ing too few beds for any reason. For ex- ample, the number of patients who would 13 ASF Monthly Progress Rpt, Sec 7, Health, 31 Dec 45, p. 17, HD. The studies made by the Surgeon General’s Office, the comments of theaters, and the documents in which the Staff authorized new bed ratios are filed in HRS: G-4 files, “Hosp, vol. V.” 14 ASF Monthly Progress Rpt, Sec 7, Health, 31 May 46, p. 22. HD. 15 (1) Diary, Resources Anal Div SGO, 16Jun 45. HD: 024.7-3. (2) DF WDGDS 15204, ACofS G-4 WDGS to CG ASF, 23 Jun 45, sub; ZI Hosps. HRS: Hq ASF Planning Div file, 700 “ZI Hosp.”<3) T/S SPOPP 702 (25 Jun 45), CG ASF to SG, 27 Jun 45, sub: ZI Hosps. Same file. 16 (1) DF WDGDS 2399, ACofS G-4 WDGS to CG ASF attn SG, 18 Aug 45, sub: ZI Hosps. SG: 322 “Hosp.” (2) Memo, SG for ACofS G-4 WDGS thru CG ASF, 14 Sep 45, sub; Cut-back in Gen and Conv Hosp Fac. Same file. 17 Memo, SG for ACofS G-4 WDGS, 8 Jun 45, sub: Hosp Fac. SG: 322 “Hosp.” 18 1st ind, SG to CG ASF, 28 Nov 45, on Memo SPOPP 705, CG ASF for SG, 9 Nov 45, sub: Cut-back in Gen and Conv Hosp Fac, ZI. SG: 323.3 (Gen Hosp). RETURN TO A PEACETIME BASIS 303 need beds in November was used as the number who would need them in Decem- ber, and to this number were added addi- tional beds that would be vacant either because of dispersion or because some pa- tients were absent from hospitals on leave and furlough.19 On 14 September 1945 The Surgeon General informed G-4 that the capacities of general hospitals could be reduced by 40,000, 38,000, and 39,000 beds and of convalescent hospitals by 21,000, 14,000, and 8,000 beds during the last quarter of 1945 and the first two quarters of 1946, and that 16,000 addi- tional general hospital beds could be eliminated during the last half of 1946. In December this program was revised, chiefly to speed the liquidation of the con- valescent hospital system.20 Soon after V-E Day the Resources Analysis Division had established a pro- cedure for reducing the number of beds in general and convalescent hospitals. It involved closing entire hospitals rather than parts of all of them, in order to free more physicians for return to civilian life—a matter that was to assume increas- ing importance as the press, the public, and the Congress continued to clamor for their release. For example, a reduction of the capacities of five 2,500-bed hospitals by 500 beds each would release only 25 physicians while the closure of one 2,500- bed hospital would release 60.21 This de- cision having been made, the Division established certain broad principles to govern the selection of particular hospi- tals for closure during successive quarters. They were as follows: leased buildings should be returned to their owners, and hospitals needed by other government agencies, such as the Veterans Adminis- tration, should be transferred to these agencies as soon as possible; hospitals in heavily populated areas should be re- tained to permit the hospitalization of pa- tients near their homes; hospitals that were less desirable because of climate and construction should be closed before others; hospitals needed for the postwar Army and for station hospital purposes should be retained; and hospitals desig- nated as specialized centers for long-term cases, such as amputation and neurosur- gery cases, should be retained as long as possible in order to keep to a minimum the transfer of those patients to other hos- pitals. In some instances, these principles con- flicted with one another. For example, Halloran and Mason General Hospitals were located in leased buildings and Mc- Guire and Vaughan were desired by the Veterans Administration, but they were also situated in areas of dense population where many beds were needed. Lovell and Tilton General Hospitals were of poor construction, being among the first of the cantonment-type general hospitals constructed during World War II, but were located on Army posts and might be needed for station hospital use. These con- 19 (1) Statement by Eli Ginzberg, Dir Resources Anal Div SGO, in Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45. HD: Resources Anal Div files, “Hosp.” (2) Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 7 Jun 45, sub: Criteria for Re- duction in Hosp Fac. SG: 323.3 (Hosp). 20 (1) Memo, SG for AGofS G-4 WDGS thru GG ASF, 14 Sep 45, sub; Gut-back in Gen and Conv Hosp Fac. SG: 322 “Hosp.” (2) Memo, SG for AGofS G-4 WDGS thru CG ASF, 21 Dec 45, same sub. SG: 323.3 (Hosp). 21 (1) Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 7 Jun 45, sub: Criteria for Re- duction in Hosp Fac. SG: 323.3 (Hosp). (2) Statement by Eli Ginzberg, Dir Resources Anal Div SGO, in Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45. HD: Resources Anal Div file, “Hosp.” (3) Ltr, SG to CGs SvGs attn Surg, 20 Dec 45, sub: Comparative Studies of Gen-Conv and Sta-Regional Hosp Systs. SG: 323.3 (Hosp). HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Name of hospital War Depart- ment directive naming or designating hospital Person for whom named Location Population of town or city ac- cording to 1940 census Type of construction Date ready for or received first patient Author- ized bed capacity as of April 1945 Specialties as of April 1945 Date of dispo- sition of last general hospital patient up to 31 Dec. 1946 Disposition as listed by Army 31 July 1951 Army and Navy... WDGO 36 4 Jun 86 Hot Springs, Ark. 21, 370 Multi-story permanent (brick) 17 Jan. 1887 1,220 Genera! medicine; arthritis; deep x-ray therapy; radium therapy Active 1951; retained for Regular Army Ashburn WDGO 68 16 Dec 42 Percy Moreau Ashburn (1872- 1940), Col., MC, USA McKinney, Tex. 8, SSS Special type resembling type A (tile) 15 Jun. 1943 1,592 General medicine; arthritis 18 Dec. 1945 Transferred to Vet. Admin. Ashford WDGO 64 24 Nov 42 Bailey Kelley Ashford (1873- 1934), Col., MC, USA White Sul- phur Springs, W. Va. 2,093 Multi-story permanent (brick) (con- verted hotel) 14 Nov. 1942 2, 025 General medicine; neurology; neuro- surgery; vascular surgery 15 Jun. 1946 Transferred to town of White Sulphur Springs, W. Va. Barnes Ltr AG 322.3 Gen Hosp (1- 9-41 )M (Ret) M-C, 11 Feb 41 Joseph K. Barnes (1817-83), Sur- geon General, USA, 1864-82 Vancouver, Wash. 18, 788 Cantonment (wood) 16 Apr. 1941 1,547 General and ortho- pedic surgery 14 Dec. 1945 Transferred to Vet. Admin. Battey WDGO 23 IS May 43 Robert Battey (1828-95), Sur- geon, Confederate Army Rome, Ga. 26, 282 Type A (brick) 7 Nov. 1943 1, 826 General medicine; general and ortho- pedic surgery; psychiatry IS Dec. 1945 Transferred to State of Georgia Baxter WDGO 64 24 Nov 42 Jedediah Hyde Baxter (1837-90), Surgeon General, USA, 16 Aug. to 4 Dec. 1890 Spokane, Wash. 122,001 Cantonment (wood) 24 Jun. 1943 2,001 General medicine; general and ortho- pedic surgery; thoracic surgery 8 Nov. 1945 Transferred to Vet. Admin, and Navy Dept. Billings Ltr AG 322.3 Gen Hosp (1— 9-41 )M (Ret) M-C, 11 Feb 41 John Shaw Bill- ings (1838-1913), Lt. Col., MC, USA Fort Benja- min Harrison (Indianapolis, Ind.) 386, 972 Cantonment (wood) 15 Jul. 1941 1,510 General and ortho- pedic surgery IS Mar. 1946 Transferred to Vet. Admin. Table 15—U. S. Army General Hospitals in the United States During World War II RETURN TO A PEACETIME BASIS Birmingham WDGO 48 24 Aug 43 Henry Patrick Birmingham (1854-1932), Brig. Gen., MC, USA Van Nuys, Calif. (Los Angeles) 1, 504, 277 Type A (stucco) 25 Feb. 1944 1, 777 General medicine; CNS syphilis; rheumatic fever; psychiatry 31 Mar. 1946 Transferred to Vet. Admin. Borden WDGO 64 24 Nov 42 William Cline Borden (1858- 1934), Lt. Col, MC, USA Chickasha, Okla. 14, 111 Cantonment (wood) 12 Mar. 1943 1,400 General and ortho- pedic surgery; deaf 20 Sep. 1946 Assumed by War Assets Admin. Brooke WDGO 58 29 Oct 42 Roger Brooke (1878-1940), Brig. Gen., MC, USA Fort Sam Houston (San Antonio, Tex.) 253, 854 Multi-story permanent (brick and tile) 4 Sep. 1942 3, 071 General medicine; trench foot; thoracic surgery; psychiatry Active 1951; retained for Regular Army Bruns WDGO 67 14 Dec. 42 Earl Harvey Bruns (1879-1933), Col., MC, USA Santa Fe, N. Mex. 20, 325 Cantonment (wood and asbestos shingle) 19 Apr. 1943 1,575 General medicine; tuberculosis 14 Dec. 1946 Transferred to Atomic Energy Commission and Christian Broth- ers College Bushnell WDGO 64 24 Nov 42 George Ensign Bushnell (1853- 1924), Col., MC. USA Brigham City, Utah 5,641 Two-story semiperma- nent (brick) 10 Oct. 1942 3,377 Neurology; ampu- tations; neurosur- gery; deep x-ray therapy; psychiatry 28 Jun. 1946 Assumed by War Assets Admin. Crile WDGO 48 24 Aug 43 George Washing- ton Crile (1864- 1943), Brig. Gen., MC. Res., USA Cleveland, Ohio 878, 336 Type A (brick) 8 Apr. 1944 1,867 General and ortho- pedic surgery; plastic surgery; ophthalmologic surgery; psychiatry 25 May 1946 Transferred to Vet. Admin. Cushing WDGO 48 24 Aug 43 Harvey Cushing (1869-1939), Col., MC, Res., USA Framingham, Mass. 23,214 Type A (brick) 27 Feb. 1944 1, 800 Neurology; plastic surgery; ophthal- mologic surgery; neurosurgery; psychiatry 30 Sep. 1946 Transferred to Vet. Admin. Darnall WDGO IS 29 Dec 41 Carl Rogers Darnall (1867- 1941), Brig. Gen., MC, USA Danville, Ky. 6,734 Multi-story permanent (brick) (converted civilian hospital) 24 Mar. 1942 921 Psychiatry IS Dec. 1945 Returned to State of Kentucky HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Name of hospital War Depart- ment directive naming or designating hospital Person for whom named Location Population of town or city ac- cording to 1940 census Type of construction Date ready for or received first patient Author- ized bed capacity as of April 1945 Specialties as of April 1945 Date of dispo- sition of last general hospital patient up to 31 Dec. 1946 Disposition as listed by Army 31 July 1951 Deshon WDGQ64 24 Nov 42 George Durfee Deshon (1865- 1917), Lt. Col., MC, USA Butler, Pa. 24, 477 Multi-story permanent (brick) (converted civilian sanitorium) 1 Dec. 1942 1, 774 General and ortho- pedic surgery; deaf 29 Apr. 1946 Transferred to Vet. Admin. DeWitt WDGO 48 24 Aug 43 Calvin DeWitt (1840-1908), Brig. Gen., MC, USA Auburn, Calif. 4,013 Type A (tile) 27 Feb. 1944 1, 852 General medicine; neurology; neuro- surgery; vascular surgery; psychiatry 30 Dec. 1945 Transferred to State of California Dibble WDGO 48 24 Aug 43 John Dibble (1890-1943), Col., MC, USA Menlo Park, Calif. 3, 258 Type A (stucco) 22 Feb. 1944 1,868 Plastic surgery; ophthalmologic surgery; blind; psychiatry IS Jun. 1946 Transferred to Federal Public Housing Authority England (Thomas M. Eng- land after 14 Nov. 1944) WDGO 57 21 Sep 43 Thomas Marcus England (1876- 1943), Lt. Col., MAC, USA Atlantic City, N. J. 64,094 Multi-story permanent (brick) (converted hotels) 15 Aug. 1943 3, 650 Neurology; amputations; neurosurgery 7 Jun. 1946 Leases canceled; returned to owners. Finney WDGO 67 14 Dec 42 John Miller Turpin Finney (1863-1942), Brig. Gen., MC, Res., USA Thomasville, Ga. 12, 683 Cantonment (tile and gyp- sum board) 5 Jun. 1943 1,994 General medicine; CNS syphilis; general and ortho- pedic surgery; psychiatry 15 Dec. 1945 Transferred to Vet. Admin. Fitzsimons WDGO 40 26 Jun 20 William Thomas Fitzsimons (1889- 1917), 1st Lt., MC, Res., USA Denver, Colo. 322, 412 Multi-story permanent (brick) 13 Oct. 1918 3,417 General medicine; tuberculosis; gen- eral and ortho- pedic surgery; thoracic surgery; deep x-ray therapy; psychiatry Active 1951; retained for Regular Army Table 15—U. S. Army General Hospitals in the United States During World War II—Continued RETURN TO A PEACETIME BASIS 307 Fletcher WDGO 67 14 Dec 42 John Pierpont Fletcher (1884- 1941), Col., MC, USA Cambridge, Ohio 15,044 Cantonment (brick) 26 Jun. 1943 1,670 General medicine; general and ortho- pedic surgery 29 Mar. 1946 Transferred to State of Ohio, Department of Public Welfare Foster WDGO 67 14 Dec 42 Charles Lovelace Foster (1871- 1941), Col., MC, USA Jackson, Miss. 62,107 Special type resembling type A (tile and brick) 11 Sep. 1943 1,905 General medicine; rheumatic fever; general and ortho- pedic surgery IS Dec. 1945 Transferred to Vet. Admin. Gardiner WDGO 63 1 Oct 43 Ruth Mabel Gardiner (1914- 43), 2d Lt„ ANC, USA Chicago, 111. 3,396,808 Multi-story permanent (brick) (con- verted hotel) 1 Oct. 1943 1,061 General and orthopedic surgery 21 Jun. 1946 Transferred to Fifth Army headquarters Glennan WDGO 23 IS May 43 James Denner Glennan (1862- 1927), Brig. Gen., MC, USA Okmulgee, Okla. 16,051 Type A (brick) 17 Dec. 1943 1,690 Prisoners of war 2 Dec. 1945 Transferred to Oklahoma A. and M. College Halloran WDGO S3 14 Oct 42 Paul Stacy Halloran (1874- 1931), Col., MC, USA Willowbrook, Staten Island (Richmond), N. Y. 174,441 Multi-story permanent (brick) (con- verted civilian buildings) 5 Nov. 1942 5,350 Neurology; general and orthopedic surgery; neurosurgery 31 Dec. 1946 Leases canceled; returned to owners Hammond WDGO 64 24 Nov 42 William Alexander Hammond (1828- 1900), Surgeon General, USA, 1862-63 Modesto, Calif. 16,379 Cantonment (wood) 24 Oct. 1942 2,540 Neurology; general and orthopedic surgery; neuro- surgery; psychiatry 20 Dec. 1945 Transferred to Slate of California Harmon WDGO 64 24 Nov 42 Daniel Warwick Harmon (1880- 1940), Col., MC, USA Longview, Tex. 13,758 Cantonment (wood) 9 Dec. 1942 2,218 General medicine; CNS syphilis; tropical disease; general and ortho- pedic surgery; psychiatry 6 Dec. 1945 Transferred to Le Tourneau Foundation Hoff Ltr AG 322.3 Gen Hosp (1— 9-41) M (Ret) M-C, 11 Feb 41 John Van Renn- sselaerHoff (1848- 1920), Col., MC, USA Santa Bar- bara, Calif. 35,958 Cantonment (wood) 12 Jun. 1941 1,141 General and ortho- pedic surgery; deaf 10 Nov. 1945 Assumed by Federal Public Housing Authority HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Name of hospital War Depart- ment directive naming or designating hospital Person for whom named Location Population of town or city ac- cording to 1940 census Type of construction Date ready for or received first patient Author- ized bed capacity as of April 1945 Specialties as of April 1945 Date of dispo- sition of last general hospital patient up to 31 Dec. 1946 Disposition as listed by Army 31 July 1951 Kennedy WDGO 64 24 Nov 42 James Madison Kennedy (1865- 1930), Brig. Gen., MC, USA Memphis, Tenn. 292,942 Two-story semiperma- nent (brick) 1 Jan. 1943 4,387 Neurology; general and orthopedic surgery; thoracic surgery; neuro- surgery psychiatry 23 Jun. 1946 Transferred to Vet. Admin. LaGarde Ltr AG 322.3 Gen Hosp (1- 9-41) M (Ret) M-C, 11 Feb 41 Lewis Anatole LaGarde (1849- 1920), Col., MC, USA New Orleans, La. 494,537 Cantonment (wood) 14 Jun. 1941 1,176 General and ortho- pedic surgery; psychiatry 7 Dec. 1945 Transferred to Vet. Admin. Lawson Ltr AG 322.3 Gen Hosp (1- 9-41) M (Ret) M-C, 11 Feb 41 Thomas Edwin Lawson (1793- 1861), Surgeon General, USA, 1836-61 Atlanta, Ga. 302,288 Cantonment (wood) 22 Jul. 1941 2,514 Neurology; ampu- tations; neuro- surgery; deep X-ray therapy 25 Jun. 1946 Transferred to Vet. Admin, and Federal Public Housing Authority Letterman WDGO 152 23 Nov 11 Jonathan Letter- man (1824-72), Surgeon Major, USA San Francisco, Calif. 634,536 Multi-story permanent (concrete, brick and tile, with stucco finish) 27 Jul. 1899 (Called U. S. Army General Hospital, Presidio of San Francisco, until 1911) 3,500 Deep X-ray therapy; radium therapy Active 1951; retained for Regular Army Lovell Ltr AG 322.3 Gen Hosp (1- 9-41) M (Ret) M-C, 11 Feb 41 Joseph Lovell (1788-1836), Surgeon General, USA, 1818-36 Ayers, Mass. 3,572 Cantonment (wood) 20 Jun. 1941 4,000 General medicine; CNS syphilis: gen- eral and ortho- pedic surgery 24 Jun. 1946 Redesignated as Station Hospital, Fort Devens, Mass. Madigan WDGO 76 22 Sep 44 Patrick Sarsfield Madigan (1887- 1944), Col., MC, USA Tacoma, Wash. 109,408 Type A (brick) 22 Aug. 1944 (Formerly an ASF station hospital) 4,300 General medicine; general and ortho- pedic surgery Active 1951; retained for Regular Army Table 15—U. S. Army General Hospitals in the United States During World War II—Continued RETURN TO A PEACETIME BASIS Mason WDGO 48 24 Aug 43 Charles Field Mason (1864- 1922), Col., MC, USA Brentwood, L. I., N. Y. 568 Multi-story permanent (brick) (converted civilian hospital). 5 Jul. 1943 3,032 Psychiatry 20 Dec. 1946 Leases canceled; returned to owners Mayo WDGO 48 24 Aug 43 William James Mayo (1861— 1936), Brig. Gen., MC, Res., USA and Charles Horace Mayo (1865- 1939), Brig. Gen., MC, Res., USA Galesburg, 111. 28,876 Type A (brick) 1 Feb. 1944 1,855 General medicine; neurology; neuro- surgery; vascular surgery IS Sep. 1946 Transferred to State of Illinois McCaw WDGO 64 24 Nov 42 Walter Drew McCaw (1863- 1939), Brig. Gen., MC, USA Walla Walla, Wash. 18,109 Cantonment (wood) 5 Mar. 1943 1,502 Neurology; general and orthopedic surgery; neuro- surgery; psychi- atry 25 Nov. 1945 Transferred to Vet. Admin. McCloskey WDGO 64 24 Nov 42 James Augustus McCloskey (1909- 41), Maj., MC, USA Temple, Tex, . 15,344 Two-story semiperma- nent (brick) 20 Oct. 1942 3,454 Neurology; ampu- tations; neuro- surgery; psychiatry 31 Mar. 1946 Transferred to Vet. Admin. McGuire WDGO 48 24 Nov 43 Hunter Holmes McGuire (1835- 1900), Medical Director, Second Army Corps, Army of Northern Virginia, Con- federate Army Richmond, Va. 193,042 Type A with VA-type buildings (brick) 29 Jul. 1944 1,765 Neurology; ampu- tations; neuro- surgery 31 Mar. 1946 Transferred to Vet. Admin. Moore WDGO 64 24 Nov 42 Samuel Preston Moore (1813-89), Surgeon General, Confederate Army Swannanoa, N. C. (Ashe- ville). 51,310 Cantonment (wood) 2 Dec. 1942 2,605 General medicine; tropical disease; general and ortho- pedic surgery; psychiatry IS Nov. 1946 Transferred to Vet. Admin. Newton D. Baker.. WDGO IS 23 Mar 43 Newton Diehl Baker (1871- 1937), Secretary of War, World War I Martinsburg, W. Va. 15,063 Type A (brick) 28 Jan. 1944 1,806 Neurology; plastic surgery; ophthal- mologic surgery; neurosurgery; psychiatry 20 Jun. 1946 Transferred to Vet. Admin. HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Name of hospital War Depart-, ment directive naming or designating hospital Person for whom named Location Population of town or city ac- cording to 1940 census Type of construction Date ready for or received first patient Author- ized bed capacity as of April 1945 Specialties as of April 1945 Date of dispo- sition of last general hospital patient up to 31 Dec. 1946 Disposition as listed by Army 31 July 1951 Nichols WDGO 64 24 Nov 42 Henry James Nichols (1877- 1927), Lt. Col.. MC, USA Louisville, Ky. 319,077 Cantonment (wood) 11 Dec. 1942 1,717 Neurology; general and orthopedic surgery; neuro- surgery 29 Mar. 1946 Transferred to Vet. Admin. Northington WDGO 23 IS May 43 Eugene Garland Northington (1880-1933), Lt. Col., MC, USA Tuscaloosa, Ala. 27,493 Type A (tile and brick) 5 Sep. 1943 2,131 Neurology; plastic surgery; ophthal- mologic surgery; neurosurgery; psychiatry 5 Apr. 1946 Transferred to city of Tusca- loosa, Ala. Oliver WDGO 64 24 Nov 44 Robert T. Oliver (1868-1937), Col., DC, USA Augusta, Ga. 65,919 Multi-story permanent (brick) (con- verted hotel) 28 Jan. 1943 2,240 General medicine; general and orthopedic surgery Inactive under 3d Army except for 500 beds trans- ferred to VA. O’Reilly Ltr AG 322.3 Gen Hosp (1- 9-41) M (Ret) M-C, 11 Feb 41 Robert Maitland O’Reilly (1845- 1912), Surgeon General, USA, 1902-09 Springfield, Mo. 61,238 Cantonment (wood) 7 Nov. 1941 3,232 Neurology; plastic surgery; ophthal- mologic surgery; neurosurgery 23 Sep. 1946 Transferred to Vet. Admin. Percy Jones WDGO 64 24 Nov 42 Percy Lancelot Jones (1875- 1941), Col., MC, USA Battle Creek, Mich. 43,453 Multi-story permanent (brick) (converted. civilian sanitarium) IS Jan. 1943 3,414 Neurology; ampu- tations; neuro- surgery; deep x-ray therapy Active 1951; retained for Regular Army Prisoner of War, No. 2. WDGO 88 23 Nov 44 Camp Forrest (Tullahoma, Tenn.) 4,549 Cantonment (wood) 21 Oct. 1944 (Formerly an ASF station hospital). 2,500 Prisoners of war IS Dec. 1945 Reverted to Station Hospital, Camp Forrest, Tenn. Later assumed by War Assets Admin. Table 15—U. S. Army General Hospitals in the United States During World War II—Continued RETURN TO A PEACETIME BASIS Ream WDGO 63 1 Oct 43 William Roy Ream (1877- 1918), Maj., MC, USA Palm Beach, Fla. 3,747 Multi-story permanent (brick) (con- verted hotel) 10 Sep. 1943 (Formerly an AAF station hospital) 21 Jul. 1944 Leases canceled; returned to owners Rhoads WDGO 67 14 Dec 42 Thomas Leidy Rhoads (1870- 1940), Col., MC, USA Utica, N. Y. 100,518 Cantonment (wood) 25 Aug. 1943 2,000 General medicine; general and ortho- pedic surgery 30 Jun. 1946 Transferred to State of New York Schick WDGO 64 24 Nov 42 William Rhinehart Schick (1910-41), 1st Lt., MC, Res., USA Clinton, Iowa 26,270 Two-story semiperma- nent (brick) 12 Feb. 1943 2,014 General medicine; CNS syphilis; general and ortho- pedic surgery; psychiatry. 25 Feb. 1946 Transferred to Vet. Admin. Stark Ltr AG 322.3 Gen Hosp (1- 9-41) M (Ret) M-C, 11 Feb 41 Alexander Newton Stark (1869- 1926), Col., MC, USA Charleston, S. C. 71,275 Cantonment (wood) 18 May 1941 2,400 General and orthopedic surgery. 23 Oct. 1945 Transferred to Charleston (S. C.), County Board of Control Thayer WDGO 23 15 May 43 William Sydney Thayer (1864- 1932), Brig. Gen., MC, Res., USA Nashville, Tenn. 167,402 Cantonment (cinder block) 4 Oct. 1943 1,867 General medicine; CNS syphilis; general and ortho- pedic surgery. 18 Dec. 1945 Transferred to Vet. Admin. Tilton Ltr AG 322.3 Gen Hosp (1— 9-41) M (Ret) M-C, 11 Feb 41 and WDGO 64 24 Nov 42 James Tilton (1745-1822), Surgeon General, USA, 1813-15 Fort Dix (Wrightstown, N. J.). 241 Cantonment (wood) 14 Jul. 1941 3,700 General medicine; general and ortho- pedic surgery; psychiatry. Redesignated station hospital 30 June 1949. Torney WDGO 64 24 Nov 42 George Henry Torney (1850- 1913), Surgeon General, USA, 1909-13 Palm Springs, Calif. 3,434 Permanent (stucco) (converted hotel) 5 Aug. 1942 1,600 General medicine; rheumatic fever; general and ortho- pedic surgery. 22 Nov. 1945 Assumed by Federal Works Admin. United States Army General Hospital, Camp Butner, N. C. WD Cir 36 30 Jan 45 Wilkins, N. C. (Durham) 60,195 Two-story semiperma- nent (brick) 30 Jan. 1945 (Formerly an ASF station hospital) 2,900 General medicine; trench foot; psychiatry 29 Mar. 1946 Reverted to Camp Butner. Later transferred to State of N. C. HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Name of hospital War Depart- ment directive naming or designating hospital Person for whom named Location Population of town or city ac- cording to 1940 census Type of construction Date ready for or received first patient Author- ized bed capacity as of April 1945 Specialties as of April 1945 Date of dispo- sition of last general hospital patient up to 31 Dec. 1946 Disposition as listed by Army 31 July 1951 United States Army General Hospital, Camp Carson, Colo. WD Cir 36 30 Jan 45 Colorado Springs, Colo. 36,789 Two-story semiperma- nent (cinder block) 30 Jan. 1945 (Formerly an ASF station hospital) 3,000 General medicine; trench foot; psychiatry 5 to 12 Apr. 1946 Reverted to Camp Carson, Colo. United States Army General Hospital, Camp Edwards, Mass. WD Cir 36 30 Jan 45 Falmouth, Mass. 6,878 Cantonment (wood) 30 Jan. 1945 (Formerly an ASF station hospital) 3,200 General and orthopedic sur- gery; psychiatry 15 Mar. 1946 Reverted to Camp Edwards, Mass. United States Army General Hospital, Camp Pickett, Va. WD Cir 36 30 Jan 45 Blackstone, Va. 2,699 Cantonment (wood) 30 Jan. 1945 (Formerly an ASF station hospital) 2,700 General medicine; general and orthopedic sur- gery; psychiatry IS Dec. 1945 Reverted to Camp Pickett, Va. Valley Forge WDGD64 24 Nov 42 Phoenixville, Pa. 12,282 Two-story semiperma- nent (brick) 12 Mar. 1943 2,509 Plastic surgery; ophthalmologic surgery; blind; psychiatry Active 1951; retained for Regular Army. Vaughan WDG0 48 24 Aug 43 Victor Clarence Vaughan (1851- 1929), Col., MC, Res., USA Hines, 111. (Chicago) 3,396,808 Type A with VA-type buildings (brick) 1 Aug. 1944 1,900 General medicine; general and orthopedic sur- gery; psychiatry 1 Apr. 1946 Transferred to Vet. Admin. Wakeman WDGO 34 25 Apr 44 Frank Bolles Wakeman (1896- 1944), Col., MC. USA Camp Atter- bury (Colum- bus, Ind.) 11,738 Two-story semiperma- nent (cinder block) 5 Apr. 1944 (Formerly an ASF station hospital) 2,700 Neurology; plas- tic surgery; ophthalmologic surgery; neuro- surgery 31 Dec. 1946 Redesignated as Station Hos- pital, Camp Atterbury Walter Reed WDGO 83 2 May 06 Walter Reed (1851-1902), Maj., MC, USA Washington, D. C. 663,091 Multi-story permanent (brick) May 1909 3,000 General medicine; thoracic surgery; amputations; deep x-ray therapy; radium therapy; psychiatry Active 1951; retained for Regular Army. Table 15—U. S. Army General Hospitals in the United States During World War II—Continued RETURN TO A PEACETIME BASIS 313 William Beaumont. WDGO 40 26 Jan 20 William Beau- mont (1785- 1853), Surgeon Major, USA El Paso, Tex. 96,810 Two-story permanent (tile with stucco finish) 1 Jul. 1921 4,000 General medicine; general and orthopedic sur- gery; plastic sur- gery; ophthal- mologic surgery; deep x-ray therapy; psychiatry Active 1951; retained for Regular Army WDGO 67 14 Dec 42 Francis Anderson Winter (1867- 1931), Brig. Gen., MC, USA Topeka, Kans. 67,833 Cantonment (brick) 5 Jul. 1943 1,771 General medicine; general and orthopedic sur- gery; psychiatry 25 to 30 Nov. 1945 Transferred to Vet. Admin. Woodrow Wilson. . WDGO 64 24 Nov 42 Thomas Woodrow Wilson (1856- 1924), President of US, World War I Staunton, Va . 13,337 Cantonment (brick) 6 Jun. 1943 1,565 General medicine; CNS syphilis; gen- eral and ortho- pedic surgery 31 Mar. 1946 Transferred to Augusta County, Commonwealth of Virginia Sources: (1) An Rpts, Hosps listed. HD. (2) Weekly Health Rpts, 1943-44. AML. (3) Weekly Hosp Rpts, 1945-46. HD. (4) Chart, Occupancy and Operating Pers Data for the General-Convalescent Hosp Syst, by SvC and Hosp, end of Apr 45. HD;322. (5) Program of Instls, vol. I, 31 Jul 51, Dept of Army. SG: 319.26. (6) Hammond’s Library Atlas of the World (New York, 1943). (7) Interv, MD Historian with Harvey J. Hall, Med Fac Planning Br, Med Plans and Oprs Div, SGO, 11 Mar 52. HD: 000.71. (8) AQ files: 322.3, 323.3, 600.05, and 680.9. (9) SG files: 323.3, 705, and 633-99. 304244 0—55 22 314 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR flicts complicated the selection of hospi- tals to be closed.22 In addition, the needs of both the Vet- erans Administration and the postwar Army had not been fully determined.23 Finally, local citizens sometimes protested the closure of hospitals, and service com- mand surgeons, because of local condi- tions, disagreed with some of the decisions made in the Surgeon General’s Office.24 Despite these difficulties, the program for closures drawn up in the fall of 1945 was followed with comparatively few changes. The actual process of closing hospitals was a responsibility of service command officials until April 1946, when general hospitals were placed again, as they had been before the war, under the direct com- mand of The Surgeon General. ASF head- quarters informed service commanders of the hospitals that would be closed each quarter; the Surgeon General’s Office decided the particular dates on which they would be closed; and several months prior to those dates the Medical Regulating Officer ‘‘blocked” those hospitals—that is, permitted no more patients to be sent to them. After hospitals were blocked, serv- ice commanders were required to revise authorized bed capacities twice monthly and to reduce personnel in accordance with these revisions. Hospital command- ers submitted information which higher authorities needed in order to declare as surplus the property no longer required by the Army. They also disposed of hospital personnel, supplies, and equipment under procedures established by ASF headquar- ters. After hospital buildings were de- clared surplus, the Medical Department lost all control over them and they were disposed of by other government agen- cies.25 In order to assure the reduction and closure of hospitals according to schedule, the Surgeon General’s Resources Analysis Division each month analyzed hospitalization reports from service com- mands and called the attention of local Army authorities to any failures in mak- ing reductions.26 Beginning in July 1945, in compliance with instructions from G-4, The Surgeon General reported monthly to that Division the progress made in con- tracting the hospital system.27 Under these procedures the Medical Department moved from a wartime to a peacetime basis for hospitalization in the United States in approximately a year’s time. By July 1946 all of the convalescent hospitals but one, the Old Farms Conva- lescent Hospital for the blind, had been closed.28 By December of that year all re- gional hospitals either had been closed or 22 Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 4 Sep 45, sub: Plan for Post V-J Day Reduction in Gen Hosp Fac. SG: 323.3 (Gen Hosp). 13 (1) Ltr, Dep SG to VA, 29 Dec 45. SG: 323.3 (Gen Hosp). (2) Memo, SG for ACofS G-4 WDGS thru CG ASF, 5 Sep 45, sub: Comd Instls for Reten- tion in Post-War Mil Estabs. SG: 370.01. 24 (1) Ltr, SG to Hon Francis J. Meyers, 28 Jan 46. SG: 323.3 (Hosp). (2) Ltr, SG to Mrs Dorothy Finn, Stockton, Calif, 15 Jan 46. Same file. (3) Statements by SvC Surgs in Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45. HD: Resources Anal Div file, “Hosp.” 25 (1) Memo, SG for Dir Mob Div ASF, 24 Sep 45, sub: Closure of ZI Gen Hosps. SG: 322 “Hosp.” (2) Ltr SPMOC 632, CG ASF to Serv Comdrs, 2 Oct 45, sub: Closure of Gen Hosps. Same file. (3) Diary, Re- sources Anal Div SGO, 13 Dec 45. HD: 024.7-3. (4) Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45. HD: Resources Anal Div file, “Hosp.” 26 Ltr, SG to CGs SvCs attn Surg, 7 Nov 45, sub: Comparative Studies of Gen-Conv and Sta-Regional Hosp Systs. SG: 323.3 (Hosp). Similar letters for other months are found in the same file. 27 Memo, SG for AGofS G-4 WDGS, 15 Jul 45, sub: Hosp Fac. HRS: G-4 files, 334 vol. II. Similar letters for other months are found in this same file and in SG: 322 (Hosp). 28 Weekly Hosp Rpt, vol. II, No 27, for week end- ing 5 Jul 46. Off file, Med Statistics Div SGO. RETURN TO A PEACETIME BASIS 315 had reverted to station hospitals.29 By the beginning of 1947 the Army (including the Air Forces) had only 54 station hospi- tals with 15,715 beds, only 14 general hos- pitals with 34,846 beds, and only 1 con- valescent hospital (Old Farms) with 100 beds.30 A comparison of bed authoriza- tions for general and convalescent hospi- tals during successive quarters of 1945 and 1946 with the program for bed reductions prepared by the Surgeon General’s Office in the fall of 1945 shows that the program was followed closely. The chief deviation occurred in a more rapid liquidation of convalescent hospitals than had been an- ticipated. A comparison of “patients remaining” in general and convalescent hospitals with authorized beds shows a close correlation between reductions in the patient-load and in hospital beds. As in earlier months, the number of beds oc- cupied continued to be considerably smaller than either the number of beds authorized or the number of patients re- maining.31 (See Table 15; also Chart 10.) 29 (1) Weekly Hosp Rpt, vol. Ill, No 49, for week ending 6 Dec 46. Off file, Med Statistics Div SGO. (2) WD GO 148, 11 Dec 46. 30 Information furnished by Resources Analysis Division, SGO, 4 Dec 50. The fourteen general hos- pitals were Army and Navy, William Beaumont, Fitz- simons, Letterman, Walter Reed, Brooke, Madigan, Oliver, Percyjones, Tilton, Valley Forge, McCor- nack, Murphy, and Pratt. The last three had been designated general hospitals in May 1946 by WD GO 45, 15 May 46. 31 (1) Memo, SG for ACofS G-4 WDGS thru GG ASF, 14 Sep 45, sub: Cut-Back in Gen and Conv Hosp Fac. SG; 322 “Hosp.” (2) Memo, SG for ACofS G-4 WDGS thru CG ASF, 21 Dec 45, same sub. SG; 323.3 “Hosp.” (3) Weekly Hosp Rpts, vol. II, No 52, for week ending 28 Dec 45; vol. HI, No. 13, for week ending 29 Mar 46; vol. Ill, No 26, for week ending 28 Jun 46; and vol. HI, No 52, for week ending 27 Dec 46. Off file, Med Statistics Div SGO. PART FOUR EVACUATION TO AND IN THE ZONE OF INTERIOR Introduction The evacuation of patients from thea- ters of operations to the zone of interior and from one point to another in the United States was an intricate operation, involving not only the transportation but also the care en route of patients suffering from all kinds of diseases and injuries. It was complicated by many factors, among them the means employed. Various types of transportation facilities were used— motor vehicles, trains, ships, and air- planes. Each of these had subtypes. For example, both hospital and transport ships returned patients from theaters. Various kinds of personnel, civilian and military, were employed to operate trans- portation facilities and care for patients aboard them—doctors, nurses, techni- cians, pilots, and many others. Moreover, equipment and supplies needed to care for patients in transit were extensive and sundry, ranging from aspirins to operat- ing tables. To some degree personnel and equipment required were governed by transportation facilities employed, be- cause hospital ships, for instance, needed more elaborate equipment and larger staffs than did airplanes. Evacuation was further complicated by its interrelationship with plans, policies, and procedures for hospitalization. For example, the division of general hospital beds between the theaters and the zone of interior was determined by—among other factors—the evacuation facilities expected to be available. On the other hand, the number of beds supplied to theaters in- fluenced the number of patients to be transferred to the zone of interior, and hence the transportation facilities that would be required. Successful operation of the specialized hospital system in the United States and observance of a policy of hospitalizing patients as near their homes as possible depended upon the evacuation system.1 To co-ordinate evacuation with hospi- talization and to use all available means— transportation facilities, personnel, and equipment—in such a way that large numbers of patients would be moved as safely and expeditiously as possible re- quired a highly organized operational system. Its development and conduct were complicated not only by the divers means employed but also by the distances trav- ersed and the agencies involved. Patients traveling by land, air, and sea from hospi- tals in theaters of operations to those in the zone of interior were the responsibility of successive military agencies. Among them were the bases and headquarters of theaters of operations; the Air Transport Command with its overseas wings; the Transportation Corps with its ports of em- barkation and debarkation in the United States; the Offices of the Chief of Trans- portation, The Surgeon General, and the Air Surgeon; service and air commands in the United States; and the headquar- ters of both the Air and Service Forces. Involvement of so many agencies made it important to define their respective areas of responsibilit y—particularly after 1 Interrelationships between hospitalization and the policies and processes of evacuation have been dis- cussed at various points in preceding chapters and will be referred to again from time to time. 320 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR the War Department reorganization in March 1942. On recommendation of SOS headquarters, this was done for major agencies the following June. The com- manding general, Army Air Forces, was charged with development and operation of air evacuation. Commanders of theaters of operations and of major commands in the United States were declared responsi- ble for the movement of patients within their own commands. The commanding general, Services of Supply, was charged with evacuating patients from all major commands—those overseas as well as in the United States—and of co-ordinating all plans of such commands for the evacu- ation of sick and wounded to be delivered to his control.2 To assist him in this func- tion, various responsibilities (which will be discussed later) were assigned to the Chief of Transportation, The Surgeon General, and port and corps area com- manders. In the early part of the war their activities were closely supervised and co- ordinated by the SOS Hospitalization and Evacuation Branch. Beginning in 1943 a series of events transferred that Branch’s responsibility and authority for evacuation to The Sur- geon General and the Chief of Transporta- tion. Early that year, it will be recalled, ASF (formerly SOS) headquarters began to return to The Surgeon General some of the functions it had assumed earlier in hospitalization and evacuation opera- tions. Some of the officers of its Hospi- talization and Evacuation Branch were transferred to the Surgeon General’s Office after the Branch was reduced in status to a section of another branch in ASF headquarters. One of them was Lt. Col. John C. Fitzpatrick, who had been active in sea evacuation operations while in ASF headquarters. Soon afterward, The Surgeon General and the Chief of Transportation decided that the latter would need constant technical advice from the Medical Department on matters of evacuation that concerned him and that the former would need a means of exercising technical supervision over evac- uation operations. Accordingly The Sur- geon General in June 1943 assigned Colo- nel Fitzpatrick as his liaison officer with the Chief of Transportation, who gave him office space for a Transportation Liaison Unit. In this capacity Colonel Fitzpatrick assisted the Chief of Transportation in estimating evacuation requirements and in planning and supervising the transpor- tation of patients by water and rail. In the spring of 1944, in anticipation of the patient load expected as a result of aggressive combat operations, the unit headed by Colonel Fitzpatrick was in- creased in size and given additional au- thority and responsibilities. In May, it will be recalled, The Surgeon General re- moved the Evacuation Branch from his Hospital Division and merged it with the Transportation Liason Unit to form a Medical Regulating Unit. This step com- bined the function of regulating the flow of patients from ports to hospitals of defin- itive treatment with that of providing for their transportation. Thus one office, rep- resenting The Surgeon General and belonging to his Operations Service but located in and working as a part of the Movements Division of the Office of the Chief of Transportation, assumed respon- sibility in the latter half of the war for supervising all evacuation operations ex- 2 (1) Ltr AG 704 (6-17-42) MB-D-TS-M, TAG to CGs AGF, AAF, SOS, et al., 18 Jun 42, sub: WD Hosp and Evac Policy. (2) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, Gen Hosps, and SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac. Both in AG: 704(6-17-42). INTRODUCTION 321 cept the movement of patients by air. The Air Forces Medical Regulating Service in the Air Surgeon’s Office controlled the transfer of patients between AAF hospi- tals and supervised air evacuation opera- tions. Collaborating closely with the ASF Medical Regulating Unit, the Air Regu- lating Office followed the pattern of the ASF office both in its development and in its procedures.3 In contrast with wartime operations, evacuation of patients from overseas areas and within the United States in peacetime had been a small-scale affair. The few troops who were in overseas areas were not engaged in combat activities; and therefore the number of patients who needed to be returned to the United States for hospital care was not large. General hospitals in this country were located in relation to troop density and served on a regional basis to treat com- plicated cases of all types rather than on a specialized basis to treat few types of cases from wide areas; and therefore the movement of patients from station to gen- eral hospitals was also a relatively simple procedure. The primary means of transporting pa- tients from overseas areas was by troop transports. No hospital ships were avail- able, and the movement of patients by air was still in the experimental stage. Trans- ports delivering troops and supplies at overseas ports took aboard patients for re- turn trips and transport surgeons cared for them in ships’ hospitals or in ships’ quarters.4 Before arrival in the United States, transport surgeons radioed to ports of debarkation lists of patients aboard, with their diagnoses and proposed disposi- tions. Ports receiving such information ar- ranged with the corps area (later called service command) in which they were lo- cated for the transportation of patients being evacuated. Upon arrival of trans- ports, port commanders issued orders transferring patients to general hospitals in which ports had bed credits and then informed The Surgeon General of the number received and of the hospitals to which they had been transferred. The New York Port, for example, had bed credits in both Tilton and Lovell General Hospitals and transferred patients within the limit of its allotments to these hos- pitals. Because the nearest meant an ambulance trip of more than two hours, the port occasionally kept in its station hospital for short periods of time patients who needed rest before further travel. Personnel both for transports and for the debarkation of patients was supplied by ports from their bulk personnel allotments or was borrowed from corps areas.5 Within the United States patients were moved from ports to hospitals, or from one hospital to another, by ambulance, by trains, and by airplanes. Ambulances available to all hospitals were used, as hospital commanders directed, for short trips. Accommodations for patients aboard regularly scheduled passenger trains were 3 (1) Ltr, SG to CG ASF thru CofT, 17 Apr 43, sub; Coord Med Serv for PE, with 2 inds. HD: Wilson files, “Book IV, 16 Mar 43-17 Jun 43.” (2) ASF Cir 147, 19 May 44. (3) WD Cir 140, 11 Apr 44. (4) AAF Reg 25-17, 7 Feb and 6 Jun 44. (5) An Rpt, FY 1944 and 45, Oprs Serv SGO. FID. (6) An Rpt, FY 1944, Oprs Div Off Air Surg. HD. (7) Ltr, Dr. Richard L. Meiling to Col Calvin H. Goddard, 30 Jun 52. HD: 314 (Correspondence on MS) XL 4 Reports of transport surgeons, required as a part of each voyage report by AR 30-1 150, 19 Septem- ber 1941, were submitted through port surgeons to Army Transport Service. For surgeon’s reports see files SG; 721.5, QM or TC: 569.1 under name of Army transport. 5 (1) AR 40-1025, 12 Oct 40. (2) WD Cir 120, 21 Jun 41. (3) An Rpt, NYPE, 1943, contains an account of activities before 1943. HD. 322 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR arranged by corps area officers with local agents of carriers involved. Normally, transfers were made without reference to such higher authority as the Surgeon Gen- eral’s Office, because station hospitals, corps area surgeons, and port com- manders had general hospital beds set aside for their use by the bed-credit sys- tem.6 Some airfields and air training centers converted airplanes available to them into airplane ambulances and used them to transfer patients from scenes of crashes to near-by hospitals or, in some instances, from one hospital to another. When airplane ambulances were not available, medical personnel on duty with the Air Corps made local and informal arrangements with Air Corps operations officers for the transportation of patients in operational planes.7 Such an informal system worked well enough as long as the number of patients to be evacuated was small and the distances they were to be moved were short, but it was not easily adaptable to the movement of large num- bers of patients over long distances. The way this system was transformed will be discussed later. It will be helpful, though, to consider first the magnitude of oper- ations that made necessary such a trans- formation. 8 An Rpts, Lovell and Tilton Gen Hosps, 1941. HD. 7 (1) Ltr, Walter Reed Gen Hosp to SG, 11 Jan 41, sub: Airplane Trans of Pnts, with inds. SG: 580.-1 (Walter Reed GH)K. (2) Ltr, Hq West Coast ACTC to CofAC, 15 Aug 41, sub: Air Amb, with inds. AAF: 452.-IB (Amb Planes). CHAPTER XIX Estimated and Actual Requirements for Evacuation from Theaters of Operations Estimating future evacuation require- ments was primarily a matter of calculat- ing the probable patient-load of theaters and of determining the part that would be transferred to the zone of interior under prevailing policies. Early in the war esti- mates of this kind were practically unnec- essary because the number of patients to be evacuated was still comparatively small, combat operations were limited, and there was plenty of space for evacuees aboard returning transports. Meeting evacuation requirements amounted sim- ply to insuring that transports had ade- quate hospital space, attendant personnel, and medical supplies, and that they were routed on return trips to places where pa- tients had accumulated. In the latter half of the war this situation changed. The number of patients evacuated, which had been less than 1,000 a month before No- vember 1942 and an average of about 3,300 from then until the middle of 1943, mounted steadily until it reached a peak of more than 57,000 in May 1945. (Table 16) Moreover, as the build-up of troops in theaters ceased, the number of returning transports declined. Under these circum- stances estimates of the evacuation load had to be made so that enough transpor- tation could be assembled to handle it; and estimates had to be made far enough in advance so that the use of transporta- tion facilities—which came to include air- planes and hospital ships as well as troop transports—could be properly co-ordi- nated. A study which the Surgeon General’s Office made in the winter of 1943-44 of the patient load that would develop dur- ing 1944 evoked a critical appraisal early that year not only of plans for supplying the Army with hospitalization but also of plans for evacuating patients from theaters of operations.1 Whether plans for evacuation would be adequate depended upon the size of the evacuation load and upon the use to be made of transportation facilities. The Sur- geon General’s estimate of the potential load was questioned by ASF headquarters and the Chief of Transportation. Subse- quently, as a result of additional informa- tion supplied by the European and Medi- 1 See above, pp. 201-02. The following three para- graphs are based upon “Hospitalization and Evacua- tion: A Re-estimate of the Patient Load and Facili- ties,” February 1944, and “Hospitalization and Evacuation, An Analysis,” March 1944, together with memorandums and letters in ASF Planning Div Program Br files 370.05 and “Hosp and Evac, vol. 3.” 324 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Date Total Patients Debarked0 Returned by Water Returned by air Number Troop Transport Hospital Ship Number Percentage of Total Patients Debarked of Total Patients Debarked Number Percentage of Total Patients Debarked Number Percentage of Total Patients Debarked 1920-40 b IS, 846 1941 « 2, 390 1942 9,248 1943* January 2, 475 2,442 98.7 2, 442 98.7 0 0 33 1.3 February 2,177 2, 136 98. 1 2, 136 98. 1 0 0 41 1.9 March 2, 351 2, 300 97.8 2, 300 97.8 0 0 51 2.2 April 4, 777 4,712 98.6 4,712 98.6 0 0 65 1.4 May 5, 349 5, 242 98.0 5, 242 98.0 0 0 107 2.0 June 6,115 5, 971 97.6 5, 222 85.4 749 12.2 144 2.4 July 5, 735 5,350 93.3 5,350 93.3 0 0 385 6.7 August 8,183 7,762 94.9 7,762 94.9 0 0 421 5.1 September 9,425 9,088 96.4 9,088 96.4 0 0 337 3.6 October 7,469 6,884 92.2 6,884 92.2 0 0 585 7.8 November 10,604 10, 195 96.1 8, 984 84.7 1,211 11.4 409 3.9 December 7,163 6,481 90.0 6,481 90.0 0 0 682 10.0 Total 71, 823 68, 563 95.5 66,603 92.8 1,960 2.7 3, 260 4.5 1944 January 7, 724 7,179 92.9 6,018 77.9 1,161 15.0 545 7.1 February 9,763 9,220 94.4 9. 220 94.4 0 0 543 5.6 March 8,894 8, 172 91.9 6, 458 72.6 1,714 19.3 722 8.1 April 7, 082 6. 249 88.2 4,994 70.5 1, 255 17.7 833 11.8 May 9,652 7,965 82.5 4, 462 46.2 3, 503 36.3 1,687 17.5 June 9,712 7,532 77.6 6, 125 63.1 1,407 14.5 2,180 22.4 July 11, 593 7,547 65.1 4, 841 41.8 2,706 23.3 4,046 34.9 August 14,060 9,708 69.0 8,044 57.2 1,664 11.8 4, 352 31.0 September 21. 383 IS, 860 74.2 11,515 53.9 4, 345 20.3 5, 523 25.8 October 20, 894 17,085 81.8 11,530 55.2 5,555 26.6 3,809 18.2 November 19, 700 16,846 85.5 11,665 59.2 5,181 26.3 2, 854 14.5 December 32,511 28, 115 86.5 21, 393 65.8 6,722 20.7 4, 396 13.5 Total 172,968 141,478 81.8 106, 265 61.4 35,213 20.4 31,490 18.2 1945 January 33, 382 29, 329 87.9 26. 191 78.5 3,138 9.4 4, 053 12.1 February 38, 251 31,989 83.6 26, 814 70.1 5,175 13.5 6, 262 16.4 March 44, 854 36, 387 81.1 31,210 69.6 5,177 11.5 8,467 18.9 April 43, 839 34,650 79.0 26,982 61.5 7,668 17.5 9, 189 21.0 May 57, 030 46,099 80.8 36, 545 64.0 9,554 16.8 10,931 19.2 June 45, 168 34, 228 75.8 26, 778 59.3 7, 450 16.5 10, 940 24.2 July 36, 873 24, 547 66.6 IS, 379 41.7 9, 168 24.9 12, 326 33.4 August 26, 258 17,469 66.5 9,575 36.5 7, 894 30.0 8, 789 33.5 September 19, 780 12, 393 62.7 8,007 40.5 4, 386 22.2 7,387 37.3 October 19,618 14, 944 76.2 10,081 51.4 4,863 24.8 4,674 23.8 November 13, 138 11,061 84.2 3,489 26.6 7,572 57.6 2,077 15.8 December 7,781 6, 121 78.7 572 7.4 5, 549 71.3 1,660 21.3 Total 385,972 299, 217 77.5 221,623 57.4 77, 594 20.1 86, 755 22.5 ° Figures through April 1943 include Army patients only; the remainder include in addition prisoner-of-war patients, some patients of Allied nations, and a few American Red Cross patients. 6 Figures from Annual Report . . . Surgeon General, 1920-41 (1920-41). c Figures for 1941 and 1942 supplied by Medical Statistics Division, SGO. d Figures for 1943-45 from History . . . Medical Regulating Service . . . They were compiled originally from monthly reports ol patients debarked, now located in SG: 70S ‘Evac Reqmts, Books I and II.” Table 16—Patients Debarked in the United States, 1920-45 REQUIREMENTS FOR EVACUATION 325 terranean theaters, the Chief of Transpor- tation decided to use lower figures. For example, The Surgeon General first esti- mated that 44,300 patients would be evac- uated to the United States during Septem- ber 1944, but the Chief of Transportation in March 1944 believed that the figure would be nearer 27,000. Neither consid- ered that airplanes would supply any sig- nificant capacity for evacuation. Past performance indicated that few patients would be transported from theaters by air, and air travel—being subject to weather conditions—was considered uncertain at best. Both officers concentrated their at- tention, therefore, on surface vessels. In determining patient capacities of transports and hospital ships expected to be available, two factors had to be consid- ered. The use of hospital ships for intra- theater evacuation, a matter which had not entered into considerations leading to their authorization, would reduce the number and therefore the total capacity of hospital ships for transporting patients from theaters to the United States. Also, capacities of transports would vary accord- ing to the standards set for lifeboats and other lifesaving equipment for patients. Under “desirable” standards, which were the highest in terms of lifesaving equip- ment, capacities would be least. If stand- ards were lowered, capacities would be increased. Under “adequate” standards a transport was permitted to load more pa- tients than it had spaces for in lifeboats, provided the latter could accommodate all litter and hospital ambulant patients. For others—mental and troop class pa- tients—only flotation equipment was nec- essary. Under “acceptable” standards even litter and hospital ambulant patients could exceed accommodations for patients in lifeboats, though flotation equipment had to be provided for the excess in these categories as well as for all other patients aboard. Hence, greatest capacities could be achieved by evacuating patients under “acceptable” conditions. Because of variations in standards of lifesaving equipment and in estimates of the evacuee load, opinions about the ade- quacy of planned shipping facilities dif- fered. Both the Chief of Transportation and The Surgeon General agreed that hospital ships already authorized would be sufficient to evacuate to the United States only a portion of the “helpless frac- tion” (estimated to be about 60 percent of the total number) of patients. They dis- agreed about the adequacy of transports for the remainder of the load, including helpless patients who could not be accom- modated aboard hospital ships. On the basis of his estimate The Surgeon General concluded that sufficient shipping would be available for evacuation from the Pa- cific but that, even under “acceptable” conditions, there would be barely enough space for patients from the European the- ater in hospital ships already authorized and in transports expected to be available. Nor would there be enough for patients from the Mediterranean. Using a lower estimate the Chief of Transportation de- cided that the space available under “acceptable” standards would be sufficient for the patients from all theaters. In view of this decision and the constant need for more troop ships, he advised against the procurement of additional hospital ships. By the end of March ASF headquarters adopted a middle-of-the-road course, ac- cepting recommendations of the Transpor- tation Corps but directing that plans for seven additional hospital ships be drawn to be used if needed, that provision be made for additional medical personnel for 326 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR sea evacuation, and that more extensive use of air evacuation be arranged in order to reduce the number of patients carried by water and thus enable higher standards to be observed on ships.2 Events in 1944 justified the course adopted by ASF headquarters. As a result of co-operative efforts of the Army Service Forces, the Army Air Forces, the War De- partment General Staff, and overseas wings of the Air Transport Command, air evacuation increased. In the spring of 1944 the Air Forces estimated that 800 to 1,910 patients from the European theater and 300 to 1,350 from the Mediterranean could be evacuated monthly in transport planes without altering their accommoda- tions and without interfering with normal high priority traffic. The installation of special equipment to support tiers of litters in aircraft cabins, it was anticipated, would raise these figures 50 percent. In May 1944 the Air Forces made plans for placing webbing-strap litter supports in sixty-five of the C-54A planes already in use and in all transport planes to be built subsequently, and the Air Transport Com- mand directed its overseas wings to pre- pare for the evacuation of the number of patients planned.3 In consequence, the proportion of the total monthly patient load evacuated by air increased from 11.8 percent in April to a peak of 34.9 percent in July 1944, and of the total annual load from 4.5 percent in 1943 to 18.2 percent in 1944. (See Table 16.) Additional hospital ships became avail- able during 1944—a cumulative total of 9 by the end ofjune, 16 by the end ofjuly, and 22 by the end of September.4 This number was insufficient to meet the de- mands of all theaters, because the ships had to be deployed in terms of world-wide shipping needs rather than according to the desires of theaters for accommodations for patients. Some were required for in- tra-theater evacuation; others for the transportation of patients to the United States.5 As troop shipping to the Mediter- ranean declined during 1944, space for patients aboard transports returning to the United States became insufficient for the evacuee load and hospital ships had to be used to a greater extent for that theater than for others. Consequently, between March and December 1944 more patients were returned from the Mediterranean by hospital ship than by transport. The Euro- pean theater, generously supplied with troop shipping because of its combat oper- ations, received fewer hospital ships pro- portionately than did the Mediterranean and hence had enough for only a third of the patients evacuated by water from that theater between April and December 1944. Because of the need for hospital ships in the Atlantic and Mediterranean, only one of those built by the Army was sent to the Pacific before 1945, and not until the latter half of 1944 did the three ships built and operated by the Navy for the Army—the Hope, Comfort, and Mercy— go into service there. Evacuation by hospi- tal ship from the Pacific during 1943 and 2 See last note above. 3 (1) Memo, SG for GG ASF (Plans and Oprs), 27 Feb 44, sub; Potentialities of Air Evac of Pnts for Overseas to US. SG: 580. (2) Rpt of Conf on Air Evac, 13 Apr 44. SG; 337.1. (3) Memo, CG ASF for AGofS OPD WDGS, 26 Apr 44, sub: Air Evac from Eur and NATO, with inds. OPD: 580.81. (4) Ltr, ATC to Eur Wing, NA Wing, Carib Wing, ATC, 11 May 44, sub: Air Evac from Eur and NATO. SG: 580. (5) Memo, CG ASF for GG AAF, 20 Jun 44, sub: Air Evac for CBI and Pac Areas. HRS: ASF Planning Div Program Br file, “Hosp and Evac.” 4 See pp. 405-10, and Table 18. 5 (1) Rads, WD (init by Mvmt Div OCT) to CG NATO, 6 Oct 43, 12 Mar 44; NATO to AG WAR, 8 and 12 Oct, 18 Dec 43; Pacific to AGWAR, 28 Jan 44; ETO to AGWAR, 5 Feb 44; WD (init by Mvmt Div OCT) to CG SOS London, 11 Feb 44. SG; 560.1; 705.1 (N Africa), (Gr Brit), (Pac). (2) Ltr, GofF to CinC SWPA, 29 Jan 44, sub: Hosp Ships, with inds. SG: 560.2. REQUIREMENTS FOR EVACUATION 327 1944 was limited therefore to the return of three shiploads of patients—one by a Navy ship from the Central Pacific in November 1943, another by a Navy ship from the South Pacific in October 1944, and the third by the Comfort from the Southwest Pacific in December 1944. Despite the lack of enough hospital ships to meet the desires of all theaters, the pro- portion of patients evacuated from the- aters to the United States aboard hospital ships increased, as those authorized be- came available, from 2.7 percent of the total in 1943 to 20.4 percent in 1944.6 (See Table 16.) Increased transportation of patients by airplane and hospital ship reduced the pro- portion of the total patient load evacuated by transports from 92.8 percent in 1943 to 61.4 percent in 1944. This reduction might have been smaller if theaters had evacuated as many patients by transport as zone of interior authorities considered proper. Failure to do so resulted in part from the lower estimates of capacity that theater officials used in figuring accommo- dations for patients aboard transports. To raise these estimates the Chief of Trans- portation in January 1944 began a survey of all transports to establish their official capacities under “adequate” standards.7 Even after these capacities were set not all theaters used transports to the extent pre- scribed. Thus the European theater until the end of 1944 adhered rather closely to the recommendation of its chief surgeon, Maj. Gen. Paul R. Hawley, that helpless patients should be evacuated only by hos- pital ships, even though the War Depart- ment had stated early that year that help- less patients would have to be evacuated by transports as well. Although forced by circumstances—increases in the patient load resulting from the invasion of the continent, the need to vacate some of the beds in hospitals in the theater, and the lack of sufficient numbers of hospital ships—to return some helpless patients to the United States in transports during 1944, the European theater steadfastly re- fused to make full use of officially an- nounced capacities.8 As a result, patients accumulated in its hospitals while beds in general hospitals in the United States re- mained empty. Theaters in the Pacific complied more readily with War Depart- ment policy on the use of transports and therefore did not develop similar backlogs, but in the fall of 1944 a problem devel- oped in the Southwest Pacific when the number of mental patients to be evacuated exceeded the capacities of returning trans- ports for patients of that type. It was solved by evacuating mental patients by air (a practice formerly considered undesirable) and by increasing and improving accom- modations aboard transports for mental patients.9 Toward the end of 1944 attention was focused upon estimates of the evacuation load for 1945 and upon an evaluation of 6(1) Study of Put Evac. HD: 705 (Evac). This study consists of work sheets on which the ASF Medical Regulating Unit listed monthly, by theater of operations, the transports and hospital ships evac- uating patients and the number of patients, by trans- portation classification, on each. (2) Roland W. Charles, Troopships of World War II (Washington, 1947), pp. 327-51. 7 (1) TC Cir 80-12, 22 Jan 44 and Misc Ltr 28, 14 Jul 44, sub: Capacity of Pers Trans. TC: 569.6. (2) Ltr, SG to South Pacific Base Comd attn Chief Surg, 25 Sep 44, sub: Pers Capacity of Trans. SG; 560. Similar letters were sent to the other theater commands. 8 (1) Memo for Record, on draft Rad, WD to Hq ComZ ETO, 19 Sep 44. HD; 705 (MRO, Fitzpatrick Stayback, 1484). (2) Interv, MD Historian with Gen Hawley, 18 Apr 50. HD: 000.71. 9 (1) Memo for Record, on draft Rad, WD (pre- pared by Mvmt Div OCT) for CinC SWPA, 9 Oct 44. HD: 705 (MRO, Fitzpatrick Stayback, 1496). (2) Memo for Record by Lt Col Lamar G. Bevil, MC (SGO), 1 Nov 44, sub: Conf Ref Evac of Disturbed Mental Pnts from SWPA. HD: MOOD “Pacific.” 328 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR the means available or required to handle it. There were several reasons for the in- quiry: first, the war was lasting longer than had been anticipated; second, the patient load in the European theater was becoming heavy because of a high inci- dence of trench foot, a larger number of casualties resulting from intensified com- bat activity, and failure to use fully the evacuation space available aboard trans- ports; and third, the possibility of victory in Europe during 1945 made it necessary to plan for evacuation in terms of the redeployment of ships to the Pacific. In a study prepared by the ASF Medi- cal Regulating Unit, adopted by the Joint Logistics and Joint Military Transporta- tion Committees, and submitted on 16 December 1944 to the Joint Chiefs of Staff, the number of patients who would need evacuation was estimated by class, by month, and by theater, for the period from December 1944 through December 1945. From these estimates were sub- tracted the numbers of patients of all classes who could be evacuated each month, from each theater, by troop trans- ports and by airplanes. The remainder represented the number of patients who would have to be evacuated by hospital ships. Conclusions drawn from these cal- culations were that a peak load of more than 54,000 patients would require evac- uation in August 1945, that hospital ships already authorized would not be able to transport all who could not be accommo- dated in transports and airplanes, and that an additional number of hospital ships ranging from two in January 1945 to twenty-eight in April would therefore be needed.10 This study led the Joint Chiefs of Staff on 21 December 1944 to approve the con- version of troop transports to ambulance- type hospital ships in sufficient numbers (later determined by the Joint Military Transportation Committee to be six) to provide additional carrying capacity for 5,500 patients.11 While neither the Joint Committee nor the Joint Chiefs expected this action to eliminate entirely the short- age of space for evacuation, they antici- pated that it would reduce the shortage to manageable proportions. Steps taken to “manage” the shortage applied primarily, though not altogether, to the European theater, which was ex- pected to have almost as many patients to evacuate early in 1945 as the Pacific and Mediterranean theaters combined. It al- ready had a backlog of patients awaiting evacuation and therefore a shortage of hospital beds. Furthermore, the patients who had accumulated would need to be evacuated from Europe early in 1945 be- cause redeployment of transports from Europe to the Pacific would reduce capac- ities for evacuation from the European theater later in the year.12 Therefore, on 3 December 1944 the Chief of Staff, on the recommendation of the Medical Regulat- ing Officer and the Office of the Chief of Transportation, overruled General Haw- ley’s objections and ordered the European theater to exploit fully the normal patient capacity of transports, even though it 10 (1) Memo, Joint Logistics Plans Cmtee for Lt Col J[ohn] C. Fitzpatrick, 15 Nov 44, sub: Hosp Ship Program. (2) Joint Logistics Cmtee (JLC 221/1), 7 Dec 44, Hosp Ship Program. (3) JCS/1199, 16 Dec 44, Hosp Ship Program, Rpt with Apps “A” to “N”, 64 pp. All in SG; 560.2. 11 Joint Mil Trans Cmtee, JMTC 89/1, 26 Dec 44, Hosp Ship Program. SG; 560.2 JMTC selected the Saturnia, Republic, President Tyler, Athos II, Columbie, and the USS Antaeus (ex St. John) for con- version. All but the last were to be converted, manned, and operated by the Army. 12 Following series of files (1945) deal with evacua- tion requirements, adequacy of hospitalization both in theaters and zone of interior, and use of evacua- tion facilities: HRS: G-4 file, “Hosp, vol. II”; HRS: ASF Planning Div Program Br files, “Hosp and Evac”; and SG; 705. REQUIREMENTS FOR EVACUATION 329 might have to reduce its evacuation policy to 90 days to supply enough patients for this purpose.13 Meanwhile, American and British officers, both in the zone of interior and in the theater of operations, were dis- cussing more extensive use of some of the larger and faster British vessels for evacu- ation. Subsequently they agreed to ar- rangements for enlarging the capacities of the Queen Mary and Queen Elizabeth for litter and hospital ambulatory patients to 2.000 and 2,500 respectively and for troop class patients to 1,000 each. This agree- ment was approved by the Combined Military Transportation Committee on 16 January 1945.14 A third step was to in- crease the evacuation of patients by air, for it had fallen from a peak of 2,846 patients returned from Europe in July 1944 to 987 in November. Again on the recommenda- tion of the ASF Medical Regulation Offi- cer, the Chief of Staff directed the Euro- pean theater on 25 December 1944 to arrange to use air evacuation to “the full- est practical extent”. Soon afterward, the theater Air Priorities Board agreed to allo- cate spaces on planes for the evacuation of 3.000 patients per month.15 A fourth step was taken in March 1945 after a re-evalu- ation of the evacuation load indicated that estimates made in December for the Southwest Pacific and European theaters were perhaps too low. With the concur- rence of The Surgeon General, the Chief of Transportation directed that restrictions imposed by lifeboat standards upon pa- tient capacities should be waived, as they had been for the Queens, for seventeen Army transports and three Navy trans- ports, and that those vessels should be pre- pared to carry “maximum” loads of patients.16 By these measures sufficient facilities were provided to meet evacuation require- ments during the first half of 1945 and to carry a peak load of 57,030 patients in May, just after V-E Day. During this pe- riod the major portion of patients came from the European theater, which was most affected by the measures adopted. In compliance with the Chief of Staff’s order of 3 December 1944, it began to use space aboard transports more fully, sending to the United States in transports during that month 15,682 patients as compared with 4,665 in November, and increasing the number steadily during the early part of 1945. The number of patients evacu- ated by air from the European theater also grew, rising from 987 in November 1944 to more than 2,500 in February 1945. By March, arrangements for enlarging the capacities of the Queens had been com- pleted and each of those vessels returned as many as 2,000 to 3,000 patients per trip. Gradually, also, greater numbers of patients were evacuated aboard transports for which maximum loading was author- 13 (1) Diary, ASF Planning Div, 2 Dec 44. HD: 705 (MRO, Fitzpatrick Stayback, 1584). (2) Interv, MD Historian with Col Fitzpatrick, 18 Apr 50. HD: 000.71. (3) Rad CM-OUT-72113 (3 Dec 44), WD (init by Mvmt Div OCT) to ComZ ETO. HRS: G-4 file, “Hosp, vol. III.” 14 (1) Tel Conv WD-TC-1367, Washington and London (OCT officials), 27 Nov 44. SG: 337. (2) Rad CM-OUT-76241 (12 Dec 44), WD (init by Mvmt Div OCT) to ETO ComZ. SG: 560.2. (3) Rad CM-IN-16292 (17 Dec 44), UK Base Sec to WD. SG: 705. (4) Memo GMT 67, 16 Jan 45, sub: Com- bined Mil Trans Gmtee, Return of Pnts and other Pers Westbound on the Queen Elizabeth and Queen Mary. Same file. 15 (1) Ltr, CG AAF to CG ASF (SG), 4 Oct 44, sub; Air Evac, ETO. SG: 580 (Gr Brit). (2) Memo, SG for CG ASF, 23 Dec 44, sub: Evac of Pnts, ETO. Same file. (3) Memo, ASF Planning Div for ASF Plans and Oprs, 6 Feb 45, sub: Air Evac to ZI. SG: 580. (4) Rad CM-OUT-82083 (25 Dec 44), WD to Hq ComZ ETO. OPD: In and Out Messages. 16 (1) Ltr, CofT for CGs BPE, NYPE, and HRPE, 5 Feb 45, sub: Pnt Capacities, Amer Trp Trans. SG: 705. (2) Memo, CofT for Naval Trans Serv, 22 Feb 45, sub: Pnt Capacity, Mount Vernon, Wakefield, and West Point. TC: 569.5. (3) Rads, CofT to PEs and ETO, 16 and 22 Mar 45. Same file. 304244 0—55 23 330 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR ized, some carrying 2,000 or more patients per trip in May. In addition, some of the hospital ships which had been used in the Mediterranean were sent to the European theater, as were the last two of the twenty- four authorized in July 1943 and the first of the five authorized in December 1944. All of these were in service by April 1945. As a result, during the first half of 1945, seventeen hospital ships made from one to four trips each from Europe to the United States. The patient load from the Medi- terranean theater, which was considerably smaller by the early part of 1945 than be- fore, was carried in the hospital ships still assigned to that theater, and in transports and airplanes.17 By April 1945, enough evacuation facilities were available for the War Department to decide, with the ap- proach of V-E Day, to speed the flow of patients from both the European and Mediterranean theaters. Accordingly, in May it placed these theaters on 60-day evacuation policies.18 Evacuation from the Pacific continued to be primarily by transport. Although plans were made as early as April 1945 to transfer hospital ships from the Atlantic to the Pacific, only one Army hospital ship— sent to the Pacific in the latter half of 1944—made a trip carrying patients from that area to the United States in the first half of 1945. The number of patients evac- uated by air from the Pacific rose from 2,763 in April 1945 to 4,665 the following June. From all theaters, 262,524 patients were evacuated to the United States dur- ing the first half of 1945. Of these, 19 per- cent were returned by air, 14.5 percent by hospital ship, and 66.5 percent by troop transport. (See Table 16.) Evacuation requirements fell off during the last half of 1945 with the cessation of hostilities. By September the patient load of the European and Mediterranean the- aters had been so reduced that it was pos- sible for them to return to a normal 120- day evacuation policy and to send patients to the United States thereafter almost exclusively by either hospital ship or air- plane. Since the Pacific had no great back- log of patients, evacuation from that area in 1945 caused no problem. In the latter half of 1945, Navy hospital ships, Army and Navy transports, airplanes, and the three hospital ships operated by the Navy for the Army evacuated large numbers of patients to the United States. To these were added ten Army hospital ships trans- ferred from the Atlantic. Just before V-J Day space for evacuation from the Pa- cific was so ample that the War Depart- ment ordered a reduction in its evacuation policy to 60 days to provide enough pa- tients to make full use of available trans- portation. After V-J Day the Pacific was ordered to return all of its patients as quickly as possible. The patient load was in consequence reduced by October to a point that it was possible for the theater to lower its ratio of beds to troop strength and to return to a 120-day evacuation policy.19 (See Table 14.) During the latter half of 1945, of the 123,448 patients evac- uated from all theaters, 29.9 percent re- turned to the United States by air, 31.9 percent by hospital ship, and 38.2 percent by transport. This represented a reversal of the situation during the first half of the year, when approximately two thirds of all patients were evacuated by transport. During the entire year, 385,792 patients were evacuated from all theaters: 22.5 percent by air, 20.1 percent by hospital ship, and 57.4 percent by transport. (See Table 16.) 17 Study of Pnt Evac. HD; 705 (Evac). 18 See p. 300. 19 Study of Pnt Evac. HD: 705 (Evac). Also see p. 301. CHAPTER XX Development of Procedures for Evacuation from Theaters to the Zone of Interior Before the patient load (described in the last chapter) could be transferred from theaters to general hospitals in the United States, policies and procedures to govern the entire operation had to be developed. Those established early in the war re- mained effective with minor modifications to its end. Proceduresfor Sea Evacuation SOS directives charged ports of em- barkation, operating directly under the Chief of Transportation, with responsibil- ity for the evacuation of patients from overseas areas to which they supplied war materiel. A basic prerequisite to the dis- charge of this responsibility was informa- tion about the kind and number of pa- tients to be evacuated. Accordingly, in August 1942 SOS headquarters an- nounced that patients would be classified for transportation purposes as mental, hospital, or troop class.1 The next month these classes were increased to four by splitting the hospital class in two: hospital litter and hospital ambulant. Mental, or Class I, patients were those who required security accommodations aboard ships or trains to prevent them from injuring or destroying themselves. Hospital litter, or Class II, patients were those whose phys- ical condition required them to remain in bed and be cared for entirely by others. Hospital ambulant, or Class III, patients were those who required medical care and service, even though they did not have to remain in bed at all times. Troop class, or Class IV, patients were those who needed little medical care en route and were able to care for themselves even in emergencies.2 In 1944 subdivisions were established for Class I, or mental patients. They were actually of three groups: those who were seriously disturbed and needed locked- ward accommodations in hospitals as well as on ships; those who were borderline cases and might or might not require locked-ward care on land but did require it aboard ships; and those who were only mildly disturbed and did not need to be 1 Memo, CG SOS (init by Lt Col J[ohn] C. Fitz- patrick) for SG, 21 Aug 42, sub; Est of Reqmt for Sea Evac. SG: 560.-2. 2 Ltr SPOPH 322.15, CG SOS to CGs and GOs of SvCs and PEs and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs. AG: 370.05. 332 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR placed under restraint in any event. Pa- tients of the last type suffered from being quartered with the more serious mental cases and, if placed in locked wards, took up space needed for the latter. Yet, under existing regulations and classifications, transport surgeons and medical officers in charge of patients on hospital ships often treated all mental patients alike, regard- less of the degree of their disability. To remedy this situation the War Depart- ment in June 1944 broke the classification for mental patients (Class I) into three parts—Class I A, Class I B, and Class I C—to conform with the three groupings just stated.3 The Chief of Transportation then ordered hospital ship commanders and transport surgeons not to place Class I C patients in restrictive quarters but to evacuate them instead in accommoda- tions used for troop class (Class IV) patients.4 To furnish ports in the United States with information about the number of pa- tients of each type to be returned to the zone of interior, SOS headquarters in September 1942 devised a system of re- ports of “essential information concerning evacuation of sick and wounded from overseas.” Offices of both The Surgeon General and the Chief of Transportation concurred in its establishment. Each over- seas commander was required to report monthly to the port commander serving his area the following information: (1) the total number of patients awaiting evacu- ation, (2) the number in each of the four classes listed above who were awaiting evacuation at each port within the thea- ter, and (3) the number in each class who were expected to require evacuation at the beginning of the following month. Upon embarkation of patients for the United States, each theater commander was required to report by air mail to port commanders in the United States the name of the ship upon which patients em- barked, the number of patients of each class aboard the ship, and the expected date and port of arrival in the United States. Receipt of such information would supply a basis for the Transportation Corps to use in providing transportation and for the Medical Department to use in assuring the availability of sufficient num- bers of vacant beds for patients being evacuated.5 Early in 1943 this system was slightly modified. In some instances embarkation reports failed to reach ports in the United States before the arrival of ships carrying patients. In others, theaters failed to sub- mit such reports. In still others, they submitted incorrect reports. For example, on 9 December 1942, 788 patients arrived from the European theater at the port of Halifax in Canada. Although the theater had reported them all as ambulatory, it was discovered upon arrival that seven were litter and 104 mental patients who required attendants. Because of the erro- neous report, insufficient medical person- nel had been sent to Halifax to care for the patients received and their debarka- 3 Ltr AG 704.11 (3 Jun 44) OB-S-E-SPMOT-M, TAG to CGs AAF, AGE, ASF, Base Comds, and TofOpns, 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comds. SG; 705.-1. 4 (1) Ltr, Hq ComZ ETO to CofT, 10 Jul 44, sub; Accommodations for Glass I A Pnts on Trp Trans. TC; 569.6. (2) Telg, CofT (Mvmt Div) to CPE, 28 Jul 44. SG: 560.2. (3) Telg, CofT (Mvmt Div) to CGs PEs, 2 Sep 44. SG: 705. (4) Ltr, CofT (Mvmt Div) to PEs, 21 Sep 44, sub: Sea Evac of Mental Pnts. SG: 560.2. 5 (1) Memo, CG SOS for AGofS OPD WDGS, 3 Sep 42, sub: Essential Inf Cone Evac of Sick and Wounded from Overseas. OPD: 370.05. (2) Ltr AG 370.05 (9-15-42) MS-SPOPH-M, TAG to CGs Def Comds, TofOpns, and Base Comds, 16 Sep 42, same sub. SG: 705.-1. PROCEDURES FOR EVACUATION 333 tion was delayed.6 To prevent similar oc- currences, as well as the arrival of patients without prior arrangements for their re- ception, theaters were directed in January 1943 to exercise more care in making re- ports of embarkation and to transmit them by radio rather than by air mail.7 Another modification in the reporting system occurred as a result of increasing participation during 1942 of agencies other than the Army Transportation Corps in the evacuation of patients. Some were returned on British ships; others, by the Air Transport Command and the U. S. Navy. For example, by the end of 1942 most patients evacuated from the South Pacific area were returned by the Navy; and from Central Africa, by the Air Transport Command. Commanders of those areas considered it unnecessary to submit reports of patients awaiting evacu- ation, since they did not normally use Army ships. While failure to receive such reports did not interfere with the Chief of Transportation’s efforts to supply suffi- cient transport lift for patients awaiting evacuation by sea, it did hamper planning for the reception of patients in the United States and for their further transporta- tion, usually by rail, to hospitals of defin- itive treatment. Therefore, on 13 January 1943 the War Department directed thea- ter commanders to report monthly, in ad- dition to information already required, the number of patients awaiting evacu- ation by air, by Navy ships, and by any other means, as well as the number in each category who were expected to need evacuation at the end of the following 30 days.8 Further changes were made later in the war. Toward the end of 1944 the return of able-bodied men and officers on “rota- tion” complicated the problem of evalu- ating the adequacy of patient lift because such persons sometimes took up space on transports which the Medical Regulating Unit had considered available for pa- tients. In August 1944, therefore, the War Department directed theater command- ers to add to reports of patients all other military personnel awaiting transporta- tion to the zone of interior.9 Early in 1945, as the patient load mounted toward its peak, the Surgeon General’s Resources Analysis Division requested additional in- formation for planning purposes. As a result, the War Department directed the- aters in March 1945 to report not only the patients awaiting evacuation and those expected to need evacuation at the end of the following month but also those that were expected to need evacuation at the end of the second and third months after the date of the report.10 To assure proper use of the information submitted by theaters, the SOS Hospital- ization and Evacuation Branch prepared a directive in October 1942 for the Chief 6 (1) Memo, Lt ColJ. C. Fitzpatrick for Chief Hosp and Evac Br Plans Div Oprs SOS, 21 Dec 42, sub: Rpt on Temp Duty, Hq 2d SvC and Hq NYPE. HD: 705 (MRO, Fitzpatrick Daybook, Aug 42-Jun 43). (2) Memo, CG SOS for CofT, 3 Jan 43, sub; Recep- tion of Pnts Evac by Sea from Overseas Comds. Same file. 7 (1) Memo, CG SOS for TAG, 2 Jan 43, sub: Compliance with Directive. AG: 704 (1-2-43). (2) Rad CM-OUT-1128, AGWAR to ETOUSA, 3 Jan 43, HD: Wilson files, “Book HI, 1 Jan 43-15 Mar 43.” 8 Ltr, TAG to CGs Def Comds, Depts, and Base Comds, 13 Jan 43, sub; Essential Info Cone Evac of Sick and Wounded from Overseas. AG: 370.05. 9 OCM form, with message prepared by OCT for dispatch to CGs Def Comds, TofOpns, and PEs, 30 Aug 44, and with Memo for Record. TC: 370.05. 10 (1) Mere js, SG (Resources Anal Div) for ASF (Plans and Oprs), 21 and 27 Feb 45, sub: Rpt for Overseas Theaters. SG; 705. (2) Rad CM-OUT- 55158, WD to all Overseas Comds, 17 Mar 45. TC; 370.05 (Monthly Rpt of Reqmts). 334 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR of Transportation to issue to port com- manders.11 It required them to transmit information received from theaters to the Office of the Chief of Transportation, to other interested port commanders, and to the commanding generals of service com- mands in which ports were located. Also, port commanders were to compare the number and types of patients to be evac- uated during the following month with accommodations aboard transports sched- uled to call at theater ports. If it appeared that there would be insufficient “lift” — that is, too few ships returning from thea- ters or unsuitable accommodations on available ships for different classes of pa- tients—port commanders were to report this fact to the Chief of Transportation in order that additional lift might be pro- vided. Finally, port commanders were to use information received in embarkation reports to plan transportation from ports in the United States to hospitals of defin- itive treatment.12 In the final months of 1942 transports arriving at overseas ports sometimes found more patients ready for evacuation than theaters had reported and hence had in- sufficient accommodations for all of them. This situation resulted from the tempo- rary and sudden accumulation of patients, particularly of Class I (mental), after re- ports had been sent in, and from the pre- emption of all space on a transport by its first port of call to the detriment of ports of later call. Measures were taken to avoid such occurrences. Port commanders were required to submit their comparisons of evacuation requirements with scheduled sailings of transports to the Office of the Chief of Transportation for review. When that Office found that accommodations on transports scheduled for return trips from theaters were insufficient for patients needing to be evacuated, it directed port commanders to determine through direct communication with theater commanders what additional evacuation space was really necessary. The Chief of Transporta- tion was then responsible for complying insofar as possible with desires of the the- ater commander. In addition, when trans- ports sailed for a theater with several ports of call, port commanders in the United States were required to inform theater commanders of their capacities and thea- ter commanders in turn were required to suballocate reported space among the several ports under their jurisdiction.13 Later in the war, the Medical Regulat- ing Unit used information submitted in reports of patients being embarked and awaiting evacuation to plan the most ef- fective use of all available evacuation facilities. Its Water Evacuation Section maintained at all times current records of patients needing transportation from dif- ferent ports in the several theaters. Com- parisons of such records with space for patients aboard scheduled transports re- vealed whether or not anticipated lift for a particular port or theater would be ade- quate. If not, the Medical Regulating Officer recommended steps to supply the required lift such as changes in the sched- ules of transports, increases in the number 11 Memo, CG SOS (Hosp and Evac Br) for CofT, 10 Oct 42, sub: Sea and Port Evac Oprs. SG; 705.-1. 12 Ltr SPTSM 370.05, CofT (Mvt Div) to CGs PEs, 23 Oct 42, sub: Sea and Port Evac Oprs, with inch SG; 704.-1. 13 (1) Ltr, Surg NOPE to CG SOS (Plans Div), 10 Feb 43, sub: Overseas Evac Plan Ships’ Hosp Space Almt, with 5 inds. HD: 705 (MRO, Fitzpatrick Day- book, Aug 42-Jun 43). (2) Memo, Chief Hosp and Evac Sec Plans Div ASF for Col [Frank A.] Heile- man, 22 Apr 43, sub: Sea Evac Oprs. HD; Wilson files, “Day File.” (3) Memos, ACofS for Oprs ASF for SG and CofT, 9 May 43, sub: Hosp and Evac Oprs. Same file. PROCEDURES FOR EVACUATION 335 of patients to be evacuated by air, or the redeployment of hospital ships.14 While directives issued during 1942 charged the Chief of Transportation and port commanders under his control with evacuation from theaters of operations, they contained no demarcation of areas of responsibility of overseas commanders and the Chief of Transportation for trans- fer of patients from control of the former to the latter. To insure co-ordination be- tween a theater and the zone of interior, such demarcation was necessary. Hence, early in 1943 the SOS Hospitalization and Evacuation Branch prepared a direc- tive on “sea evacuation operations” which the War Department issued on 25 Jan- uary 1943.15 This directive detailed spe- cifically for the first time the respective responsibilities of the Chief of Transporta- tion, port commanders, and theater com- manders. The Chief of Transportation was charged with the care, treatment, and safety of patients after their ships had left overseas ports. Up to that point theater commanders were responsible. These com- manders were charged with selecting pa- tients to be evacuated, with concentrating them at or near ports of embarkation, and, in co-ordination with overseas port officials, with placing them on ships bound for the United States. They were responsi- ble for insuring that patients were not placed on ships lacking suitable accom- modations. For example, a theater com- mander was not to permit mental (Class I) patients to be embarked in excess of a ship’s capacity for patients of that type. Furthermore, he was to prevent the load- ing of ships with more patients than could be “reasonably expected to be evacuated to lifeboats should it become necessary to abandon ship.” This left the decision as to suitability of accommodations up to the- aters. Eventually, though, they were forced to substitute the War Department’s opinion of suitable accommodations for their own. As transportation and medical officials of ports in the zone of interior completed surveys of transports during 1944, theaters were expected to use offi- cially announced capacities for patients of all classes.16 Theater commanders were also re- sponsible for providing adequate medical personnel for patients embarked and for furnishing any additional medical sup- plies requested by transport surgeons. Personnel whom they placed on ships nor- mally belonged to the Chief of Trans- portation and were supplied to theaters on an “attached” basis. Medical hospital ship platoons of various sizes were at- tached to United States ports by the Chief of Transportation. Port commanders then ordered them to temporary duty in the- aters of operations. Only when such pla- toons were not available were theater commanders required to supply medical troops of their own. As with personnel, theater commanders were expected to furnish additional medical supplies to transports only in unusual or emergency circumstances. Normally port command- ers in the United States placed aboard each transport enough medical supplies to care for all troops on its outbound voyage and for patients, on the inbound voyage, 14 Examples of the records kept may be found in “Estimate of Evac Reqmts [Weekly],” Books 1 thru 8, 3 1 Jan 44-27 May 46, and “Evac Reqmts—Monthly Rpt,” Books 1 and 2, Nov 43-May 46. SG: 705. Also see Study of Pnts Evac. HD: 705 (Evac). 15 Ltr AG 370.05 (1-19-43) OB-S-SPOPH-M, TAG to CGs Theaters, Depts, Base Comds and Task Forces, and COs Base Comds and Task Forces, 25 Jan 43, sub: Sea Evac Oprs. AG; 704 (1-19-43). 16 See above, p. 327. 336 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR equal in number to one fourth of the transport’s troop capacity. Theater commanders were given addi- tional responsibilities in connection with sea evacuation operations in the latter part of the war. To reduce the medical personnel who would be needed for as- signment to regularly organized medical hospital ship platoons, they were required after 8 June 1944 to form Medical Depart- ment officers, nurses, and enlisted men being returned to the United States on “rotation,” into provisional medical hos- pital ship platoons. Regularly organized platoons were saved for use only when provisional platoons could not be formed. In the same month, theater commanders were directed to furnish transport sur- geons and hospital ship commanders not only with evacuation orders but also with lists of patients showing diagnosis, trans- portation classification, and type of ac- commodation needed for each. Similar lists had formerly been prepared by trans- port surgeons and hospital ship command- ers for submission to zone of interior port officials for use in debarkation activities. Now, their preparation by theaters saved time for medical officers aboard ships and assisted them in placing patients in suit- able accommodations. Theater officials were expected, in addition, to assemble complete sets of records for each patient and to deliver them, along with patients’ baggage and valuables, to ships upon which patients were embarked. When records were missing, theater commanders either had new ones prepared or sub- mitted to ships’ officers certified state- ments of those missing and of the reasons for their absence.17 Near the end of the war an additional duty was placed on theater personnel. Up to that time debar- kation tags containing information similar to that found on embarkation lists were prepared and attached to patients aboard ship.18 In July 1945 a War Department circular required theater hospitals to pre- pare and attach identification tags to each patient before his embarkation. These tags were made of four perforated sections. The first three could be detached to serve theater ports, ships, and United States ports as records of patients handled. The last section, containing information about a patient’s diagnosis, could be used by debarkation hospitals in assigning patients to wards.19 The directives just discussed served as a basis for co-ordination of activities of the- aters and the zone of interior in the evacu- ation of patients by sea. A further step— the co-ordination of activities of transport surgeons with those of the ports of debar- kation in the United States—was taken in 1943. In the spring the New York Port issued instructions for transport surgeons. In addition to describing the manifold duties and responsibilities of transport surgeons for sanitation aboard transports, for the care of outbound troops, and for the care and treatment of inbound pa- tients, these instructions covered the duties of transport surgeons in the trans- fer of patients from ships to ports. Upon arrival at a zone of interior port, each transport surgeon was required to submit to a port surgeon’s representative a list of all Army patients, showing for each a 17 (1) Ltr AG 704.11 (3Jun 44) OB-S-E-SPMOT- M, TAG to CGs AAF, AGF, ASF, Base Comds, and TofOpns, 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comds. SG: 705.-1. (2) Ltr, GofT to CG NATOUSA, 13 Nov 43, sub: Embarkation of pnts. HD: 705 (MRO, Fitzpatrick Stayback, 493). (3) Ltr, Stark Gen Hosp to CG CPE, 10 Jan 44, sub: Pnt Lists for Hosp Ships, with 4 inds. SG: 705.-1. (BB). 18 TG Cir 50-31, 30 May 44, sub: Use of Debarka- tion Tag (Manual for Trans Surg); (Revised 1 7 Jul 44). TC; 710. 19 WD Cir 218, 20 Jul 45. PROCEDURES FOR EVACUATION 337 brief diagnosis, a classification (neuro- psychiatric, medical, or surgical), and whether litter or ambulatory, along with records accompanying each patient. Each transport surgeon was required to submit a list of the baggage of patients and a list of patients’ money and valuables in the surgeon’s possession. Finally, he was to complete all entries on a debarkation tag for each patient and was to insure the at- tachment of such tags to the clothing of all except those who were neuropsychiatric. Tags for the latter were to be delivered to debarkation officers. These actions were designed to assist ports in planning the transfer of patients to general hospitals and to assist these hospitals in assigning them to proper wards.20 As experience accumulated and the evacuation load grew heavier, the Trans- portation Corps, assisted by the Medical Regulating Officer, supplied transport surgeons and hospital ship commanders with more specific instructions than for- merly. Toward the end of 1943 the guide for transport surgeons which the New York Port had issued earlier was sent to other ports for transmission to the surgeons of transports which called at them.21 About the same time, general regulations cover- ing the sailing of hospital ships were pub- lished. Later, as the number of hospital ships in service increased, the Charleston Port, which had been designated as the home port for Army hospital ships serving the European and Mediterranean the- aters, issued a sixty-one page manual of instructions for their commanders. It covered such subjects as reports and records, procedures in case of death, reg- ulations for sanitation and hygiene, quar- antine procedures, suggestions for the care of patients at sea, supplies and equipment, and the like.22 Instructions issued to trans- port surgeons and hospital ship com- manders also included procedures to be followed in preparing for debarkations at ports in the United States, but gradually many of their duties in this connection were transferred, as already described, to theater officials. As that happened medi- cal officers on ships became responsible for checking for accuracy and completeness the embarkation lists and identification tags prepared in theaters. Procedures for Air Evacuation Though few patients were transported by air from theaters to the United States in the first year and a half of the war, such demands for air evacuation as were made resulted in the establishment during 1942 of a basic system of air evacuation. Earliest requests for the evacuation of patients by air from outlying areas came particularly from the Alaska Defense Command. Before the war that Com- mand had asked for airplane-ambulance service to the United States; in the first half of 1942 it renewed its requests, point- ing out then and later that evacuation by sea was uncertain, delaying the move- ment of patients in some cases from two to four weeks and subject at all times to interruption by enemy activities.23 To the demands of Alaska were added in July 20 (1) Instructions for Transport Surgeons, Off Port Surg, NYPE, 26 May 43. HD; 560 (NYPE), (2) ARs 55-350, 14 Sep 42; 55-415, 11 Dec 42. 21 Ltr, GofT (Mvmt Div) to CGs PEs, 9 Dec 43, sub: Guide for Trans Surgs. HD: 705 (MRO, Fitz- patrick Stay back, 583). 22 (1) AR 55-530, 30 Dec 43. (2) CPE, Instructions (Med) to Hosp Ship Comdrs, 30 Aug 44. HD: 560 (CPE). (3) TCP 16, 4 Apr 45, US Army Hosp Ship Guide. HD: 560. 23 (1) Gordon H. McNeil, History of the Medical Department in Alaska in World War II (1946), pp. 167-192. HD. (2) Ltrs, GG Alaska Def Gomd to CG Western Def Comd and Fourth Army, 14 Jul and 6 Oct 42, sub: Aircraft Amb for Alaska. AG: 452. The 1 4 July 1942 letter cites earlier letters on the same subject dated 10 November 1941 and 6 April 1942. 338 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR 1942 a request of the Newfoundland Base Command for air evacuation to New York. The Surgeon General’s Office and SOS headquarters approved this request and passed it on to the Army Air Forces, which in June had been charged with responsi- bility for the development and operation of air evacuation.24 The Air Surgeon saw in these demands an opportunity to develop an air evacua- tion system,25 but basic decisions had to be made first as to (1) who within the Army Air Forces would be responsible for plan- ning and operating this system, (2) whether or not special airplane ambu- lances would be provided, and (3) the ex- tent to which air evacuation would be en- couraged or permitted. On 25 August 1942 the Air Surgeon foreshadowed the answer to the second question when he stated that “airplanes have not been pro- duced in sufficient quantity to allot planes solely for ambulance use. . . .” 26 On the same day he recommended that the Air Transport Command be charged with planning, developing, and operating a system of air evacuation from outlying bases to the United States.27 Three days later the Air Staff an- nounced its decisions. Special planes would not be provided for the evacuation of patients from overseas bases and the- aters; but air evacuation would be carried out in connection with the routine opera- tion of air transports. Since the Air Trans- port Command operated such transports, it would operate the air evacuation sys- tem. The Air Surgeon—not the Air Trans- port Command—would be responsible for planning and establishing policies for this system.28 To discharge this responsibility, the Air Surgeon expanded his Office, as- signing to it in September and October two officers—Maj. (later Col.) Richard L. Meiling and Col. Wood S. Woolford— who had already demonstrated an interest in air evacuation.29 Meanwhile the Air Surgeon had drafted a policy governing the extent of air evacu- ation. After approval by the Air and Gen- eral Staffs it was announced to theaters by the Chief of Staff of the Army on 25 Sep- tember 1942. Air evacuation would be ac- complished “upon call” on the Air Trans- port Command, but such calls would be kept “to [a] minimum.” Theater com- manders would classify patients for air evacuation according to the following order of precedence: first, emergency cases for whom essential medical treatment was not available locally; second, cases for whom air evacuation was a “military necessity”; and third, cases—except psy- chotics—who required prolonged hospi- talization and rehabilitation.30 24 (1) Ltr, CG Eastern Def Comd and First Army to CG AAF, 31 Jul 42, sub: Air Amb Evac of Pnts from Newfoundland Base Comd, with 3 inds. SG: 705.-1 (Newfoundland)F. 25 The chief of the SOS Hospitalization and Evac- uation Branch gained this impression after confer- ring with representatives of the Air Surgeon. Diary, Hosp and Evac Br SOS, 12 Nov 42. HD: Wilson files, “Diary.” 26 4th ind, CG AAF (Air Surg) to SG, 25 Aug 42, on Ltr, CG Eastern Def Comd and First Army to CG AAF, 3 1 Jul 42, sub; Air Amb Evac of Pnts from Newfoundland Base Comd. SG; 705.-1 (New- foundland^. 27 Ltr, Air Surg to ACofAir Staff A-4, 25 Aug 42, sub: Evac of Casualties by Air. AAF; 370.05. 28 (1) Memo, CG AAF (ACofAir Staff A-4) for CG ATC, 28 Aug 42, sub: Evac of Casualties by Air. (2) 1st ind, Same to Air Surg, 28 Aug 42, on Ltr Air Surg to ACofAir Staff A-4, 25 Aug 42, same sub. Both in AAF: 370.05. 29 (1) An Rpt, FY 1943, Oprs Div ASO. USAF: SCO Hist Br. (2) Medical History, I Troop Carrier Command From 30 April 1942 to 31 December 1944, pp. 49-50. Same file. (3) Ltr, Dr. Richard L. Meiling to Col Calvin H. Goddard, 30Jun 52. HD: 314 (Cor- respondence on MS) XL 30 (1) Rad CM-OUT-8628 thru 8637, Marshall to CGs Bases, Def Comds, and Theaters, 25 Sep 42. OPD: 704.1. These messages were all identical. (2) Memo, Lt Col Milton W. Arnold, AC, for Lt Col M. T. Stallter, 9 Sep 42, sub; Evac of Casualties by Air. AG: 580.-1. PROCEDURES FOR EVACUATION 339 After basic decisions were made about air evacuation from theaters, representa- tives of the Air Surgeon’s Office, the SOS Hospitalization and Evacuation Branch, and the Air Transport Command collabo- rated in establishing operational proce- dures and delineating responsibilities of various participating commands. Where- as the Air Transport Command was re- sponsible for equipment attached to planes, such as litter brackets, the Medi- cal Department was to furnish all medical supplies and equipment used in the care of patients en route. Supplies such as litters and blankets were to be furnished by theaters, but were to be returned by the Services of Supply after patients ar- rived in the United States. Medical air evacuation transport squadrons, consisting of nurses and enlisted technicians, were to be assigned to the Air Transport Com- mand to furnish attendants for patients aboard transport planes. Theater com- manders were to transfer patients to points along regular ATC routes. They were also to co-ordinate plans for air evacuation to the United States with the commanders of ATC wings serving their respective areas, reporting to the latter daily the location and number of litter, hospital ambulant, and troop class patients who should be picked up. Flight surgeons alone would determine the suitability for flight of pa- tients selected by theater commanders. Finally, the Air Transport Command would be responsible for the care and treatment of patients from the time it ac- cepted them in theaters until it delivered them to SOS or AAF control in the United States.31 Although ATC medical officers alone could determine the final suitability of pa- tients for flight, after the first half of 1944 theater medical authorities were responsi- ble for establishing the general groups of patients to be transported by air. They agreed that litter patients should take precedence over the less serious cases. The chief surgeons of both the European and Mediterranean theaters considered pa- tients requiring neurosurgery, maxillo- facial surgery, and plastic surgery, as well as those who were blind, to be among those who should have priorities in air evacuation. Both believed that serious mental disturbances were a contraindica- tion to transportation by air.32 On the other hand, in the fall of 1944 the South- west Pacific theater included mental pa- tients among the groups to be evacuated by air as a regular procedure. Success in this practice resulted in the preparation in August 1945 of a standing operating pro- cedure for the air evacuation of psychiatric patients.33 Early in 1943 the Air Priorities Division of the Air Transport Command deter- mined the priority of patients designated for air transportation as against priorities already established for passengers and 31 (1) Rpt, Mins of Mtg, ATG, 13 Oct 43, Air Evac of Wounded. AAF; 370.05. (2) Memo, CG SOS for CG AAF, 9 Nov 42, sub: Evac Oprs. AG: 704 (17 Jun 42)(1). (3) Memo, CG SOS for CG AAF, 12 Nov 42, sub: Status of Hosp Cons and Evac Fac for Alaska Sta. AG: 632. (4) 2d ind, CofSA to CG Alaska Def Comd, 21 Nov 42, on unknown basic Ltr. AG: 632. (5) Ltr, CG AAF to Surg 1 1th AF, 13 Dec 42, sub: Recommended Plan of Air Evac. AAF: 370.05. (6) Diary, SOS Hosp and Evac Br, 17 Dec 42. HD: Wil- son files, “Diary.” 32 (1) Logistical History of NATOUSA-MTOUSA, 30 November 1945 (Naples, Italy, 1945), pp. 328-29, HD: MTO, 314. (2) Off Chief Surg Hq ETO, Admin Memo 147, 2 Nov 44; Admin Memo 16, 23 Mar 45, and other correspondence dealing with selection of patients for air evacuation. HD: ETO, 370.05 (Evac Br Corresp 1944-45). 33 History of the Medical Department, Air Trans- port Command, 1 January 1945-31 March 1946. HD: TAS. For a discussion of medical considerations in- volved in air evacuation, see Sidney Leibowitz, “Air Evacuation of Sick and Wounded,” The Military Sur- geon, vol. 99, No. 1 (July 1946), pp. 7-10. 340 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR cargo in general. Three degrees of preced- ence for the latter two were announced in January. Persons whose movement was required by an emergency so acute that any delay would seriously and directly impair the war effort were given a Class 1 priority. Passengers and cargo whose transportation by air was absolutely nec- essary for the accomplishment of a mission essential to the prosecution of the war were given a Class 2 priority. Class 3 priorities were given to passengers and cargo whose transportation by air was vital to the war effort but not of an ex- tremely urgent nature.34 In February 1943 ATC headquarters announced that pa- tients would normally have Class 3 priori- ties but could not be displaced, or “bounced,” once they were en route, ex- cept at the discretion of ATC flight sur- geons at stopover points. In effect, this gave patients a Class 3 priority for loading but a Class 1 priority for the duration of flight. In emergencies, ATC announced, patients might be given initially the highest priority at a theater commander’s disposal. Medical attendants were to travel under the same priorities as patients during flights to the United States; to in- sure their prompt return to theaters which supplied them, they were then to be given a Class 2 priority.35 An important change in the system of determining priorities was made in 1944. Beginning in April the Air Transport Command allocated transport space on a tonnage basis to each theater commander, and theater priorities boards then deter- mined the amount of space that would be set aside for patients, for other personnel, and for cargo.36 Among the obvious ad- vantages of this system was the increased certainty with which both theater sur- geons and Medical Regulating Officers in the United States could plan air evacua- tion. The use of air evacuation necessitated a system by which airports in the United States and air bases along Air Transport Command routes could be informed of the arrival of patients by plane. In October 1943 the Air Transport Command issued a regulation making ATC officers respon- sible for the necessary reports. It required a base embarking patients for another to inform it by the fastest means of com- munication available. It also required the pilot of a plane carrying patients to report his cargo to the operations officer of the next stopping point thirty minutes before arrival. After planes landed in the United States, ports of aerial debarkation—using a code devised by the ASF Medical Regu- lating Unit—reported patients received to the Air Forces Regulating Officer.37 Procedures for Debarkation Patients transported from theaters to the zone of interior by the Transportation Corps and the Air Transport Command had to be transferred soon after arrival to service commands for definitive treatment. It was necessary, therefore, to determine the point where responsibility for their transportation and care devolved upon service commands, and to establish pro- cedures for their debarkation, their move- ment from ships and planes to near-by 34 Air Priorities Div, ATC, Directive No 5, Prior- ities for Air Trans, 9 Jan 43. AAF: 580 “Air Trans.” 35 (1) Ltr AFATC 580.1, CG ATC to CGs Overseas Comds, Wing Comdrs, 26 Feb 43, sub: Air Priorities Instruction No 4. AAF: 370.05. (2) WD Memo 95-6- 43, 26 Feb 43. AG: 580.81 (1-10-43). 36 (1) WD Cir 130, 4 Apr 44. (2) AAF Reg 25-6, 29 Apr 44. 37 (1) ATC Reg 25-6, 15 Oct 43. (2) AAF Ltr, 4 Oct 44, sub: Rpt of Pnts for Trf. (3) Comments by Brig Gen Richard L. Meiling USAF, 30 Jun 52. HD: 314 (Correspondence on MS) XI. PROCEDURES FOR EVACUATION 341 hospitals, and their reception and prep- aration for further transportation to hos- pitals of definitive treatment. Problems in this connection were not as great for air bases as for port commands because pa- tients arrived by plane in smaller groups and fewer numbers than by ship. In the early period of the war ports of embarkation were responsible for sending patients who arrived from theaters to gen- eral hospitals for further treatment.38 This responsibility conflicted with a basic prin- ciple of Army evacuation, namely, that support was always from rear to front. According to it, responsibilities of ports for the movement of patients should have ended at their normal rear boundaries. Failure to observe this principle is perhaps accounted for by the lingering influence of peacetime practices. In peacetime the most common movement of patients in the United States was from station to general hospitals and in such instances station commanders were responsible for issuing orders and arranging transportation. So long as the number of evacuees arriving at ports was small, it was perhaps logical that port commanders should perform this service for them as well as for patients from port complements. The practice of considering command- ers of ports of embarkation responsible for transferring evacuees to general hospitals had to be partially modified after patients began to return to the United States by air. Under current regulations theater commanders issued orders directing them to report to commanders of seaports re- sponsible for the supply and evacuation of respective theaters. As a result patients who traveled by air from the Caribbean, for example, landed in Florida with orders to report to the commander of the New Orleans Port of Embarkation. In such in- stances they had to be sent by rail from Miami to New Orleans for subsequent transfer to a general hospital, rather than directly to the general hospital which was nearest Miami (Lawson General Hospital, Atlanta, Ga.). This not only caused incon- venience to patients and delayed their treatment, but also added unnecessary burdens to transportation facilities that were already overtaxed. In February 1943 SOS Headquarters referred this problem to the Air Surgeon’s Office. On the recom- mendation of the latter the War Depart- ment in May directed overseas command- ers not to designate, in orders transferring patients to the United States, specific commanders to whom they were to report. At the same time air bases in the United States were granted authority to issue orders transferring patients to general hospitals for definitive treatment.39 Unlike port commanders, commanders of air bases serving as debarkation points operated debarkation hospitals or at least used station hospitals located on such bases for debarkation processing of pa- tients. They were responsible for remov- ing patients from airplanes and transport- ing them and their baggage to such hos- pitals. To discharge this responsibility they were required by ATC regulations to sup- ply a team of at least one medical officer and four enlisted men to meet each plane bringing in patients. They did not assume the additional responsibility and authority of arranging for the transportation of pa- tients from air debarkation hospitals to 38 (1) AR 40-1025, 12 Oct 40; G 1, 21 Aug 42; C 4, 5 Jul 43. (2) WD Gir 64, 1 Jun 42. (3) WD Cir 316, 6 Dec 43. 39 (1) Ltr, CG Trinidad Sector and Base Comd to CG NOPE, 27 Jan 43, sub: Designation of Specific Hosp in Evac Orders with 5 inds. AAF; 370.05 (Evac). (2) WD Cirs 1 19, 1 1 May 43, and 137, 16 Jun 43. 342 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR general hospitals. Instead they normally called upon service commands to perform this function, but in extreme emergencies might arrange locally, or apply to the Air Surgeon, for air transport.40 Early in the war commanders of ports of embarkation were responsible for re- moving patients from ships and also for transporting them to debarkation hospitals operated by service commands. By the middle of 1943 several developed “SOP” (Standing Operating Procedures) for this operation. The SOP for the New York Port, for example, explained procedures for the transfer of patients from transports to near-by hospitals. Upon arrival of a ship, a party from the port went aboard to verify the reported number and classifica- tion of patients and to receive from the transport surgeon his list of patients classi- fied according to diagnosis (medical, sur- gical, or neuropsychiatric). This list was sent immediately to Halloran General Hospital, so that room in appropriate wards could be prepared. Ambulatory patients, the first to be debarked, were dispatched to Halloran in commercial buses in groups of ten, with two enlisted men as medical attendants for each group. Litter patients were placed in ambulances, each carrying four patients and one at- tendant. Finally, mental patients were consigned to ambulances, with necessary attendants. After patients were removed from a ship, their valuables were turned over to the boarding officer for transmis- sion to the receiving hospital. Baggage of small groups was sent by the port direct to the hospital, while that of large groups was handled by the baggagemaster’s section of the Army Transport Service or, later, the port’s water division. Patients’ records were put in proper order and transmitted to Halloran General Hospital. The port surgeon’s office then sent reports of de- barkation to the Chief of Transportation, The Surgeon General, the commander of the New York Port of Embarkation, and the surgeon of the Second Service Com- mand.41 For debarking patients from ships and transporting them to general hospitals port commanders normally used person- nel and vehicles belonging to installations under their control. For example, the Charleston Port trained as litter bearers enlisted men belonging to its own medical detachment and to port and service bat- talions in training or on duty in the area. It also used its own ambulances, trucks, and passenger cars to carry patients to Stark General Hospital, which was located near by.42 This procedure sufficed when the number of patients received was small. When large-scale operations were ex- pected, other arrangements had to be made. In the fall of 1942, for instance, to assist in the reception of casualties from the North African invasion the New York Port called upon the Second Service Com- mand for both personnel and vehicles and used, in addition, an ambulance section of a Ground Forces medical regiment.43 In 40 (1) Memo, Air Surg for ACofAir Staff A-4, 24 Feb 43, sub: Air Evac Casualties, with draft of direc- tive to all air commands in the United States. AAF: 370.05. (2) ATC Reg 25-6, 15 Oct 43 and 29 Apr 44; AAF Reg 25-17, 6 June 44; AAF Ltr 25-10, 11 Jul 44 and 9 Dec 44. 41 Ltr, Surgs Br NYPE to Port Surg NYPE, 12 Jul 43, sub: SOP of Trans and Evac Off, with inds. HD: 370.05. 42 (1) Ltr, Surg CPE to GofT, 19 Nov 42, sub; Overseas Evac Plans. SG: 705.-1. (2) An Rpt, 1943, Med Dept CPE. HD. 43 (1) Mins, Conf on Evac of Mil Pers, 26 Oct 42. TC: 370.05. (2) Ltr, Surg NYPE to Col H. D. Offutt, SGO, 12 Nov 42, with inds. SG: 705 (NYPE). (3) Memo for Record, on 1st ind SPOPH 370.05 (1 1-24- 42) Hosp and Evac Br SOS to GofT, 26 Nov 42, on unknown basic Ltr. HD: 705 (MRO, Fitzpatrick Day- book, Aug 42-Jun 43). PROCEDURES FOR EVACUATION 343 such instances ports actually controlled the movement to hospitals of only small numbers of patients, while they continued to be responsible for the larger groups moved in service command vehicles by service command personnel. Early in 1944 this procedure was changed. To provide a clear-cut line of demarcation between responsibilities of ports and service commands and to sim- plify operations by having only one agency furnish vehicles and personnel for transportation from ports to hospitals, the Second Service Command proposed, and the commanding general of the Service Forces approved, a change in the transfer point.44 After 11 April 1944 it was nor- mally at shipside rather than in trains or hospitals.45 In the case of New York this proved advantageous. The Second Service Command controlled a number of near- by medical installations upon which it could call for ambulances and personnel to move large shipments of patients to Halloran and Mason General Hospitals. In other instances this change introduced the very situation it was designed to cor- rect. The Ninth Service Command, for example, had to call upon the San Fran- cisco Port for twenty buses each capable of carrying thirty-seven ambulatory patients to assist in transporting patients from docks to the Letterman General Hospital. In any event the removal of patients from ships to debarkation hospitals required close co-operation between port and serv- ice command officials.46 For the transportation of patients from docks to hospitals, service commands used ambulances, buses, and trains, depending upon the physical condition of patients and the distances to be traveled. The Sec- ond Service Command, for example, transferred patients from piers located in Brooklyn, Staten Island, New Jersey, and the North River to service command de- barkation hospitals by ambulance, gov- ernment bus, commercial bus, and hospital train. During 1944 this Command called upon as many as twenty of its installations to supply vehicles and personnel for such movements. In a single day, it reported, more than 200 ambulances and 55 buses were used to move 3,000 patients received in one convoy. The First Service Com- mand normally used trains to move pa- tients from ships in the Boston harbor to Camp Edwards and Camp Myles Stand- ish hospitals. The Fourth Service Com- mand used motor vehicles almost exclu- sively to transport patients from the Charleston port to Stark General Hospital. In the Ninth Service Command patients were transported from the San Francisco port to Letterman General Hospital in buses and ambulances, but they were moved from the Seattle port to Madigan General Hospital in small groups by am- bulance and in large groups by rail.47 Ports continued to be responsible for debarking patients from ships. Normally they used their own men, including spe- cially trained port and sanitary companies, as litter bearers, but in some instances they 44 (1) Rpt, Conf CGs of SvCs, Dallas, Tex, 17-19 Feb 44. HD: 337. (2) Memo, CG ASF (Control Div) for CofSA thru SG and GofF, 26 Feb 44, sub: Control of Med Serv at PE, with 3 inds. SG: 705. (3) Rpt, Conf to Discuss Proposed Changes in AR 170-10 and Cir 316, 6 Mar 44. SG: 337.-1. (4) Memo, Opns Div ASF for Planning Div ASF, 10 Mar 44, sub: Evac of Returning Casualties from Ports. TC; 370.05 (Evac of Pnts). 45 ASF Cir 99, see IV, pt 2, 11 Apr 44. 48 An Rpts, 1944, Letterman Gen Hosp; NYPE; and 1st, 2d, 4th, and 9th SvGs. HD. 47 An Rpts from SvCs, Ports, and Gen Hosp (Hal- loran, Hammond, LaGarde, Letterman, Lovell, Madigan, McGuire, Stark) and Sta Hosps (Cp Ed- wards, Cp Myles Standish) for 1944 and 1945 ex- plain debarkation procedures and reception of patients by hospitals. HD. 344 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR still borrowed enlisted men from service command hospitals. To save personnel and speed operations the Boston Port used wheeled litters to move patients on its piers. Ports differed in the order in which they unloaded patients. Some unloaded mental patients first, and then ambulatory patients. Others reversed this order. Usu- ally litter patients were debarked last be- cause such preparations as transferring them to litters could be made while other patients were being debarked. As ports gained experience in operations and im- proved procedures, the time required to unload ships decreased. For example, the Charleston Port cut the time from five hours at the beginning of 1944 to two hours by the end of 1944 and then to one hour for a 600-patient hospital ship dur- ing 1945. The Boston Port reported that on one occasion in 1945 as many as 1,958 patients, among them 287 litter cases, were moved from a transport to near-by trains in two hours and twenty minutes.48 The manner in which general hospitals received evacuees differed from one to another. In May 1943 The Surgeon Gen- eral directed hospitals receiving large numbers of patients from either ships or trains to admit them directly to wards, without “processing” them through hospi- tal receiving offices. The reason was to avoid delays in giving patients needed food, rest, and treatment. Halloran Gen- eral Hospital had developed a different system, and on request of the hospital and the Second Service Command, The Sur- geon General approved its continued use. There, a receiving ward had been estab- lished to care for a large number of pa- tients. It contained a mess hall for the prompt feeding of patients, space for the medical inspection of patients and for the care of those needing immediate medical treatment, bathing facilities, and a cloth- ing room in which patients received fresh hospital clothes and stored their own clothing. There was also space for a bat- tery of typists brought in to complete all of the paper work required for the admis- sion of patients. The average length of time patients stayed in this building, be- fore being admitted to wards, was reported to be 61 minutes.49 With the growth of the evacuee load in 1944 and 1945 debarkation hospitals had to transfer evacuees to other hospitals as rapidly as possible—normally within sev- enty-two hours—so as to keep enough beds vacant for large groups of new pa- tients arriving in quick succession. With such a short period of time the medical and surgical care afforded evacuees had to be limited. They were given necessary medications and their dressings were changed, while a brief examination served to check the accuracy of the diagnosis car- ried in medical records and to determine their ability to undertake further travel. Primary emphasis was upon administra- tive matters. Records required for use in debarkation hospitals had to be prepared; reports of patients received had to be made to Washington; orders for their transfer to other hospitals had to be issued; patients had to be outfitted with complete 48 (1) Files SG: 705 (ports or debarkation hospitals) contain correspondence dealing with debarkation dif- ficulties and operational procedures; for example, Memo, CG 4th SvC for CG ASF, 13 Jun 44, sub; Evac of Overseas Casualties at Stark Gen Hosp. SG: 705 (Stark GH). (2) History of Stark General Hospi- tal, Charleston, S. C., 1941-45. HD. (3) An Rpts, Boston, Charleston, Hampton Roads, New Orleans, New York, San Francisco, and Seattle PEs, 1944, 1945. HD. 49 Ltr, Halloran Gen Hosp to SG, 19 May 43, sub: Admission of Pnts when Arriving in Convoy. SG: 705.1 (Halloran GH). (2) An Rpt, Halloran Gen Hosp, 1943. HD. PROCEDURES FOR EVACUATION 345 uniforms and given partial payments;50 and arrangements had to be made for their transportation. The paper work thus required was voluminous. Beginning in the latter part of 1944 attempts were made to simplify it. Concurrently, it will be re- called, the Surgeon General’s Office was engaged in a more general project to standardize and simplify administrative procedures in all hospitals. Changes that were made in debarkation procedures were of two types. In June 1944 the Con- trol Divisions of Stark General Hospital and the Fourth Service Command pro- posed the elimination of records required for patients admitted to hospitals for defin- itive treatment but not needed for those in transit and the simplification of entries in other records. As a result, evacuees were not admitted to the registers of debarka- tion hospitals and their names were not entered on admission and disposition sheets. In addition, standard rubber stamp entries were authorized for use in patients’ service and field medical records.51 Dur- ing the winter of 1944-45 another meas- ure toward simplifying the work of debar- kation hospitals was adopted: the installa- tion of addressograph equipment. With this equipment hospitals prepared plates for use in making rosters and in issuing orders and thus eliminated the necessity of typing each separately.52 Though seem- ingly small when considered individually, the significance of such measures can be judged more accurately if the total evacu- ation load of different hospitals is taken into account. Stark General Hospital, for example, admitted 44,003 patients in the nine-month period from 1 January 1945 to 30 September 1945, while Halloran ad- mitted about 69,500 and Letterman about 73,000 during the entire year.53 50 That is, partial payments of the pay and allow- ances due service men, made by the Army pending full settlement of their accounts. 51 (1) Memo, CofT (Mvmt Div by Lt Col J. G. Fitzpatrick) for SG (Hosp Div), 23 May 44. TC: 370.05. (2) Memo, CG 4th SvC for CG ASF (Control Div), 13 Jun 44, sub: Evac of Overseas Casualties at Stark Gen Hosp, with inds. SG: 705 (Stark GH). 52 (1) Memo, SG (Control Div) for QMG, 30 Aug 44, sub: Use of Addressograph and Embossing Equip in Debarkation FIosps. SG: 413.51. (2) Ltr, SG to CG 2d SvC, 20 Dec 44, sub: Admitting Off Procedure for Pnts Retd from Overseas. SG: 705 (2d SvC). (3) Memo, Hosp Div SGO for HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 3 19.1-2. (4) Memo, NP Cons Div SGO for Hosp Div SGO, 14 May 45, sub; Procedure of Pnts Reed from Overseas thru Stark Gen Hosp. SG: 705 (Stark GH). 53 An Rpts, Stark, Halloran, and Letterman Gen Hosps, 1945. HD. 304244 0—55 24 CHAPTER XXI Movement of Patients in the United States The movement of patients in the United States, although fairly simple early in the war when it involved only the transfer of individuals or small groups from station to general hospitals, began to assume differ- ent characteristics about the middle of 1943. A steady increase in the number of evacuees received from theaters—from about 3,000 per month early in 1943 to a peak of more than 57,000 in May 1945— focused attention on the transportation of patients from debarkation to general hos- pitals. Meanwhile declining troop strength in the United States, along with establish- ment of regional hospitals to serve in lieu of general hospitals for patients from camps in surrounding areas, reduced to a trickle the transfer of zone of interior pa- tients to general hospitals. Growth of the Army’s fleet of hospital cars from 24 early in 1943 to 380 by the end of the war, along with a shortage of commercial sleepers and diners, meant that emphasis shifted from the transportation of patients on regular passenger trains to their movement on Army hospital trains. A change in Air Force policy in the spring of 1944, permit- ting certain planes to be assigned pri- marily to evacuation operations in the United States, resulted in a transition from sporadic to regular movement of patients by air. Finally, compliance with the policy established early in 1943 of transferring patients from debarkation hospitals to hospitals designated as specialized centers and located as near as possible to patients’ homes complicated the problem of plan- ning their transportation. Regulating the Flow of Patients Although The Surgeon General was designated by Army directives as the chief medical “regulator,” in the early part of the war he exercised only a general influ- ence over the distribution of patients among Army hospitals. His office granted ports unlimited bed credits in general hos- pitals located nearest them. Port com- manders then transferred patients to such hospitals, reporting later to the Surgeon General’s Office the number received from theaters, the date of their arrival, and the name of the hospital to which they had been transferred.1 Station hospitals trans- ferred patients to general hospitals in which they held bed credits. General hos- 1 (1) WD Cir 120, 21 Jun 41. (2) An Rpt, 1943, NYPE. HD. (3) Ltr, SG to CG HRPE, 14 Aug 42, sub; Rpt of Pnts Arriving from Overseas. SG: 705.-1 (HRPE). MOVEMENT OF PATIENTS IN THE UNITED STATES 347 pitals normally did not hold bed credits in other general hospitals and hence had to request the Surgeon General’s Office to authorize transfers and to designate re- ceiving hospitals. In order to know which had vacant beds, The Surgeon General began in April 1943 to require all general hospitals to submit daily bed status reports to his Office.2 When general hospitals re- quested the transfer of patients to other such hospitals in order to free beds for subsequent arrivals from near-by ports, his Office authorized the transfer of groups, sometimes as large as 250. Decisions as to particular patients to be transferred were left to hospital commanders. Normally, then, in the first part of the war the Sur- geon General’s Office authorized the transfer of patients in bulk and depended upon local commanders to request indi- vidual transfers to comply with the policy of hospitalizing patients near their homes and in specialized centers.3 Later in the war, as the movement of patients in the United States increased and grew more complex, a new procedure was developed to give the Surgeon Gen- eral’s Office greater control over the trans- fer of individual patients. It involved re- ports to the Medical Regulating Unit of patients received at debarkation hospitals and of vacant beds in general and con- valescent hospitals. In May 1944 the Medical Regulating Officer established a system for debarkation hospitals to use in requesting the transfer of patients to other hospitals. Instead of asking for authority to transfer a certain number of patients without regard to disabilities or home lo- cations, debarkation hospitals reported in coded teletype messages the geographical destination (home), diagnosis or special disability, sex and military status, and general physical condition (litter or am- bulatory) of each patient received. For ex- ample, one male enlisted neurosurgical patient whose home was in Florida was reported as “6NCY”; ten such patients, as “6NCY10.” In August 1944 this system was revised, and additional medical clas- sifications or diagnoses were listed, along with more exact definitions of each. About the same time, the system of daily bed status reports was changed. In the fall of 1943 a code had been established for hos- pitals to use in reporting vacant beds. In August 1944 this code was modified so that hospitals reported vacant beds not in such general categories as medicine, sur- gery, and neuropsychiatry but in terms of the particular diseases or injuries for which they had been designated as spe- cialized centers. For example, hospitals with vacant beds for male neurosurgical patients reported them under code “12TVKN.” Early in 1945 both debarka- tion and bed status reports were further revised to reflect changes in specialty designations of hospitals and thereby to permit a greater degree of accuracy in sending patients to proper hospitals. Using both reports together, the Medical Regu- lating Unit was able to direct debarkation hospitals to transfer patients, in small groups or as individuals if necessary, to general hospitals that specialized in the diseases or injuries with which they suf- 2(1) AR 40-600, 6 Oct 42. (2) Ltr, SG to CO Billings Gen Hosp, 26 Apr 43, sub: Daily Bed Rpt. SG: 632.2 (Billings GH). By July 1943 the Hospitali- zation and Evacuation Division, SGO, was receiving daily reports from 28 hospitals, giving number of patients, number of medical, surgical, and neuro- psychiatric beds, and number of patients transferred to and received from other general hospitals. 3 Telegrams in which the Surgeon General’s Office authorized the transfer of patients are filed in SG: 704.-1 and 705.-1. See also weekly diaries of the Hos- pital Administration Division. HD. 348 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR fered and that were located as near as practical to their home addresses.4 At first this system applied only to pa- tients being transferred from debarkation hospitals to general hospitals of definitive treatment, but gradually it was extended to cover even the transfer of patients from station and regional hospitals to general hospitals. Because of crowded conditions of general hospitals in the populous north- eastern part of the United States, in July 1944 The Surgeon General directed that no patients should be transferred to cer- tain hospitals in that area without prior approval of the ASF Medical Regulating Officer. In effect, this directive canceled all bed credits which station or regional hospitals held in the hospitals listed. About two months later additional hospi- tals were placed in this category, raising the number thus restricted from thirteen to thirty-one. Ultimately, early in 1945 the system that originated as a means of authorizing the transfer of evacuees from debarkation to general and convalescent hospitals was formally extended to include all transfers to such hospitals.5 The degree of control which the Medical Regulating Officer thus achieved over the use of beds in general and convalescent hospitals en- abled him to authorize transfers of pa- tients promptly and to use beds effectively when they were at a premium in the first half of 1945. Centralized control over the transfer of patients to general and convalescent hos- pitals did not assure that policies on the hospitalization of patients near their homes and in specialized centers would be wholly complied with. Hospital beds in the United States were not distributed in proportion to density of population. Hence, early in 1945 when the patient load became great enough to fill general and convalescent hospitals, it was impos- sible for the Medical Regulating Officer to send all patients to hospitals located near their homes. Furthermore, the neces- sity of sending patients to specialized cen- ters sometimes conflicted with and out- weighed the desirability of sending them to hospitals near their homes. Finally, de- barkation hospitals had time for little more than superficial examinations of pa- tients before requesting their transfer to other hospitals. As a result, the medical classifications reported by debarkation hospitals were sometimes incorrect and patients were sent to general hospitals when they should have been sent to con- valescent hospitals.6 Some idea of the complexity of the process of authorizing patient-transfers may be gained from the work load of the ASF Medical Regulating Unit. In the early part of 1945 it received bed status reports from 64 general, 12 convalescent, and 7 temporary debarkation hospitals. Information from these reports was posted daily to show at all times the ability of hospitals to accept patients. Each day the Unit received approximately 100 tele- grams, 10 letters, and 25 telephone calls requesting the transfer of patients in small groups or as individuals. Every month it received in addition fifty to sixty coded 4 (1) History . . . Medical Regulating Service. . . . (2) ASF Cirs 149, 20 May 44; 284, 30 Aug 44; 249, 4 Aug 44; and 89, 10 Mar 45. (3) Ltr, CG ASF (SG) to CO Billings Gen Hosp, 15 Oct 43, sub: Daily Bed Rpt. SG; 632.-2 (Billings GH)K. Identical letters were sent to other general hospitals. Telegrams and correspondence on bed capacities and patient trans- fers are filed in HD: 705 (MRO Staybacks), 705 (MRO Chart on Pnt Capacities in Hosps), and 705 (MRO Daily Diaries, Daily Bed Status). 5 Telg SPMDD-DR, SG (MRO) to all SvCs, 3 Jul 44, 17 Sep 44, 21 May 45, 6 Sep 45. HD: 705 (Med Reg Unit book). 6 See above, pp. 211-12, 240-41. MOVEMENT OF PATIENTS IN THE UNITED STATES 349 telegrams from debarkation hospitals re- questing the transfer of patients to general hospitals; the typical request covered 500 patients who had to be transferred be- cause of their diagnoses, home addresses, sex, and military status to an average of forty-five different hospitals.7 Procedures for Rail Evacuation The principal method of moving pa- tients in the United States—other than by ambulance—was by train—either regular passenger trains or hospital trains made up of Army hospital cars supplemented by commercial equipment. During most of 1942 patients were moved almost ex- clusively in Pullman cars of passenger trains, because the necessity of transport- ing large groups was practically nonex- istent and the Army had only six hospital cars. For groups of patients and attendants numbering fewer than fifty, local trans- portation officers arranged with railroads for cars and routings. For larger groups, the Office of the Chief of Transportation made necessary arrangements, upon re- quest of local transportation officers.8 Toward the end of the summer of 1942, SOS headquarters, the Chief of Trans- portation, and The Surgeon General be- gan to plan for the operation of hospital trains. By that time the delivery of addi- tional hospital cars—enough to serve as the nuclei of eight hospital trains—was expected, and an increase in the number of evacuees was impending. Since several agencies were involved, delineation of their responsibilities for the control and operation of hospital cars was compli- cated. Although hospital cars were pro- cured by the Transportation Corps and used by the Medical Department, SOS headquarters decided with the approval of both The Surgeon General and the Chief of Transportation that they should be “attached” to (i.e., placed under the jurisdiction of) service commands. A serv- ice command hospital was being con- structed near each port which lacked one, and it was anticipated that patients de- barked at ports would be transported by motor vehicles to such hospitals and there turned over to service command control. Hence, ports would have no need for hos- pital cars. In addition, it was thought that service commands could furnish personnel and medical supplies for hospital trains more easily than could ports. Experience had already shown that service commands where ports were located would need hos- pital cars most, because general hospitals in such commands would receive large numbers of patients for transfer to hospi- tals further inland. Plans were therefore made to attach six hospital cars each to the Second, Fourth, and Ninth Service Commands, four to the Eighth, and two to the Sixth (for use in evacuating patients from areas in Canada), and service com- mands were directed to furnish supplies and medical attendants for hospital trains. Any of the hospital cars could be attached to or detached from service commands by the Chief of Transportation. Either one unit car and two ward cars, or one ward dressing car and two ward cars, were to form the nucleus of a hospital train. Sup- plemental Pullmans, diners, and other 7 Memo, Dirs Hosp and Resources Anal Divs SGO for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. 8 (1) Memo, CofT for SG, 28 Mar 42, sub: Basic Plan for Evac of Sick and Wounded. HD; 705. (2) AR 30-925, C 2, 22 Aug 42. (3) WD Cir 192, 16 Jun 42. (4) Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs and PEs, and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs, with inch HD: 705. 350 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR rail equipment were to be used to com- plete it.9 After the decision to attach hospital cars to service commands was made, SOS headquarters issued directives establish- ing procedures for their use. The directives conflicted with one another and with Army regulations governing the trans- portation of personnel in general. As al- ready noted, War Department regulations permitted local transportation officers to arrange with railroads for the transporta- tion of groups of persons numbering less than fifty (after June 1943 less than forty), but provided that the Chief of Transporta- tion would arrange for the transportation of all larger groups. This meant arranging with railroads for carrier-owned equip- ment and for routes and schedules.10 On the other hand, SOS directives provided that local transportation officers could ar- range for all routings of hospital cars with- in the boundaries of service commands to which they were attached. Another stated in contradiction that except in emergen- cies service commands would ask the Chief of Transportation for routing in- structions to cover the movement of each hospital car. Two SOS directives stated that service command transportation of- ficers would arrange with railroads for all supplemental rail equipment, while an- other limited them to arrangements for supplemental equipment needed when hospital cars were moved within service command boundaries. None of the SOS directives took account of Army regula- tions requiring the Chief of Transporta- tion to arrange for equipment and rout- ings for the movement of large groups.11 Such conflicting instructions caused con- fusion about which both the Office of the Chief of Transportation and service com- mands complained.12 The feasibility of attaching cars to serv- ice commands and then attempting to divide authority for controlling their use was questioned in the winter of 1942 and again in the spring of 1943. The com- manding general of the Eighth Service Command believed that hospital cars would be used most in the transportation of patients arriving from theaters of oper- ations and proposed, therefore, that they should be controlled exclusively by the Transportation Corps and operated by ports.13 The Chief of Transportation con- sidered this possibility, but agreed with the SOS Hospitalization and Evacuation Branch to follow plans already made. Nevertheless, in preparation for the recep- tion of casualties from the North African invasion, all hospital cars were temporar- ily transferred to the New York and Hampton Roads Ports and placed under their jurisdiction.14 In December 1942 both the Chief of Transportation and the Hospitalization and Evacuation Branch agreed that they should be returned to 9 (1) Memos, CG SOS for CGs 2d, 4th, 6th, 8th, and 9th SvCs, CofT, and SG, 18 and 26 Aug 42, sub: Location and Control of Hosp Tns. AG: 531.4. (2) Ltr, CofT to CGs PEs and SvCs, 9 Sep 42, sub: Con- trol of Hosp Tns. TC: 531.4. For a discussion of dif- ferent types of Army-owned hospital cars, see below, pp.372-75, 381-83. 10 (1) WD Cir 192, 16Jun 42. (2) AR 55-130, 28 Dec 42, with C 2, 4 Jun 43. 11 (1) Memos cited n. 9(1). (2) Ltr cited n. 8(4). 12 (1) Ltr, CG Ft Sam Houston to CG NYPE, 27 Sep 42, sub: Control of Hosp Tns, with inds. HD; Wilson files, 531.4. (2) 3d ind, CG SOS to CG SFPE thru CG 9th SvG, 3 Nov 42, on telg (n d) from CG 9th SvC. AG; 322.38. (3) Memo, Tank Car Br OCT for Col William J. Williamson, OCT, 16 Nov 42, sub: Opr of Hosp Tn Cars. TG: 531.4. 13 Rpt, Gonf of CGs SvCs, New Orleans, La., 17 Dec 42. HD: 337. 14 (1) Ltr, CG SOS to TAG, 31 Oct 42, sub: Hosp and Evac for Special Opr. TC; 531.4. (2) Memo, CG SOS for SG and CofT, 1 Nov 42, same sub. HRS: ASF Planning Div file, “Hosp and Evac No 15.” MOVEMENT OF PATIENTS IN THE UNITED STATES 351 service commands.15 In the spring of 1943, when plans were being made to receive ninety-six hospital cars ordered earlier, a representative of The Surgeon General suggested that it would be advantageous eventually, when large numbers of pa- tients began to arrive from theaters of op- erations, to have service commands sup- ply personnel for hospital trains but to place all hospital cars in pools under the exclusive control of the Chief of Transpor- tation. Presumably such an arrangement would have promoted the more efficient use of cars, but the Transportation Corps preferred to continue the system of attach- ing cars to service commands in which ports were located, and The Surgeon Gen- eral’s representative concurred in plans for the allocations of 45 cars to the Second, 24 to the Third, and 27 to the Ninth Serv- ice Commands.16 Later in the war, when a shortage of carrier-owned equipment combined with a steadily increasing evacuation load to require the greatest possible use of Army hospital cars, centralized control was adopted, along with other measures, to achieve that goal. By the winter of 1943- 44 it was widely recognized that maxi- mum use was not being made of hospital cars. In many instances they returned empty to home stations after delivering patients to general hospitals. In others, service commands permitted hospital cars to stand idle while they arranged for car- rier-owned equipment to transport pa- tients. In February 1944 the Surgeon General’s Office pointed to this situation and suggested again that better use could be achieved by centralizing control of hos- pital cars in the Office of the Chief of Transportation.17 Before this step was finally taken, a movement already begun to achieve closer co-operation between the Transportation Corps and the Medical Department had to be completed. Late in 1943 the Evac- uation Branch of the Surgeon General’s Office had agreed to supply the Office of the Chief of Transportation with copies of all messages authorizing general and de- barkation hospitals to transfer patients to other hospitals, enabling the latter to an- ticipate requests from service commands for rail equipment. A short time later the Chief of Transportation established an evacuation unit in his Traffic Control Division. It collaborated with the Surgeon General’s Office and service commands in planning rail movements, and for this pur- pose kept a current record of the location and use of each hospital car. In May 1944 the transfer (already mentioned) of the Surgeon General’s Evacuation Branch to the Medical Regulating Unit, which was physically located in the Office of the Chief of Transportation, enabled medical officers who authorized the transfer of pa- tients from debarkation to other hospitals to consult at all times with transportation officers as to the availability of Army hos- pital cars and carrier-owned equipment. Conversely, transportation officers had readily available information as to the lo- 15 (1) Ltr, CofT to CGs NYPE and HRPE, 10 Dec 42, sub: Hosp Cars. TC: 531.4. (2) Diary, Hosp and Evac Br SOS, 22-23 Dec 42. HD: Wilson files, “Diary.” (3) Memo, ACofT for CofT, 22 Dec 42, sub: Asgmt of Hosp Tn Cars. TG: 531.4. 16 (1) Memos, Mtg, Off Chief Rail Div OCT, 22 Apr and 18 May 43. SG: 453.-1. (2) Ltr, CG ASF to CGs 2d, 3d, and 9th SvGs, 22 May 43, sub: Location of Add Hosp Cars. TC: 531.4. (3) Memo, Mvmt Div OCT for ACofT, 2 Jul 43, sub: Mtg of SvC Comdrs. Same file. 77 (1) Memo for Record, on 3d ind, CG ASF to CofT, 10 Sep 43, on unknown basic ltr. HD: Wilson files, “Day File.” (2) Ltr, Dir Hosp Admin Div SCO to Surg 9th SvC, 4 Dec 43. SG: 705.-1 (9th SvG)AA. (3) Hosp and Evac: Re-estimate of Pnt Load and Facs, pp. 25-26. HD; 705.-1. (4) Rpt, Conf CGs of SvCs, Dallas, Tex, 17-19 Feb 44. HD: 337. 352 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR cation, destination, number, and types of patients to be moved by rail.18 As the offices of The Surgeon General and the Chief of Transportation developed closer co-operation in planning the move- ment of patients by rail, measures were adopted to centralize the control of hospi- tal cars. At the end of 1943, SOS direc- tives that had caused confusion by attempting to divide responsibility for their use between service commands and the Office of the Chief of Transportation were superseded by a War Department circular which agreed in its provisions with general transportation regulations. The routing, including scheduling for train connections, of all hospital cars— whether empty or loaded and whether moving within or beyond service com- mand boundaries—was centralized in the Office of the Chief of Transportation. Moreover, local transportation officers were specifically limited in the arrange- ments which they could make for supple- mental rail equipment to instances when fewer than forty persons were to be car- ried on hospital trains. When larger groups were moved the Office of the Chief of Transportation alone could make all ar- rangements. For several months this Of- fice was indulgent, accepting generally the recommendations of service com- mands as to dates of hospital train move- ments and the make-up (that is, the com- bination of Army-owned with carrier- owned cars) of hospital trains. Later, in the spring of 1944, it began to exercise its authority to arrange without consultation with service commands for the rail trans- portation of groups of patients numbering forty or more. Informed by the Medical Regulating Unit of the patients to be moved and of their destinations, the Traf- fic Control Division determined the make- up of hospital trains and set the dates of their departure. Upon the recommenda- tion of the Medical Regulating Officer it diverted hospital cars to places where they were needed, informing service commands to which they were attached only if this action delayed their return to home sta- tions for more than ten (later five) days. This meant, for example, that a car at- tached to the Second Service Command, carrying patients to a hospital in the Fifth Service Command, might be loaded with other patients at the latter place and diverted to a destination in the Fourth Service Command before being returned to its home station.19 Further centralization in rail evac- uation operations and more extensive use of hospital cars was achieved during 1945 when the size of groups for which service commands might independently arrange commercial transportation was reduced from a maximum of thirty-nine to four- teen. As long as service commands could arrange for the movement of groups of pa- tients that were large enough to warrant the addition of a special tourist or sleep- ing car to a regularly scheduled train (that is, any group of fifteen or more per- sons), it was possible for such a car to be procured to move patients along a route 18 (1) Memo, CofT for SG, 23 Oct 43, sub: Opr of Hosp In Cars. SG: 453.-1. (2) Memo, Maj Samuel N. Farley, TC, for Lt Col I. Sewell Morris, TG, 27 Oct 43, sub: Conf in SGO re Better Util of Govt- Owned Hosp Cars. Off file, Hosp Evac Unit, OCT. (3) Memo, Same for Same, 17 Jan 44, sub: Functions of the Hosp Evac Unit. Same file. 19 (1) Interv, MD Historian with Samuel N. Farley, 9 Oct 52. HD: 000.71. (2) WD Cir 316, 6 Dec 43. (3) ASF Cir 147, 19 May 44. (4) Memo, Lt Col John C. Fitzpatrick for Gen [Raymond W.] Bliss, 23 May 44, sub: Util of Hosp Tns. HD: 705 (MRO, Fitzpatrick Stayback, 1334). (5) Memo, SG for Fiscal Dir ASF, 26 Jul 44. SG: 322 (Hosp Tns). (6) ASF Cir 328, 30 Sep 44. (7) Transcript of Proceedings, Hosp Tn Conf, 15-16 Feb 45. HD: 531.4. MOVEMENT OF PATIENTS IN THE UNITED STATES 353 over which an Army hospital car—under orders of the Office of the Chief of Trans- portation—was traveling empty at ap- proximately the same time. The Chief of Transportation therefore recommended in May 1945 that arrangements for the movement of all groups of patients and attendants numbering fifteen or more per- sons should be centralized in his Office. This recommendation was approved and in June 1945 local transportation officers were limited to making arrangements for the movement of individuals and of groups of patients and attendants num- bering fourteen or less. Knowing the lo- cations and routes of all Army hospital cars, the Chief of Transportation could then arrange to use them in moving some of the groups which service commands had formerly dispatched in extra sleeping and tourist cars of regularly scheduled passenger trains.20 Despite the fact that centralized control of hospital cars and hospital train move- ments was not wholly approved by service commands, the Surgeon General’s Office considered such control essential. One service commandsurgeon felt that his lack of control over the personnel on hospital cars from other commands jeopardized the loading and care en route of patients whom he was transferring. A local trans- portation officer in another service com- mand believed that he could expedite the movement of patients from the debarka- tion hospital which he served if he were permitted to arrange rail movements in- dependently. Still another service com- mand complained of the use elsewhere of personnel which it supplied to care for pa- tients being transported from its own de- barkation hospital. Other objections arose from the difficulty service commands en- countered in property and mess manage- ment on hospital cars attached to them but diverted elsewhere for use. In reply to such complaints, The Surgeon General re- peatedly explained that centralized con- trol of the movement of hospital cars and hospital trains was necessary to insure the maximum use of all available rail equip- ment, both Army- and carrier-owned, in the orderly transportation of large num- bers of patients.'21 Measures other than centralization of control were adopted to achieve better use of hospital cars, conserve medical person- nel, and relieve railroads of furnishing more sleeping cars. In June 1944 the Transportation Corps requested carriers to return hospital cars in passenger rather than in freight service. In this way hospi- tal cars that had to be moved without pa- tients spent less time idle than they might have otherwise.22 By the early part of 1945 the Transportation Corps itself began to arrange hospital-car routes and schedules, without reference to railroad representa- tives. Though this procedure was a de- parture from the Army’s agreement with the railroads, the latter apparently inter- 20 (1) Memo, CofT for ACofS G-4 WDGS, 16 May 45, sub: Routing Control and Carriers’ Equip for Mvmt of Puts and/or Med Attendants in Groups of 15 or More. . . . TC: 511 (AR 55-130). (2) WD Cir 177, 15 Jun 45. 21 (1) Ltr, Surg 2d SvC to Brig Gen Raymond W. Bliss, SGO, 3 Feb 44. SG: 531.2 (2d SvC)AA. (2) Diary, Evac Br MRU Oprs Serv SGO, 20 Jun 44. HD: 024.7-3. (3) Ltr, CG Letterman Gen Hosp to Lt Col John C. Fitzpatrick, MRO, 14 Nov 44. HD: 705 (MRO, Maloney Stayback, 127). (4) Memo cited n. 19(4). (5) Ltr, MRO to CG Letterman Gen Hosp, 21 Nov 44. SG; 705.1 (Letterman GH). (6) Ltr, Dep Chief for Hosp and Domestic Oprs, Oprs Serv SGO to Surg 2d SvC, ca. 28 Dec 44. SG: 531.2 (2d SvC)AA. (7) Memo, Maj Frederick H. Gibbs, MAC, for Surg 4th SvC, 29 Jan 45, sub: Hosp Tn Serv, Stark Gen Hosp, with 2 inds. SG: 453 (Stark GH)K. 22 Ltr, Lt Col I. Sewell Morris, TC, to A. H. Gass, Mil Trans Sec AAR, 6 Tun 44, with reply dated 8 Tun 44. TC: 531.4. 354 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR posed no objection. Its chief advantage was that hospital cars could be sent along unauthorized routes (those not normally used by railroad companies) to reduce mileage and to deliver groups of patients at different hospitals. The higher cost which railroads charged for such move- ments was considered by the Surgeon General’s Office to be fully justified by the ends achieved.23 In addition to the larger problem of using hospital cars to the best advantage, others were encountered in the operation of hospital trains. One of them, feeding patients on hospital trains, was partially solved by the procurement of Army hos- pital kitchen cars and the installation of buffet-kitchens in other hospital cars.24 To govern the procurement of food for these cars, along with the bookkeeping proce- dures involved, the ASF Control Division, the Surgeon General’s Office, and the Of- fice of The Quartermaster General col- laborated in the preparation of a standard subsistence procedure for hospital trains in the last part of 1944.25 Other problems arose in accounting for hospital cars and their equipment, and in their mainte- nance. In September 1944 a circular gov- erning accounting procedures was pub- lished by ASF headquarters, while some months earlier the Transportation Corps prepared technical bulletins on the main- tenance of hospital cars.26 Another prob- lem involved the position of hospital cars in trains. In the winter of 1943-44 the Transportation Corps requested carriers to place hospital cars on regular passenger trains in such a position that the public would not have to use them as passage- ways. Carriers agreed to place them either directly ahead of or directly behind other passenger cars in the same train. Further- more the carriers agreed, upon the request of the Chief of Transportation and the rec- ommendation of The Surgeon General, to place “buffer” cars (cars in which no pa- tients were carried) between hospital cars and locomotives when special hospital trains were made up.27 The carriers also co-operated in observing a request of The Surgeon General that patients be trans- ported only in air-conditioned cars. By Army regulations and an agreement with railroads, patients were authorized “sleep- ing car accommodations in tourist sleep- ing cars if available, otherwise standard sleeping cars.” Of the entire fleet of Pull- man tourist cars, only four hundred were air-conditioned, and it was therefore im- possible for carriers always to supply air- conditioned tourist cars when they were requested. For a time during 1944 they supplied higher-priced air-conditioned standard sleeping cars without any in- crease in cost, but in December of that year they revised an earlier agreement 23 (1) Memo, CofT for SG (MRO), 14 Feb 45, sub: Routing of Hosp Tn Travel, with inds. SG: 531.4. (2) Ltr, Lt Col E. B. White, TC, to Interterritorial Mil Cmtee, 9 Mar 45. TC: 531.4. After the war ended, in November and December 1945, the Army and Navy agreed upon a procedure for the joint use of Army hospital cars in the United States. This agreement contributed to the conservation of carrier-owned equipment and still greater use of Army-owned hos- pital cars. ASF Cir 441, 11 Dec 45. 24 See below, pp. 381-86. 25 WD Cir 480, 22 Dec 44. Also see WD Cir 184, 21 Jun 45. 26 (1) ASF Cirs 286, 1 Sep 44; 401, 9 Dec 44. (2) TB 55-285-1, 24 Jul 44; TB 55-285-2, 24 Aug 44, on Echelon Maintenance for Hosp and Kitchen Cars. A complete manual for operation of the new unit cars (TM 55-1254, 15 Dec 45, Car, Railway, Hospital Unit) was issued after the end of the war. 27 (1) Ltr, Hosp Tn Comdr to CG 2d SvC, 21 Oct 43, sub: Trans Rpt of Hosp Tn Mvmt HT-69, Main 57616, 14-19 Oct 43, with inds. SG: 453.-1. (2) Ltr, CofT (Tfc Control Div) to AAR, 24 Jan 44. TC: 531.4 (Placement of Hosp Cars on Regular Tn). (3) Ltr, SG to SvCs, 2 Dec 44, sub: Use of Buffer Cars in Connec- tion with Mvmt of Pnts by Rail. SG: 453 (SvCs). MOVEMENT OF PATIENTS IN THE UNITED STATES 355 with the Army to provide special rates for standard sleeping car equipment.28 The problems just reviewed are repre- sentative only, in no way intended to be an exhaustive listing, of those encountered by authorities on a higher level than hos- pital train commanders. These command- ers were faced with other problems which were perhaps even more varied and com- plex. Solutions for most of them had to be found locally, for there was no War De- partment manual on hospital train oper- ations. During 1945 a series of conferences of hospital train commanders, attended by representatives of The Surgeon Gen- eral and the Chief of Transportation, were held to discuss such common questions as linen exchange procedures, feeding diffi- culties, the handling of baggage, entrain- ing and detraining plans, personnel and equipment requirements, means of pro- viding recreation aboard trains, and prob- lems of hospital car maintenance and op- eration.29 Some idea of the scope of hospital train operations may be gained from the follow- ing figures. During 1944, 172 hospital trains carrying 37,371 patients were dis- patched from the Second Service Com- mand to general and convalescent hospi- tals scattered throughout the United States. During the period from 26 June 1944 to 15 October 1945, 205 hospital trains evacuated 35,697 ambulatory pa- tients and 17,320 litter patients from Stark General Hospital. From January to Au- gust 1945, inclusive, the hospital train de- tachment of the First Service Command made 232 trips to 1,334 destinations, cov- ering 48,888 miles and moving 67,608 pa- tients. Between July 1944 and December 1945, the Ninth Service Command moved 56,061 patients in hospital cars and 29,439 in Pullmans.30 Despite the widespread use of centrally controlled hospital trains, service com- mands retained throughout the war the authority to arrange with common car- riers for the movement of patients as in- dividuals or in small groups. The main difficulty they encountered was in secur- ing accommodations for them in sleeping or parlor cars occupied also by civilians. In November 1943 the ASF Control Divi- sion investigated complaints of hospitals about delays in getting reservations for pa- tients and found that they were justified. The average period that elapsed between the time transportation was requested and was made available for 27,265 patients was 3.8 days. In some instances it ranged as high as 15.3 days. Continuation of this situation would mean not only that the treatment of patients would be delayed but also that some hospitals in time would become hopelessly overcrowded. In Feb- ruary 1944, therefore, ASF headquarters directed The Surgeon General, with the assistance of the Chief of Transportation and service commands, to arrange with railroads for securing promptly rail ac- commodations for Army patients.31 28 (1) AR 55-125, 9 Jan 43; C 1, 4 Jun 43; C 2, 4 Aug 43. (2) Memo, CofT for SG, 22 Aug 44, sub: Ac- commodations in Air-Conditioned Sleeping Cars, with inds. SG: 53 1.2. (3) WD Gir 240, 7 Aug 45. (4) Ltr, CofT (Tfc Control Div) to GAO (Claims Div), 1 Oct 45. TC: 531.4. 29 (1) Mins, Hosp Tn Conf, 15-16 Feb 45, Miller Fid, NY; Hosp Tn Unit Comdrs Conf, 10-13 Jul 45, Presidio of San Francisco. HD: 531.4 (Conf). (2) An Rpts, 1st, 2d, 4th, and 9th SvCs, 1944 and 45. HD. (3) Ltr, 9956 TSU Letterman Gen Hosp to SG, 22 Mar 50, sub: Ref Mat for Util of Hosp Tns. HD: 453.1. 30 An Rpts, 1st, 2d, 4th, and 9th SvCs, 1944 and 45. HD. 31 (1) AR 55-130, 28 Dec 42, with C 2, 4 Jun 43. (2) WD Girs 229, 24 Sep 43; 316, 6 Dec 43. (3) His- tory of Control Division, ASF, 1942-45, App, Project 95-2. HD. 356 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR In conferences held in Chicago and Washington during April and May 1944, representatives of The Surgeon General, the Chief of Transportation, and the Rail- road Interterritorial Military Committee agreed upon procedures for obtaining reservations for individuals and for groups of fewer than fifteen persons. For this pur- pose, patients were divided into five classes. Class I patients were those who were acutely sick or injured and whose immediate movement to hospitals staffed and equipped to care for them was “a matter of extreme urgency.” Class II pa- tients were similar cases whose movement might be delayed safely for forty-eight hours. Class III patients were those who needed to be moved for medical reasons but whose transfer could be delayed ap- proximately seventy-two hours; this group included patients received from theaters of operations at debarkation hospitals. Class IV patients were those being moved, not for medical reasons, but for their own convenience; their transfer might be de- layed for approximately six days. Class V patients were those being discharged from the service, being returned to duty, or being sent on sick leave; their movement could be delayed about ninety-six hours. The carriers agreed to appoint special representatives for each individual rail- road to assist hospital commanders in ob- taining accommodations for patients of all classes within the time limits established for each. Hospital commanders were en- joined to co-operate with such representa- tives and, when requesting transportation for patients in either of the first two classes, were required to submit certificates attest- ing that transportation for Class I patients was necessary immediately and for Class II patients within forty-eight hours.32 The question of priorities for patients over civilians came up when this agree- ment was reached. Army authorities agreed with railroad representatives that establishment of such priorities would carry the unintentional implication that railroads were not “doing the job.” There- fore they decided against it. In the follow- ing June, representatives of The Surgeon General, the Chief of Transportation, and railroad companies maintained a like position when the Office of Defense Trans- portation proposed a system of priorities. Soon afterward, however, the Interstate Commerce Commission, on the recom- mendation of the Office of Defense Trans- portation, issued an order which provided for the dispossession of passengers to ob- tain accommodations for patients. While this action protected railroads against un- warranted lawsuits by civilians who were displaced, the Surgeon General’s Office feared that it might create unjustified hysteria on the part of the public instead of dissuading it from unnecessary travel and, at the same time, might endanger the Army’s good relations with the rail- roads. To avoid the latter contingency, and particularly the unwarranted use of priorities by general hospitals, the Army in October 1944 revised the circular de- scribing the voluntary agreement worked out in May. Restating that agreement, the revised version of the circular required hospital commanders to submit to rail- roads, along with each request for reserva- tions, certificates attesting the classifica- 32 (1) Memo, SG for CG ASF thru CofT, 20 Mar 44, sub: Delays in Trans of Pnts to Hosps, with inds. SG: 531.2. (2) Memo, CofT (Mvmt Br) for SG, 16 May 44, sub; Delays in Trans of Pnts to Hosps. Same file. (3) Ltr, CofT to SG, 29 Apr 44, sub: Apmt of RR Rep at US Army Gen Hosps in Arranging Accom- modations for Litter and Ambulatory Cases. SG: 705. (4) Ltr, Western Mil Bu to Member RR Assn, 9 May 44, sub; Accommodations for Litter and Ambulatory Cases. SG: 531.2. (5) WD Cir 234, 12 Jun 44. MOVEMENT OF PATIENTS IN THE UNITED STATES 357 tion of each patient, those in Classes III, IV, and V as well as in Classes I and II, and indicating the period of time within which accommodations should be pro- vided. In addition it provided that the Interstate Commerce Commission order should be invoked only in accordance with the provisions of this circular. It also forbade the use of priorities to dispossess passengers to secure accommodations for medical attendants returning to home stations.33 Presumably, so long as railroads lived up to terms of the May agreement, the Army would not dispossess passengers to secure accommodations for patients. Procedures for Air Evacuation Air evacuation in the United States in the early part of the war was limited to the movement of individuals or groups of three to four patients from scenes of crashes to hospitals or from one hospital to another. In 1942, for instance, Maxwell Field transported a few patients by plane to Lawson General Hospital, and MacDill Field sent others to both Lawson and Walter Reed General Hospitals. At the time of the North African invasion, the Hampton Roads Port arranged for the flight of a patient suffering from a brain injury to Walter Reed General Hospital.34 Such flights were exceptional and the first sizable air evacuation of patients in the United States did not occur until the be- ginning of 1944. For sporadic flights prior to that time, the Air Forces normally set aside no single group of planes, and it was therefore imperative that air evacuation be carried out normally in administrative, training, or transport planes.35 Moreover, until the latter part of 1942, no personnel was trained especially for air evacuation operations. Air station surgeons either ar- ranged with local operations officers for the transportation of patients by planes belonging to their stations or called upon the surgeons of training centers to supply the necessary accommodations. They either accompanied patients themselves or sent nurses or doctors from air station hospitals as attendants. AAF headquar- ters authorized SOS installations to sub- mit requests for the air transportation of patients to near-by Air Forces installa- tions, the Air Transport Command, troop carrier commands, and the Air Surgeon’s Office.36 During the winter of 1943-44 there were widespread demands, for a variety of reasons, for air transportation of patients in the United States. On 16 November 1943, for example, the commander of Ash- ford General Hospital requested air evac- uation to relieve congestion on railroads in that area. A few weeks later the com- mandant of the School of Air Evacuation suggested it to provide training for air evacuation personnel and to increase the comfort of patients.37 Early the next Janu- 33 (1) ICC, Order 213, Tide 49, Transportation and Railroads, 27 Jun 44. HD: 531.4. (2) Memo, Col Aflbert] H. Schwichtenberg for SG, 26 Jun 44, sub; Rail Trans of Pnts. SG: 53 1.2. (3) WD Cir 405, 14 Oct 44. See also WD Cirs 61, 26 Feb 45, and 471, 15 Dec 44. 34 (1) Ltr, Base Surg AAB MacDill Fid to CG AAF (Air Surg), 1 7 Nov 42. AAF: 370.05 (Evac Book No 1). (2) Ltr, Surg HRPE to CO Langley Fid, 16 Dec 42, sub; Air Trans for Overseas Sick and Wounded Arriving at HRPE. AAF: 452.1 (Amb Plane). 35 See below, pp. 429-33. 36 (1) 3d ind, Hq AAF to Port Surg HRPE, 5 Jan 43, on Ltr, HRPE to GO Langley Fid, 16 Dec 42, sub: Air Trans for Overseas Sick and Wounded Arriving at HRPE. AAF: 452.1 (Amb Planes). (2) Ltr, 6th SvC to AAF (Air Surg), 16 Apr 43, sub; SOP, with ind. AAF: 370.05 (Evac). 37 Ltrs, CO Ashford Gen Hosp to CO AAB, Rich- mond, Va., 16 Nov 43; AAF School of Air Evac, Bow- man Fid, Ky., 6 Dec 43, sub; Trans of Pnts by Air. AAF: 370.05 (Evac, Book 1). 358 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR ary the director of the Surgeon General’s Hospital Administration Division con- ferred with the Deputy Chief of Air Staff on the “feasibility of moving patients by air from port hospitals.” 38 The following month, at a conference of service com- manders, the commanding general of the Second Service Command stated that air transportation for patients was “most desirable,” and suggested its use particu- larly for small groups who needed to be moved without delay.39 In April the flight surgeon assigned to Brooke General Hos- pital propounded still another reason: the evacuation of patients by air would be economical, saving the Government, ac- cording to his estimate, at least fifty dollars per patient.40 A combination of such reasons, along with increases in aircraft production, a shortage of Pullman cars, and the absolute necessity of moving large numbers of patients who arrived in the United States from theaters of operations, were responsible for the extensive use of air evacuation in this country during the latter half of the war. The first large-scale movement of pa- tients by air in the United States was made in January 1944. At that time three troop carrier command planes, with per- sonnel from the School of Air Evacuation, were sent to Stark General Hospital to move patients being debarked from two hospital ships. In a period of ten flying days, between 7 and 19 January, these planes flew 661 patients in 29 loads to 5 general hospitals. No cases of air sickness occurred and only twelve patients re- quired medication, such as the admin- istration of aspirin or morphine, during flight. The success of this mission prompted the commanding general of the Service Forces to congratulate the Air Forces and to express the hope that patients might be evacuated by air from ports of debarkation “repeatedly in the future.” 41 During the spring of 1944 plans were made to convert that hope into a reality. In April the Air Transport Command was made responsible for the movement of pa- tients by air in the United States (as it had been made responsible earlier for air evac- uation from theaters of operations). Soon afterward it assigned to its Ferrying Divi- sion as a special mission the movement of about 700 patients from coastal medical installations to various hospitals through- out the United States. The next month the Transport Command delegated its re- sponsibility for domestic air evacuation to the Ferrying Division, and began to ear- mark transport planes for evacuation only.42 In June representatives of AAF and ATC headquarters, the Ferrying Division, the Air Surgeon, and The Surgeon Gen- eral agreed upon procedures for domestic air evacuation operations. When the ASF Medical Regulating Officer desired to move patients by air, he informed the AAF Medical Regulating Officer, request- ing necessary arrangements. The latter telephoned the Ferrying Division in Cin- cinnati, Ohio, to determine availability 38 Diary, Hosp Admin Div (SGO), 8 Jan 44. SG: 314.8. 39 Rpt, Conf GGs of SvCs. Dallas, Tex., 17-19 Feb 44. HD: 337. 40 Ltr, Off Fit Surg Brooke Gen Hosp to CG AAF thru Central Flying Tng Gomd, 28 Apr 44, sub: Trf by Air of AAF Pnts from Brooke Gen Hosp to AAF Conv Ctr. AAF: 370.05 (Evac, Book 2). 41 (1) Ltr, CG ASF to CG AAF, 4 Feb 44. AAF: 370.05 (Evac). (2) Ltr, AAF Sch of Air Evac to CG AAF, 16 Feb 44, sub: Air Evac, with inch Same file. (3) The Air Surgeon’s Bulletin, Vol. I, No. 4 (1944), pp. 12-13. 42 (1) Initial Medical History (11 February 1943 to 30 June 1944), Headquarters Ferrying Division, Air Transport Command. HD: TAS. (2) Memo, Lt Col Richard L. Meiling for Air Surg, 27 Apr 44, sub: Air Evac 19-25 Apr 44. AAF; 370.05. (3) See below, pp. 436-37. MOVEMENT OF PATIENTS IN THE UNITED STATES 359 and location of planes and then informed the ASF Medical Regulating Officer if the mission could be accomplished within the time limits desired. If so, the ASF Medical Regulating Officer directed hospitals to prepare patients for the movement planned and the AAF Medical Regulat- ing Officer informed the Ferrying Divi- sion of the mission to be accomplished.43 The Ferrying Division co-ordinated plans for each flight with the hospital from which patients were being transferred at least 24 hours in advance of the plane’s departure. Flight attendants supplied by this Division to care for patients en route also arranged to have them properly tagged for identification and to have their records and valuables carried along with them. To permit hospitals receiving pa- tients to prepare for their reception, flight attendants notified them in advance by telephone of the expected time of arrival.44 During the period from April 1944 to August 1945 the Ferrying Division trans- ported about 100,000 patients from de- barkation hospitals to general and con- valescent hospitals throughout the United States. Each patient was flown an average of 1,388 miles.45 The procedure by which this was accomplished made it possible, after control of hospital train movements was also centralized in Washington, for the ASF Medical Regulating Officer to co-ordinate the use of planes and trains in domestic evacuation, thereby relieving railroads of a tremendous burden. It also enabled the Regulating Officer to observe more closely than might have been other- wise possible the policy of transferring pa- tients promptly and directly from debar- kation hospitals to installations where they would receive final treatment. 43 (1) Rpt, Conf on Air Evac, 7 Jun 44. SG: 580. (2) Memo, SG for CG AAF attn Reg Off, 7 Jul 44. SG: 580.-1. 44 (1) Organizational History of the Ferrying Divi- sion, June 20, 1942 to August 1, 1944. ATC: Hist Div. (2) 1st ind, GG Ferrying Div ATC (Surg) to CG ATC attn Surg, 24 Sep 44, on Ltr, CG 2d SvC to GG ASF attn SG, 29 Aug 44, sub: Air Evac. SG: 580. 45 Andres G. Oliver and Hampton C. Robinson, Jr., “Domestic Air Transportation of Patients,” The Air Surgeon’s Bulletin, Vol. II, No. 1 1 (1945), p. 400. CHAPTER XXII Providing the Means for Evacuation by Land Supplying enough ambulances and rail cars of suitable types for the transportation of patients in the United States and in overseas areas was a continuing problem. Plans for improved types were being made before the war started, and when it ended new ones were still being developed and ordered. Numerous difficulties were en- countered in this process, as well as in manning and equipping hospital trains. Motor Ambulances Of all conveyances the motor ambu- lance was the most widely used and trans- ported the largest number of patients. The type in greatest use was the general-service ambulance. Capable of serving in training camps in the United States as well as in communications and combat zones of the- aters of operations, it was called at differ- ent times the field ambulance, the station ambulance, and the cross-country ambu- lance. Others of more specialized—and therefore more limited—use were the met- ropolitan and multipatient ambulances. General-Service Ambulances Because general-service ambulances were basic conveyances for patients in both peace and war, experiments to im- prove them were made between World Wars I and II. In 1932 a field ambulance on a (4 x 2)1 chassis of IVfc-ton capacity was developed by the Medical Depart- ment Equipment Laboratory and by 1939 it had replaced ambulances of World War I type. Although this ambulance was de- signed for use at Army posts and camps in the United States as well as for field serv- ice with tactical units, it was not entirely satisfactory for either. It rode too roughly and was too poorly heated and ventilated for the comfort of patients in the United States, and it got stuck in the mud too easily for satisfactory service in the field or in forward areas of theaters of operation.2 The Surgeon General’s Office concluded that heavier ambulances, perhaps of the metropolitan type normally used by civil- ian hospitals, should be used not only at Army hospitals in the United States but also in communications zones of theaters, and that a light ambulance, able to oper- 1 That is, having four wheels, two of which were attached to the engine drive-shaft. 2 (1) Ltr, SG to TAG, 21 Feb 34, sub: Repl of War- time Ambs. HRS: G-4/29094. (2) Ltr, QMG to TAG, 15 Apr 35, sub; Mil Characteristics for Ambs, Light Fid Type. QMG: 45 1.8. For letters on motor vehicular requirements and assignment of ambu- lances see files HRS: G-4/29714 and QMG: 451.8; for changes in specifications and rear spring improve- ments see files SG: 451.8-1 and 451.8-1 (Carlisle Bks). PROVIDING THE MEANS FOR EVACUATION BY LAND 361 ate over bad terrain, should be developed for use in combat zones.3 Beginning in 1937 the Medical Depart- ment and the Quartermaster Corps had experimented with development of such an ambulance. Meanwhile the General Staff reaffirmed its policy of limiting the types of chassis used by the Army in order both to assure the mass production of ve- hicles and to simplify the procurement and distribution of spare parts as well as the maintenance and repair of vehicles. It an- nounced in August 1939 that all tactical vehicles (that is, those used by table-of- organization units) would be all-wheel- drive types, and that only five chassis would be considered standard for the Army: V2-ton, lV2-ton, 21/2-ton, 4-ton, and VV^-ton.4 The Medical Department Equip- ment Laboratory and Holabird Quarter- master Depot then concentrated on exper- iments with a V2-ton (4 x 4) chassis, and in June 1940 The Surgeon General an- nounced that the ambulance built on it would be “accepted as the new cross- country motor ambulance for use in all divisional and corps units in the combat zone.” 5 This ambulance, like the one it was to replace, could carry four litter pa- tients. When the first of this type was de- livered for testing early in January 1941, the Surgeon General’s Office and the Laboratory found that the ambulance which had been developed primarily for use in combat zones rode so comfortably and was so well heated and ventilated that it would serve satisfactorily for hos- pitals in the zone of interior as well.6 In short, the new cross-country ambulance was a better general-service ambulance than the lV2-ton (4 x 2) field ambulance. A change in standard chassis required a change in the new ambulance during 1942. In 1941 two new chassis—%-ton (4 x 4) and %-ton (4 x 4)—were introduced, and the V2-ton (4 x 4) was dropped from the Army’s standard list. As early as Feb- ruary 1942 the Quartermaster Corps was anticipating issuing %-ton ambulances in place of vehicles.7 About four months later plans for the change had been completed, and %-ton ambulances were ordered along with other %-ton ve- hicles. Although similar in appearance to the V2-ton ambulance, the new %-ton am- bulance had a shorter wheelbase, larger tires, and more clearance under the axle.8 The Medical Department Equipment Laboratory thought that these differences made it more comfortable for patients and less apt to get stuck in mud and sand. While the cross-country ambulance was designed mainly for use in theaters of op- erations, it was used widely in the zone of interior as well. The stoppage of passen- ger-car production early in the war cur- tailed the procurement and use of metropolitan ambulances built on pas- 3 2d ind, SG to TAG, 3 Jan 40, on Ltr, SG to TAG, 25 Nov 39, sub: Fid Ambs, Motor. SG: 451.8-1. Also see the following T/Os: 8-508, Sta Hosp, 25 Jul 40; 8-507, Gen Hosp, 25 Jul 40. 4 Ltr AG 451 (6-15-39) Misc-D, TAG to SG, 12 Aug 39, sub: Standardization of Motor Vehs. AG: 451 (8-12-39). 5(1) For letters on these experiments see files QMG: 451.8 and 400.112 T-M, 1937-40, and SG; 451.8-1 and 451.8-1 (Carlisle Bks), 1937-40. (2) Ltr, SG to Dir MD Equip Lab, 1 Jun 40, sub: Critical Measurement Data on Cross-Country Amb. HD; McKinney files, Jun 40. 6 Memo, Col Gjarfield] L. McKinney (Planning Subdiv) for SG, 14 Jan 41, sub: New Cross-Country Amb; Insp at Carlisle Bks, 13 Jan 41. Off file, Re- search and Dev Bd SGO, “Cross-Country Amb.” 7 (1) Ltr QM 451 M-ES, QMG to SG, 14 Feb 42, sub: Reclassification of Amb, Fid, with 3 inds. QMG; 451.8. (2) Memo, TAG for CGs AGF and AAF, C of Arms and Servs, 6 Apr 42, sub: Standardization of Wheeled Motor Veh Chassis and Trailers. AG: 451 (4-4-42). 8 (1) TM 9-2800, 1 Sep 43, Standard Military Mo- tor Vehicles. 304244 0—55 25 362 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR PLACING THE FOURTH LITTER PATIENT IN A FIELD AMBULANCE senger-car frames.9 The Medical Depart- ment therefore used what was available. As ambulances of the cross-country type were delivered to the Army, they were first distributed to table-of-organization units. Those of the older type (IVfc-ton field ambulance) that were no longer needed by such units were divided among posts, camps, and stations in the United States.10 As ambulances of the old type wore out or as requirements exceeded supply, ambu- lances of the new types were issued to zone of interior installations. In addition, 356 chassis for IVfe-ton (4 x 4) trucks were taken from a civilian pool of motor vehi- cles in 1943 and were used to build modi- fied field ambulances for service in lieu of unavailable metropolitan ambulances.11 Thus, in addition to the metropolitan am- bulances either on hand or procured from available stocks at the beginning of the war, hospitals in the United States used four types of ambulances; the (4 x 2) field ambulance; the IVfe-ton (4 x 4) modified field ambulance; the Vfc-ton (4 x 9 For letters on efforts to secure additional metro- politan ambulances and their procurement and dis- tribution see file SG: 451.8-1 (1939-43). Also see His- tory of the Automotive Division, War Production Board, 1941-45 (1945). Natl Archives: WPB 020.1. 10 SG Cir 81, 8 Aug 41, sub: Admin Motor Veh. For letters on distribution and redistribution of field ambulances from tactical units to zone of interior hos- pitals see files: SG: 451.8-1, AG: 451.8, and HRS: G-4/29714 for 1940-43. 11 Memo, ACofS for Oprs ASF for CofOrd, 6 May 43, sub; Reqmts for Fid Ambs. AG: 451.8 (5-6-43). PROVIDING THE MEANS FOR EVACUATION BY LAND 363 FIELD AND METROPOLITAN AMBULANCES USED IN 1942 4) cross-country ambulance; and the %- ton (4 x 4) ambulance. By the winter of 1942-43 it appeared that the %-ton ambulance was not entire- ly satisfactory for overseas use. SOS head- quarters thought it took up too much shipping space, and some theaters ex- pressed dissatisfaction with its perform- ance. The Southwest Pacific, for instance, stated that lighter vehicles with greater traction were needed for the rough muddy trails over which patients had to be trans- ported, while reports from North Africa indicated that the %-ton ambulance was difficult to land from lighters, lacked the traction and drive needed in that theater, and had insufficient angles of approach and departure to allow it to operate easily over ditches and hills of rough terrain.12 The SOS Requirements Division in Jan- uary 1943 proposed several methods of overcoming these difficulties: shipment of the standard ambulance in a two-unit pack for reassembly in theaters of oper- ations, replacement of its metal body with bows and a tarpaulin top, and provision of “litter kits” for use in adapting stand- 12 (1) Diary, SOS Hosp and Evac Br, 13, 16, 22, and 28 Jan 43. HD: Wilson files, “Diary.” (2) Ltr, GinC SWPA to CG SOS, 21 Nov 42, sub: Improve- ment of Equip and Orgn, US Army, with 3 inds. SG: 322.15-1. (3) Memo, Col Robert C. McDonald, Hosp and Evac Br Oprs Div ASF for Gen [Le Roy] Lutes, 21 Apr 43, sub: Gen Kenner’s Rpts, with incls. HD; Wilson files, “Book IV, 16 Mar 43-17 Jun 43.” (4) Ltr, Joseph A. Keeney, Army Med Serv Tec Cmtee to Col Calvin H. Goddard, 7 Jul 52. HD: 314 (Corre- spondence on MS) XI. 364 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR MOTOR AMBULANCES. Left to right, Vi-ton (4x4), 3A-ton (4x4), and 3A-ton (6x6), the last being an experimental vehicle which was never standardized. ard vehicles to the transportation of patients.13 The Surgeon General’s Office coun- tered with a different proposal. The Med- ical Department Equipment Laboratory had already begun to evaluate experi- ments of medical units in replacing litter bearers with motor vehicles—particularly V4-ton (4 x 4) trucks, or jeeps—to trans- port patients from battalion aid stations to collecting stations. By the middle of 1942 it had decided that none of the standard vehicles of the Army were satisfactory for this purpose. Some were too rough; some had silhouettes that were too high; and others—notably the unprotected and un- covered jeep—were so small that litters protruded over their sides or ends. Conse- quently the Medical Department Tech- nical Committee and the Surgeon Gen- eral’s Office had proposed in August 1942 the development of a light forward-area ambulance on a nonstandard chassis—a 14-ton (4 x 4) chassis to which an extra axle and two wheels were added, making it a %-ton (6 x 6) chassis. SOS headquar- ters had disapproved this proposal be- cause it conflicted with the War Depart- ment’s policy of using only standard chassis.14 The Surgeon General’s Office still believed that this vehicle was a prac- tical solution to the dual problem of sav- ing space on ships and furnishing theaters with ambulances that could be used far forward in rough terrain and in February 13 Memo, CG SOS for SG, 30 Jan 43, sub: Ambs. SG; 451.8-1. 14 (1) Mins, MD Tec Cmtee, 17 Aug 42. (2) 1st ind, CG SOS to SG, [29 Aug 42], on unknown basic hr. (3) Memo, Chief Dev Br Research and Dev Div SGO for Chief Fid Equip Br Research and Dev Div SGO, 3 Sep 42, sub: Forward Area Amb. All in Off file, Re- search and Dev Bd SGO, “Amb, Forward Area.” PROVIDING THE MEANS FOR EVACUATION BY LAND 365 1943 recommended again that this type should be developed at once. The SOS Requirements Division referred this rec- ommendation to the Army Ground Forces, principal user of front-line ambu- lances. Rather than introduce a new type of chassis, AGF headquarters recom- mended the modification of the %-ton (4 x 4) ambulance and the issuance of “litter kits” for use with standard field trucks.15 The Surgeon General’s Office consented, and during the early part of 1943 the Ordnance Department and the Medical Department Equipment Labora- tory collaborated in the development of an ambulance on a %-ton (4 x 4) chassis that incorporated improvements desired for field use and had a body that could be “knocked down” for shipment. By July 1943 two experimental vehicles had been tested, and in August the Surgeon Gen- eral’s Office recommended that one with plywood and steel paneling be adopted as standard.16 As the 1944 ambulance pro- curement program was nearing comple- tion (April 1944), the new “knock down” ambulance was standardized, and the older %-ton vehicle, which had been is- sued widely to units in all areas, was re- classified as a limited standard item.17 Metropolitan Ambulances The possibility of procuring metropoli- tan ambulances in addition to those on hand or acquired at the beginning of the war was raised in the middle of 1944. Early in June the War Production Board called the attention of ASF headquarters to an opinion of the Ambulance Body Manufacturers Industry Advisory Com- mittee that “The Army may not have considered the need for street ambulances to be used in connection with [Army] hos- pitals in this country.” 18 Referring the matter to the Surgeon General’s Office on 21 June 1944, ASF headquarters routinely called for recommendations as to possible Army requirements for “street” ambu- lances. When The Surgeon General took this opportunity to insist upon the pro- curement of 200 metropolitan ambu- lances, ASF headquarters disapproved, stating that no suitable commercial chassis were in production, that the conversion of passenger cars frozen in the civilian pool would be too expensive, and that require- ments for metropolitan ambulances could continue to be met by using field (or gen- eral-service) ambulances.19 The Surgeon General’s Office then surveyed service command needs and in January 1945 re- ported its findings. The 149 metropolitan ambulances already in use were so badly worn as to require replacement, and 151 additional vehicles of that type were needed by ASF and AAF hospitals. Ac- cordingly The Surgeon General requested 15 1st ind, SG to CG SOS, 5 Feb 43, 2d ind, CG SOS (Reqmts Div) to CG AGF, 18 Feb 43, and 3d ind, CG AGF to GG ASF, 10 Apr 43, on Memo, CG SOS for SG, 30 Jan 43, sub: Amb. AG: 451.8 (1-30-43) and Off file, Research and Dev Bd SGO, “Gross-Country Amb.” 16 (1) Memo, CG ASF for SG, 19 Apr 43, sub: Amb, with ind. SG; 451.8-1. (2) Ord Tec Cmtee, Item 20641, 12 Jun 43. HD: 451.8. (3) Ltrs, MD Equip Lab to SG, 18 Aug, 21 Oct 43, sub; Amb, Cross-Country, Improvements, with inds. SG: 451.8-1. 17 (1) Memo, CofOrd for CG ASF (Reqmts Div), 10 Mar 44, sub: Truck, 54-ton, 4x4, Amb KD-Stand- ardization and Rev of Mil Characteristics, with 2 inds. AG: 451.2. (2) Ord Tec Cmtee, Item 23100, 9 Mar 44. HD: 451.8. Limited standard vehicles were usable substitutes for standard vehicles and were issued as long as the supply on hand lasted. 18 Ltr, WPB to ASF, 9Jun 44. SG: 451.8-1. 19 (1) Memo, CG ASF for SG, 21 Jun 44, sub: Street Amb for Use in US, with 2 inds. (2) Memo, CG ASF for SG, 20 Jul 44, sub: Amb, Metropolitan, 54-ton, 4x2, with 2 inds. Both in SG: 451.8-1. 366 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR ASF headquarters to authorize the devel- opment of “substitute standard” metro- politan ambulances by the conversion of light sedans which the War Department had on hand. The Ordnance Department began such a project, but the war ended before it was completed.20 Multipatient Ambulances Toward the end of the war the Medical Department succeeded in getting a multi- patient ambulance and thus achieved, in part at least, a goal toward which it had worked in the early war years. From 1939 until the middle of 1943 the Surgeon Gen- eral’s Office and the Medical Department Equipment Laboratory had conducted almost continuous experiments to develop a single large vehicle that could serve not only as a multipatient ambulance both in the zone of interior and in combat areas but also as housing for mobile laboratories, operating rooms, and wards and as a means of transporting surgical, shock, and other specialized teams to areas where they were critically needed.21 They had experimented with 2V2-ton (4 x 2) front- wheel-drive bus-type vehicles, van-type semitrailers pulled by IVfe-ton and 2V2-ton tractors, and 21/2-ton (6 x 6) trucks.22 These experiments failed mainly because an attempt was being made to use a single vehicle for several purposes, and none possessed all of the characteristics re- quired. For example, the front-wheel- drive bus was a nonstandard vehicle and lacked sufficient traction for cross-country use, while the semitrailer lacked maneu- verability in combat areas and was too rough for patients. The 2V2-ton (6 x 6) truck, on the Army’s standard list, was successfully used in the development of a surgical truck for armored divisions, but the Quartermaster Corps thought that it would be unsatisfactory as an ambulance because full loads of ambulatory patients would overload its front axles and wheels. Thus the Medical Department reached the middle of 1943 without having devel- oped a standard multipatient ambulance. Meanwhile its Equipment Laboratory converted eight experimental, nonstand- ard, front-wheel-drive bus-type vehicles, which had been procured in 1940 and 1941 and had been found unsatisfactory for field use, into multipatient ambulances for service at ports in the United States. In June four apiece were issued to Letter- man and Halloran General Hospitals in place of the passenger buses requested by Letterman, and instead of the additional standard general-service ambulances re- quested for Halloran by the second Service Command.23 The next month the Labo- ratory recommended that the project for the development of a multipatient ambu- lance be continued, but Surgeon General 20 (1) Ltr, SG to all SvCs, 26 Sep 44, sub: Amb, Metropolitan, 54-ton, 4x2, Reqmts, with replies. SG: 451.8- (2) Ltr, SG to CG 7th SvC, 15 Sep 44, sub; Trans of PW Pnts in Carry-alls, with 7 inds. Ord; 451.8- (3) Ord Tec Cmtee, Item 27294, 20 Mar 45, sub: Amb, 54-ton, 4x2, Light Metropolitan. HD: 451.8. 21 Ltr, MD Equip Lab to SG, 27 Dec 45, sub: Hist of Amb, Bus-Type, Experimental, MD Equip Lab Proj F 2. HD: 451.8. 22 For documents on these experiments see files for 1940-43 as follows: SG; 451.8-1 (Carlisle Barracks), 451.8- 451.2-1, and AG: 451.8. 23 (1) Ltr, Letterman Gen Hosp to 9th SvC, 22 Mar 43, sub: Req for Passenger Buses, with 2 inds. SG: 451.8- (9th SvC). (2) Memo, 2d SvC Ord Br for DepCofOrd Tank-Auto Gtr (Detroit), 24 Apr 43, sub: Motor Vehs, with 6 inds. SG: 451.8 (2d SvC). (3) Ltr, SG to CG ASF, 14 Jun 43, sub; Conversion of Surg Hosp Vehs to Bus-Type Ambs. SG: 451.2-1 (Carlisle Bks). PROVIDING THE MEANS FOR EVACUATION BY LAND 367 Kirk directed that it be dropped.24 During the following year his Office and the Laboratory concentrated on the develop- ment of such special purpose vehicles as mobile medical and dental laboratories, optical repair units, and dental and sur- gical operating trucks.25 In the second half of 1944 the question of furnishing multipatient ambulances was reopened. In July Letterman General Hospital asked for the replacement of the four worn-out multipatient ambulances which it had received in mid-1943. To this request Ninth Service Command head- quarters added four more for other de- barkation hospitals on the west coast (two for Birmingham General Hospital and two for Fort Lewis). By October the num- ber requested for the Ninth Service Com- mand was doubled.26 Meanwhile, during July and early August, Mitchel Field, which served as a debarkation point for air evacuees, converted four Ordnance maintenance trucks into special multipa- tient ambulances for the transportation of patients from planes to the Mitchel Field Hospital and from that installation to Halloran General Hospital. To meet the need thus demonstrated, the Surgeon General’s Office proposed on 11 September 1944 the development of a special ambulance to be used only in the United States and to carry twelve to six- teen litter patients. This limitation was expected to eliminate difficulties encoun- tered earlier in attempts to develop multi- patient ambulances that could carry either litter or ambulatory patients in both the zone of interior and combat zones. At first ASF headquarters was re- luctant to approve a developmental proj- ect for a vehicle in small demand. It pro- posed, instead, that The Surgeon General submit a list of standard military vehicles that would be satisfactory, when modified, for the use intended. Believing that no standard military vehicle was suitable, the Ordnance and Medical Departments de- cided that front-wheel-drive bus-type ve- hicles of the kind procured for experi- mental purposes in 1940 and 1941 should be used. An important factor in this deci- sion was the statement by the company making such vehicles that it had “open production facilities” and could therefore “offer favorable delivery,” if standard en- gines, transmissions, and axles were made available to them.27 In addition, The Sur- geon General pointed out, a pilot model had already been developed in 1940. He requested, therefore, that the Chief of Ordnance be authorized to procure twenty-four such vehicles for Medical De- partment use. This request was approved by ASF headquarters on 4 November 1944.28 24 (1) Ltr, SG to MD Equip Lab, 6 Jul 43, sub: Dropping and/or Suspension of Dev Projects, with ind. SG: 451.8-1. (2) Ltr, SG to CG ASF (Reqmts Div), 22 Jul 43, sub: Bus-Type Amb (Project F-2 and Mobile Hosp Ward (F 15.01)). Same file. (3) Memo, Chief Fid Equip Dev Br SGO for Chief Research Coord Br SGO, 27 Jul 43, sub; Experimental V*-ton Amb. Off file, Research and Dev Bd SGO, “Bus- Type Amb, F-2.” 25 For full discussions of these projects, see John B. Johnson, Jr, and Graves H. Wilson, A History of Wartime Research and Development of Medical Field Equipment (1946), pp. 295-730. HD. 26 (1) Memo, CG Letterman Gen Hosp for CG 9th SvC, 20 Jul 44, sub: Repl of Ambs, Bus-type, with 3 inds. SG: 451.8 (9th SvC). (2) Ltr, SG to CG Letter- man Gen Hosp, 26 Sep 44, sub: Multi-litter Ambs (Bus-Type), with 2 inds. Same file. 27 Having “open production facilities” meant that the company’s plant could begin production immedi- ately without having to await the completion of other orders. 28 Ltr, CG ASF (Dir of Sup) to CG 2d SvC, 21 Jun 44, sub: Trucks, 1 IGton, (4 x 4) Ord Maintenance, for Mitchel Fid, with 12 inds. SG: 451.8. 368 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR EXTERIOR VIEW OF MULTIPATIENT METROPOLITAN AMBULANCE, 1945 Production of the new 12-litter ambu- lances began almost immediately after the contract was awarded late in December 1944. Preliminary work on blueprints and specifications had already been com- pleted, and on 8 January 1945 construc- tion of the first model began. At the end of February it was road-tested by Ordnance and Medical Department representatives. By late March the first two were delivered to the Army, and during May—the month when the greatest number of pa- tients arrived from theaters of opera- tions—other multipatient ambulances were ready for delivery to hospitals.29 Meanwhile, the Surgeon General’s Office had surveyed requirements and found that additional ambulances of this type would be needed—forty-seven for service commands and fifty-one for the Air Forces. In June 1945 ASF headquarters approved their procurement. The next month the Ordnance Department began the process of standardizing the new ambulance. Before this was done in Sep- 29 (1) Ltr, SG to CGs SvCs, 26 Feb 45, sub: Amb, 1-ton, 4x2, 12 litter, Metropolitan Front Drive, with replies. SG: 451.8 (SvCs). (2) See letters on develop- ment and inspections, modifications in litter supports, and changes in rear springs in Off file, Research and Dev Bd SGO, “Amb, Bus-Type, Experimental, F-2.” PROVIDING THE MEANS FOR EVACUATION BY LAND 369 INTERIOR OF THE MULTIPATIENT METROPOLITAN AMBULANCE tember 1945, V-J Day occurred and the contract for ninety-eight additional multi- patient ambulances was canceled.30 Hospital Trains At the beginning of 1939 the Medical Department had no hospital trains on hand and only indefinite plans for procur- ing them in the event of war. The Army had disposed of its World War I hospital cars because it was cheaper to transport the few patients who required movement in peacetime in Pullman cars and tourist sleepers of regularly scheduled trains. Thereafter the Medical Department had assumed that three types of trains would be used in the event of another war: (1) trains made up entirely of government- owned cars; (2) “semipermanent” trains composed of one government-owned ad- ministrative car, called a unit car, and an appropriate number of commercial bag- gage cars, Pullman cars, tourist sleepers, and chair cars; and (3) improvised trains 30 (1) Ord Tec Cmtee, Items: 28530, 26 Jul 45; 29055, 13 Sep 45; 29740, 8 Oct 45, sub: Amb, Wi-ion, 4x2, 12-litter Metropolitan. HD: 451.8. (2) Memo, SG for CG ASF (Reqmts and Stock Control Div), 6 Sep 45, sub: Ambs. SG: 451.8. 370 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR consisting of any available commercial rolling stock. Trains of the last type were considered undesirable because they lacked accommodations for the emergency treatment of patients and for train admin- istration. There were doubts that those of the first type could be constructed in suf- ficient numbers during wartime. Hence, emphasis was placed upon planning for the conversion of commercial cars into unit cars. Such plans were drawn during the twenties and approved by the General Staff in 1931.31 Development of the “Ideal” Unit Car During 1939 more specific planning for hospital trains was inspired by planning for rail transportation undertaken by the Army Engineers, urged on by the deteri- orating international situation. As a part of a more general project to furnish light- weight trains for use on damaged or poor- ly laid tracks in theaters of operations, the Engineers in January 1939 proposed a government-owned hospital train built from standard military cars (20-ton, 28- foot-long, four-wheeled box cars). It was to consist of a personnel car, a dressing (or operating) car, nineteen ward cars, and a kitchen car, and was to be used, accord- ing to the Engineers, to transport patients “from the front line to any point in the Communications Zone or Zone of In- terior.” The Surgeon General’s Office and the Medical Department Board agreed to adopt this train “for planning purposes,” believing that they were not thereby elim- inating the possibility of using other types of trains in communications zones. On 4 August 1939 the Engineers announced that they were basing plans for all trains in theaters of operations on the use of 20- ton railway cars. Shortly afterward, before committing itself further, the Surgeon General’s Office turned to a study of trains used during World War I both in theaters of operations and in the zone of interior.32 This study showed that trains made up entirely of government-owned cars had been used effectively in Europe but that the semipermanent, or unit-car, type of train had been more successful in the United States. The unit car had had a kit- chen large enough to feed 250 people, space for transporting 28 litter patients, and quarters for 1 officer, 2 noncommis- sioned officers, and 2 cooks. Among its ad- vantages had been its flexibility, its econ- omy of procurement and operation, and its provisions for feeding patients. As a single car attached to a regularly scheduled train, it had been used to transport twenty-eight or fewer patients; with one or two Pullman cars, it had been attached to regularly scheduled trains to carry more patients; and it had been used, along with Pullman cars, tourist sleepers, chair cars, and baggage cars, to make up a spe- cial hospital train with accommodations for over 200 patients. Conversion of a Pullman car into a unit car was thought to have been cheaper than the construc- tion of cars for an entire train. Moreover, since other cars used in connection with it had been owned either by railroads or by the Pullman Company, only the unit car 31 (1) Ltr, QMG to SG, 29 Dec 21, sub: Disposition of Hosp Cars, with 5 inds. Natl Archives, SG: 531.4-1. (2) Ltr, Bd of Engr Equip to CofEngrs, 9 Mar 31, sub; US Army Specifications, Car, Unit, Hosp, with 2 inds. CE; 531.43, pt 1. (3) US Army Specification 43-13, with drawing 43190, 30Jul 31. SG: 453.-1. (4) Ltr, SG to Comite International de la Croix-Rouge, Geneve, 15 Feb 36. Natl Archives, SG; 322.2-5. 32 (1) Memo, Engr Bd for CofEngrs, 12 Jan 39, sub; SP 70, Type Plans and Specifications for Motive Power and Rolling Stock on Standard Gauge Rys (Rpt 559, Prelim Rpt on Hosp Tns, Engr Bd, 23 Dec 38), with 9 inds. SG: 453.-1. (2) Rpt, MD Bd MESS Carlisle Bks, Pa, 30 Mar 39. Same file. PROVIDING THE MEANS FOR EVACUATION BY LAND 371 had had to be “deadheaded” (returned empty) to the trains’ point of origin. Fur- thermore, the unit car’s kitchen facilities had helped to solve one of the major prob- lems of World War I—the feeding of pa- tients. Because of these advantages, and since the Engineers were already working on plans for cars for completely govern- ment-owned trains, the Surgeon General’s Office concentrated in the winter of 1939- 40 on the development of plans for an “ideal” unit car.33 The plans drawn were for a car that differed considerably from the unit car of World War I and to some extent from one that had been planned in 1931. The latter presumably represented an improvement over the World War I car. It was to have side doors for loading patients and, in ad- dition to the kitchen, an operating or dressing room and more space for attend- ants, but its capacity for patients had been reduced from twenty-eight to ten. In the fall of 1939 the Surgeon General’s Plans and Training Division decided to elimi- nate all spaces for patients, in order to in- crease the feeding capacity of the kitchen to 500, enlarge the operating room and make an aisle around it, provide roomier quarters for more medical attendants, and furnish storage space for foods and med- ical supplies. These changes were intended to produce a car which would have most of the facilities planned by the Engineers for the several administrative cars (dress- ing, kitchen, and personnel) of the pro- posed overseas train and would be “ideal” for use in mass evacuation in the United States.34 After preliminary plans for the unit car had been drawn, the Medical Depart- ment Board and the Surgeon General’s Office studied “in a new light” the Engi- neers’ proposal to use only lightweight trains in theaters of operations. They found that the General Staff had “not specifically approved” the 20-ton car for a hospital train, but that it had approved (in 1931) the unit car. Moreover, they considered the train proposed by the Engineers to be “unsatisfactory” and “a reversion to that [type] used prior to 1863.” Finally, they had an alternative to offer; the unit car “included all the neces- sary facilities for the care of the sick and wounded” and could be used with com- mercial cars to make a complete hospital train either in the zone of interior or in theaters of operations. The Surgeon Gen- eral and the Engineers then reached a compromise on 8 May 1940. The latter agreed with The Surgeon General that, as a first choice, hospital trains in theaters of operations should consist of the unit car and other heavy cars appropriate to it. The Surgeon General agreed that hospital trains of lightweight cars could be used in areas where the construction of roadbeds made the use of heavier equipment im- practical.35 Thereafter, the Surgeon Gen- eral’s Office and the Medical Department Board collaborated with the Quartermas- ter General’s Office and the Pullman Company in completing specifications for the unit car, and with the Engineers in 33 (1) Memo, Maj H[erbert] E. Tomlinson (SGO) for Col [Robert Du R.] Harden, 25 Aug 39, sub: Hosp Tns in World War. SG: 453.-1. (2) The Medical Department . . . in the World War (1923), vol. I, pp. 334-35; (1923), vol. V, pp. 180-86; (1925), vol. VIII, pp. 37-41. 34 (1) Memo, SG (Capt Joe A. Bain) for QMG, 4 Oct 39, sub: Hosp Unit Car. SG: 453.-1. (2) Memo, SG (Col James E. Baylis, Exec Off) for MD Bd, 6 Feb 40. Same file. 35 (1) 9th ind, SG to CofEngrs, 15 Apr 40; 10th ind, CofEngrs to SG, 4 Jun 40; 1 1th ind, SG to MESS, 8 Jun 40, on Memo, Engr Bd for CofEngrs, 12 Jan 39, sub: SP 70, Type Plans and Specifications for Mo- tive Power and Rolling Stock on Standard Gauge Rys. SG: 453.-1. (2) Notes on Conf on Hosp Tns, TofOpns, by Capt Bain, 8 May 40. Same file. 372 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR STATIONARY BEDS IN HOSPITAL WARD CAR, 1941 making preliminary designs for cars for the lightweight train.36 In the fall of 1940, when the establish- ment of Army bases in the Atlantic and the prospective passage of selective serv- ice legislation created a potential need for hospital trains, the Surgeon General’s Of- fice requested that two Pullman cars be converted into unit cars. This request was approved. Furthermore, in December 1940 the Engineers ordered, along with other railway equipment, enough 20-ton cars to test some for use in hospital trains.37 Needfor Ward Cars and Their Development About the time the first unit cars were delivered, the Surgeon General’s Office found, contrary to its expectations, that government-owned hospital cars of an- other type would be needed. When the decision was made to eliminate spaces for patients in the unit car, the Planning and Training Division had expected that litter patients would be carried in tourist sleep- ers. About a year later, in February 1941, it discovered that tourist sleepers, like 36 (1) Memo, SG for TAG, 6 May 40, sub: Hosp Unit Car. TG: 531.4. (2) Rpts, MD Bd No 190, 27 Aug 40, Hosp Unit Car; No 174, 27 Aug 40, Hosp Tn, Combat Area; No 174, 9 Sep 40, Berth for Hosp Tn. SG: 453.-1. 37 (1) Memo SG for TAG, 5 Sep 40, sub; Hosp Tns, with 4 inds. SG: 453.-1. (2) Purchase Order 51536, 16 Dec 40, Haffner-Thrall Co, Chicago. CE: 453, pt 6. (3) Extract from History of the Development of Railroad Equipment, prep by Hist Staff, Engr Bd, Ft Belvoir, Va. HD: 531.4. PROVIDING THE MEANS FOR EVACUATION BY LAND 373 Pullman cars, had washrooms at either end, instead of straight through-and- through aisles, and that patients on litters could therefore not be carried from sleep- ers to unit-car operating rooms.38 For the latter to be of any use, it was necessary to develop a special ward car. During the spring of 1941 the Pullman Company, fol- lowing recommendations of the Medical Department, prepared plans for convert- ing standard Pullman cars into ward cars. This was to be done by removing existing washrooms and installing other toilet and washing facilities in such a way as to leave a straight aisle; by adding wide side doors to permit easy loading and unloading of litter patients; and by replacing the Pull- man berths with sixteen two-tiered sta- tionary beds made by the Simmons Com- pany. Such beds were chosen, instead of Glennan adjustable beds used during World War I, because they were thought to be more comfortable and cheaper to procure. In July 1941 the General Staff approved a request from The Surgeon General for four cars of this type, and con- tracts were let with the Pullman Com- pany in September. It was then antic- ipated that a hospital train would consist of one government-owned unit car, two government-owned ward cars, a baggage car, and a variable number of standard Pullman or chair cars. The four ward cars were delivered in November and Decem- ber 1941.39 (Table 17) When the Japanese attacked Pearl Harbor, the Army had two unit cars and four ward cars—enough government- owned equipment to serve as the nuclei of two hospital trains. The unit cars had not been used during 1941 because they were not air-conditioned and no ward cars were available for use with them. The ward cars just delivered had not been used either, but they had been favorably received by Medical Department officers who had seen them. Enough rail equip- ment for six additional hospital trains was needed, according to previous plans, for a full mobilization of the Army.40 Ward Dressing Cars Replace Unit Cars Early in January 1942 the Surgeon General’s Office began to plan for addi- tional hospital cars. In the course of a few months the concept of the types of cars needed changed radically. Despite lack of experience with the new unit cars, the Surgeon General’s Planning and Training Division decided to abandon them as a type. In view of earlier statements and subsequent experience it is probable that the following factors accounted for this de- cision. The unit car developed in 1940 had no space for patients. Capable of feed- ing up to 500 persons, its kitchen could be used to capacity only with trains consist- ing of about eighteen cars. On such trains, serving food from a unit car to patients in other cars was a real problem. Moreover, since patients transported in the United States did not normally require surgery en route, the operating room of the unit 38 (1) Ltr, SG (Col Albert G. Love) to Hq 8th CA (Col A[lbert] P. Clark), 19 Mar 40. Off file, Research and Dev Bd SGO, “Unit Car.” (2) Memo, Gapt Bain for Brig Gen Albert G. Love, 6 Feb 41, sub: Hosp Unit Car. Same file. 39 (1) Ltrs, SG to Pullman Co, Chicago, 4 Mar, 20 Mar, 2 May, and 9 May 41; Pullman Go to SG, 14 Mar, 22 Apr, 24 Apr, 5 May, and 27 May 41. SG: 453.-1. (2) Ltr, SG to CofEngrs, 31 May 41, sub: Hosp Ward Cars. CE; 453, pt 6. (3) Ltr, SG to TAG, 31 May 41, same sub, with 4 inds. SG: 453. (4) Memo, CofEngrs for QMG, 25 Nov 41, same sub. CE: 453, pt 6. 40 (1) Rpt, Observer, Second and Third Army Ma- neuvers, Sabine-Red River-Louisiana-Area, 15-26 Sep 41. SG: 354.2-1 (Maneuvers, Gen). (2) Memo, SG for TAG, 6 May 40, sub; Hosp Unit Car. SG: 453.-1. 374 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Table 17—Hospital Car Procurement Program, 1940-45 Ordered Type of Car Delivered Numbers Assigned Declared Surplus Date Number Total 380 November 1940. . . 2 Unit February 1941.... 1 and 2 (Changed to 8200-8201, Jul 42 and to 89200-201, Aug 44) November 1945- February 1946 September 1941. . . 4 Ward November - De- cember 1941. 1-4 (Changed to 8900-8903, Jul 42). November 1945- February 1946 March 1942 6 Ward Dressing. . July-August 1942. 8917-8922 (Changed to 89000-005, Apr 43). November 1945- February 1946 March 1942 12 Ward July-August 1942. 8904-8915 November 1945- February 1946 January 1943 32 Ward Dressing. , September - De- cember 1943. 89006-89037 November 1945- February 1946 January 1943 64 Ward September — De- cember 1943. 8916-8979 November 1945- February 1946 August 1943 40 Kitchen March — Septem- ber 1944. 8731-8770 March-June 1946 May 1944 100 New Unit November 1944- May 1945. 89300-89399 March-June 1946 January 1945 100 New Unit May-August 1945. 89400-89499 Retained February 1945.... 20 Kitchen March-July 1945. 8711-8730 October - Novem- ber 1945 Sources: Hosp. Cars in Interchange Service—Ail Standard Gauge. HD; 453.1 (Hosp. Car Procment). (2) Correspondence filed in AG Technical Records: SG 453.1 and 531.4; TC, same file numbers. car was larger and more elaborate than was needed.41 To replace the unit car the Surgeon General’s Office and the Pullman Com- pany developed a ward dressing car in the early months of 1942. It contained a small surgical dressing room and space for thirty litter patients, but it lacked kitchen facil- ities. It differed from the ward car only in the replacement of a toilet and berths for two patients with an operating or dress- ing room. This room, which could also be used as a loading room, was equipped with an operating or dressing table, a washstand, a sterilizer, and a locker for surgical instruments. The dressing table could be used in the center of the room, moved down the aisle of the car to a pa- tient’s berth, or stored at the side of the car. Food would come from commercial dining cars. Thus the Medical Depart- 41 (1) Rpt of MD Bd to consider MD Bd Project No 190, Hosp Unit Car, 8 Jul 41. SG: 453.-1. (2) Ltr, SG (Maj Thomas N. Page) to Pullman Go, 13 Jan 42. Off file, Research and Dev Bd SGO, “Hosp Ward Car.” (3) Ltr, SG (Lt Col Hjoward] T. Wickert) to Pullman Co, 13 Feb 42. SG: 453.-1. (4) Ltr, Lt Col Thomas N. Page to Modern Hosp Pub Co, Chicago, 1 Dec 42. Same file. PROVIDING THE MEANS FOR EVACUATION BY LAND 375 merit placed its reliance early in World War II, as it had in World War I before the unit car was developed, upon railroad and Pullman companies for feeding pa- tients. Instead of stationary Simmons beds, two-tiered Glennan adjustable berths were to be used in both ward and ward dressing cars. Chief advantage of the latter was that upper berths could be pulled down to form backs for lower berths and thus make places for patients to sit. To provide enough government- owned equipment for six hospital trains, in addition to that already available for two, the Engineers ordered six ward dressing cars and twelve ward cars in March 1942. They were delivered to the Charleston, New Orleans, San Fran- cisco, and New York Ports in July and August.42 (See Table 17.) Air-Conditioning Hospital Cars About a month before the new cars were delivered, the Surgeon General’s Of- fice initiated action to get them air-condi- tioned. In response to a hospital train commander’s request, that Office asked SOS headquarters in June 1942 to have air-conditioning equipment installed in all hospital cars. Action on this request was delayed because of differences of opinion about the more desirable kind of equipment between the Surgeon Gen- eral’s Office on the one hand and the En- gineers and the Transportation Corps on the other. Both the Engineers and the Transportation Corps favored the use of ice-activated air-conditioning equipment, apparently because it was simpler to in- stall and because it was commonly used on Pullman cars at the time. The Surgeon General’s Office preferred a type of me- DRESSING ROOM IN HOSPITAL WARD DRESSING CAR, 1942 chanical air-conditioning equipment which was thought to insure more even temperatures and was not dependent upon batteries for operation when hospi- tal cars were standing.43 A mechanical system of this type, produced by Moun- tain Aire Products, Incorporated, was in- stalled in one hospital car for testing in the fall of 1942. Subsequently, as a result of these tests, differences of opinion arose 42 (1) Ltrs, Pullman Co to SG, 13 Jan, 26 Jan, 10 peb 42, with blueprints, Plan 4103-A, 4103-B. SG: 453.-1. (2) Specifications for Remodeling 18 Pullman Parlor Cars to Hosp Ward Gars for WD, from Pull- man Co, 30 Jan 42. Off file, Research and Dev Bd SGO, “Hosp Ward Cars.” 43 (1) Ltr, Med Sec 1927 CASU, Hosp Tn No 1 (San Francisco) to Surg 9th CA, 22 May 42, sub: Air- Conditioning for Hosp Tn No 1, with 5 inds. SG: 453.-1. (2) Memo SPOPM 673, ACofS for Oprs SOS for GofEngrs, 18 Jun 42, sub: Mechanical Air Condi- tioning for Unit Cars. Same file. PLANS FOR HOSPITAL CARS, 1941-42 HOSPITAL WARD DRESSING CAR, 1942 CaDocity-30 Patients HOSPITAL WARD CAR, 1941-42 HOSPITAL UNIT CAR, 1941 Capacity — No Patients PROVIDING THE MEANS FOR EVACUATION BY LAND 377 even within the Transportation Corps as to whether this or an ice-activated system was desirable but officially the Transpor- tation Corps in December 1942 recom- mended installation of ice-activated sys- tems and “declined to accept responsibil- ity” for the performance of Mountain Aire systems. Despite this “veiled threat,” the Surgeon General’s Office requested that Mountain Aire equipment be installed in all ward and ward dressing cars. SOS headquarters resolved this deadlock by directing the Chief of Transportation to install air-conditioning equipment in all cars and by allowing him to determine the type of equipment that would meet performance requirements recommended by The Surgeon General.44 After the Transportation Corps and the Medical Department agreed upon desirable per- formance standards, the former in the spring of 1943 had ice-activated air-con- ditioning equipment installed in the ward and ward dressing cars which had been delivered during 1941 and 1942. The in- stallation of such equipment in hospital cars ordered after the fall of 1942 raised no problem, because they were procured with the air-conditioning systems nor- mally used by companies supplying the cars—some mechanical and some ice-ac- tivated.45 Later, during 1945, the Moun- tain Aire system was removed from the car in which it had been installed and was replaced with an ice-activated system.46 Toward the end of the war the Transpor- tation Corps as well as the Surgeon Gen- eral’s Office came to prefer mechanical air-conditioning systems, because of the difficulty of icing cars en route and the fear of ice shortages, but they considered a change undesirable at that time lest it delay completion of additional cars being ordered.47 Disagreement About the Type and Number of Cars Soon after the Surgeon General’s Office first requested air-conditioning for hospi- tal cars, SOS headquarters raised the question of whether those being procured were of the proper type and number. At that time neither the Surgeon General’s Office nor SOS headquarters had had ex- perience in the operation of hospital trains during World War II. Moreover, with the majority of troops still in training in the United States, the ultimate strength of theaters of operations and the number of casualties to be returned to the zone of in- terior were not yet fully envisioned. Nor was the strain which the war was to put on commercial transportation entirely comprehended. Nevertheless, officers con- cerned with secret planning for the North African invasion were anticipating the reception of casualties from that opera- tion, and those intimately involved in transportation problems were beginning to be aware of some of the difficulties 44 (1) Memo, Engr Bd for CofEngrs, 7 Oct 42, sub: Air Conditioning of Pullman Type Hosp Cars, with 2 inds. SG: 453.-1. (2) Memo, CofT (Rail Div) for SCO (Lt Col J. B. Klopp), 12 Dec 42, sub: Mountain Aire Air-Conditioning System, with 4 inds. Same file. (3) Memo, Col H. T. Wickert for Gen [Larry B.] McAfee, 5 Jan 43. Off file, Research and Dev Bd SCO, “Hosp Tns, Air Conditioning.” 45 (1) Memo, CofT (Rail Div) for SG (Col J. B. Klopp), 4 Feb 43, sub; Air Conditioning for Hosp Cars, with incl “Mil Characteristics of Air Condition- ing for Hosp Cars.” SG: 453.-1. (2) Ltr, CofT for CGs 1st, 2d, 3d, 4th, 8th, and 9th SvCs, 10 Feb 43, sub: Air Conditioning of Hosp Cars. TC: 531.4 (Hosp Gars). 46 (1) Memo, CofT for SG, 21 Nov 44, sub: Air Conditioning on Ward Dressing Car 89002. SG; 453.1. (2) Memo, CofT (Rail Div) for Procmt Div OCT, Cincinnati, 13 Mar 45, sub: Cooling Syst on Hosp Car 89002. TG: 531.4. 47 Memo, Sup Div OCT to Rail Div OCT, 19 Jan 45. TC: 531.4. 304244 0—55 26 378 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR railroads would encounter in meeting transportation needs of both the civilian population and the armed forces. In this atmosphere the Assistant Chief of Staff for Operations of SOS headquarters, to whose Hospitalization and Evacuation Branch a Medical Corps officer, Ft. Col. William C. Keller, had recently been assigned for the purpose of advising on rail evacuation, issued a directive on 23 July 1942 that pro- voked a re-examination of the hospital train program. It called upon the Engi- neers to develop a new type of hospital car, called a rail ambulance car, and sug- gested that twenty-seven of them—three for each of the nine service commands— should be procured by 1 January 1943. The reason for this directive, apparently, was a belief in SOS headquarters, first, that the hospital cars being procured were of an unsatisfactory type because they had to be supplemented with commercial Pull- mans, sleepers, diners, and baggage cars, and second, that available railway facili- ties would be inadequate when patients began to arrive from theaters in large numbers. The proposed car was to have spaces for twenty to thirty-three patients, depending upon whether berths were two- or three-tiered; quarters for medical at- tendants, including one officer, one nurse, and four enlisted men; kitchen facilities capable of feeding both patients and at- tendants; and a dressing room and phar- macy. Because of a developing shortage of Pullman cars and tourist sleepers, lounge cars were to be used for conversion. Each lounge car thus converted would decrease demands of the Medical Department for commercial sleepers and would, at the same time, relieve the railway dining serv- ice of some of its load. From seven to eighteen cars of this type could make up complete hospital trains; or single cars, at- tached to regularly scheduled trains, could move patients in small groups.48 The Surgeon General objected both to the proposed type of car and to the sug- gestion that additional hospital cars were needed. He pointed out that small num- bers of patients could still be moved in Pullman cars of regularly scheduled trains. For the mass movement of patients he pre- ferred a complete train made up of gov- ernment-owned ward and ward dressing cars and commercial baggage, sleeping, and dining cars to one consisting entirely of government-owned rail ambulance cars. A train of the latter type, he con- tended, was wasteful of both personnel and equipment. One having 10 cars would have 10 dressing rooms and 10 kitchens and would require 10 officers, 10 nurses, and 40 enlisted men. The Surgeon Gen- eral stated that patients were not put on trains until doctors felt reasonably sure that they would need little treatment in transit. Hence so many dressing rooms were not needed. Moreover, he believed that regular dining car service could be used for feeding patients either in Pull- man cars of regularly scheduled trains or in the cars of complete hospital trains. In his opinion the transportation of sick and wounded would rate so high a priority that the Medical Department would always be able to get sufficient com- mercial cars for its use. Furthermore, the Surgeon General’s Office opposed the use of three-tiered berths because it was diffi- cult to get litter patients into the top one.49 48 (1) Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub; Proposed Rail Amb Car. SG: 322.2-5. 49 1st ind, SG to CofEngrs, 1 Aug 42, on Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub: Proposed Rail Amb Car; also 2d ind, CofEngrs to CG SOS thru SG, 24 Aug 42; and 3d ind, SG to CG SOS, 29 Aug 42 (init Col H. T. Wickert). SG: 322.2-5. PROVIDING THE MEANS FOR EVACUATION BY LAND 379 After first stating that the eight hospi- tal trains which his Office had planned would be sufficient, The Surgeon General reviewed requirements about a month and a half later and concluded in Octo- ber 1942 that additional trains would be needed. On the basis of four litter patients per 1,000 troops per month from a total overseas strength of 2,500,000, he esti- mated that 10,000 litter patients would have to be moved from ports to hospitals each month. The eight trains (twenty-four cars) already planned, making three 1,000-mile trips per month, could move 2,160 litter patients per month. For the remainder, The Surgeon General esti- mated that thirty-two additional hospital trains would be needed. He recom- mended, therefore, that instead of rail ambulance cars thirty-two ward dressing cars and sixty-four ward cars be pro- cured.50 This recommendation, as well as types of hospital cars in general, was dis- cussed on 9 October 1942 in a conference of representatives of the Surgeon General’s Office, the Engineers, the Transportation Corps, and the SOS Hospitalization and Evacuation Branch.51 The Surgeon Gen- eral later expressed the belief that this conference had settled the issue in favor of ward and ward dressing cars. Before giving The Surgeon General’s recommendations formal approval, SOS headquarters asked the Transportation Corps about the prospective availability of commercial diners and sleepers. In this connection it called attention to World War I experience, especially to difficulties in feeding patients.52 In reply the Trans- portation Corps emphasized the burden already placed upon commercial dining car service by wartime travel and troop movements and, in addition, raised a new point. Instead of using one ward dressing and two ward cars as the nucleus of a complete hospital train, the Transporta- tion Corps proposed that one rail ambu- lance car be used for that purpose. If this should be done only 32 hospital cars would be needed, instead of 96, and the remaining 64 cars could be used for regu- lar troop movements.53 It seems that the Transportation Corps believed that com- mercial dining cars would not be available in sufficient numbers but that Pullman and tourist sleepers would. SOS head- quarters therefore decided not to approve The Surgeon General’s recommendation, but directed the Engineers instead to pro- cure thirty-two self-contained rail ambu- lance cars.54 The Surgeon General’s Office, which “considered the controversial matter [of the types and numbers of hospital cars re- quired] finally settled” by the 9 October 1942 conference, was displeased with this action and on 18 November asked for another conference “to arrive at a com- plete and final decision.” 55 During that meeting The Surgeon General’s repre- sentative stated that he preferred ward 50 4th ind SPOPH 322.15, AGofS for Oprs SOS to SG, 25 Sep 42; 5th ind SPMGP 322.2-5, SG to CG SOS, 10 Oct 42, on Memo SPOPM 370.05, AGofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub; Proposed Rail Amb Car. SG: 322.2-5. 51 Rpt, Conf, 9 Oct 42, sub: Adequacy of Hosp Tn Equip. SG: 453.-1. 52 Memo SPOPH 322.15, CG SOS for CofT, 22 Oct 42, sub: Rail Amb Cars. TC: 531.4. 53 (1) Memo, Mvmts Div OCT for Maj Gen Cfharles] P. Gross, 29 Oct 42, sub: Rail Hosp Tns. TC; 531.4. (2) Memo, CofT (Maj Gen C. P. Gross) for ACofS for Oprs SOS, 30 Oct 42, sub: Rail Amb Cars. Same file. 54 6th ind SPOPH 370.05, ACofS for Oprs SOS to CofEngrs thru SG, 6 Nov 42, on Memo SPOPM 370.05, ACofS for Oprs SOS for CofEngrs thru SG, 23 Jul 42, sub: Proposed Rail Amb Car. SG: 453.-1. 55 (1) Diary, SOS Hosp and Evac Br (Keller), 16 Nov 42. HD: Wilson files, “Diary.” (2) Memo, SG for CG SOS, 18 Nov 42. HRS: Hq ASF Control Div file, “Evac.” 380 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR and ward dressing cars, regardless of the number procured, to rail ambulance cars. In addition the Surgeon General’s Office went on record as preferring to feed pa- tients from kitchens improvised in railway baggage cars, if diners should not be avail- able, rather than to agree to the procure- ment of rail ambulance cars. After this conference SOS headquarters reversed its decision and on 24 November directed the Transportation Corps to procure not less than forty and, if practical, as many as ninety-six ward and ward dressing cars. Contracts for the higher number were let in January 1943.56 (See Table 17.) Development of a Hospital Train for Overseas Use In the course of discussions about the numbers and types of hospital cars needed for the zone of interior, the question of trains for theaters of operations came up. Before mid-1942 the Engineers had switched from a 20- to a 40-ton car as the standard for overseas military trains. After studying blueprints and proposals for 40- ton cars, the Surgeon General’s Office and the SOS Hospitalization and Evacuation Branch agreed in August 1942 to use them in hospital trains built for theaters of oper- ations.57 Following Medical Department recommendations, the Engineers com- pleted preliminary drawings and specifi- cations for a combat-zone hospital train of twenty-one 40-ton cars (operating, per- sonnel, kitchen, and ward cars) by the end of November 1942. The Surgeon General’s Office then suggested changes in the pro- posed specifications and in January 1943 recommended to the Chief of Transporta- tion that one train of 40-ton cars should be constructed immediately for service testing and that all trains included in the Army supply program should be procured as soon as possible after completion of such tests.58 In February 1943 the Army supply pro- gram included forty overseas hospital trains of twenty-one cars each for procure- ment in 1943 and 1944, but none had been ordered and SOS headquarters doubted that these figures actually repre- sented requirements. The SOS Hospi- talization and Evacuation Branch there- fore conferred on 18 February 1943 with representatives of the SOS Requirements Division, the Surgeon General’s Office, and the Transportation Corps. The Sur- geon General’s representative informed SOS headquarters that only fifteen over- seas trains would be needed in 1943 and five more in 1944. On 23 February 1943 SOS headquarters directed Transportation Corps to procure that number, plus one additional train of ten cars for experi- mental and training purposes. Soon after- ward the War Department learned that the European theater was procuring twenty-three hospital trains in the United Kingdom and on 8 April 1943 the Sur- geon General’s Office requested the Trans- portation Corps to have only the experi- mental train constructed.59 56 (1) Memo SPAOG 370.05, ACofS for Oprs SOS for CofT, 24 Nov 42, sub: Ward Cars (Med). TC: 531.4. (2) Memo SPMC 322.2-5, SG for CG SOS, 25 Nov 42. Same file. 57 (1) Diary, SOS Hosp and Evac Br (Keller), 6-7 Aug 42. HD: Wilson files, “Diary.” (2) Memo, ACofS for Oprs SOS for CofT, 10 Aug 42, sub; Conf on Rail Evac. HD: Wilson files, “Book I, 26 Mar 42-26 Sep 42.” 58 2d ind, SG to CofT (Rail Div), 8 Jan 43, on Memo, Engr Bd for CofT (Rail Div), 30 Nov 42, sub: Lightweight, Combat Zone, Hosp Tn, with 10 draw- ings and 10 specifications. SG: 453.-1. 59 (1) Memo, SOS Reqmts Div for SOS Plans Div Hosp and Evac Br, 11 Feb 43, sub: Hosp Gars, with Memo for Record. AG: 531.43 (9-29-42). (2) Memo, SOS Reqmts Div for CofT, 23 Feb 43. AG: 322.38. (3) Memo, CofT for SG, 25 Mar 43, sub; Hosp Tn for Tng Purposes, with 2 inds. SG; 453.-1. PROVIDING THE MEANS FOR EVACUATION BY LAND 381 During the latter half of 1943 this train was completed and exhibited to the public on a cross-country trip. It was then used for the evacuation of patients from the California-Arizona Maneuver Area, re- turned to Hampton Roads for two test runs, sent to Camp Ellis (Illinois) for use in training hospital train units, returned to the manufacturer for the correction of deficiencies, and displayed as a part of the Fifth War Bond Drive in New York City. Complaints about the mechanical aspects of the train were numerous, but the most important from the viewpoint of patient evacuation were that the ward cars were poorly ventilated, crowded even when they carried a normal load of patients (six- teen in each car), and uncomfortably rough even at speeds of less than thirty- five miles per hour.60 Finding no further need for this train in the United States, the Technical Division of the Surgeon Gen- eral’s Office in July 1944 drafted messages in which the War Department queried the European and North African theaters as to whether or not they could use it. The latter agreed to accept the train and in September 1944 it was taken to Hampton Roads for shipment to southern France.61 Improvement of Existing Cars and Procurement of Kitchen Cars In late 1942 and the first half of 1943, while the types and numbers of hospital cars needed for the zone of interior were being discussed and the program for trains for theaters was being re-examined, ex- perience made it possible to evaluate the hospital unit, ward, and ward dressing cars. The unit cars had proved to be of little use, for reasons already explained. Ward and ward dressing cars appeared to fulfill their purposes and required only minor modification, such as the installa- tion of storage lockers, floor lights, bulle- tin boards, and bedside holders for pa- tients’ food trays. These changes were incorporated in specifications for new cars. They were also made in the ward and ward dressing cars already delivered.62 Two major problems in the operation of hospital trains appeared: safeguarding neuropsychiatric patients during transit and feeding patients and medical at- tendants from commercial diners. Hospital train commanders found that in trans- porting mentally disturbed patients either restraints and sedation had to be used or additional attendants had to be assigned. As a partial solution to this problem, they recommended the use of wire screens inside car windows.63 Throughout late 1943 and early 1944, the Medical Department col- laborated with the Transportation Corps and the Pullman Company in developing a standard screen to meet this need. It was made of heavy mesh wire and was de- signed to fit inside the windows of stand- ard tourist and Pullman cars. It was re- 60 (1) Memo, Col I. Sewell Morris, OCT for Mvmt Div OCT, 4 Nov 43, sub; Hosp Tn for Calif-Ariz Ma- neuver Area. HD; 453.1 (10-Car Hosp Tn, Overseas). (2) Ltr, CO 3d Hosp Tn to SG, 15 Dec 43. TC: 531.4. (3) Memo, CofT for SG, 20 Apr 44, sub; Ten-Car Hosp Tn. . . . SG: 453.-1. (4) Ltr, CofT to SG, 4 Apr 44, sub: Hosp Tn, Contract W-2789-tc-1201. TC: 531.4. 61 (1) Draft rad prepared by Tec Div SGO for dis- patch to ETO, 1 Jul 44. SG: 322 (Hosp Tn)H. (2) Weekly Diary, Tec Div SGO, 29 Jul-4 Aug 44. HD: 453.1 (10-Car Hosp Tn, Overseas). (3) Routing Forms, AAR, 13 Sep 44. TC; 511 “Main 39595.” 62 (1) Memo, SG for CofT, 4 Mar 43, sub: Hosp Gar Changes. SG: 453.-1. (2) Memo SPTSY 453, CofT for SG, 8 Mar 43, sub: Hosp Cars, with Rpt of Insp of Cars being Air-Conditioned. Off file, Research and Dev Bd SGO, “Hosp Tns, Air Conditioning.” 63 (1) Ltr, Hq 2d SvC to Hosp Tn No 2, Ft Mon- mouth, N.J., and Hosp Tn No 1, Tilton Gen Hosp, Ft Dix, N.J., 3 Apr 43, with 4 inds. SG: 322.2-5. (2) See other train reports, SG: 322.2-5 and TC: 531.4 (Hosp Tn Mvmts). 382 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR movable and could be locked in place by means of the standard bunk key carried by all Pullman porters. Issued on the basis of a set of thirty-two (enough for one car) for each hospital train, these guards were helpful in preventing patients from hurt- ing themselves on car windows and from attempting to escape.64 The feeding problem was more com- plicated. Train commanders were almost unanimous in complaints about difficul- ties of feeding patients from commercial diners. These diners often failed to meet Army standards of sanitation, carried no foods for special diets, served meals that became monotonous, provided midmorn- ing or midafternoon nourishment for pa- tients only at excessive costs, were not open for meals for attendants on night duty, and were often uncoupled at junction points, leaving both patients and attendants without meals for the remainder of their journeys.65 Moreover, the fear that dining cars would be unavailable for all needs— expressed by SOS headquarters and the Transportation Corps in the fall of 1942— was becoming a reality. The entire prob- lem was discussed in February 1943 in a series of conferences on railway rates be- tween railroad officials and representa- tives of the Surgeon General’s Office, the Transportation Corps, and the SOS Hos- pitalization and Evacuation Branch. At that time the railroads agreed to supply hospital trains with dining cars or, if diners were not available, with baggage cars that could be used as kitchen cars.66 Soon after- ward the Transportation Corps asked the General Staff for authority to convert twenty-one idle Coast Artillery kitchen cars into hospital kitchen cars. After spending several months modifying and testing one, the Medical Department and the Transportation Corps decided that they were too small and lightweight to operate with fast passenger trains. In July 1943, therefore, they agreed to seek authority to procure forty kitchen cars of the type being built for use with troop trains. Since cars in that number would provide one kitchen car for each group of three ward and ward dressing cars—the same ratio by which kitchen cars were provided for troop cars—ASF headquar- ters approved the request on 16 August 1943. By December one hospital kitchen car was delivered for service testing, and the remainder, incorporating minor changes made as a result of this test, were delivered during 1944.67 (See Table 17.) Development of a “New-Type” Unit Car Within two months after ASF head- quarters approved the procurement of hospital kitchen cars and before all ward 64 (1) Ltr, SG (Tec Cmtee) to CG ASF (Reqmts Div), 22 Jul 43, sub: Window Guards for Hosp Tns. SG: 453.1. (2) Ltr, SG to MD Equip Lab, 15 Sep 43, sub: Window Guards for Tourist and Hosp Ward Cars. Same file. (3) Ltr, SG for CGs all SvCs, 26 Apr 44, sub: Window Guards for Hosp Tns. SG: 453.1 (SvCs). 65 Reports of hospital train movements are replete with descriptions of difficulties involved. See TC: 531.4 (Hosp Tn Rpts) and scattered rpts in SG; 322.2-5 and 453.1. 66 (1) Ltr, Interterritorial Mil Cmtee Rail Carriers to CofT (Tfc Control Div), 25 Jan 43, with incls. TC: 531.4. (2) Diary, SOS Hosp and Evac Br (Keller), 24-26 Feb 43. HD: Wilson files, “Diary.” (3) Ltr, In- terterritorial Mil Cmtee Rail Carriers to SG, 6 Apr 43, with inch SG: 453.1. (4) Memo W55-33-43, sub: Trans of Hosp Cars and Tns, 10 Aug 43. AG: 531.4 (6 Aug 43). 67 (1) Memo, CofT (Tfc Control Div) for ACofS OPD WDGS, 2 Mar 43, sub: Kitchen Cars. TC; 531.4. (2) Memo, SG for CofT, 7 May 43, same sub. Same file. (3) Memo, SG for CofT, 29 Jul 43, same sub. SG; 453.1. (4) Memo, Dep Dir of Oprs ASF for CofT, 16 Aug 43, same sub. HD: Wilson files, “Day File, Aug 43.” (5) Rpt, 1247 SCSU for CG 2d SvG, 23 Dec 43, sub: Rpt of USA Kitchen Car, 8731. Same file. PROVIDING THE MEANS FOR EVACUATION BY LAND 383 and ward dressing cars already ordered had been delivered, the Surgeon Gen- eral’s Office in October 1943 requested that additional cars of still another type be provided. The reason was that a change was gradually being made in the distribu- tion of patients among general hospitals. Establishment of a policy of caring for patients from theaters of operations in hos- pitals near their homes and designation of particular hospitals for the specialized treatment of certain disabilities meant that patients arriving on a single ship would be distributed among many differ- ent general hospitals. For a time the prac- tice of sending a complete trainload of patients (from 200 to 300) to one general hospital continued, and it was often neces- sary to retransfer patients to other hospi- tals. During the latter half of 1943, how- ever, the Second Service Command began to try to send patients directly from the debarkation hospital in New York to the general hospitals in which they would re- ceive treatment. This was done by making up trains in sections which could be cut off at intermediate points for routing to dif- ferent general hospitals. Each section con- sisted of a combination of ward cars, ward dressing cars, and commercial sleeping cars. The chief difficulty encountered in this practice was in feeding patients. Un- til kitchen cars were delivered, the entire train had to depend upon uncertain com- mercial dining car service. Even if kitchen cars had been available, each section sep- arated from the main train would have still been dependent upon commercial dining service.68 On 15 October 1943, therefore, the Surgeon General’s Office requested the Transportation Corps to provide fifty “new type unit cars” by May 1944. These cars, for which a sketch had been drawn by the Hospital Construction Branch, were to be similar to the rail am- bulance car designed by the Engineers in the fall of 1942.69 They were to be used as parts of complete hospital trains; for sec- ondary movements from the main, or pri- mary routes of hospital trains; and for the transportation of small groups of patients on nonhospital trains. Although ASF headquarters had formerly advocated the use of such cars, it replied in November 1943 that no new developmental project should be started unless it was essential to winning the war and directed, as a prelim- inary step to further action on The Sur- geon General’s request, an evaluation of the passenger traffic problem with partic- ular reference to the transportation of patients. The next month this headquar- ters modified its position by authorizing the conversion of the two unit cars that had been delivered to the Army in 1941 into pilot models for the new type.'0 Reappraisal of the Hospital Train Program Before the pilot models were completed for service testing, the Surgeon General’s Office re-examined the entire hospital train program. Early in 1944, it will be recalled, a group in this Office had com- pleted a detailed study of the anticipated patient load.71 It was estimated that 30,000 patients per month would have to be moved by train by October 1944 and that at least 75 percent of them would have to be moved in government-owned 68 (1) Ltr, CO 1247 SGSU 2d SvC to SG, 2 Oct 43, sub: Cons of Hosp Unit Gars. TC: 53 1.4. (2) Memo, CofT for SG, 23 Sep 43, sub: Govt-Owned Hosp Cars, with 1 ind. Same file. 69 Memo, SG for CofT, 15 Oct 43, sub: Unit Car, New Type, with Drawing (7 Oct 43). TC: 531.4. See above, pp. 377-80. 70 Memo, SG for CofT, 18 Sep 43 (corrected 18 Oct 43), sub: Unit Car, New Type, with 5 inds. TC; 531.4. 71 See above, pp. 323-25. PLANS FOR RAIL AMBULANCE CAR AND NEW HOSPITAL UNIT GAR RAIL AMBULANCE CAR PROPOSED BY SOS HEADQUARTERS 1942 Capacity — 33 Patients „ NEW HOSPITAL UNIT CAR, 1944 Capacity-30-36 Patients PROVIDING THE MEANS FOR EVACUATION BY LAND 385 cars. Assuming that each car could carry twenty-five patients per trip and could make four trips per month, 225 cars would be needed. Since 120 were already avail- able or authorized, The Surgeon General requested 105 additional hospital cars of the new unit type. At the same time he asked that buffet kitchens be installed in all ward and ward dressing cars. The Transportation Corps agreed with The Surgeon General as to the type of cars de- sired but believed, on the basis of a study just made, that as many as 200 additional hospital cars would be needed. On 11 April 1944 representatives of ASF head- quarters, the Surgeon General’s Office, and the Transportation Corps agreed that it would be quicker and more economical to construct new cars than to try to lease commercial cars for conversion. Two weeks later ASF headquarters approved both the alteration of ward and ward dressing cars and the procurement of 100 new cars. Additional ones would not be authorized, it was stated, until military requirements became “firmer.” 72 Contracts for altering old cars and building new ones were let with the American Car and Foundry Company in May 1944, and by late fall of that year cars of both types were ready for trial runs.73 The new unit car was similar to the unit car of World War I and to the rail ambu- lance car proposed in 1942 in that it had space for both patients and attendants as well as facilities for caring for patients and for feeding all passengers. It was different in that it was built specifically as a hospi- tal car, instead of being converted from existing rolling stock, and was equipped “with every travel luxury.” Ten feet longer than Pullman cars, its body was of steel and was mounted on easy-riding six-wheel trucks. At one end was a stainless steel kitchen, with a refrigerator, an ice cream cabinet, a coal range, sinks, a steam table, and a coffee urn. Both the press and the Army called this the “principal innovation in the new car.” Next to the kitchen was a pharmacy and receiving room, with wide doors on each side for loading litter pa- tients. This room could be used also as an emergency operating or dressing room. Adjoining it were two sets of three-tiered berths that could be used for seriously ill patients, for mental patients, or for medi- cal attendants. This section was separated from the main ward by a sterilizer room on one side of the car and a toilet and washroom on the other. The main ward section had a row of five three-tiered Glennan-type berths on each side. They could be adjusted to provide seating space, or the two lower berths could be used for litter patients and the upper berth for am- bulatory patients or attendants. Between the main ward and the vestibule were storage lockers and a shower bath on one side of the car, and a roomette each for an officer and a nurse on the other. Each car was carpeted, equipped with special light- ing fixtures, and air-conditioned.74 Al- though less luxurious and lacking specific accommodations for doctors and nurses, hospital ward and ward dressing cars, after the installation of the kitchenettes in space made available by removal of berths for four patients, could be used in much 72 Memo, SG for CG ASF, 30 Mar 44, sub: Hosp Cars, ZI, with 4 inds. SG: 322.2-5 and TC: 453.9. 73 (1) TC-3066, Specifications for Cons of Car, Hosp, 8 May 44. Off file, Research and Dev Bd SGO, “Unit Car, New Type.” (2) Memo, CofT (Reqmts Div) for CG ASF (Dir of Mat), 14 Jun 44, sub: Hosp Cars, ZI, with 3 inds. SG: 322.2-5. 74 (1) Railway Age, Vol. 117, No. 26 (1944), pp. 964-66. (2) American Car and Foundry Company, Report to Workers, pp. 76-79. Lib Congress. (3) For details of development see files SG: 453.1, TG: 531.4, and Off file, Research and Dev Bd SGO, “Hosp Unit Car.” 386 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR WARD IN NEW HOSPITAL UNIT CAR, 1944 (note adjustable berths). the same way as the new unit cars. Thus by the end of the war, the Medical De- partment had what were in effect only two types of hospital cars; unit cars and kitchen cars. With development of the new unit car and modification of ward and ward dress- ing cars, a change occurred in hospital train movements. Gradually the practice developed of making up hospital trains for a number of destinations and of including in them variable numbers of hospital cars in different combinations. Ordinarily, re- gardless of the inclusion of hospital cars with kitchen facilities, hospital kitchen cars were used for feeding all patients so long as a number of hospital cars remained attached to the train. This practice was followed because it was more efficient to prepare food in one place than in many different places. All cars of a hospital train did not proceed to the same destination. At “gateways” (railway junctions) sepa- rate cars were cut away from the main route and were attached to commercial trains to carry loads of patients to different destinations. After delivering initial loads, cars were often diverted to transport addi- tional groups of patients from one general hospital to another before being used again as parts of a complete hospital train. Whenever cars were separated from hos- pital trains, their buffet kitchens were used to feed patients.75 Thus the hospital cars 75 (1) Rpts, Hosp Tn Conf, 15-16 Feb 45, Miller Fid, SI, N.Y.; 10-13 Jul 45, Presidio of San Francisco. HD; 531.4 (Conf). (2) Records of hospital train move- ments, filed in OCT, Tfc Control Div, form OCT 145. PROVIDING THE MEANS FOR EVACUATION BY LAND 387 RECEIVING ROOM IN NEW HOSPITAL UNIT CAR, 1944 finally in use in World War II possessed an adaptability which permitted them to be used along with other cars to make up a complete hospital train or singly to trans- port small groups of patients on commer- cial trains. Procurement of Additional Hospital Cars In the winter of 1944-45 the Surgeon General’s Office reviewed the anticipated patient load and re-estimated the hospital and evacuation facilities that would be required. On the assumption that V-E Day would occur in June 1945, it was esti- mated in December 1944 that the number of patients returned to the United States each month from January through August 1945 would range from 32,000 to 36,000 and would decrease thereafter.76 A drop in the patient load would result in no less need for hospital cars, for after V-E Day the major portion of patients would arrive at Pacific ports and a car operating from one of them could make fewer round trips and carry fewer patients per month, be- cause of the greater distance to general hospitals, than could one from an Atlantic port. At the same time, railroads were finding it increasingly difficult to supply the Army with enough commercial cars of the desired type. To assure adequate num- bers of hospital cars, the Surgeon General’s Office on 19 December 1944 asked for 100 additional unit cars as soon as possible. ASF headquarters approved this request, 76 See above, pp. 327-28. 388 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR and contracts were let with the American Car and Foundry Company in January 1945.77 Meanwhile, it became apparent that more kitchen cars would be needed because the increasing number and changed type of hospital cars permitted the operation of more than forty trains at one time. On 22 January 1945, The Sur- geon General requested the Transporta- tion Corps to procure twenty troop kitchen cars from the Defense Plant Corporation for use with hospital trains. This request was approved, and the twenty cars were delivered within the next few months and put into use immediately, without signifi- cant alterations.78 (See Table 17.) The peak of the patient load arriving from theaters of operations came before the second group of 100 unit cars was de- livered. In May 1945, when the greatest number of patients in any single month arrived, the Army was using 120 old cars and 100 new unit cars, plus almost 60 kitchen cars. During that month, 47,044 patients were moved by train. This re- quired the use of 1,200 Pullman cars to supplement government-owned cars.79 Thereafter, the number of patients de- clined rapidly and by late August 1945, when the last of the cars ordered in Janu- ary had been delivered, the Medical De- partment declared surplus thirty-six modi- fied ward and ward dressing cars. After V-J Day the decline in the patient load permitted the disposal of additional cars and by the middle of 1946 the Medical Department retained only 100 unit cars.80 (See Table 17.) Problems in Manning Hospital Trains At the beginning of the war the Medical Department had a table of organization for a hospital train unit. Revised early in 1942, it was reissued in April as Table of Organization 8-520. It provided for a self-sustaining unit to operate a complete hospital train with a capacity of 360 pa- tients. To perform its own administrative, mess, and supply functions as well as to care for patients, each unit was authorized 4 Medical Corps officers, 6 nurses, and 33 enlisted men.81 Eight such units were or- ganized between June 1942 and June 1943, and for a short time there was con- fusion about their purpose both in SOS headquarters and among service com- mands. In September 1942, on recom- mendation of the Surgeon General’s Office, SOS headquarters made it clear that such units were intended for service in theaters of operations and were to be employed in the United States on training trips only.82 About the same time, there was concern about attendants for patients being trans- ported by train in the United States. After the North African invasion, casualties be- gan to arrive in increasing numbers. Fur- thermore, hospital cars which the Army had ordered early in 1942 were delivered 77 (1) History . . . Medical Regulating Service . . . , Tab 5, Hospital Trains. (2) Memo, SG for CG ASF (Planning Div) thru CofT, 19 Dec 44, sub; Hosp Cars, ZI, with ind. SG: 322.2-5. (3) Memo, ASF Planning Div for ASF Reqmts and Stock Control Div, 21 Dec 44, same sub. HRS: ASF Planning Div Pro- gram Br file, “Hosp and Evac.” 78 (1) Memo, SG for CofT (Rail Div), 22 Jan 45, sub: MD Kitchen Cars. SG: 453.1. (2) Memo, Maj R. W. Tonning (OCT) for Rail Div OCT, 18 Jun 45, sub: Conv of 20 Trp Kitchen Cars. TC: 531.4. 79 Information supplied by Troop Movements and Records Section, Traffic Control Branch, Passenger Division, OCT. 80 (1) Memos, SG for CofT (Mil Ry Serv), 27 Sep 45, 27 Feb 46, and 2 Apr 46, sub: Release of Surplus Hosp Cars. SG; 453. 81 T/O 8-506, 1 Nov 40; T/O 8-520, 1 Apr 42. 82 (1) An Rpt, Oprs Serv SCO, 1943. HD. (2) 2d ind, CG SOS to CG 4th SvG, 22 Sep 42, with Memo for Record, on Memo, CG 4th SvC for CG SOS, 29 Aug 42, sub: Hosp Tn. AG: 322.38. PROVIDING THE MEANS FOR EVACUATION BY LAND 389 and in August the entire fleet of twenty- four were assigned to service commands.83 In discharging responsibility for manning them, service commands encountered difficulty in determining how many doc- tors, nurses, and enlisted men were needed. SOS directives instructed them to use as a guide Table of Organization 8-520, but it applied to an entirely different situation. In the zone of interior hospital trains were to be composed of three hospital cars sup- plemented with such common-carrier equipment as Pullmans, diners, and bag- gage cars. They carried varying numbers of patients and depended upon the rail- roads in the early part of the war for mess service. To supply service command sur- geons with a more appropriate guide, SOS headquarters on 24 December 1942 di- rected The Surgeon General to prepare a manning table for zone of interior hospital trains. Submitted six days later, this table indicated that 2 doctors, 1 nurse, and 14 enlisted men were needed for 100 patients; 2 doctors, 1 nurse, and 16 enlisted men for 200 patients; 3 doctors, 1 nurse, and 19 enlisted men for 300 patients; and 3 doc- tors, 1 nurse, and 21 enlisted men for 400 patients. Soon afterward SOS headquar- ters directed the Second Service Com- mand—and presumably others—to use this guide in requisitioning personnel for use aboard hospital trains.84 As experience accumulated in transport- ing increasingly large numbers of patients, ASF headquarters in August 1943 issued a new guide—Table of Distribution 8- 1520—which differed from the one pre- pared by the Surgeon General’s Office in December 1942. Whereas the old guide had covered groups of patients ranging by hundreds from 100 to 400, the new one covered groups increasing by twenty-fours from 118 to 358. This change reflected the growing tendency to send small groups of patients to different hospitals instead of making mass movements from a port to one or two hospitals only. The old guide had called for 2 doctors, 1 nurse, and 16 enlisted men for 200 patients; the new one called for 3 doctors, 1 administrative offi- cer, 3 nurses, and 11 to 16 enlisted men for 190.85 Despite a moderate increase in per- sonnel in the new guide, it proved inade- quate, at least in one service command, and was not followed. During the period from 15 March 1944 through 12 May 1944, seventeen hospital trains evacuated patients from Stark General Hospital in the Fourth Service Command. Each car- ried an average of 190 patients and had assigned as attendants an average of 6 doctors, 3 administrative officers, 5 nurses, and 57 enlisted men.86 Presumably other service commands also were free to use more attendants than the guide called for. Another problem which service com- mands encountered was the manner in which train personnel should be handled administratively. Until the middle of 1943 all commands assigned such personnel to station or general hospitals. Difficulties caused by this procedure were illustrated by the experience of the Second Service 83 See above, pp. 349, 375. 84 (1) Ltr SPOPH 322.15, CG SOS to GGs and COs of SvCs and PEs, and to SG, 15 Sep 42, sub: Mil Hosp and Evac Oprs, with inch AG: 704. (2) 2d ind, CG SOS to SG, 24 Dec 42, with Memo for Record; 3d ind, SG to CG SOS, 30 Dec 42, with incl; and 4th ind, CG SOS to CG 2d SvC, 5 Jan 43, with Memo for Record, on Memo, CG SOS for CG 2d SvC, 21 Nov 42, sub: Auth to Activate Two Hosp Tns. AG: 320.2 (11-21-42). 85 (1) T/D 8-1520, 12 Aug 43, Hosp Tn, ZI. (2) See pp. 347-48. 86 Memo, 1st Lt Theodore Kemp, Control Div [4th SvC] for Maj Maxwell, 5 Jun 44, sub: Pers Reqmts for Hosp Tn. HD: 531.4 (Pers Reqmts). There is no indication in the document cited as to the organiza- tion to which Major Maxwell was assigned. 390 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Command. For example, officers, nurses, and enlisted men used to operate one of its trains were assigned to Halloran Gen- eral Hospital. This hospital assigned them to ward duties, maintained their records, paid them, and considered them adminis- tratively a part of the hospital staff. In consequence, nurses and enlisted men often worked on wards until the departure time of trains, without opportunities to rest and prepare themselves for trips. To get enlisted men released from ward duties for train trips, the train commander had to request the permission of the command- ing officer of the hospital medical detach- ment who, in turn, had to request permis- sion of the chief of the section for whom these men worked in the hospital. Officers who were assigned to wards lost contact with patients they left behind while away on train trips. Working part of the time in the hospital and part on hospital trains, officers and enlisted men found it difficult to demonstrate to hospital authorities their fitness for promotion and were often passed over when promotions were made. Enlisted men who were absent from the hospital on paydays failed to receive their pay and, unless paid on a supplemental payroll, had to await the next regular pay- day a month later. The hospital consid- ered this situation just as unsatisfactory as did the train commander because it had officers, nurses, and enlisted men upon whom it could not always depend for hos- pital service. Nevertheless this system kept all personnel fully occupied in the inter- vals between train movements, and per- haps some of the problems connected with it could have been solved by minor admin- istrative changes. The Second Service Command however adopted a different solution by requisitioning additional per- sonnel for train operations and assigning it, along with that already available, to a separate unit, the 1247th Service Com- mand Service Unit.87 During 1944 other service commands followed this example. The organization of train units that were separate from hos- pital detachments was discussed at a serv- ice commanders’ conference in February 1944 and was indorsed by the command- ing general of the Service Forces. After- ward, in July 1944, the First, Third, and Ninth Service Commands organized sepa- rate train units. At least one of them, the First, placed its train unit under the direct control of the service command surgeon in the spring of 1945. The Fourth Service Command followed a different procedure. In September 1944 a receiving and evacu- ation detachment, consisting of litter bearers and clerks as well as train person- nel, was organized at Stark General Hos- pital.88 The organization of separate units, if their members were kept fully occupied, was superior to the use of hospital person- nel for train service, since it simplified administration in all respects. Service command surgeons encountered difficulty in getting adequate personnel allotments for train operations. Having estimates of the potential patient load, the Surgeon General’s Office attempted early in 1944 to forestall this difficulty. In April it submitted to ASF headquarters an esti- mate of medical attendants needed by each service command during 1944 for train operations. ASF headquarters took 87 (1) Rpt, Hosp Tn 1, Halloran Gen Hosp to CG 2d SvC ASF (Med Br Sup Div), 5 May 43, sub: Rpt of Hosp Tn Mvmt, HT 16-21-1-11, Main 24025, 27-28 Apr 43, with Supp. SG: 53 1.4. (2) An Rpt, 2d SvC, 1943. HD. 88 (1) Rpt, Conf CGs of SvCs, Dallas, Tex, 17-19 Feb 44. HD: 337. (2) An Rpts, 1st and 9th SvCs, Mc- Guire and Stark Gen Hosps, 1944, HD. (3) GO 49, 14 Apr 45, Hq ASF, 1st SvC, Boston. HD: 531.4. PROVIDING THE MEANS FOR EVACUATION BY LAND 391 the position that service commands should determine their own needs and should submit requisitions accordingly.89 Under this system, service command surgeons apparently failed to get the strength actu- ally needed for train operations. For ex- ample, at the end of 1944 the surgeon of the Second Service Command had an allotment of 589 for assignment to hospital trains, but used 1,175. To make up the dif- ference, he attached to trains 586 persons from other medical installations in the command. The Surgeon General discussed this problem with the Chief of Staff at the end of 1944. As a result service commands got additional personnel. For example, the number assigned to train service in the Second Service Command increased by May 1945 to 1,322—58 physicians, 1 den- tist, 75 other officers, 91 nurses, 1,053 enlisted men, and 44 civilians.90 Supplies and Equipment for Hospital Trains Equipment for the care and comfort of patients on hospital trains had to be planned for each hospital car developed, and consideration had to be given to bal- ancing the necessity of items for medical use against the limited amount of space available. Hence, large items of equipment that were fixed parts of hospital cars, such as berths, instrument cabinets, storage lockers, instrument sterilizers, bedpan washers and sterilizers, cooking ranges, refrigerators, coffee urns, and the like, were planned along with cars in which they were to be installed and became a part of the specifications for their construc- tion. Builders of hospital cars normally procured and installed such items, but in some instances the Medical Department procured certain special ones, such as in- strument sterilizers and operating tables, for installation by builders.91 Supplies and items of equipment that were not fixed parts of hospital cars were listed in tables of allowances and in Medi- cal Department equipment lists. The lat- ter were the more important, because hospital cars carried few items supplied by services other than the Medical Depart- ment. By the fall of 1940, when procure- ment of the first two unit cars was ap- proved, the Surgeon General’s Office had developed an equipment list for cars of that type. Like other Medical Department equipment lists, it included such items as drugs and biologicals, gauzes and band- ages, surgical instruments, linens, office supplies, and mess equipment.92 Later, in 1942, when ward and ward dressing cars 89 (1) Memo, Dep Dir Plans and Oprs ASF for Dir Pers ASF, 26 Apr 44, sub: Reqmts for Med Pers to Cover Rail Mvmts . . . , with inch HRS: ASF Plan- ning Div Program Br file, “Hosp and Evac, vol. 3.” (2) Memo, Dep Dir Plans and Oprs ASF for DepGofS for SvCs ASF, 8 May 44, sub: Est of Numbers of Sick and Wounded Arriving from Overseas, with inch Same file. 90 (1) History, Office of the Surgeon, Second Corps Area and Second Service Command From 9 Septem- ber 1940 to 2 September 1945. HD. (2) Notes for Gen Kirk on Gonf with Gen Marshall, Summary: 25 Dec 44. HD; 024 (Resources Anal Div, Jul-Dec 44). 91 (1) Gen Specifications for Hosp Unit Cars for WD, 4 Jun 40. TC: 453. (2) Rpt of MD Bd, Med Fid Serv Sch, 27 Aug 40. SG: 453.-1. (3) 1st ind, SG to MSO Carlisle Barracks, Pa., 10 Apr 41, on Ltr, MSO Carlisle Barracks, Pa., to SG, 7 Apr 41, sub: Car, Railroad, Hosp Unit, Unit Gar No 2. Off file, Re- search and Dev Bd, SGO, “Hosp Unit Cars.” (4) Specifications for Remodeling 18 Pullman Parlor Cars to Hosp Ward Cars for the WD, 30 Jan 42. Off file, Research and Dev Bd, SGO, “Hosp Ward Car.” (5) TC US Army Specification No TC-3066, 8 May 44, Construction of Car, Hospital. Off file, Research and Dev Bd, SGO, “Unit Car, New Type.” (6) Ltr, SG to CO Hosp Tn SGSU 1247, 27 Jun 45, sub: Steri- lizers for Hosp Ward Gars. SG: 453 (2d SvC)AA. 92 (1) Memo, [Col] A[lbert] G. L[ove] for Lt Col [Francis G.] Tyng, 10 Oct 40, sub: Hosp Unit Gar. Off file, Research and Dev Bd, SGO, “Unit Car.” (2) Med Equip for Hosp Unit Car, Oct 40. Same file. 392 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR were developed, equipment lists were pre- pared for them also, and when their de- livery was expected in the spring of that year the Surgeon General’s Office re- quested SOS headquarters to approve the inclusion of assemblages, packed accord- ing to these lists, as authorized items in tables of allowances for hospital cars. Approval was given, and these lists be- came the official basis for the issuance of equipment and supplies to ward and ward dressing cars when they were first deliv- ered to the Army in the late summer of 1942.93 These early equipment lists were neces- sarily theoretical in nature, because the Medical Department had had no experi- ence, when they were prepared, in oper- ating hospital cars of the types developed during World War II. In 1943 they were revised. Subsequently, as experience ac- cumulated, hospital train commanders proposed further revisions. Their recom- mendations were at variance with one an- other, and the Surgeon General’s Office had difficulty in deciding which to accept.94 Hence, at a hospital train com- manders’ conference in February 1945, a representative of the Surgeon General’s Technical Division distributed a tentative equipment list, based upon recommenda- tions already submitted, for consideration by officers who were responsible for the care of patients aboard hospital trains. After discussing the items listed, train commanders and The Surgeon General’s representative agreed upon which should be retained, deleted, or added.95 New equipment lists for ward, ward dressing, unit, and kitchen cars were then pub- lished in March 1945.96 Several months later it appeared that train commanders were dissatisfied with the supplies and equipment agreed upon and at a confer- ence in July 1945 they proposed changes. Some, such as in the substitution of twelve bath towels for twelve hand towels, the Surgeon General’s Office approved. Others it refused to authorize because The Surgeon General insisted upon retaining in all hospital cars enough equipment of certain types, such as surgical instruments, to provide for emergencies or accidents that might occur as well as for the routine care of patients en route.97 In addition to revising equipment lists, the Surgeon General’s Office either devel- oped new items or permitted hospital train commanders to do so. For example, upon a recommendation of the Fourth Service Command, the Surgeon General’s Office in 1944 developed a better mattress of a different size for use on hospital trains.98 Accepting a suggestion from the Second Service Command, it soon afterward de- veloped an adjustable back rest. This item contributed to the comfort of patients by enabling them to change positions while 93 (1) Memo, Lt Col Thomas N. Page for Lt Col Griffin and Lt Col Hays, 20 Apr 42. Off file, Research and Dev Bd, SGO, “Hosp Ward Cars.” (2) Ltr, SG to Reqmts Div SOS, 10 May 42, sub: Med Equip for Hosp Tn, with ind. SG: 453.-1. (3) Memo, GG SOS for CGs 2d, 4th, 6th, 8th, and 9th SvCs and for SG, 26 Aug 42, sub; Control of Hosp Tns. HD; 531.4. 94 (1) Ltr, CO 2d SvC Hosp Tns 1247th SGSU to SG, 2 Oct 43, sub: Changes to Med Equip, Ward and Unit Cars. SG: 453.-1. (2) Diary, Tec Div SGO, 25 Nov-1 Dec 44. HD. (3) Memo, Post Sup Off [Stark Gen Hosp] to SG, 21 Jan 45, sub; Mess Equip on Hosp Gars, with 2 inds. SG: 453. 95 (1) Transcript of Proceedings, Hosp Tn Conf, 15-16 Feb 45. (2) Diary, Tec Div SGO, 17-23 Feb 45. HD. 96 ASF Catalog Med 10-14, Med Equip List, 27 Mar 45. 97 (1) Transcribed Mins of Hosp Tn Unit Comdrs’ Conf, 10-13 Jul 45. HD. (2) Memo, Capt George R. Allen for Dir Tec Div SGO, 30 Jul 45. Off file, Re- search and Dev Bd SGO, “Unit Gar, New Type.” 98 (1) Diary, Tec Div SGO, 3-9 Jun 44, 25 Aug-1 Sep 44. HD. (2) Transcript of Proceedings, Hosp Tn Conf, 15-16 Feb 45. HD. PROVIDING THE MEANS FOR EVACUATION BY LAND 393 in train berths." Another example of new equipment was the bath tray. Fitting on the sides of hospital berths, this tray sim- plified the work of nurses in bathing pa- tients in bed. It was first put in use by the Second Service Command in the latter part of 1944. The Surgeon General’s Of- fice adopted the idea and began a devel- opment project for such a tray but the war ended before it was standardized.100 Items included in the equipment lists of hospital cars were considered to be the minimum in type and quantity that should be kept aboard at all times. Hence, hospi- tal car commanders were authorized to draw equipment and supplies, to replace those used, from any medical supply of- ficer in the United States. Normally, how- ever, home stations made replacements.101 To avoid bookkeeping, linen was ex- changed on an item-for-item basis. Regu- lations early in the war required hospitals to exchange linen with hospital trains when patients were transferred to their control. It happened frequently that such exchange either delayed train schedules or was not made at all. At the train com- manders’ conference in February 1945, therefore, it was decided that the exchange of soiled for clean linen would normally be deferred until the end of a trip or until points were reached at which trains stopped for lengthy periods. In cases where soiled linen was not replaced by one of the hospitals to which patients were delivered, that hospital furnished a receipt for the linen it received so that train commanders could draw clean linen from general hos- pitals at the ends of trips.102 "(1) Ltr, SG to CO 2d SvC Hosp Tns 1247th SCSU, 11 Sep 44, sub: Back Rests. SG: 442.7 (2d SvC)AA. (2) Diary, Tec Div SGO, 28 Apr-4 May 45. HD. 100 (1) Ltr, Chief Hosp and Evac Br 2d SvC to CG ASF attn SG, 14 Oct 44, sub: Hosp Tns, with inch SG: 700.7-2. (2) Ltr, SG to CO 2d SvC Hosp Tns 1247th SCSU, 2 Dec 44. SG: 453 (2d SvC)AA. (3) Diary, Tec Div SGO, 21-27 Jul 45. HD. 101 (1) Diary, Tec Div, SGO, 17-23 Feb 45. HD. (2) ASF Cirs 286 and 401, 1 Sep and 9 Dec 44. 102 (1) Ltr, CG Lovell Gen Hosp to SG, 8 Feb 45, sub: Linen Exchange for Hosp Cars, with 2 inds and Memo for Record. HRS: Hq ASF Planning Div Pro- gram Br file, 370.05 “Hosp and Evac.” (2) Transcript of Proceedings, Hosp Tn Gonf, 15-16 Feb 45. HD. 304244 0—55 27 CHAPTER XXIII Providing the Means for Evacuation by Sea Most of the patients evacuated from theaters of operations to the zone of in- terior were transported in surface vessels. It is therefore important to consider in the following discussion the types of vessels used, reasons for their employment, and problems encountered in suiting them to the transportation of patients, along with difficulties in furnishing such vessels with the supplies, equipment, and attendants required for the care of patients en route. Ships’ Hospitals and Hospital Ships At the beginning of 1939 the Army had four transports in which to return patients from overseas bases, such as Hawaii and the Philippines. With the expansion of ex- isting bases and the establishment of new ones in the Atlantic during 1939 and 1940, additional transports were added to the Army’s fleet, and efforts were made to en- large and improve their hospital facilities. These efforts were only partially success- ful, because funds for such work were limited. Furthermore, the ships themselves were too old to warrant extensive altera- tions, and the speed with which some were put into transport service left no time for major changes.1 In view of this situation as well as the probability that large numbers of patients would be evacuated in subse- quent months, the New York Port of Em- barkation proposed in the fall of 1940 that the U.S. Army Transport Chateau Thierry should be converted into a part-time hos- pital ship, to carry freight and troops on outbound voyages and return with full loads of patients.2 On recommendation of the chief of his Hospital Construction Sub- division, The Surgeon General disap- proved, stating that the proposed trans- port was not suitable for conversion, that its use would violate the terms of the 1 The United States Army Transports U. S. Grant, St. Mihiel, Chateau Thierry, and Republic had been in almost continuous service since World War I. The Hunter Liggett, Leonard Wood, and American Legion were added in 1939. Others added to meet Army expan- sion needs were the Irwin, Kent, Munargo, Orizaba, and President Roosevelt (Joseph T. Dickman.) For their his- tories, see Roland W. Charles, Troopships of World War II (Washington, 1947), pp. 1-68. Information on problems of providing hospital facilities on these ships may be found in SG files: 560-69 (BB), 632.-1 (BB), 632.-2 (BB), 721.5-1 (BB) under name of transport; AG: 57 1, 573.27; TG: 571.4; and in surgeons’ reports attached to voyage reports filed in TC: 721.1. Also see Chester Wardlow, The Transportation Corps: Responsi- bilities, Organization, and Operations (Washington, 1951), pp. 136-44, in UNITED STATES ARMY IN WORLD WAR II. 2(1) Ltr, Supt ATS NYPE to QMG thru GO NYPE, 27 Sep 40, with 1st ind. TC: 632 (Chateau Thierry). (2) Ltr, CG NYPE to QMG, 26 Nov 40, sub: Inadequate Hosp Fac on Trans. AG: 573.27 (1 1-26-40). (3) Ltr, Port Surg NYPE to SG, 29 Nov 40, sub: Inadequate Hosp Fac on Trans. SG: 632.-1 ( Chateau Thierry /BB. PROVIDING THE MEANS FOR EVACUATION BY SEA 395 Geneva and Hague Conventions,3 and that its employment in the evacuation of small numbers of patients from scattered areas would be uneconomical. He recom- mended instead that “the idea of develop- ing a hospital ship be given further study,” and that the Army continue to use trans- ports for the evacuation of its sick and wounded from overseas areas.4 During 1941 the question of whether or not hospital ships would be provided re- mained unanswered. The question also arose of whether the Army or the Navy would be responsible for the evacuation of Army patients. Existing plans called for the control of all water transportation by the Navy beginning on M-Day (Mobili- zation Day), and during the early part of 1941, under policies announced by the President, the Navy began to take over Army transports on which hospital areas had been enlarged and improved. Dis- turbed by this loss to the Navy of evacua- tion space and fearing a repetition of World War I experiences, when the Navy failed to evacuate patients to the satisfac- tion of the Army, the surgeon of the New York Port in October 1941 proposed that a hospital ship should be provided for the Army.5 Reaction in Washington was mixed. Some officers in the G-4 Division of the General Staff, in the Office of The Quartermaster General, and in the Sur- geon General’s Office were favorably im- pressed; but the chief of the Surgeon Gen- eral’s Hospital Construction Subdivision doubted “the wisdom and productivity of this proposal.” 6 In transmitting it to the General Staff, The Surgeon General asked for decisions as to the policy on evacuation and as to whether the Army or the Navy would be responsible for transporting the Army’s patients.7 The Japanese attack on Pearl Harbor occurred before further ac- tion was taken on the New York Port’s proposal. Basic Decisions on Water Evacuation in 1942 Entry of the United States into the war made necessary both immediate and long- range plans for facilities for the evacuation of patients from theaters of operations. An agreement between the Army and Navy soon after Pearl Harbor for the Army to continue to operate transports despite pre- war plans to the contrary partially solved this problem,8 for the Army could con- tinue to evacuate patients aboard them. Other questions remained to be answered: (1) whether or not hospital ships would be 3 The Geneva Conventions of 1864, 1906, and 1929 established principles for belligerents to follow in the care, treatment, and transportation of the sick and wounded of land warfare; the Hague Conven- tions of 1899, 1904, and 1907 adapted to maritime warfare the provisions of the Geneva Conventions. The Hague Convention of 1907 was signed by the representatives of forty-three countries, among them the United States, China, France, Great Britain, Ger- many, Italy, and Japan. In 1942 the Medical Depart- ment published an article on the Conventions, along with copies of their texts. Albert G. Love, “The Geneva Red Cross Movement; European and Amer- ican Influence on its Development,” Army Medical Bulletin, No. 62 (1942). 4 (1) Memo, Lt Col John R. Hall, SCO, for Plan- ning and Tng Div SCO, 10 Dec 40, sub: Conv of USAT Chateau Thierry into a Hosp Trans Ship. (2) 2d ind, SC to QMG, 28 Dec 40, on Ltr, CG NYPE to QMG, 26 Nov 40, sub: Inadequate Hosp Fac on Trans. Both in SG; 632.-1 (Chateau Thierry)BB. 5 (1) Ltr, Surg NYPE to SG thru CG NYPE, 29 Oct 41, sub: Hosp Ships, with 4 incls. HRS: G-4/ 29717-100. (2) Memo, ACofS G-4 WDGS for ACofS WPD WDGS, 19 Nov 41, sub: Trf of ATS to Navy. HRS: G-4/297 17-51. 6 Memos, Col A[rthur] B. Welsh for Col [Howard T.] Wickert, undated; Col Wickert for Cols [Harry D.[ Offutt and [John R.] Hall, 7 Nov 41, sub: Hosp Ships. HD: 560.2. 7 2d ind SGO 541.-2 (BB), SG to AG, 24 Nov 41, on Ltr, Surg NYPE to SG thru CG NYPE, 29 Oct 41, sub: Hosp Ships. HRS: G-4/297 17-100. 8 Wardlow, op. cit., pp. 200-201. 396 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR used, and (2) if so, the extent to which they would be used and whether or not the Army or Navy would control them. Opinions on these points differed dur- ing the first half of 1942. General Head- quarters approved the use of both trans- ports and hospital ships for evacuation, but believing that the enemy would not respect the terms of the Hague Conven- tion granting hospital ships immunity from attack, GHQ recommended that all plans for evacuation should be prepared with that probability in mind. GHQ also recommended that a decision be sought on whether the Army or Navy would operate hospital ships.9 Taking the posi- tion that transports could be used for evacuation from areas with ample ship- ping, as demonstrated in World War I, The Surgeon General recommended a continuation of that method for all large theaters; but because of disruption by the war of peacetime transport schedules, he now proposed that two hospital ships (one for the Atlantic and one for the Pacific) should be provided for the evacuation of patients from small scattered bases. He made the latter recommendation contin- gent upon respect by the Axis Powers for the terms of the Hague Convention—the primary consideration, in his opinion, in any decision to use hospital ships. The Surgeon General also announced that he preferred to evacuate Army patients in ships operated solely under Army control. In any case, he wanted no division of re- sponsibility. The agency responsible for operating ships for evacuation should be responsible also, in his opinion, for the medical care and administrative control of patients aboard them.10 The Quarter- master General recommended the con- version of two Army transports into vessels that could be used either as hospital ships or as ambulance transports. If employed in the latter capacity they could be oper- ated by the Army Transport Service and would sail under convoy, carrying troops on outbound voyages and returning full loads of patients to the United States.11 A group of officers in G-4, most of whom were later transferred to SOS headquar- ters and among whom was a Medical Corps officer (Maj. William L. Wilson), maintained that Convention-protected hospital ships—at least six—should be used in addition to transports to evacuate Army patients from major theaters despite uncertainty about the attitude of the Axis Powers toward the Convention. Further- more, having ascertained that the Navy had no plans for providing hospital ships for the Army and being convinced by World War I history of the futility of de- pending upon the Navy for evacuation, this group wanted the Army both to own and to operate the vessels procured for use as hospital ships.12 In the first half of 1942 the G-4 group pressed for approval of its plans. After the Bureau of the Budget disapproved sup- plemental estimates for funds for six hos- pital ships submitted in January 1942, because the Maritime Commission stated 9 (1) Memo, Chief Surg GHQ for CofS GHQ 9 Jan 42, sub: Return of Sick and Wounded from Foreign Theaters. HD; 541 (Trans). (2) Memo, GHQ for ACofS G-4 WDGS, 14 Jan 42, sub: Hosp Ships. . . . HRS: G-4/29717-100. 10 (1) Memo, SG for AGofS G-4 WDGS, 5 Jan 42, sub: Plan for Water Trans for Sick and Wounded. SG; 541.2. (2) Memo, SG for JCS (Col [Russell I.] Vittrup), 6 Jun 42, with inclosed notes. SG: 560.-2. 11 Ltr, QMG to TAG, 14 Feb 42, sub: Hosp Space on Army Trans. TC: 632 (Army Trans). 12 (1) Memo, ACofS G-4 WDGS for TAG, 24 Jan 42, sub: Hosp Space on Army Trans. HRS: G-4/ 29717-100. (2) Memo, CG SOS for CofSA, 28 Apr 42, sub: Hosp Ships, with 9 incls. HD: Wilson files, “Book IV, 16 Mar 43-17 Jun 43.” (3) The Medical De- partment ... in the World War (1923), vol. I, pp. 357- 71. PROVIDING THE MEANS FOR EVACUATION BY SEA 397 that it would procure ships required by the Army, G-4 requested the Commission on 12 February 1942 to procure six hos- pital ships, along with several vessels of other types, for the Army’s use. When the Commission replied that hospital ships fell “properly under the cognizance of the Navy Department,” G-4’s Transportation Branch disagreed and asked the Commis- sion to reconsider its opinion. Receiving no reply to this request by late April 1942, SOS headquarters (recently established and containing many officers formerly in G-4) pursued the matter further. In letters prepared for the signature of the Secre- tary of War, it urged the Maritime Com- mission to procure six hospital ships for the Army, whether to be operated by the Army or Navy, and called upon the Sec- retary of the Navy to settle with the Army this question of jurisdiction. The adminis- trator of the recently established War Shipping Administration, who was also chairman of the Maritime Commission, replied that he could not allocate vessels for use as hospital ships until the Army and Navy had agreed upon “strategic re- quirements.” Because of its close relation to other shipping problems, the Secretary of the Navy proposed that the whole ques- tion be referred to the Joint Staff Planners, a group working under the Joint Chiefs of Staff.13 The investigation conducted by the Joint Staff Planners and the Joint Chiefs of Staff covered not only the strategic ship- ping situation but also other matters: the probability of enemy respect for the Geneva and Hague Conventions, the Brit- ish practice of evacuating patients by sea, and the estimated evacuation require- ments for operations in the Pacific and for Bolero (the build-up of American troops in the United Kingdom for an invasion of the European continent). The views of the Chief of the Bureau of Medicine and Surgery of the Navy and of The Surgeon General of the Army were also sought. The latter restated the position which he had taken earlier. The former believed that both Army and Navy patients should be evacuated by transports that were manned and operated by the Navy but were supplied with enough Army officers and enlisted men to care for Army medi- cal records. If hospital ships should be used, he disapproved painting and mark- ing them as international conventions stipulated. Rather he proposed that they be painted like transports for travel in convoy and reveal their identity as hospi- tal ships only under “desirable” circum- stances. In view of agreement between the two medical services on the use of trans- ports for evacuation and in the interest of economy in shipping, the Joint Chiefs of Staff announced on 25 May 1942 that the normal means of evacuating patients from areas with “more or less continuous trans- portation service” would be by returning troop transports. Since the Army and Navy disagreed on the question of hospital ships, the Joint Chiefs announced a com- promise decision in June 1942. Three ves- sels would be procured and operated as hospital ships under the Hague Conven- tion. They would be built according to plans supplied by the Army, would be operated under the “general direction” of the Army, and would be provided with Army medical complements, but would be converted under supervision of the 13 (1) Memo, ACofS G-4 WDGS for CofSA, 8 Feb 42, sub; Supp Ests “D,” FY 1942. AG; 111 (1-31-42). (2) Ltrs, CofSA for US Mar Comm, 12 Feb, 7 Mar, 1 May 42; US Mar Comm to CofSA, 24 Feb, 4 May 42. SG: 560.-2. (3) Ltr, SecNav to SecWar, 6 May 42, sub: Basis of Responsibility for Procurement and Opr of Hosp Ships. AG: 573.27 (5-6-42). 398 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Navy and would be operated by Navy crews.14 Although authorized in the mid- dle of 1942, the first of these ships was not placed in service until June 1944. In the course of these protracted nego- tiations, the Army—believing that the general problem of evacuating patients from ground operations in overseas the- aters was one for solution within the War Department—partially took matters into its own hands.15 In March 1942 the earlier proposal of The Quartermaster General to convert transports into vessels that could be used either as hospital ships or as am- bulance transports was revived by the Transportation Corps. The Surgeon Gen- eral reversed his prewar position in oppo- sition to the use of ambulance transports and in April supported this proposal as a means of caring for immediate needs. Even if hospital ships should be author- ized, he pointed out, their construction would require at least eighteen months.16 SOS headquarters approved, and late in May 1942 the Acadia was withdrawn from regular transport service. From June to October it underwent conversion at the Boston Port of Embarkation, emerging with a capacity of approximately 1,100 troops outbound and 530 patients in- bound. Making its first trip as an ambu- lance transport in December 1942, the Acadia continued to sail as such until placed under the protection of the Hague Convention as a hospital ship in May 1943.17 Providing Facilities for Evacuation by Transports Early in the War In view of shipping shortages, uncer- tainty about the use of hospital ships, and the decision for the Army to continue to operate troop transports, the most obvious method of meeting immediate evacuation needs was the use of transports. Existing regulations required each to have a hospi- tal with beds equal in number to 1 per- cent of its passenger capacity for cases of sickness en route.18 Before the war the number of hospital beds on most trans- ports had been increased to provide addi- tional space for patients being evacuated from overseas areas. In March 1942 the Office of the Chief of Transportation pro- posed that the larger bed capacities be officially authorized for all transports— those to be procured as well as those al- ready in service. Both the Surgeon Gen- eral’s Office and SOS headquarters approved, and in June 1942 the higher ratios were authorized. Changes were made in the fall of that year in the pro- portion of beds for different types of pa- tients, but not in the total number authorized. The first eight months of the year had shown that 75 percent of the patients evacuated to the United States were mental cases. To provide more ac- commodations for them SOS headquar- ters on 8 September 1942 directed the 14 (1) JMTC 4/M, 9 May 42, Evac of Sick and Wounded from Overseas. SG: 704.-1. (2) JCS 52, 21 May 42; JCS 52/1, 29 Jun 42. Records and Admin Br, Off ACofS G-3 WDGS. (3) Ltr, Bu of Med and Surg USN to JPS, 4 Jun 42, sub: Evac of Sick and Wounded from Overseas. SG: 704.-1. (4) Memo, SG for JCS (Col Vittrup), 6 Jun 42. SG; 560.-2. 15 Ltr, SecWar to SecNav, 1 May 42, sub: Evac of Army Sick and Wounded from Overseas. AG: 560. 16 Memo, CofT for CG SOS, 13 Mar 42, sub: Hosp Space on Army Trans, with 2d ind, SG to CG SOS, 8 Apr 42. SG: 632.-1 (BB). 17 (1) Sailing Orders 82, Vessel: USAT Acadia, Outbound Voyage 5, 18 May 42. TG: 565.3 (Acadia). (2) Ltr, Surg NOPE to Col John R. Hall, SGO, 18 May 42, with reply dtd 20 May 42. HD: 560.2 “Hosp Cons Br SGO—Hosp Ships.” (3) Memo, Chief Misc Br SOS for Gen [Le Roy] Lutes, 24 Jun 42, sub: Hosp Ships. HD: Wilson files, “Book I, 26 Mar-26 Sep 42.” (4) TC: 561-565 (Acadia); and OPD: 370.05. 18 AR 30-1150, 19 Sep 41. PROVIDING THE MEANS FOR EVACUATION BY SEA 399 Chief of Transportation to convert a por- tion of general ward beds of each ship’s hospital into beds for mental patients.19 Thus during 1942 ratios (expressed in per- centages) of hospital beds to troop berths were authorized for various types of trans- ports as follows: sion sometimes approved plans that would not have been acceptable under ordinary conditions, but it disapproved others in part or in whole, and thus conversions were sometimes delayed. To prevent such delays and to standardize improvements made at different ports on different types of vessels, the Surgeon General’s Office in November 1942 prepared a list of general specifications for ships’ hospitals.21 Early in 1943 the Water Division of the Office of the Chief of Transportation sent it to all ports for use as a guide. Minimum stand- ards thus established were as follows: a “suitable” surgical suite, minimal facilities for pharmacy and laboratory, adequate toilets for the hospital area with separate toilets for isolation wards, safety devices for wards for mental patients, a small X-ray unit with darkroom, berths of not more than two tiers, and beds equal in number to those authorized by SOS head- quarters. Preferably, the hospital was to be located slightly aft of midship, not more than one deck below the uppermost “con- tinuous weather deck,” adjacent to cabins whose berths could be used for patients, and relatively close to lifeboats. It was to be well ventilated and lighted and was to Percent Hospital Beds to Troop Berths Type of Ship and Patient Mar 1942 Sept 1942 Owned and permanently converted ships-total. . . . ... 5.0 5.0 Ward ... 4.0 2.5 Isolation ... 0.5 0.5 Mental ... 0.5 2.0 Chartered and fully converted ships-total. . . . ... 4.0 4.0 Ward ... 3.0 2.0 Isolation . . . 0.5 0.5 Mental ... 0.5 1.5 Temporarily or hastily converted ships-total.... . . . 3.0 3.0 Ward ... 2.0 1.5 Isolation . . . 0.5 0.5 Mental ... 0.5 1.0 Meeting standards set for ships’ hospi- tals on vessels converted into troop trans- ports depended upon the time available to ports for modifications and improvements. Throughout 1942 transports were has- tened into service and sent out heavily loaded, sometimes with numbers of troops that exceeded ships’ rated capacities by 10 percent.20 Changes in hospital areas of such vessels could be made only while they were undergoing initial conversions for the transport service or were in port between voyages for maintenance and repairs. Hence their hospital facilities varied. On some, completely new hospital areas were constructed. On others, existing hospitals were enlarged and improved. As a rule the Transportation Corps submitted to the Surgeon General’s Hospital Construction Division for review the plans for hospital areas of vessels being converted. This Divi- 19 (1) Memo, CofT for SG, 28 Mar 42, sub: Basic Plan for Evac of Sick and Wounded. HD: 705. (2) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac, with inch HD: 705.1. (3) Memo, ACofS for Oprs SOS for CofT, 8 Sep 42, sub: Fac for Care of Mental Pnts on Trans. HD: 705 (MRO, Fitzpatrick Daybook). 20 For example, see Memo, Oprs Off OCT for Water Div OCT, 15 May 42, sub; Increased Trp Ca- pacities. TG: 541.1. 21 (1) Ltr, SG (Hosp Cons Div) for CofT, 26 Nov 42, sub; Gen Specifications for Hosp Areas on Con- verted Trans. SG: 632.-1 (BB). (2) Memo, Maj John C. Fitzpatrick for Chief Hosp and Evac Br Plans Div SOS, 1 7 Sep 42, sub: Rpt of Surv of Ships and Ships’ Hosps. HD: 705 (MRO, Fitzpatrick Ref file). (3) Ltr, CofT to Supt ATS NYPE, 3 Oct 42, sub: Hasty Convs. SG: 632.-1 (BB). 400 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR have passageways wide enough for the removal of patients on litters.22 Construction of new transports offered the possibility of assuring suitable ships’ hospitals provided there was effective co- ordination among the Surgeon General’s Office, the Office of the Chief of Transpor- tation, and the Maritime Commission. For a time, plans drawn by the Maritime Commission were not submitted to the Surgeon General’s Office and the latter considered hospitals on some of the new vessels unsatisfactory. After a series of con- ferences early in 1943 the Maritime Com- mission agreed to submit its plans there- after to the Transportation Corps and the Surgeon General’s Office for review and comment.23 Early in 1943 a significant change was made in accommodations for mental pa- tients on transports. Until that time some berths had been enclosed with wire cages, making spaces approximately 6x3x3 feet each in which seriously disturbed mental patients might be placed to avoid endangering themselves and others. In January 1943 the New York Port surgeon proposed the elimination of such “unnec- essary and inhumane” accommodations. The neuropsychiatry section of the Sur- geon General’s Office supported this pro- posal. It pointed out that advances in medical practice, such as the use of seda- tion, hydrotherapy, and diversional activ- ity, with minimum mechanical restraint, made it possible to care for mental pa- tients in specially constructed wards. The Chief of Transportation therefore re- quested the Maritime Commission to eliminate metal cages from future trans- ports and directed port commanders to re- move existing ones and provide suitable security-ward space instead on other transports. Although surgeons of several ports argued that they would then be un- able to care for mental patients, especially on long voyages in tropical areas, the Transportation Corps and The Surgeon General remained firm.24 To guide trans- port and port surgeons in caring for seri- ously disturbed patients without metal cages, they issued a memorandum on the care of mental patients on transports in July 1943.25 Later in the war, as will be seen below, the Army reverted to the use of individual cells for severely disturbed patients. In the fall of 1942 British vessels, such as the liners Queen Mary and Queen Eliza- beth, which since early 1942 had been car- rying American troops overseas,26 were brought within the program for enlarging the patient-capacity of transports. Since the British did not move helpless patients in transports, the Queens had inadequate laboratory and surgical equipment and each had only 175 beds for patients. In October 1942 the Army started arrange- ments for the installation of a 300-bed hospital on each ship. British officials in Washington were at first unsympathetic to 22 Ltr, CofT (Water Div) to CGs PEs attn ATS, 26 Jan 43, sub: Gen Specifications for Hosp Areas on Converted Trans, with inch TC: 632. 23 Correspondence on ships’ hospitals of troop ships and reports of conferences with Maritime Commis- sion representatives are found in SC: 632.-1 (BB) and TG: 632. 24 (1) Ltr, Surg NYPE to SC (Col Tynes), 19 Jan 43, sub: Psychotic Pnts on Army Trans. TC: 632. (2) Memo, SC for CofT 15 Feb 43, sub: Elimination of Gages for Care of Mental Cases on US Army Trans. SC: 632.1 (BB). (3) Ltr, CofT to US Mar Comm, 27 Feb 43. TC: 632. (4) TC Cir 35, 1 Mar 43, Elimina- tion of Cages for Mental Pnts. (5) Letters from port surgeons at San Francisco and New Orleans contain- ing objections to removal of cages are filed in SC: 632.-1 (BB) and TC: 632. 25 Ltr, CofT (Mvmt Div) for CGs PEs, 10 Jul 43, sub: Care of Mental Pnts on US Army Trans. TC; 370.05 (Army Vessels). 26 (1) Wardlow, op. cit., pp. 6, 222-24. (2) Charles, op. cit., p. 309. PROVIDING THE MEANS FOR EVACUATION BY SEA 401 the American plan for putting larger hos- pitals aboard, but changed their attitude after American officials explained that shortages of shipping and lack of hospital ships made it imperative to evacuate pa- tients on transports. Final agreement was that the United States would install a 300-bed hospital on each ship while in an American port. The proportion of beds in general wards, isolation wards, and mental wards would be the same as that already established for hastily converted trans- ports. When completed, each hospital would be operated by American Army personnel. The construction of new hospi- tal areas began early in November when the Queen Mary came into port. Several months later work was begun on the Queen Elizabeth.-7 Renewed Efforts to Get Army Hospital Ships, 1942-43 Neither the policy announced by the Joint Chiefs of Staff in the spring of 1942 nor efforts to supply evacuation facilities in compliance with this policy silenced demands for Army hospital ships. As early as April 1942 General Hawley (then Colo- nel), Chief Surgeon of the U. S. Army Forces in the British Isles (later the Euro- pean Theater of Operations), announced in a letter to The Surgeon General the policy upon which the European theater was to insist: helpless patients would not be evacuated on ships subject to enemy attack (transports) but only on hospital ships plainly marked and operated under the terms of the Hague Convention. Re- peatedly thereafter the European theater requested hospital ships of the War De- partment, stating in August 1942 that five would be needed by April 1943 and five more by the following September.28 To these demands were added, in the fall of 1942, requests for hospital ships from ports in the United States that were responsible for evacuating patients from scattered island bases.29 Some bases were not on the itinerary of regularly scheduled transports and hence needed other means of evacu- ation. The most logical seemed to be the use of hospital ships on a “pick-up” serv- ice. In response to these needs, the Sur- geon General’s Office in October 1942 recommended the procurement of three hospital ships, in addition to the three already authorized by the Joint Chiefs of Staff. They would be used to collect pa- tients from scattered island bases, to evac- uate casualties from large-scale landing operations, or to supplement transports in evacuating patients from the more distant and larger theaters.30 The Chief of Trans- portation referred this recommendation to the Joint Staff Planners. Earlier, in August, a request for three Convention- protected ships which General Eisenhower 27 (1) Memo, ACofS for Oprs SOS for SG, 6 Oct 42, sub: Med Equip and Sups for US Hosp Fac aboard HMT Queen Mary and Queen Elizabeth. SG: 475.5-1 (BB). (2) Memo, ACofS for Oprs SOS for CofT, 6 Oct 42, sub: Instl of US Hosp Fac on FIMT Queen Mary and Queen Elizabeth. HD: 705 (MRO, Fitzpatrick Daybook). (3) Memo, SOS Hosp and Evac Br for ACofS for Oprs SOS, 2 Nov 42, sub: Add Hosp Fac on Two British Ships. SG: 705.-1 (BB). 28 (1) Ltr, USAFBI (Chief Surg, Col Paul R. Haw- ley) to SG, 25 Apr 42. SG: 560.2 (Gr Brit). (2) Rads CM-IN-4037 (1 1 Aug 42), CM-IN-6044 (17 Aug 42), CM-IN-7813 (21 Aug 42), USASOS (London) to AGWAR; CM-OUT-5084 (16 Aug 42), CM- OUT-7479 (24 Aug 42), AGWAR to USASOS (London). OPD: In and Out Messages. 29 (1) Diary, Misc Br SOS (Col [William L.] Wil- son), 20 Jul 42, HD: 705 (MRO, Extracts from Hosp and Evac Br SOS Diaries). (2) Ltr, CG CPE to GofT, 25 Sep 42, sub; Hosp Ship for the CPE, with 2 inds. SG; 560.-2. 30 1st ind, SG to CG SOS, 23 Oct 42, on Memo, CG SOS for SG, 1 6 Oct 42, sub: Rpt of Progress. SG: 632.-1 (BB). 402 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR wanted by the end of September for the North African invasion had also been re- ferred to that group. In both instances, the Joint Staff Planners, weighing the need for vessels to transport troops and cargoes against the need for hospital ships, decided that additional vessels could not be spared for the latter purpose and reaffirmed the existing policy of using transports as the normal means of evacuation. On 12 No- vember 1942 the Joint Chiefs of Staff dis- approved requests for additional hospital ships.31 Early in 1943 events caused a change in existing policy. To demands of the Euro- pean theater were added requests of the Southwest Pacific and North Africa for hospital ships not only for evacuation to the zone of interior but more particularly for intratheater use. In February 1943 the Southwest Pacific informed the War De- partment that it was converting a Dutch ship, the Tasman, into a hospital ship, and asked that it be certified under the terms of the Hague Convention.32 The North African theater, like the European, had adopted a policy of evacuating no helpless patients in transports. Early in March 1943 it refused to load litter patients on the Acadia, which was making its second trip as an ambulance transport. Later that month this theater cabled Washington for two hospital ships for use in evacuating patients to the United Kingdom.33 Con- currently, evidence was accumulating that the enemy would respect the terms of the Hague Convention. Germany and Italy permitted British hospital ships to operate unmolested in the Mediterranean, and they, along with Japan, had announced they were operating their own hospital ships. Furthermore, several Allied Gov- ernments, as well as the U. S. Navy, had followed the lead of the British and placed hospital ships under Red Cross (Hague Convention) protection.34 Along with insistent demands of the- aters for hospital ships and growing evi- dence of enemy respect for the Hague Convention, it appeared in the first half of 1943 that loss of transport and cargo space through conversion of vessels to hospital use was a less cogent reason than formerly for not authorizing hospital ships. By that time the troop ship fleet had grown through new construction and the conver- sion of freighters. Moreover, British hospi- tal ships were occasionally being used to transport American patients from the European theater to the United States. A request by that theater in January 1943 that medical personnel and equipment be 31 (1) Memos, CofT for JPS, 21 Aug and 2 Nov 42, sub: Hosp Ships. TC: 564. (2) JPS 27/5/D, 24 Aug 42; JCS 52/2, 29 Aug 42. HD: 705 (MRO, Fitz- patrick Ref file, Aug 42-May 43). (3) JCS 52/3, 12 Nov 42. Records and Admin Br, Off ACofS G-3 WDGS. 32 Rad CM-IN-9207, SWPA to AGWAR, 18 Feb 43. HD: 705 (MRO, Fitzpatrick Daybook, Apr 42- Jun 43). For conversion plans for these ships see HD: SWPA 560.2 (Tasman and Maetsuycker); for letters about certifying the Tasman see: TC; 561-565.1 (Tasman ). 33 (1) Rpt, 204th Hosp Ship Co, USAT Acadia, voyage 2 (8 Feb-11 Mar 43). TC: 721.5 /Acadia). (2) Rad CM-IN-14498, NATO to WD, 27 Mar 43. SG; 560.-2 (N. Africa). (3) An Rpt Med Sec NATOUSA, 1943. HD. 34 (1) Memo, CinC US Fleet, for JCS, 26 May 43, sub; Hosp Ships, incl A to [JPS] 360-9 (JCS 3 15/2) Memo, JPS for JCS. Records and Admin Br, Off ACofS G-3 WDGS. (2) See list of hospital ships (US Army and Navy, Allied Governments, and Axis Pow- ers) in State Dept file 740.00117 Eur War 1-1648. By May 1943 Japan had 20 hospital ships, while Ger- many and Italy had 33. The British Commonwealth of Nations had about 30 hospital ships for use in the Atlantic, Mediterranean, and Indian Ocean. The U.S. Navy had converted the Solace into a modern hospital ship, and it was at Pearl Harbor on 7 De- cember 1941. It was designated as a Convention-pro- tected ship on 31 October 1942. The Navy ship Relief was likewise designated as a hospital ship on 5 Feb- ruary 1943. PROVIDING THE MEANS FOR EVACUATION BY SEA 403 transported by these ships on return trips led to a study of the legality of such action by the Army Judge Advocate General. In March 1943 he issued an opinion that hos- pital ships, whether British or American, might be used for the transportation of medical personnel and equipment without violating the provisions of the Hague Con- vention.35 This meant that space on hospi- tal ships could be used for medical trans- port purposes to compensate, in part at least, for the loss of vessels to ordinary transport service. Still another factor influencing decisions about hospital ships early in 1943 was the tardiness with which the three ships au- thorized by the Joint Chiefs of Staff in June 1942 were being made available. The delay was caused largely by division of responsibility for them between the Army and Navy and subsequent misunderstand- ings over submission of plans and selection of types of hulls. Even the most optimistic estimated in the spring of 1943 that they would not be ready until mid-1944.36 In view of these circumstances The Surgeon General raised anew the hospital ship question. He now proposed that hos- pital ships be provided for the evacuation of all helpless patients. On 30 March 1943 he recommended that the Acadia should be registered immediately as a hospital ship under the Hague Convention, “in view of the urgency of the situation in the African theater”; that a second transport should be converted into a hospital ship as soon as possible; that completion of the three ships being built by the Navy should be “expedited”; and that five additional vessels should be procured for use as hos- pital ships by 1 July 1944.37 Subsequently, in April 1943, representatives of the Chief of Transportation, the Surgeon General’s Office, and the ASF Hospitalization and Evacuation Branch discussed additional details of the proposed program. They agreed that vessels selected for conversion should be suitable for use as hospital ships but should also have some characteristics, such as excessively slow speeds, which made them undesirable for service as transports with convoys. They agreed also that the Army should procure and operate hospital ships and that Army hospital ships should be provided with facilities for emergency diagnosis and treatment only, rather than with elaborate facilities for definitive surgical and medical care as on Navy hospital ships. Finally, they decided that the first step in achievement of this program would be to request the Joint Chiefs of Staff to amend the policy on evacuation facilities established in May 1942. Subsequently, Colonel Fitzpatrick prepared an impressive study for submis- sion on 24 April 1943 to the General Staff. Its crux was the recommendation that the Joint Chiefs of Staff (1) should approve the use of Convention-protected hospital ships as the normal means, when available, of evacuating the helpless fraction of sick and 35 (1) Ltr, CG SOS ETO to CG SOS, 4 Jan 43, sub; Util of Hosp Ships for Trans Med Units and Sups, with 2 inds. HD; 705 (MRO, Fitzpatrick Daybook). (2) Memo SPJGW 1943/1760, JAG War Plans Div for JAG, 18 Mar 43, sub: Hosp Ships. SG: 560.2. 38 (1) Memos, CG SOS for VCNO, 14 Jul and 10' Sep 42, sub: Hosp Ships for Evac of Sick and Wounded from Overseas. TC: 564. (2) Memo, Col A[chilles] L. Tynes for SG, 11 Sep 42, sub: Rpt on Conf on Cons of Hosp Ships. SG: 632.-1 (BB). Re- ports of progress in planning and converting these ships were made currently by OCT to SG and SOS. See files HD: 560.2 (Hosp Cons Br, Hosp Ships, Hope, Mercy, and Comfort). (4) Ltr, VCNO to GofSA, 18 Dec 42, sub; Procedure for Acquisition and Conv of USS Comfort (AH-6), USS Hope (AH-7), USS Mercy (AH-8). SG: 560.2. 37 Memo, SG for ACofS OPD WDGS thru CG ASF, 30 Mar 43, sub: Hosp Ships, with 2 inds. SG: 560.-2. 404 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR wounded, (2) should authorize steps to implement this revision of policy at the earliest practicable date, and (3) should approve the use of hospital ships on out- bound voyages for the transportation of medical supplies and personnel. The War Department General Staff approved this recommendation and forwarded it on 12 May 1943 to the Joint Chiefs of Staff.38 The provision of hospital ships for the North African theater did not await this recommendation. In response to North Africa’s request for two hospital ships, the Operations Division of the General Staff offered on 7 April 1943, after consultation with both the Chief of Transportation and The Surgeon General, to convert the Acadia into a hospital ship if the theater was willing to forego its use in the trans- portation of troops. After both the Com- bined and Joint Chiefs of Staff had consid- ered the theater’s acceptance of this offer, North Africa was notified on 22 April that the Acadia would be converted into a hos- pital ship. A second ship, the Seminole, was selected and approved for use as a hospital ship a week later.39 Both ships were stripped of armament and other belliger- ent features; their hulls were painted white with a horizontal green band on each side; and red crosses, which could be illuminated at night, were painted on their sides, decks, and funnels. On 6 May the Secretary of War informed the Secretary of State of the designation of the Acadia as a hospital ship; four days later, of the Seminole. Structural work required in the conversion of the Seminole delayed her de- parture until September 1943, but the Acadia, which had already been fitted out as an ambulance transport, sailed from New York to North Africa on her maiden voyage as a hospital ship on 5 June 1943.40 Six days later the Army received full authority to procure and operate its own fleet of hospital ships. On 11 June 1943 the Joint Chiefs of Staff amended the ear- lier policy, announcing that the helpless fraction of patients would be evacuated in hospital ships if they were available. At the same time they approved the use of hospital ships for the transportation of medical supplies and personnel on out- bound voyages. To permit observance of the amended policy, the Joint Chiefs au- thorized the conversion of slow-speed pas- senger vessels and of EC-2 cargo ships (Liberty ships) to provide a total of 15 hospital ships by 31 December 1943, 19 by 30 June 1944, and 24 by 31 December 1944. All but three—those already au- thorized for construction by the Navy— were to be procured, converted, manned, and operated by the Army alone. Since it had already sent the Acadia on its maiden voyage as a hospital ship and had begun the conversion of the Seminole, the Army thus had authority to place nineteen ad- 38 (1) Ltr, CG ASF for AGofS OPD WDGS, 24 Apr 43, sub; Hosp Ships, with 9 incls. OPD: 573.27. (2) Memo, CofT for CG ASF, 11 May 43, sub: Hosp Ships. TC: 564. (3) Memo, CofSA for Secretariat JCS, 12 May 43, sub: Hosp Ships, with inch OPD: 573.27. 39 (1) Rads CM-IN-14498 (27 Mar 43); CM-IN- 6760 (12 Apr 43); CM-IN-12911 (21 Apr 43), NATOUSA to WD. (2) Rads CM-OUT-3358 (8 Apr 43); CM-OUT-5910 (14 Apr 43); CM-OUT- 92pl (22 Apr 43); CM-OUT-12622 (30 Apr 43), WD to NATOUSA. OPD: In and Out Messages. Under the CCS plan the British would furnish 10 hos- pital ships and 6 hospital carriers, and the United States would provide 2 hospital ships as soon as avail- able. 40 (1) Memo, AGofS OPD WDGS for CofS, 5 May 43, sub: Designation of USAT Acadia as Hosp Ship. OPD: 573.27. (2) Ltrs, SecWar to SecState, 6 and 10 May 43. Same file. For plans and problems of con- version see file SG; 632.-1 (BB) and HD: 560.2 (Hosp Ships, Hosp Cons Br). PROVIDING THE MEANS FOR EVACUATION BY SEA 405 ditional hospital ships in operation by the end of 1944.41 The Hospital Ship Program, 1943-45 Selection of vessels for conversion into hospital ships was important to The Sur- geon General because their basic charac- teristics largely determined the success of conversion. The width of a ship’s beam determined whether passageways would be wide enough to permit the handling of litter cases. The size of its superstructure determined whether patients could be lo- cated above the water line in areas that had natural ventilation and from which patients might be removed easily if it be- came necessary to abandon ship. The cruising range of a vessel determined whether it was suitable for transoceanic service, and its speed determined the num- ber of trips per month and thus the num- ber of patients it might evacuate. In June 1943, therefore, The Surgeon General ar- ranged with the Chief of Transportation for joint inspection of vessels before selec- tion for conversion.42 The ships chosen represented a com- promise. In several instances, vessels were rejected by the Surgeon General’s repre- sentatives, either because they had speeds of less than ten knots, had fewer than three decks above the water line, or were of too narrow beam. On the other hand, despite its objection to their slow speed and low deck heights, the Surgeon Gen- eral’s Office had to agree to the conver- sion of six EC-2 cargo ships. The remain- ing fifteen ships (including the Acadia and Seminole) were of varying ages and speeds. Seven had been built between 1901 and 1919; seven, between 1920 and 1926. Six had speeds of 10 to 12 knots; four, of 13 to 14 knots; and five, of 15 to 16 knots. Some had been coastwise vessels only and later proved unsuitable for use in the Pacific during stormy seasons.43 (Table 18.) All of the vessels selected were convert- ed into hospital ships according to plans approved by the Surgeon General’s Hos- pital Construction Branch. Plans for the conversion of the six EC-2’s were drawn by Cox and Stevens, naval architects in New York City; those for the remainder, by the Maintenance and Repair Branch of the Water Division, New York Port of Embarkation. A civilian architect from the Surgeon General’s Office, assigned temporarily in New York, represented the Medical Department in the initial stages of planning. Subsequently, completed plans were referred to the Surgeon Gen- eral’s Hospital Construction Branch for final approval. In all planning, emphasis was placed on the number of patients’ berths that could be provided rather than upon elaborate clinical facilities.44 A major problem in planning hospital ships was the location and arrangement of the surgical suite and other professional rooms, wards for different types of pa- tients, and quarters for the ship’s crew and 41 (1) JCS 315, 13 May 1943; JCS 3 15/1, 30 May 43. Records and Admin Br, Off ACofS G-3 WDGS. (2) Memo, JCS for ACofS OPD WDGS, 11 Jun 43, sub: Hosp Ships. OPD: 573.27. (3) Memos, Dir of Oprs ASF for SG and CofT, 18 Jun 43, sub: Hosp Ships. SG: 560.-2. 42 Memo, Maj Gen Norman T. Kirk (SG) for Lt Col John C. Fitzpatrick, 30 Jun 43, sub; Hosp Ships. SG: 560.-2 (BB). 43 For correspondence dealing with the hospital ship conversion program, inspection of and accept- ance or rejection of certain transports (e.g., Robin Adair, Manuel Arnos, Utahan, William L. Thompson), revision and changes in plans for hospital areas, prob- lems of construction, and Medical Department in- spections during conversion, see TG: 564, SG: 632.1 (BB), SG; 560.2, and HD: 560.2 (Hosp Ships, Hosp Cons Br). 44 Tynes, Construction Branch, pp. 94, 113. HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Vessels Used for Conversion “ Designation as Hospital Ship First Voyage 6 Decommissioning of Hospital Ships Name Name Year Place of Patient Capac- ity b Speed “ (Knots) Date Announcement by WDGO Port of Da ce Destination Announcement by WDGO Built Conversion Num- ber Date Departure Number Date Acadia Acadia 1932 New York.. 787 18 3 May 43 27 3 Jun 43 New York. . 5 Jun 43 N. Africa 17 11 Feb 46 Aleda E. Lutz... . Colombie 1931 New York. . 778 16 13 Feb 45 23 3 Apr 45 New York. . 18 Apr 45 United Kingdom. 33 Algonquin Algonquin 1926 Mobile 454 IS 11 Sep 43 65 9 Oct 43 New Or- 2 Feb 44 N. Africa 6 11 Jan 46 leans. Willard A. Hoi- 1921 ner. brook.• Blanche F. Sig- Stanford White. 1943 New York. . 590 11 20 Apr 44 43 29 May 44 New York.. 7 Jul 44 United Kingdom. 47 24 May 46 1918 706 16 16 May 44 29 Nov 43 61 1 Aug 44 8 Jan 44 21 Sep 5 Mar 44 ford. Chateau Thierry.. Chateau Thierry- C 1-B Hull 1920 484 16 5 44 17 11 Feb 46 1943 705 IS 20 May 44 3 Feb 44 Los Angeles. 21 Jun 21 Jul 12 Jul 44 George W. Car- ver. 1943 592 11 40 17 May 44 27 May 44 44 cific. United Kingdom. 10 25 Jan 46 18 Dec 45 Emily H. M. Weder. 1920 New York.. 738 13 2 Mar 44 42 New York.. 44 120 chanan. Kent 1918 288 12 3 Jan 44 11 Dec 44 19 14 Jul 13 Apr 44 88 17 Oct 45 Ernestine Koran- Dorothy Luck- 1919 cisco. New York. . 722 12 19 24 Mar 45 New York.. 45 United Kingdom. 117 9 Oct 46 da. enbach. 1927 1,628 19 13 Feb 45 41 23 May 45 30 Jun 23 Sep 45 United Kingdom. 3 7 Jan 46 2 Nov 46* ger. C 1-B Hull 1943 705 IS 31 May 44 Los Angeles. 44 President Tyler *. 1920 cific. Curdy. Jarrett M. Hud- Samuel F. B. 1942 New York. . 582 11 20 Apr 44 46 6 Jun 44 New York. . 2 Sep 44 United Kingdom. 3 7 Jan 46 dleston. Morse. John J. Meany. .. Z e b u 1 o n B. 1942 Boston 582 11 20 Apr 44 47 6 Jun 44 New York. . 27 Jul 44 Italy 10 25 Jan 46 V ance. John L. Clem.... 1918 286 12^ 10 24 Feb 44 28 3 Apr 44 IS Jun 31 Aug 19 Mar 44 88 17 Oct 45 1901 Jacksonville Boston 592 18 Feb 44 26 44 United Kingdom. United Kingdom. 17 11 Feb 46 Louis A. Milne. . . Lewis Lucken- 1919 952 12 19 Sep 44 2 5 Jan 45 Boston 45 94 22 Aug 46 bach. 1920 758 12 24 Feb 44 35 25 Apr 44 19 Jul 31 Aug 4 Sep 44 75 22 Jul 46 2 Nov 46* more. C 1-B Hull... 1943 70S IS 31 May 44 13 Feb 45 Los Angeles. 44 1907 1,242 12 62 26 Jul 45 45 cific. 17 ' 11 Feb 46 leans. cific. 1920 504 16 22 Feb 44 25 27 Mar 44 27 21 Mar 46 St. Olaf St. Olaf 1942 586 11 24 Feb 44 51 19 Jun 44 3 Jun 43 1 Sep 43 4 Jan 44 17 May 44 12 Aug 20 Sep 4 Sep 8 Apr 16 Jul 44 120 18 Dec 45 1925 454 14 8 May 43 3 Aug 43 29 Nov 43 27 43 3 7 Jan 46 1907 543 14 52 1 43 120 18 Dec 45 1921 455 14 44 10 25 Jan 46 Wisteria William Osier. . . 1943 New York. , 588 11 23 Feb 44 40 New York,. 44 United Kingdom. 75 22 jul 46 ° Charles, op. cit., and Bureau of Ships, Navy Department, Ships’ Data U. S. Naval Vessels (Washington, 1945), vol. HI. b Summary charts in History . . Medical Regulating Service. . . Ships’ capacities varied from time to time because of alterations in wards. See lists of capacities, rlL): 36U.Z. 0 Conversion into hospital ship suspended after V-T Day. d Converted a nd designated as hospital ship by the Navy for the Army: operated by the Navy for the Army until the spring of 1946; transferred to the Army for operation in April and May 1946. • Decommissioning not announced by General Order. The Secretary of War informed the Secretary of State of this action on 2 November 1946. Table 18—United States Army Hospital Ships in World War II PROVIDING THE MEANS FOR EVACUATION BY SEA 407 medical complement. Experience in plan- ning ships’ hospitals for transports and in converting the Acadia and Seminole served as a guide at first. More satisfactory stand- ards evolved as additional experience ac- cumulated with later conversions. Nor- mally the Surgeon General’s Office pre- ferred to have the following located on decks above the water line: quarters for officers, nurses, and medical attendants; the surgical suite; clinical and administra- tive areas; and wards for litter patients, for patients who had communicable dis- eases, and for those who were seriously disturbed mentally. Decks at the water line, or just below it, were considered suit- able for wards for neuropsychiatric and ambulatory patients, for quarters for the ship’s crew, and for galleys and mess rooms. Storerooms, the morgue, and the laundry were placed in lower areas, in- cluding the hold. To achieve maximum stability, the surgical suite—consisting of two operating rooms, a sterilizing room, a scrub-up area, rooms for sterile and non- sterile supplies, and an X-ray and dark- room—was preferably placed on the main deck slightly aft of center. To insure free- dom from unnecessary traffic, isolation and mental wards were considered best located when they were aft. Clinical and administrative areas, including the dress- ing room, pharmacy, laboratory, sur- geon’s office, medical records office, chap- lain’s office, Red Cross office, transporta- tion agent’s office, post exchange, and commissary, were considered best located on the deck above the water line near the forward gangway or side-port entrance, to permit easy access when the ship was in port.45 Wards were provided on all ships for patients with communicable diseases, and for mental, medical, and surgical cases. Because of the large number of mental pa- tients requiring evacuation, the Move- ments Division of the Transportation Corps proposed in the fall of 1943 to de- vote approximately half the capacity of each hospital ship to accommodations for them. Wards for such patients were equipped for safety with concealed radia- tors and pipes, shatterproof electric light fixtures, heavy doors with viewing panels, locks which could be operated by a master key, and protective bars over all portholes. For the care of acutely disturbed patients there were steel cells 3 to 4 feet wide and 7 feet long. For patients with mild neuro- psychiatric disorders, large wards with minimum security devices were used. Iso- lation wards for patients with communi- cable diseases were separated into rooms accommodating no more than eight (and preferably four) patients, and were equipped with separate bathrooms, diet kitchens, linen closets, utility rooms, and scrub-up areas. All wards had two-tiered berths and were provided with adequate administrative areas, such as utility rooms, diet kitchens, and offices.46 In the summer of 1945 mesh wire enclosures were con- structed on the decks of some hospital ships to provide areas where mental pa- tients could get fresh air and exercise.47 In addition to the general arrangement of hospital facilities, the Surgeon General’s 45 Letters dealing with recommendations made by the Hospital Construction Branch are found in SG; 632.1 (BB), HD; 560.2 (Hosp Cons Br, Hosp Ships, Gen), and HD: 560.2 (Hosp Cons Br, file for each hosp ship). Blueprints and photographs of each hospi- tal ship are located in above files. 46 (1) Tynes, Construction Branch, pp. 101, 107ff. (2) Memo, CofT for SG, 9 Oct 43, sub; Hosp Ships. SG: 560.2. (3) Memo, SG for CofT, 4 Jan 44, sub: Mental Fac Aboard Hosp Ships. SG: 632.1 (BB). 47 Memo, CofT for SG, 12 Apr 45, sub: Proposed Location of Mental Pnt Incls on Hosp Ships. SG: 632.1 (BB). 408 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR SURGICAL WARD ON USAHS SHAMROCK Office was also interested in features of construction that promoted sanitation and comfort. As a safety precaution and as a buffer against noise, it insisted that bulk- heads should be of double-thick fireproof material that was easy to clean. White tile was considered necessary for the decks of washrooms, operating rooms, sterilizing and workrooms, dressing stations, clean- ing gear rooms, utility rooms, diet kitch- ens, prophylactic stations, pharmacies, laboratories and autopsy rooms. For the rest of the hospital area a deck covering of cement composition or of heavy linoleum was considered satisfactory. Deckheads of a material similar to that used for bulk- heads were needed as protection against dust in operating rooms, sterilizing rooms, dressing rooms, and smaller wards, and, in addition, as a safety measure—for cov- ering exposed pipes and fixtures—in all mental wards.48 Numerous difficulties were encountered in converting the vessels into hospital ships. Lacking a suitable table of organ- ization for hospital ship complements at the beginning of the program, the Med- ical Department had to estimate the num- ber of officers, nurses, and attendants for whom quarters would be needed on each ship. Late in 1943, when The Surgeon General revised the existing table of or- ganization, some of the conversion plans 48 (1) Tynes, Construction Branch, pp. 101, 106. (2) Memo, SG for CofT, 26 May 43, sub: Steel Bulk- heading in Hosp Ships. SG: 632.1 (BB). (3) Ltr, Water Div NYPE to CofT, 2 Nov 43, sub: Hosp Ships, with 4 inds. Same file. PROVIDING THE MEANS FOR EVACUATION BY SEA 409 SURGICAL WARD ON USAHS LOUIS A. MILNE already prepared had to be modified to provide different sets of quarters.49 About the same time, the decision to devote 50 percent of each hospital ship’s capacity to accommodations for mental patients caused further revisions in plans already drawn. Changes in the size of the mer- chant marine crews, along with friction between maritime unions on the one hand and the Transportation Corps and Sur- geon General’s Office on the other about the size and location of crew quarters, tended to cause revisions in plans. In some instances changes in approved plans were requested by representatives of the Sur- geon General’s Office (Maj. Howard A. Donald and Lt. Col. Achilles L. Tynes) as they inspected work in progress at various ports.50 Of perhaps even greater impor- tance were delays in shipyards. Some had difficulty in hiring enough workmen to keep conversion moving along rapidly. Others failed to get materials when they were needed. Still others, heavily commit- ted to the Navy, devoted their workers and materials to naval landing craft with higher priorities.51 As a result of these difficulties the entire 49 For example, see Memo, Lt Col A. L. Tynes for SG, 27 Oct 43, sub: Rpt of Insp of SS Ernest Hinds. HD: 560.2 (Hosp Cons Br, Hosp Ship file). 50 (1) Tynes, Construction Branch, pp. 95-1 16. (2) Correspondence concerning conversions are filed in SG; 560.2, 632.1 (BB), and in HD; 560.2 (Hosp Cons Br, Gen), 560.2 (Hosp Cons Br, under name of each hosp ship). 51 (1) Memo, SG for ASF Dir of Mat, 1 7 Feb 44, with inds. SG: 632.1 (BB). (2) Memo, Col R. M. Hicks (Water Div OCT) for Howard Bruce, 23 Feb 44, sub: Hosp Ship Gonvs. TC: 564. 304244 0—55 28 410 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR DRESSING STATION ON USAHS LOUIS A. MILNE program was delayed. Only three Army hospital ships were in service by the end of 1943. One per month was placed in serv- ice from February through May 1944, and one of the three ships being con- structed by the Navy was commissioned the next month. Thus by the end of June 1944 there were nine hospital ships serv- ing the Army, instead of the nineteen an- ticipated. The next month seven more were completed and in August and Sep- tember two additional Army hospital ships and the two remaining hospital ships being constructed by the Navy for Army use were ready for their first trips. The final two ships of twenty-four authorized in June 1943 were placed in service in March and April 1945. (Table 18) Mean- while the Southwest Pacific had convert- ed two vessels, the Tasman and Maetsuycker, for intra-theater use. Although controlled by the American Army, these vessels were Dutch hospital ships, sailing under Dutch registry and certified under the Hague Convention by the Netherlands Govern- ment.52 As Army hospital ships were readied for service, the problem of naming them arose. The Navy named its hospital ships for abstract qualities and hence desig- nated the three ships it was building for the Army as the Comfort, Hope, and Mercy. 52 For further information on these vessels, see TC: 565.1-DB (Tasman); HD: SWPA 560.2 (Tasman and Maetsuycker); and State Dept: 740.001 17 Eur War 1939/1-1648 (Netherlands Hosp Ships). Also see WD Memo W40-21-43, sub: Use of SS Tasman as a Hosp Ship, 20 Oct 43, in AG: 560 (16 Oct 43). PROVIDING THE MEANS FOR EVACUATION BY SEA 411 THE USAHS LARKSPUR Trying not to trespass upon this system and at the same time trying to designate Army hospital ships appropriately, the Surgeon General’s Office proposed in July 1943 that they be named for flowers. Transportation Corps officials believed that this might complicate rather than simplify their identification as hospital ships. Since all of the vessels being con- verted were well known in the world’s shipping registers, an enemy encountering one could identify it, if designated as a hospital ship under its existing name, by its ascribed physical characteristics and silhouette. It was therefore decided to re- tain names that were not “entirely incon- sistent” with the vessels’ new mission and to name others for flowers. In the spring of 1944 the Coast Guard objected to this practice fearing that the Army’s naming of hospital ships for flowers would cause confusion with Coast Guard ships carry- ing the same names. As a result, at the suggestion of the Surgeon General’s Office most hospital ships commissioned there- after were named for deceased Army medical officers and nurses.53 (See Table 18.) 53 (1) Memos, SG for CofT, 1 Jul 43; CofT for SG, 22 Jul 43, sub: Names for Hosp Ships. (2) Ltrs, USCG to CofT, 3 Mar 44; CofT to USCG, 9 Mar 44. (3) Memos, CofT for SG, 14 Mar 44, 8 Jan 45, sub: Names for Hosp Ships. All in TC: 569.61. (5) TC Cir 80-4, 5 Feb 44, with supp, 25 Mar, 30 May 44, and 10 Feb 45. 412 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Continuation of Efforts To Insure Adequate Hospital Facilities on Transports, 1943-45 Although standards for ships’ hospitals had been established by the middle of 1943, meeting these standards continued to involve certain problems. One was to obtain desired modifications of Maritime Commission plans. In reviewing them the Surgeon General’s Office sometimes found major faults: failure to comply with direc- tives about the percentage of hospital beds to be provided; unsatisfactory location of hospital areas, as for example in the stern two decks below the lifeboat loading deck, instead of nearer midship and one deck higher; improper arrangement of certain medical facilities, such as the combination of the surgical suite and the dispensary; and failure to provide such accommoda- tions as utility rooms and dressing sta- tions. Unless construction of ships was too far advanced, the Commission generally made the revisions requested by the Sur- geon General’s Office.54 Less success was achieved in negotia- tions with the British to improve hospitals on their transports. Normally they fol- lowed a policy of making few if any struc- tural changes in ex-passenger vessels. In December 1943 this problem was referred to the Combined Military Transportation Committee and, as a result, the Transpor- tation Corps and the Medical Depart- ment had to approve specifications for hospital areas aboard British transports that were considerably lower than those for American transports. For example, ac- cording to a decision of the Committee, British transports were not required to have wards for mental patients or separate operating and sterilizing rooms. Instead of the latter, they had one room which served as a combination surgeon’s office, records room, sterilization room, dressing station, and emergency operating room.55 Increases in the number of mental pa- tients to be evacuated and in the propor- tion of seriously disturbed cases required further changes in transports’ hospitals. In the fall of 1943, on the recommendation of the Surgeon General’s liaison officer, the Chief of Transportation directed that capacity for mental patients should be in- creased by 3 percent of the troop capacity of each Army-owned and chartered trans- port. He also requested the War Shipping Administration to make similar changes on ships it operated for the Army. This meant an increase in authorized accom- modations for mental patients from 2 to 5 percent of the troop capacity of Army- owned transports and from 1 Vi to 49/i per- cent of that of chartered transports. The percentage of berths for patients of other types remained unchanged. In order to provide additional accommodations for mental patients without diminishing troop capacity, staterooms that were used on outbound voyages for officers and non- commissioned officers were to be altered. “Potential weapons” were to be removed and electrical fixtures supplied with guards; suitable doors were to be installed 54 (1) Tynes, Construction Branch, p. 117. (2) Ltr, SG to CofT, 16 Sep 43, sub: Gen Arrangement Plans for Hosp Sec on C4-S-B2 Mar Comm Trp Trans. (3) Memo, SG for CofT, 27 Sep 43, sub: Hosp Facs on US Army Trans, C-3 Type. (4) Ltr, Mar Comm to SG, 28 Sep 43, sub: C4-S-B2 Trp Trans, Hosp Spaces. All in SG: 632.-1 (BB). 55 (1) Ltr, CofT to SG, 18 Dec 43, sub; Proposed Hosp Revision Aboard HMT Queen Mary. SG; 632.-1 (Queen Mary jBB. (2) Memo, SG for CofT, 1 7 Feb 44, sub: Comments on Proposed Agreement Cone Mini- mum Standards Aboard Brit and Amer Trp Ships. SG: 560.-1 (Gr Brit). (3) Ltrs, CofT to CGs PEs, 15 Mar 44; CofT to CGs TofOpns, 19 Apr 44, sub; Min- imum Standards on Brit and Amer Trans, with Rpt CMTC, 18 Feb 44, 82d Mtg. TC: 337 (Trp Trans). PROVIDING THE MEANS FOR EVACUATION BY SEA 413 and bars placed across portholes; and berths were to be modified so that the lower two could be fixed by bolting or welding and the top one removed before the loading of patients.56 About a year later action was taken to provide more suitable accommodations for severely disturbed patients. On 25 Oc- tober 1944, the Operations Division, War Department General Staff, in a meeting with representatives of the Chief of Trans- portation, The Surgeon General, and others, decided that transports should have locked cells for some patients and small wards for others. Subsequently, the Transportation Corps announced that in- dividual cells would be provided on trans- ports sailing to the Southwest Pacific equal in number to .75 percent of their troop capacities and on those sailing to other areas equal to .30 percent of their capacities. Approximately half the re- maining accommodations for mental pa- tients were to be in small locked wards holding twelve or fewer patients.57 A study in the winter of 1944 of the an- ticipated patient load indicated that, among other measures, fuller use would have to be made of the British Queens and “maximum loading” of certain transports would have to be authorized. A series of conferences among Medical Department, Transportation Corps, and British repre- sentatives in the European Theater of Operations and in Washington resulted in arrangements in January 1945 to use the Queen Elizabeth and the Queen Mary on westbound trips primarily for the evacu- ation of patients. To increase their patient- carrying capacities to 3,500 and 3,000 respectively (the number of patients who could be fed three meals a day from the ships’ kitchens), additional pantries had to be installed, accommodations for more medical personnel provided, and facilities for patients modified. These changes were limited mainly to installing rails alongside patients’ berths, furnishing additional bedpan washers and sterilizers, and pro- viding food carts for serving hot meals to patients unable to attend mess forma- tions.58 To permit the “maximum loading” of seventeen Army and three Navy trans- ports—that is, loading them with the maximum number of patients who could be properly fed and otherwise cared for regardless of lifeboat restrictions—similar changes had to be made aboard these ves- sels. In March 1945 the Chief of Trans- portation established the following stand- ards for such changes; additional diet kit- chens, food-serving pantries, and food carts should be provided to insure the serving of food in a palatable condition; sufficient bedpan washers and sterilizers should be installed to care for all litter pa- tients; additional mattresses and pillows should be provided; lee rails should be at- tached alongside the berths of all litter pa- tients and all ambulatory patients who 56 (1) Ltr, CG USAFFE to TAG, 24 Aug 43, sub: Evac of Psychotic Cases to US, with 2 inds. AG: 704.11. (2) Ltr, CofT to CGs PEs, 18 Nov 43, sub: In- crease in Mental Pnt Capacity on Trans. TG: 632 (Army Vessels). (3) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub; Procedure for Evac of Pnts by Water or Air from Overseas Comd. AG: 704.11 (3 Jun 44). (4) See pp. 399-400. 57 (1) Memo OPD 370.05, ACofS OPD WDGS for CG ASF, 27 Oct 44, sub: Evac of Mental Pnts from the SWPA. HRS: ASF Planning Div and Program Br file 370.05, “Hosp and Evac.” (2) Memo, Mvmt Div OCT for Water Div OCT, 6 Nov 44, sub: Mental Accommodations on Trp Trans. SG: 705. 58 (1) Rads GM-OUT-72113 (3 Dec 44); CM- OUT-76241 (12 Dec 44), WD (prepared by Lt Col J[ohn] C. Fitzpatrick) to Hq ComZ ETO. SG: 560.2. (2) Rpt, CMTC 67, 16 Jan 45, sub: Return of Pnts and Other Pers West-Bound on the Queen Elizabeth and Queen Mary. SG: 705. 414 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR could not care for themselves without as- sistance; and additional dispensaries and surgical dressing rooms should be con- structed for the routine dressings and emergency care patients might need en route.59 These changes increased the ca- pacities of seven transports to an average of more than 1,300 patients each, includ- ing mental and litter cases.60 Additional Hospital Ships and Modifications for Pacific Service In authorizing five additional Army hospital ships in December 1944 to help handle the patient load in 1945, the Joint Chiefs of Staff directed that changes in vessels selected should be kept to the mini- mum necessary to fit them as “ambu- lance-type hospital ships.” Recognizing the necessity of this policy, The Surgeon General agreed that existing deck struc- tures of these ships should be used to the greatest possible extent, but insisted that each ship should have a proper surgery and X-ray department, adequate messing facilities for feeding bed patients, and suit- able office space.61 In this instance the Joint Military Transportation Committee selected the vessels to be used and once again the Surgeon General’s Office col- laborated with the New York Port of Em- barkation in the preparation of plans for conversion. One of these ships was ready for service by April 1945; another, two months later; and the third, in September 1945.62 Work on the remaining two was suspended after V-J Day and they were again placed in the transport service to re- turn troops from overseas areas. While plans were being made to put five additional Army hospital ships in service, steps were taken to prepare those already available for Pacific duty. During 1944 the surgeons of some complained that ventilation of these vessels was so poor that patients often found the heat and odors almost unbearable. Early in 1945 representatives of The Surgeon General and the Chief of Transportation agreed that it would be ideal to have hospital ships completely air conditioned, as were those of the Navy, but in view of shortage of time they decided that only portions of them, such as operating rooms, clinics, and certain wards, should be air condi- tioned and that efforts should be made to increase the exhaust ventilation of other areas. This program was approved for the five newly authorized ships, and during May, June, and July 1945, at least eight others were routed to the New York Port of Embarkation for the installation of air- conditioning equipment.63 Medical Attendants for Service on Transports Determining a Method of Supplying Personnel The question of how medical attendants were to be supplied to care for patients 59 (1) Memo, CofT for Dir Nav Trans Serv, 22 Feb 45, sub: Pnt Capacity Mt. Vernon, Wakefield and West Point. (2) Rads, WD for CGs PEs, UK Base Sec, Hq ComZ ETO, POA, MTO, SWPA, 14 and 22 Mar 45. (3) Ltr, CG NYPE to CofT, 20 Apr 45, sub; In- crease of Litter Capacity of Trp Ships. All in TG: 569. 60 Total patient capacities of the vessels varied from 404 on the Borinquen to 2,618 on the George Washing- ton. See list of maximum capacities in History . . . Medical Regulating Service . . . , sec 6. 61 (1) JCS 1199, 16 Dec 44, Hosp Ship Program; JCS 1199/1, 5 Feb 45, same sub. (2) Memo, Col Afchilles] L. Tynes for SG, 21 Dec 44, sub: Plans for Proposed Conv of French Ships, Athos II and Colombie, into US Army Hosp Ships. Both in SG: 560.2. 62 See Table 18. 63 (1) Memo SPTOM 560, Mvmt Div OCT for Water Div OCT, 31 Mar 45, sub: Surv of Ventilation Systs Aboard Hosp Ships. HD: 705 (MRO, Newman Staybacks). (2) Memo, Mvmt Div OCT for Gen R[obert]H. Wylie, 14 Jul 45, sub: Repair Status of US Army Hosp Ships. SG: 705. PROVIDING THE MEANS FOR EVACUATION BY SEA 415 being evacuated by Army troop transport arose early in the war. In January 1942, G-4 directed The Surgeon General and The Quartermaster General to include in plans for sea evacuation operations rec- ommendations about the source and use of personnel for ships. In response The Surgeon General proposed the establish- ment of Medical Department pools at ports in the zone of interior and in thea- ters of operations. From such pools port commanders in the zone of interior could assign appropriate medical staffs to ships’ hospitals on outbound transports and the- ater commanders could assign additional attendants to care for patients on return trips. After completing voyage assign- ments, the attendants could return to the- ater pools by the first available ship. When not on transport duty, they could be used to supplement the staffs of hospi- tals located near ports either in the zone of interior or in theaters of operations.64 SOS headquarters at first partially ap- proved The Surgeon General’s plan. On 18 June 1942 it authorized port com- manders to establish pools of Medical De- partment personnel, under control of port surgeons, from which to furnish comple- ments for ships’ hospitals. According to a guide supplied by The Surgeon General, the permanent complement aboard each transport was to consist of the ship’s sur- geon and twelve enlisted men. Before de- parture of a transport from the United States, a port surgeon was to estimate the number of patients it would return from theaters and, according to a graduated table in the guide, was to assign necessary attendants. In emergencies overseas com- manders could supply additional attend- ants.65 This system proved inadequate, perhaps for several reasons. Ports in the United States had trouble getting enough medical personnel to operate the system. In the absence of a large backlog of pa- tients in theaters, it was impractical to estimate the number of evacuees to be re- turned. Finally, port pools were difficult to keep in operation because ships some- times were diverted and did not return directly to home ports. The SOS Hospitalization and Evac- uation Branch therefore suggested a dif- ferent plan in August 1942. Calling for the use of table-of-organization units listed in the troop basis, it promised to insure the availability of attendants at all times. Therefore SOS headquarters directed The Surgeon General to prepare an appro- priate table. It was to provide not only for units to care for groups of 25, 50, 75, 100, 250, and 500 patients but also for units to serve as permanent medical complements of transports. The latter were to operate ships’ hospitals on outbound trips and were to serve as administrative and tech- nical nuclei around which supplementary platoons could function when patients were being returned to the United States. The Surgeon General prepared the table as directed, but protested against its adop- tion. Because table-of-organization units were inflexible, he contended, they were wasteful of personnel when used in oper- ations characterized by variable factors, such as ships’ destinations, length of voy- 64 (1) Memo AG 573.27 (10-29-41), TAG for SG, 26 Jan 42, sub: Hosp Space on Army Trans. HD: 541 (Equip for Trans). (2) Ltr, SG to TAG, 16 Feb 42, sub: T/O for Hosp Ship and Tabulation of Med Pers Reqmts for ATS to Evac from Overseas, with 5 incls. Same file. (3) Memo, SG to CG SOS (Dir of Oprs), 30 Apr 42. HD; 705 (Hosp and Evac, Col Welsh file). 65 (1) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Oprs Plans for Mil Hosp and Evac, with incls. (2) Ltr, SG to CGs all PEs, 29 Jun 42, sub; Opr Plans for Mil Hosp and Evac, with 3 incls. Both in HD: 705 (Hosp and Evac). 416 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR ages, outbound loads, and the number and type of patients on return trips. Nevertheless, the General Staff supported SOS headquarters and directed the acti- vation of ten platoons in September. The next month, the table of organization for “Medical Hospital Ship Platoons, Sep- arate,” was published. It provided for a permanent complement of medical per- sonnel that included one officer and twelve enlisted men for each transport, and for supplementary platoons varying in size from seven to eighty-eight officers, nurses, and enlisted men to care for dif- ferent numbers of patients.66 Publication of this table did not settle the question entirely. In November 1942, when SOS headquarters was about to ac- tivate thirty additional platoons, The Sur- geon General again objected to their use. Whether because of this objection or for other reasons, SOS headquarters seems to have compromised. Supplementary pla- toons were organized to serve aboard transports carrying patients, but table-of- organization units to serve as the perma- nent medical complements were never activated. Instead, SOS headquarters continued to supply personnel for this purpose in allotments to port com- manders.67 Measures to Conserve Personnel Steady and large increases in evacua- tion in the latter half of the war, along with other demands for shares of a limited supply of medical personnel, especially doctors, intensified the problem of provid- ing attendants for patients aboard trans- ports. In the fall of 1943 the use of inflexi- ble table-of-organization units was ques- tioned by the Surgeon General’s Personnel Board and by ASF headquarters as being wasteful. The use of theater pools was again considered, but Lt. Col. John C. Fitzpatrick, liaison officer of The Surgeon General with the Chief of Transportation, defended the use of platoons. They con- stituted the surest way, he insisted, for ASF to discharge its responsibility for the care of patients after they left theater con- trol. In October 1943 representatives of The Surgeon General, the Chief of Trans- portation, the General Staff, and ASF headquarters reviewed the entire question and decided that “platoons should be modified and retained.” They agreed also that maximum use should be made of re- turning casual medical personnel to sup- plement the medical service on transports. These measures, they expected, would promote manpower economy.68 Modifications were made not so much in platoons themselves as in their use. When the table under which they were organized was revised in October 1943, nurses were eliminated, as the Chief of Transportation recommended. Thereafter they were to be furnished, if needed, by theater commanders.69 Of more impor- tance, the Office of the Chief of Transpor- tation in November 1943 developed a guide for theaters to use in placing pla- toons aboard transports. This guide took account of the fact that variations in types 66 (1) Memo, AGofS for Oprs SOS for SG, 28 Aug 42, sub: T/O for Med Pers on Amb Ships and Trp Trans, with ind. (2) Memo, AGofS for Oprs SOS for Dir Mil Pers SOS, 1 Oct 42, same sub. (3) Memo, SG for GG SOS (Mob Br), 19 Oct 42. All in SG: 320.3. (4) T/O 8-534, 27 Oct 42. 67 (1) Memo for Record, on Memo, CG SOS for TAG, 14 Nov 42, sub: Constitution and Activation of 30 Hosp Ship Plats, Sep. AG: 320.2 (1 Oct 42) (3). (2) Memo, Hosp and Evac Br Plans Div SOS for Mob Br Plans Div SOS, 8 Dec 42, sub: Med Pers on Army Trans. HD: 705 (MRO, Fitzpatrick Daybook, Aug 42-Jun 43). (3) Memo, CG SOS for GofT, 4 Jan 43, sub: Almts for Ships’ Complements. SG: 320.3-1. 68 (1) Rpt, SG Pers Bd Mtgs, 16 Sep-29 Sep 43. SG: 334.7-1. (2) Rpt, SC Pers Bd to Oprs Serv SGO, 28 Oct 43, sub: Study of MD Pers. HD: 334 (Kenner Bd). 69 T/O&E 8-534, 21 Oct 43. PROVIDING THE MEANS FOR EVACUATION BY SEA 417 of patients required variations in the num- ber of attendants provided. For example, while two 100-bed platoons would be re- quired to care for 100 mental or litter pa- tients, a 25-bed platoon was sufficient for a like number of ambulatory or troop class patients. A 100-bed platoon could care for 150 patients if 75 percent were either ambulatory or troop class. This guide, which geared the size of platoons to the type as well as number of patients, was designed to permit a flexibility in use that would contribute to economy. In Novem- ber 1943 it was sent to the European theater; the following March, to the North African. In June 1944 it was issued to all theaters in a revised directive on evacuation operations.70 Another economy measure was the elimination of small platoons. With actual and anticipated increases in the patient load early in 1944, it was unlikely that those with less than 100-bed capacity would be needed. Small units—of 25-, 50-, and 75-bed capacities—were author- ized one Medical Corps officer each, as was the 100-bed unit. Thus the use of small platoons to attend groups of patients numbering 100 or more was wasteful of Medical Corps officers. In April 1944 the Chief of Transportation requested ASF headquarters to convert all platoons of 25-, 50-, and 75-bed capacities, a total of 184, to 100-bed units. This action in- creased their table-of-organization capac- ity from 7,275 to 18,400 patients without any increase in the number of Medical Corps officers and with the addition of only 1,964 enlisted men and 184 Dental Corps officers. With the eighty-seven 100- bed platoons already organized, this gave a total table-of-organization capacity of 27,100 patients.71 When additional pla- toons were required later, none of less than 100-bed capacity was organized. Another measure to supply attendants for patients evacuated by transport was the use of medical personnel returning to the United States in a duty status. The number of enlisted men, officers, and nurses in this category increased as the war lengthened and as they accumulated enough overseas service to return home on “rotation.” Under an agreement reached in October 1943, the War Department on 8 June 1944 directed theater commanders to form such personnel into provisional medical hospital ship platoons and to re- turn to the United States no Medical Corps officer below the grade of colonel and no nurse whatever without assuring the full use of his or her services en route. Subsequently, in the fall of 1944 and early in 1945, when the Chief of Transportation requested the activation of additional platoons, The Surgeon General disap- proved, suggesting instead that theaters be directed to form more provisional pla- toons.72 Other measures were also necessary to 70 (1) Ltr, GofT to CG ETOUSA 13 Nov 43, sub: Util of Med Hosp Ship Plat, Sep. HD: 705 (MRO, Fitzpatrick Stayback, 498). (2) Rad GM-OUT-7672, WD (Mvmt Div OCT) to CG NATOUSA, 18 Mar 44. SG: 322.8-1. (3) Ltr, TAG to GGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd, with incl 4. AG; 704.1 1 (3 Jun 44). 71 (1) Ltr, GofT to GG ASF thru SG, 1 Apr 44, sub: Reorgn of Med Hosp Ship Plat (Sep). HD: 705 (MRO, Fitzpatrick Stayback, 1077). (2) Memo, GofT for CG ASF, 20 Apr 44, sub; Request for Activation of Add Med Hosp Ship Plats, Sep, with 10 incls. HRS: ASF Planning Div Program Br file, “Hosp and Evac. vol. 3.” 72 (1) Ltr, TAG to GGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd. AG: 704.1 1 (3 Jun 44). (2) Ltr, GofT to CG ASF thru SG, 25 Oct 44, sub: Request for Prov Med Hosp Ship Plats, Sep. HRS: ASF Planning Div Pro- gram Br file, “Hosp and Evac.” (3) Memo, GofT for CG ASF thru SG, 24 Mar 45, sub: Request for Prov Med Hosp Ship Plats, Sep, with 2 inds. SG: 322 (Plat). 418 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR provide, within the amount of medical personnel available, sufficient attendants for patients on transports. Attempts were made to increase the use of regularly or- ganized platoons by reducing the time they spent in the United States and in re- turning to theaters. Although such units were assigned to the Chief of Transporta- tion, for a time the commanders of ports actually controlled them while they were in the United States. In the fall of 1944 their control was centralized in the Move- ments Division of the Office of the Chief of Transportation. Knowing where platoons were needed as well as schedules of ships leaving from all ports, this Division could arrange for the return of platoons to the- aters more quickly than could ports. Later, the War Department suggested that the- aters might establish air priorities for them, in order to reduce the time nor- mally required for their return. Another measure taken in the fall of 1944 was the deployment of platoons from “isolated theaters,” such as the Middle East, India, and South Pacific, to other more active theaters, such as the European.73 Problems in the Use of Platoons Questions arose about the control of platoons. The first ten were assigned to the New York Port of Embarkation, but all others were assigned to the Chief of Trans- portation and were attached to ports. In December 1942 The Surgeon General asked where and how they were to be placed aboard transports carrying pa- tients. Representatives of his Office, of the Office of the Chief of Transportation, and of SOS headquarters subsequently de- cided that platoons should be attached to overseas theaters on a temporary duty basis and that theater commanders should be responsible for placing them on trans- ports as needed.74 After attachment to theaters platoons came under the admin- istrative control of theater commanders. This step gave rise to complaints that the- aters employed them improperly when they were not escorting patients to the United States. One complained of being assigned to work in medical supply; another, of being required to sort mail. Nevertheless the War Department fol- lowed a policy of not interfering with the- ater commanders in the control of platoons attached to their commands and inter- vened only when the care of patients was affected.75 When the Southwest Pacific failed to place sufficient attendants on transports evacuating patients during 1944, the Movements Division of the 73 (1) History . . . Medical Regulating Service . . . , sec 3. (2) Rad CM-OUT-69352, WD to CG USAF POA, 28 Nov 44. TC; 322 (Med Hosp Ship Plats). Similar messages were sent to other theaters. (3) Memo for Record, on draft Rad, WD to SWPA and POA, 26 Nov 44. HD: 705 (MRO, Gay Stay- back, 151). (4) Memo, CG ASF for CofT, 8 Dec 44, sub: Request for Prov Med Hosp Ship Plats, Sep. HRS; ASF Planning Div Program Br file, “Hosp and Evac.” 74 (1) Ltr, TAG to CGs NYPE, 1st, 4th, 5th, and 8th SvCs and to SG, 30 Sep 42, sub: Constitution and Activation of 10 Plats. AG; 320.2 (9-30-42) (10). (2) Ltr, TAG to CGs NYPE, 1st, 4th, 5th, 7th, and 8th SvCs and to SG and CofT, 16 Nov 42, sub: Consti- tution and Activation of 30 Plats (Sep) Ship Hosp. AG; 320.2 (1-10-42) (3) Sec 15. (3) Memo, CG SOS for TAG, 5 Jan 43, same sub. AG: 320.2 (1 1-21-42). (4) Memo, SG for Hosp and Evac Br Plans Div SOS, 21 Dec 42. SG: 200.3-1 (BB). (5) Diary, SOS Hosp and Evac Br, 22 Dec 42. HD; Wilson files, “Diary.” (6) Memo for Record, on Memo, CG SOS for SG, 24 Dec 42, sub: Med Hosp Ship Plat, Sep. HD; Wilson files, “Book 2, 26 Sep-31 Dec 42.” (7) Memo, GofF for CGs PEs, 17 Jun 43, sub: Mvmt Orders, Med Hosp Ship Plats, Sep. TG: 322 (Med Hosp Ship Plats). 75 (1) Ltr, CO 584th MHSP, HRPE to SG, 28 Jan 44, sub: Duties Performed by a Med Hosp Ship Plat Overseas. HD: 705 (Hosp Ship Plats). (2) Memo, MRO (Gay) for Gol J[ames] T. McGibony, 15 May 45, sub: Misuse of Med Pers. HD: 705 (MRO, New- man Stayback, 159). PROVIDING THE MEANS FOR EVACUATION BY SEA 419 Office of the Chief of Transportation initiated a War Department cablegram to that theater calling attention to “re- peated reports” that it both overloaded transports and supplied insufficient medi- cal personnel, even though platoons were available. This message pointed out that the Army would suffer serious criticism unless such practices were corrected.76 In 1945 reports reached the Surgeon Gen- eral’s Office that nursing care on trans- ports returning from the Pacific was below “desirable standards.” Believing the cause of this situation to be an inclusion in pro- visional platoons of enlisted men not technically qualified to care for patients, the Chief of Transportation had a War Department message sent to the Pacific urging greater selectivity in choosing men for provisional platoons.77 The medical hospital ship platoon, a wartime development, seems to have justi- fied its existence. On V-E Day 176 regu- larly organized platoons were being used to attend patients returning from the European theater, and several months later there were 116 in the Pacific. Al- together there were 332 platoons in serv- ice in August 1945.78 Officers familiar with their work agreed generally that they per- formed excellently, in view of the difficult mission and adverse conditions—long hours, arduous tasks, and a minimum of leave and recreational opportunities. Moreover, although some felt that den- tists, pharmacists, and laboratory tech- nicians were not really needed in such platoons, representatives of the Surgeon General’s Office agreed in May 1945, in reviewing experience with such units, that their table of organization needed no change. After the war the Medical Regu- lating Officer proposed only one change— the second officer in each platoon might be of any branch of the Medical Depart- ment instead of specifically of the Dental Corps.79 Hospital Ship Complements Although the Army had no hospital ships in the first part of the war, as already pointed out, efforts were made to get them and the Surgeon General’s Office drafted a table of organization for a medical hos- pital ship company early in 1942. Pub- lished in April, it provided for a unit of 14 officers, 35 nurses, 1 warrant officer, and 99 enlisted men to care for 500 patients, and for supplementary units of 2 officers, 4 nurses, and 11 enlisted men for each additional group of 100.80 The approval in May 1942 of the conversion of the Acadia into an ambulance transport and a request in August 1942 by the European theater for three hospital ships made it appear that units organized under this 76 Draft Rad, WD (Mvmt Div OCT) to CinC SWPA, 9 Oct 44, sub: Evac of Puts from Milne Bay. HD: 705 (MRO, Fitzpatrick Stayback, 1495). 77 Draft Rad, WD (Mvmt Div OCT) to CinC AFPAG, CGs SFPE, SPE, TAPE, 20 Jul 45. HD: 705 (MRO, Newman Stayback, 195). 78 Reports of locations, assignments, and move- ments of platoons were kept from March 1943 until their inactivation in 1945-46. See monthly reports in TC: 322 (Med Hosp Ship Plats); in HD; 705 (MRO, Stayback files: Fitzpatrick, Jun 43-Apr 44; Zolnaski, Mar-Nov 44), and in SG: 705, Plats, week- ly Status Rpts, beginning in Mar 44. 79 (1) History . . . Medical Regulating Serv . . . , secs 3 7 and 3.8. (2) Memo for Record, Re- sources Anal Div SCO, 7 May 45, sub: Mtg of T/O Rev Cmtee for Redeployment. HD: 705 (MRO, Newman Stayback, 151). (3) Memo, MRO for Dir Hosp and Dom Oprs SCO, 23 Nov 45, sub: ASF MD T/O&E. HD: 705 (MRO, Hodge Stayback, 514). (4) George F. Jeffcott, A History of the United States Army Dental Service in World War II, Ch. X, pp. 35-42. HD. 80 (1) Ltr, QMG to TAG, 14 Feb 42, sub: Hosp Space on Army Trans. AG; 573.27. (2) T/O 8-537, 1 Apr 42. 420 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR table would be needed. SOS headquarters therefore directed The Surgeon General to plan to supply personnel for them.81 As a result, four hospital ship companies were activated in October and November 1942. One was placed on the Acadia when it became an ambulance transport in De- cember 1942. The other three were not used until the first of the Army’s hospital ships went into service in the summer of 1943.82 After the Army began to select trans- ports for conversion under the 24-hospi- tal-ship program, the table of organiza- tion for hospital ship companies had to be revised. It was designed to supply person- nel for ships with 500 or more beds, but those to be converted were to have vary- ing capacities, ranging from about 300 to 700. Moreover, experience aboard the Acadia returning patients from North Africa had revealed certain inadequacies in the old table. Furthermore, Army hos- pital ships were to be manned by both civilians and soldiers—the former to oper- ate vessels and the latter to care for pa- tients. But there were some services which might be performed by either group. Hence a decision had to be made as to which services each was to perform and military personnel had to be provided accordingly.83 The division of responsibility for border- line services came up in July 1943 when plans were drawn for the conversion of the transport Agwileon into the hospital ship Shamrock. The Surgeon General’s Hospital Construction Branch discovered that the New York Port of Embarkation had de- voted much space considered desirable for litter patients—almost an entire deck lo- cated above the water line— to quarters for the merchant marine crew. To increase this vessel’s capacity for litter patients, the Water Division of the Office of the Chief of Transportation directed reduction of the area occupied by the civilian crew by cutting down both the size of the crew and the space allowed each of its remaining members. The steward’s department was then cut from seventy to thirty-five. Despite some reduction in original space allowance for individual members of the civilian crew, they continued to be pro- vided with more commodious quarters than the Army allowed enlisted men. As a result, The Surgeon General and the Chief of Transportation agreed to use en- listed men as much as possible in order to save space for patients.84 During the fall of 1943 the respective duties of the civilian and military crews were agreed upon and the table of organization for hospital ship companies was revised. It was published on 7 December 1943 as Table of Organi- zation and Equipment 8-537T, Hospital Ship Complement.85 While the new table provided for com- plements to serve on ships ranging in ca- pacity, by hundreds, from 200 to 1,000 81 (1) Memo, CG SOS for SG, 22 Aug 42, sub: Add Hosp Ships. SG: 560.-2. (2) Memo, SG for CG SOS, 24 Aug 42, sub: Request for Auth and Activation of Certain Req SOS Med Units. SG: 320.3-1. 82 (1) Memo, CG SOS for ACofS G-3 WDGS, 10 Oct 42, sub: Deletion of 107th Gen Hosp from Cur- rent Trp Basis, with Memo for Record. AG: 320.2 (10-10-42). (2) Diary, SOS Hosp and Evac Br (Fitz- patrick), 31 Dec 42. HD: Wilson files, “Diary.” (3) See pp. 398, 403-04. 83 (1) Ltr, CO 204th Hosp Ship Co to GG NYPE thru Surg NYPE, 8 May 43, sub: Request for Change in T/O. TC: 320.3 (Acadia). (2) Harold P. James, Transportation of Sick and Wounded [1945]. HD. 84 Memo, Lt Col Afchilles] L. Tynes for SG, 3 Jul 43, sub: Revised Plans for Hosp Ship Agwileon. HD: 560.2. 85 (1) Memo for Record, by Maj Howard A. Donald, SGO, 27 Sep 43, sub: T/O for Hosp Ship Cos. SG: 320.3-1. (2) Rpt of Conf, Med Hosp Ship Complement, 30 Sep 43. SG: 560.-2. (3) Memo, SG for CG ASF, 13 Nov 43, sub: T/O 8-537, Hosp Ship Complement. AG: 320.3 (20 Nov 43) (2). PROVIDING THE MEANS FOR EVACUATION BY SEA 421 beds, it differed from the old primarily in the number of enlisted men authorized for nonmedical duties. A comparison of the complement authorized for a 500-bed ship under the new table with that for a vessel of the same capacity under the old one illustrates the changes made. The number of doctors—eight—remained the same. While the number of nurses was reduced from thirty-five to thirty-four, a hospital dietitian was added. The number of den- tists was reduced from two to one, but Medical Administrative Corps officers were increased from two to three. One Sanitary Corps officer and one chaplain were added to the commissioned staff. Although the number of technicians was reduced by one, the number of medical supply and administrative men was in- creased from twelve to seventeen. Greatest changes affected enlisted men in the non- medical services and were governed by the division of duties between civilian and military crews announced by the Trans- portation Corps in December 194 3.86 Be- cause the civilian crew was to prepare food for all persons aboard, with the ex- ception of special diets for patients, the seventeen military cooks formerly author- ized were reduced to one. Since the mili- tary crew was to furnish cooks’ helpers, the latter were raised in number from ten to twelve. In addition, the military crew was to supply guards for certain sections of the ship (primarily those occupied by pa- tients), operate the laundry, and supply dining room service for assigned enlisted men, patients, and both civilian and mili- tary personnel authorized to eat in the saloon mess. It was also to provide room service for all patients and military per- sonnel. For these purposes forty-seven en- listed men were added. To permit them to serve in wards when not engaged in non- medical duties, thirty-one were to be trained and classified as ward orderlies. Division of responsibilities between military and civilian crews in the fall of 1943 did not eliminate all problems in- volved in using both civilians and enlisted men on hospital ships. In February 1944 the crews of two threatened to strike un- less civilians were placed in some of the jobs filled by enlisted men. To avoid an interruption in evacuation operations, The Surgeon General and the Chief of Transportation agreed to a compromise.87 Responsibility for furnishing dining room service in the saloon mess (for both the civilian and military personnel eating there) and for supplying cooks’ helpers was transferred to the civilian crew, and the average number of civilians in the steward’s department was increased from about thirty-five to about forty-five. This change removed enlisted men from their point of greatest contact with the civilian crew and was expected to reduce friction between the two groups. While it was not reflected in a reduction of the military crew until early in 1945, the change did affect plans for the conversion of trans- ports into hospital ships, for the drawings already made had to be modified to pro- vide quarters for the additional civilians. Thereafter, the Chief of Transportation supplied the Surgeon General’s Office with manning tables for each of the hospi- tal ships being provided, so that accom- 86 OCT Cir 164, sub: Div of Responsibility Aboard US Army Hosp Ships, 10 Dec 43, (revised 15 Mar 44). HD; 705 (MRO, Fitzpatrick Staybacks, 840, 970). 87 (1) Memo, Dir Hosp Admin Div SCO for Chief Hosp Cons Br Hosp Div SCO, ca. Feb 44, sub: Qtrs for Civ Crews, Hosp Ships. HD: 560.2 (Hosp Ships, Hosp Cons Br). (2) Memo, SG (Fitzpatrick) for GofT (Water Div), 22 Feb 44, sub: Full Civ Crews Aboard Army-Opr Hosp Ships. HD; 705 (MRO, Fitzpatrick Stay back, 848). 422 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR modations for the civilian crew might be planned and, at the same time, as much space as possible be saved for patients.88 Early in 1945 the table of organization for hospital ship complements was revised. Two of the five additional hospital ships authorized in December 1944 were to have capacities exceeding 1,000 beds each. The revised table took this situation into account, providing for a complement for a 1,500-bed ship. It also reflected the shift of responsibility for providing cooks’ helpers from the military to the civilian crew by reducing the number authorized for a 500-bed ship from ten to two. These two were kept to assist one military cook in the preparation of special diets for pa- tients. The number of “basic” soldiers was also reduced—from twelve to seven. Nevertheless, the total number of enlisted men in the complement for a 500-bed ship was reduced by only five, because two men were added to perform nonmedical functions, the number of technicians was increased from forty-four to forty-eight, and four men were added to conduct educational and physical reconditioning programs. One nurse was eliminated. Otherwise the number of commissioned officers remained the same. The new table also reflected a function not originally an- ticipated for Army hospital ships—hospi- talization of casualties resulting from the initial phases of landing operations. Unlike Navy hospital ships, which were fitted for definitive medical and surgical treatment at sea, Army hospital ships were planned and staffed to transport patients who had already received treatment in shore instal- lations and needed only a minimum of medical and surgical care en route. After some had been used in support of amphib- ious operations, the suggestion was made that the tables of organization of comple- ments of such ships should be revised to include an appropriate concentration of specialists. The Surgeon General’s Office believed that the sporadic use of Army hospital ships for amphibious operations did not justify such action. Therefore the new table authorized the reinforcement of normal complements with special medical professional service teams when hospital ships were used in support of amphibious landings.89 Since a hospital ship complement was assigned to each ship, the activation and training of complements was keyed to the program of converting transports to hospi- tal ships. From the time the first four were activated in the latter part of 1942 until the end of January 1945, twenty-five addi- tional complements were organized and trained. Three were used on the Hope, Comfort, and Mercy. Twenty-four were used on hospital ships operated by the Army, while two were never used because com- pletion of the ships for which they had been organized was suspended when the war ended.90 Problems in Providing Supplies and Equipment for Hospital Ships and Transports Furnishing medical equipment and supplies for patients evacuated by sea de- pended upon many variable factors. 88 (1) Tynes, Construction Branch, pp. 96-100. (2) Ltr SPTOW 231.81, CofT to SG, 7 Mar 44, sub: Auth Manning Scales Aboard US Army Hosp Ships. SG: 320.4-1. (3) For other manning tables, see HD: 560.2 (Hosp Cons Br, under name of ship). 89 (1) T/O&E 8-537, 3 Mar 45. (2) Memo, MRO for SG (Orgn and Equip Allowance Br), 16 Jun 45, sub; Recomd Changes in T/O&E. HD: 705 (MRO, Hodge Stayback, 361). 90 History . . . Medical Regulating Service . . ., sec 4.21, with inch PROVIDING THE MEANS FOR EVACUATION BY SEA 423 Among them were the type of ship (troop transport, ambulance ship, or hospital ship), the size and patient capacity of each, the kinds of patients carried (litter, mental, and ambulatory), and the num- ber of days at sea (determined by the speed of each vessel and the length of its voyage). For this reason the initial issue of medical items, as well as replacement is- sues after each voyage, required individual consideration by port surgeons and medi- cal supply officers. Before the war they collaborated locally with transport sur- geons in determining the needs of each transport and in supplying initial and re- placement allowances of medical items.91 In connection with more general planning for sea evacuation operations early in 1942, The Surgeon General proposed that this system be continued, but that port surgeons be guided by lists of equipment to be supplied by his Office. SOS head- quarters announced its approval of this proposal on 18 June 1942.92 Meanwhile in collaboration with transport surgeons, the medical supply officer of the New York Port had prepared typical requisitions for use in making initial issues of equipment and supplies to transports hurriedly placed in service after the war began.93 The Surgeon General’s guide, distrib- uted at the end of June 1942, contained lists of equipment and supplies for 60-day voyages for 500-bed hospital ships, 500- bed ambulance ships, and transports car- rying outbound troops in multiples of 1,000 and inbound patients in multiples of 100. Among the items included in each list were drugs and biologicals, surgical gauzes, surgical instruments, dental sup- plies and equipment, laboratory supplies and equipment, X-ray supplies and equip- ment, operating room equipment, and the like.94 In the fall of 1942 the Surgeon Gen- eral’s Office revised these lists and in De- cember issued them in a new form.95 The problem of equipping and supply- ing hospital ships assumed new importance after the Army was authorized to provide and operate its own. Vessels selected for conversion under this program were to have patient capacities varying from about 300 to 700. It was therefore necessary for the Surgeon General’s Supply Division to prepare individual equipment lists, at least for the first few ships converted.96 After they were prepared the Transporta- tion Corps was informed of fixed equip- ment and its dimensions, so that plans could be made for its installation, and medical depots were instructed to make initial issues of supplies and equipment to each hospital ship.97 In the winter of 1943-44 the Surgeon General’s Office de- veloped standard equipment lists for hos- pital ships with 200-, 500-, and 1,000-bed capacities and for 100-bed expansion 91 For example, see Ltr, Port MSO NYPE to SG, 30 Mar 42, sub: Med Equip of Trans. HD: 541 (Equip for Trans). 92 (1) 2d ind, Act SG to CG SOS (Dir Oprs), 8 Apr 42, on Memo, CofT for CG SOS, 13 Mar 42, sub: Hosp Space on Army Trans. SG: 632.-1 (BB). (2) Ltr SPOPM 322.15, CG SOS to CGs and GOs of GAs, PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Oprs Plans for Mil Hosp and Evac, with inch AG: 704. 93 Ltr, Surg NYPE to SG thru GG NYPE, 18 Mar 42, sub: Standardized Initial Med Sups for Army Trans, with 2 inds. HD: 541 (Equip for Trans). 94 Ltr, SG to CGs PEs, 29 Jun 42, sub: Opr Plans for Mil Hosp and Evac, with 3 tables. HD: 705 (Hosp and Evac). 95 (1) Memo, ACofS for Oprs SOS for SG, 22 Aug 42, sub: Basic Equip Lists for Hosp Ships and Ships’ Hosps. AG: 573.27 (8-22-42). (2) Instructions for Transport Surgeons, NYPE, 1943. HD: 560.2 (NYPE). 96 For example, see (1) Ltr, SG to SPE, 3 Nov 43, sub: Conv of S.S. President Fillmore into a Hosp Ship. HD: 560.-2 (Hosp Ships). (2) Ltr SPMC 632.-1 (BB), SG to SFPE, 3 Nov 43, sub: Conv of S.S. Ernest J. Hinds into a Hosp Ship. Same file. 97 Memo, SG for CofT, 26 Nov 43, sub: Med Equip for Ships. SG; 475.5 (BB). 424 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR units.98 These lists were revised, along with those for transports, in March 1944 and again in April 1945." In addition to medical items ships needed other supplies and equipment. Medical Department units serving on ships needed certain organizational equip- ment. To meet this need, tables of equip- ment were issued early in 1943 for medical ambulance ship companies and for medi- cal hospital ship companies.100 Certain housekeeping items, such as mess equip- ment, beds, mattresses, and blankets, were required for ships’ operating crews as well as for medical staffs and patients. During 1942 the Medical Department and the Transportation Corps worked out a divi- sion of responsibility for supplying them. In general the Transportation Corps agreed to furnish all nonmedical items and all mess equipment, beds, mattresses, blankets, and linens not used for “strictly medical” purposes.101 In planning to equip the Hope, Comfort, and Mercy, the Army and the Navy en- countered difficulty in dividing items for which each was responsible. The Army understood that the Navy and its contrac- tors were to supply all medical equipment that was fixed, or attached, to these ships and that the Army was to furnish all port- able medical equipment. It turned out that the Army had to supply all, including fixed medical equipment, such as dental operating chairs, operating tables, and X-ray machines.102 Uncertainty existed for a while, also, over whether the Army or the Navy with its contractors was to supply housekeeping items. This matter was clarified in an agreement by which the Navy was to supply all portable mess- ing equipment, linens, and blankets, and its contractors were to furnish all mat- tresses and pillows except those furnished by the Navy for enlisted crews employed in ships’ operations.103 During the first half of the war other problems developed in connection with the equipment of ships. The Surgeon Gen- eral’s Office believed that adjustable berths similar to beds used in hospitals were needed for seriously ill patients. As a re- sult, a particular type of adjustable berth, known as a “gatch bed,” was developed for use on Army hospital ships.104 Alternat- ing current (AC) electrical equipment, which the Medical Department had in stock and procured in the early part of the war, was unsuitable for use on ships which had direct current (DC) systems. To solve this problem direct current equipment was procured in a few instances, but generally converters were placed on ships so that equipment in stock could be used. Because of the possibility of creating signals that would reveal ships’ positions to enemy naval craft, the use of electrotherapeutic equipment on transports was limited.105 98 Equip Lists Nos 97239-05 (200 bed); 97239-10 (500 bed); 97239-15 (1000 bed); 97239-20 (100 bed expansion units), in ASF Med Sup Catalog MED 3, 1 Mar 44. 99 (1) ASF, MD Consolidated Equip List No 3, 5 Mar 44. (2) ASF Med Sup Catalog MED 10-4, Apr 45. i°° T/E 8-538, 20 Jan 43; T/E 8-537, 10 Apr 43. 101 Memo, SG (Tng) for CofT (Water Div), 14 Sep 42, sub: Med Equip for Hosp Ships, Amb Ships and Trans Ships. SG: 475.5-1 (BB). 102 Tynes, Construction Branch, p. 92. 10:i See SGO (Hosp Cons Br) correspondence with Cox and Stevens, New York City and with the Navy (BuShips) in HD: 560.2 (Hosp Cons Br, Hosp Ships Hope, Mercy, and Comfort). 104 Ltr, SG (Tynes) to CofT (Water Div), 17 Nov 42, sub: Plans for Double Deck Hosp Berth With Gatch Bottom Berth. SG; 427.-4 (BB). 105 (1) Ltr AH6/S63(665-517), AH7/S63, AH8/- S63, BuShips to SupShip NY, and San Pedro, Calif, 28 Jun 43, sub: Hosp Ships, AH6 to 8, A.C. Power Sups for LG. Sys. TC: 632 (Hosp Ships). (2) Memo, CG SOS (Lutes) for CofT, 8 Oct 42, sub: Electro- therapeutic and X-ray Equip Aboard US Army Vessels. HD; 705 (MRO, Fitzpatrick Daybook). PROVIDING THE MEANS FOR EVACUATION BY SEA 425 A significant development occurred in the latter half of the war in connection with the laundries of hospital ships. Laun- dries aboard ships were necessary if the quantities of linens carried were not to be inordinate. Yet laundry operations con- sumed a tremendous volume of fresh wa- ter, and while hospital ships could not afford to curtail laundry operations it was imperative that fresh water for other uses receive higher priority. To solve this prob- lem the Surgeon General’s Office devel- oped a salt-water washing process. In the summer of 1944 successful tests at the Na- val Receiving Station and the Army Medical Center (both in Washington, D. C.) demonstrated that salt-water wash- ing was both safe and efficient. The proc- ess that was developed involved the use of salt water and certain detergents for suds and first rinses and of fresh water for the final rinse and sour. This process, ulti- mately used on all Army hospital ships, reduced by about 80 percent the amount of fresh water ordinarily needed for laun- dry operations.106 108 (1) Historical Record, Laundry Section, Hos- pital Division, [SGO], 1 July 1944, pp. 22-25, and exhibit 27. HD: 024. (2) Diary, Hosp and Dom Oprs SGO, 18 Aug 44, par 6, Laundry Sec. HD: 024.7-3. 304244 0—55 29 CHAPTER XXIV Providing the Means for Evacuation by Air Experiences of World War II firmly established air transportation as an accept- able if not preferable method of evacu- ation, not only within theaters but also from overseas areas to the zone of interior and from one point to another within the latter. Because of insatiable demands from all quarters for aircraft, the movement of patients by plane, even more than by sur- face vessels, had to be fitted in with the transportation of troops and cargo. In the- aters this problem was often solved by informal arrangements between local sur- geons and air force commanders. In the zone of interior agreement was reached only after a debate over whether special planes would be provided for evacuation alone or whether all transport planes would have a dual purpose—the transpor- tation of troops and cargo in one direction and of patients in the other. The Medical Department wanted special ambulance planes for use in all areas—combat zones, communications zones, and the zone of in- terior. AAF headquarters, on the other hand, insisted upon maximum use of all planes and therefore adopted a policy of using aircraft with other primary missions for evacuation also. Thereafter, the Medi- cal Department and the Army Air Forces collaborated in arrangements for the adaptation of transport planes to the evacuation mission. Aircraft Prewar Plans for Airplane Ambulances Before the war, plans for the procure- ment and use of airplane ambulances were nebulous. Perhaps one reason was that there was no tradition of using special planes in wartime for evacuation only. With the development of air transporta- tion during World War I and the years that followed, surgeons of various airfields had experimented with the development and use of small airplane ambulances.1 Repeatedly in the 1930’s The Surgeon General had requested the procurement of at least seven airplane ambulances for the movement of patients in the United States during peacetime and for experi- ments upon which plans for their use in wartime could be based. In each instance, because of difficulty encountered in secur- ing sufficient funds for the procurement of requisite planes for training and for de- fense of the United States, the General 1 David N. W. Grant, “Airplane Ambulance Evac- uation,” The Military Surgeon, vol. 88, Np. 3 (1941), pp. 238-43. PROVIDING THE MEANS FOR EVACUATION BY AIR 427 Staff, on the advice of the Chief of the Air Corps, had disapproved The Surgeon General’s requests.2 Instead, a policy established as early as 1931 continued in effect. Special airplane ambulances were not normally provided, but regular trans- port planes were fitted with litter-holding brackets to enable them to move patients from one hospital to another. In excep- tional cases only, training centers were permitted to convert small planes into air- plane ambulances for crash-rescue work (that is, the rapid removal of persons from airplane accidents to hospitals of their home stations).3 During 1940 opinion among medical officials as to the need for airplane ambu- lances in wartime crystallized. Experience of the Germans in air evacuation during the Polish campaign, an account of which appeared in the Army Medical Bulletin/ perhaps contributed to this development. The chief of the Medical Division of the Office of the Chief of the Air Corps, the surgeon of GHQAir Force, and The Sur- geon General agreed that two types of planes would be needed—small planes for the transportation of one or two casualties from medical stations in divisional areas to hospitals farther in the rear, and large planes for the removal of greater numbers of patients from evacuation hospitals to general hospitals in communications zones or the zone of interior. They agreed also that such planes should be set aside exclusively for air evacuation and should be under the control of theater headquar- ters.5 The Chief of the Air Corps and the General Staff implied approval of these propositions, and the latter on 5 Septem- ber 1940 directed the Chief of the Air Corps to maintain plans for converting standard transport airplanes and suitable single-engine airplanes to ambulance use.6 This directive uncovered an important problem. While the procurement of large ambulance planes was expected to be relatively simple, since either civilian or military transports could be readily con- verted by the installation of litter racks, the procurement of small airplane ambu- lances promised to be considerably more difficult. In September 1940 the Chief of the Air Corps stated that no small planes suitable for conversion were either avail- able or anticipated for procurement. The General Staff then verbally modified its directive, relieving the Air Corps of re- sponsibility for maintaining plans for the wartime conversion of single-engine air- planes.7 Soon afterward, when the Gulf 2 (1) Memo, ACofS G-4 WDGS for CofSA, 8Jun 32, sub: Aircraft for Amb Serv. HRS: G-4/29413. (2) Ltr, SG to TAG, 7 Nov 33, same sub, with 3 inds. AAF: 452.1 (Amb Planes). (3) Memo, ACofS G-4 WDGS for CofSA, 22 Nov 33, same sub. HRS; G-4/29413. (4) Ltr, SG to TAG, 5 Sep 34, same sub, with 3 inds. AAF: 452.1 (Amb Planes). (5) Memo, ACofS G-4 WDGS for CofSA, 17 Sep 34, same sub. HRS: G-4/29413. 3 (1) 2d ind, CofAG to Chief Mat Div AC Wright Fid, 5 Dec 31, on Ltr, Maj Robert [E. M.] Goolrick, AG to GofAC thru Chief Mat Div Wright Fid, 23 Oct 31, sub: Amb Airplanes. AAF: 452.1 (Amb Planes). (2) Memo, Chief Med Sec OGofAC for SG, 25 Jan 38. SG: 451.8-1. 4 (1) Ltr, SG to CofAG, 5 Apr 40, sub: Airplane Casualty Evac in the German-Polish War. SG: 580.1. (2) Army Medical Bulletin, No. 53 (July 1940), pp. 1-10. 5(1) Ltr, Surg GHQ AF to Chief Med Div OGofAC, 20 Jun 40. SG; 320.3-1. (2) Memo, Chief Med Div OGofAC for SG, 21 Jun 40. Same file. (3) Ltr, SG to TAG, 11 Jul 40, sub; Air Corps Med Trans Group. AG: 320.2 Med (7-11-40). 6 (1) 2d ind, CofAG to TAG, 24 Jul 40, on Ltr, SG to TAG, 11 Jul 40, sub: Air Corps Med Trans Group. (2) Memo, ACofS G-3 WDGS for CofSA, 7 Aug 40, sub: Air Amb Serv. (3) Memo, TAG to GofAC, 5 Sep 40, same sub. All in AG; 320.2 Med (7-11-40). 7 (1) R&R Sheet Comment 1, Exec OGofAC to Tng and Oprs, Plans and Mat Divs OGofAC, in turn, 9 Sep 40, sub: Air Amb Serv. AAF: 452.1-B (Amb Planes). (2) R&R Sheet Comment 3, Plans Div OGofAC to Mat Div OGofAC thru Exec, 17 Sep 40, same sub. Same file. 428 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Coast Air Corps Training Center re- quested procurement of single-engine air- plane ambulances for peacetime crash- rescue work, the Chief of the Air Corps disapproved the purchase of airplanes ex- clusively for ambulance service, but stated, strangely enough, that small planes already in service might be converted into ambulances.8 A subsequent investigation confirmed his earlier opinion that light planes in service were not suitable for con- version. Some were too old; others were too small; and still others had openings that were too small to admit litters and were incapable of enlargement without weakening the fuselages of planes.9 Early in 1941, therefore, the Chief of the Air Corps permitted the conversion into am- bulances of three small planes of a new type just being procured—0-49s—pro- vided this action did not seriously delay the assignment of planes to observation squadrons.10 By July 1941 it was reported that each of these had been converted to carry one litter patient and a medical at- tendant, in addition to the pilot, and had been assigned to training centers.11 Meanwhile the Surgeon General’s Of- fice and the Medical Division of the Office of the Chief of the Air Corps had been making plans for the use of airplane am- bulances in both forward and rear areas of combat zones. During 1940 and 1941, as will be seen later, they developed a table of organization for units that would evac- uate patients in airplane ambulances and requested the publication of information about such units in a Medical Depart- ment field manual. They also devoted at- tention to the problem of developing a small plane suitable for use in front-line areas. From the time when the National Research Council suggested in October 1940 that an Autogiro might solve this problem, the Surgeon General’s Office maintained a steady correspondence with the company producing such planes. In September 1941 representatives of that Office and of the Medical Division of the Office of the Chief of the Air Corps wit- nessed a demonstration of an Autogiro and discussed with company officials the characteristics desired in a front-line air- plane ambulance.12 By the latter part of November the company producing Auto- giros submitted drawings for an ambu- lance. The Air Corps Materiel Division agreed that this type of plane, if success- fully developed, would be useful in for- ward areas, but believed that the one pro- posed would be unsuccessful because of its weight. It recommended, therefore, that further action on the question of an am- bulance Autogiro be suspended until after completion and testing of others being developed for Air Corps tactical mis- sions.13 8 (1) R&R Sheet Comment 6, Mat Div OCofAC to Med Div OCofAC, 3 Dec 40, sub: Air Amb Serv. (2) R&R Sheet Comment 7, Med Div to Mat Div, 16 Dec 40, same sub. (3) R&R Sheet Comment 10, Plans Div OCofAC to Exec, OCofAC, 31 Dec 40, same sub, with approval by GofAC. All in AAF: 452.1-B (Amb Planes). 9 Memo, Fid Serv Sec Mat Div Wright Fid for Tec Exec Mat Div Wright Fid, 1 7 Jan 41, sub; Info . . . Regarding Amb Airplanes. AAF: 452.1-B (Amb Planes). 10 (1) R&R Sheet Comment 1, Mat Div OCofAC to Exec OCofAC, 23 Feb 41, Comment 3, Tng and Oprs Div OCofAC to Exec OCofAC, 1 Mar 41; and Com- ment 4, Exec OCofAC to Mat Div OCofAC, 4 Mar 41, sub: Amb Airplanes. All in AAF: 452.1-B (Amb Planes). 11 Memo, Mat Div Wright Fid for Mat Div OCofAC, 29 Jul 41, sub: 0-49 Amb Airplanes. AAF: 452.1-B (Amb Planes). 12 See SG: 452.-1, and Off file, Research and Dev Bd SCO, “Amb Airplane.” 13 (1) Memo, Mat Div OCofAC for Mat Div Wright Fid, 28 Nov 41, sub; Amb Autogiro. AAF: 452.1-B (Amb Planes). (2) Memo, Mat Div Wright Fid for Mat Div OCofAC, 3 Jan 42, same sub. Same file. PROVIDING THE MEANS FOR EVACUATION BY AIR 429 C-46 TRANSPORT PLANE READY TO UNLOAD PATIENTS. The ambulance on the right is a 3A ton (4x4) knock-down type. Decision Not To Provide Separate Transport Planes for Evacuation Soon after war began, the need for air evacuation was met by the peacetime practice of using regular transports. The first occasion requiring the movement by air of large numbers of patients occurred in January 1942 during construction of the Alcan Highway to Alaska. The sec- ond occurred in Burma in April 1942. In both instances regular transport planes (G-47s) already equipped with litter brackets were pressed into ambulance service.14 Successful evacuation by transports did not remove the desire of some military agencies for separate airplane ambu- lances. In July 1942 the Alaska Defense Command asked for a large airplane am- bulance, and was supported in its request by the Western Defense Command. The next month The Surgeon General re- quested an airplane ambulance for use in transporting patients from the Newfound- land Base Command to the United States. These requests produced a confirma- tion—in view of the wartime demand for planes for other purposes—of the existing policy of not providing special planes for ambulance service only, but of equipping all transports with litter brackets so they might be used for evacuation as well as for normal missions.15 AAF headquarters encountered some difficulty in the observance of this policy. 14 Frederick R. Guilford and Burton J. Soboroff, “Air Evacuation: An Historical Review,” Journal of Aviation Medicine, Vol. 18 (December, 1947), pp. 601-16. 15 (1) Ltr, CG Alaska Def Comd to CG Western Def Comd, 14 Jul 42, sub: Aircraft Amb for Alaska, with 2 inds. AG: 452 (7-14-42). (2) Ltr, CG Eastern Def Comd to CG AAF, 31 Jul 42, sub: Air Amb Evac of Pnts from Newfoundland Base Comd, with 4 inds. SG: 705.-1 (Newfoundland)F. 430 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR INTERIOR OF C-46 TRANSPORT PLANE, equipped with webbing strap litter supports. Litter brackets were not always installed in transport airplanes, particularly in new types developed to meet wartime needs. In August 1942 the Air Service Command stated that C-53 transport planes were being procured without litter supports and that the makers of these planes con- sidered it impossible, because of difficulty in obtaining parts for litter racks for C-47s, to install them in C-53s before January 1943. The commanding general, Army Air Forces, then directed the Ma- teriel Command to review its transport procurement program to assure the instal- lation of litter supports in planes during their manufacture and to provide for their installation in all C-53s purchased with- out them.16 Several months later the Air Transport Command requested that litter supports be provided by manufacturers for all C-46s. Expressing irritation with failure to equip transport planes with litter supports, the AAF Directorate of Military 16 1st ind, Chief Fid Serv Air Serv Comd AAF to CG Air Serv Comd AAF, 4 Aug 42, and 3d ind, CG AAF to CG Mat Comd AAF, 21 Aug 42, on Ltr, Chief Overseas Div Air Serv Comd AAF to Chief Fid Serv Air Serv Comd AAF, 20 Jul 42, sub: Litter Racks for C-53 Airplanes. AAF: 370.05 (Evac). PROVIDING THE MEANS FOR EVACUATION BY AIR 431 INTERIOR OF C-54 TRANSPORT PLANE equipped with metal litter supports. Requirements called upon the Materiel Command for a report. In reply that Command summarized the situation. All C-47s were completely equipped with litter supports during production. While a shortage of critical materials had pre- vented installation in the first twenty-four C-46s delivered, all others would come equipped. Beginning in December 1942, all C-53s would be provided with litter brackets by manufacturers. Meanwhile, the Air Forces would install them in 200 planes of that type already delivered. Beginning in January 1943, supports for ten litters would be placed in each C-60. Finally, all new types of transports would be equipped with litter supports when deliveries began.17 Small Planes for Ambulance Service at Training Centers The question of the assignment to train- ing centers of small ambulance planes for rescue work was raised again when the 17 R&R Sheet Comment 1, CG ATC to Mil Reqmts Dir AAF, 26 Oct 42; Comment 2, Mil Reqmts Dir AAF to Mat Comd AAF, 2 Nov 42; and Comment 3, Mat Comd AAF to Mil Reqmts Dir AAF, 5 Nov 42, sub: Removable Insulation and Litter Supports for G-46 Airplanes. AAF; 370.05 (Evac). 432 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Southeast Air Corps Training Center re- quested in May 1942 the assignment of one each to its flying training schools. While the AAF Directorate of Military Requirements observed a policy of neither developing nor altering an airplane so as to provide an additional type, it was will- ing that planes of other types be used to carry patients. It therefore directed the AAF Materiel Command on 18 June 1942 to examine all small transport and liaison planes being procured in order to determine which could be readily adapt- ed, with least modification, to carry litters.18 The Materiel Command reported in August 1942 that small planes most suit- able for adaptation to ambulance service were the AT-7 and the G-64. The Air Forces had 127 of the former on hand, and 300 C-64s were being procured. Either could be modified to carry at least two lit- ters and a medical attendant, in addition to the pilot. They would be more suitable than the 0-49s (L-ls) already converted, because the latter required more extensive modification and carried only one litter and a medical attendant, in addition to the pilot. The Materiel Command there- fore requested authority to have a local subdepot modify one AT-7 and to have a manufacturer modify one C-64 in pro- duction, in order to determine which would be preferable as an ambulance.19 This recommendation was considered by AAF headquarters, along with a re- quest of the Flying Training Command for assignment to the Gulf Coast, West Coast, and Southeast Air Force Training Centers of sixty-two small ambulance planes and of thirteen larger planes of greater cruising range, such as C-60s.20 On 20 August 1942 the Assistant Chief of Air Staff for Training, A-3, announced that all small planes being procured were earmarked for other missions.21 AT-7s were in such demand for the navigation training program that C-60s were being modified to supplement them. All C-64s being procured were to be used in com- munications work, pilot dispersal, and light cargo movement. Consequently it was decided not to modify AT-7s, but to have manufacturers equip all C-64s, be- ginning in January 1943, with brackets for three litters. Since none of the latter were assigned to the Flying Training Command, the commanding general, Army Air Forces announced on 8 Novem- ber 1942 that it would have to meet its re- quirement for airplane ambulances by having litter supports installed in planes already on hand.22 The issue of airplane ambulances in the United States came up again on 12 Jan- uary 1943 when the Air Surgeon proposed the assignment of L-IBs—liaison planes 18 Ltr, CG Southeast AC Tng Ctr to CG Flying Tng Comd AAF, 7 May 42, sub: Amb Airplanes, with 5th ind, Dir Mil Reqmts AAF to CG Mat Comd AAF, 18 Jun 42. AAF: 452.-1 (Amb Planes). 19 (1) Rpt, AAF Mat Ctr Wright Fid, 10 Aug 42, sub: Selection and Modification of Small Aircraft for Amb Serv. (2) R&R Sheet Comment 1, Mat Comd AAF to War Orgn and Mvmt Dir AAF, 16 Aug 42, sub: Amb Airplanes. Both in AAF: 452.-1 (Amb Planes). 20 Ltr, CG Flying Tng Comd AAF to CG AAF, 5 Aug 42, sub: Amb Airplanes. AAF: 452.-1 (Amb Planes). 21 R&R Sheet Comment 5, AC of Air Staff for Tng A-3 to War Orgn and Mvmt Dir AAF and Indiv Tng Dir AAF, 20 Aug 42, sub; Amb Planes. AAF; 452.-1-B (Amb Planes). 22 (1) Interoffice Memo, Captjohn P. Marshall Mat Comd AAF to Col Seesums, 19 Aug 42, sub: Amb Airplanes. (2) R&R Sheet Comment 3, Indiv Tng Dir AAF to War Orgn and Mvmt Dir AAF, 5 Oct 42; Comment 7, Indiv Tng Dir AAF to Mat Comd AAF, 22 Oct 42; Comment 10, War Orgn and Mvmt Dir AAF to Indiv Tng Dir AAF, 2 Nov 42, same sub. (3) Memo, CG AAF for CG Flying Tng Comd AAF, 8 Nov 42, same sub. All in AAF; 452.1 (Amb Planes). PROVIDING THE MEANS FOR EVACUATION BY AIR 433 modified by manufacturers to carry one litter and one medical attendant, in ad- dition to the pilot—to meet a need ex- pressed by the Second Air Force. Soon afterward the Flying Training Command renewed its attempt to get airplane ambu- lances. By this time—the spring of 1943— training programs, such as the glider tow- ing program, were being curtailed and small liaison planes (L-ls) formerly used were no longer needed. As a result, some of them were assigned for ambulance serv- ice to the Second Air Force, and the Fly- ing Training Command was permitted to modify about 100 liaison-type planes to meet its needs.23 Soon afterward the AAF Requirements Division announced offi- cially a policy which it had formerly ob- served without publicity. When a training station needed a special airplane to be held always in readiness purely as an am- bulance airplane, its requirement would be treated as a special one and would be met by the conversion of a suitable avail- able plane. Such conversions were to be held to a minimum and were to be made only when specifically approved by AAF headquarters.24 The Question of Airplane Ambulances for Use in Combat fpnes After the war began, the Air Surgeon and The Surgeon General continued to plan for the use of small airplane ambu- lances in combat zones. Their problem in this instance was twofold: (1) to find a suitable plane and (2) to get it delivered in appropriate numbers for use by evac- uation units. Various types of planes were considered. It was agreed that a successful one would have to accommodate at least two litters and a medical attendant, in addition to its pilot, and would have to be able to go in and out of small fields over tops of trees and other obstructions. Before the war, as mentioned above, The Surgeon General had thought that an Autogiro might be developed with these characteristics. In May 1942 an aircraft corporation sub- mitted photographs of a small airplane ambulance which it had developed.25 Both The Surgeon General and the Air Surgeon proposed that it be studied and demonstrated, even though it could ac- commodate only a pilot and one patient,26 but after consultation with the AAF Di- rectorate of Military Requirements the Materiel Command informed the com- pany that the Army had no use for such a plane. It stated that litter bearers were the most effective means for removing casual- ties from battlefields with rough terrain; that even if the terrain were suitable for landing, a plane was too vulnerable a tar- get to risk in advanced areas; and, finally, that any plane that lacked room for a medical attendant was unsatisfactory.27 Somewhat later, in June, another manu- facturer demonstrated to representatives 23 (1) R&R Sheet Comment 1, Air Surg to Mil Reqmts Dir AAF, 12 Jan 43, and Comment 3, War Orgn and Mvmt Dir AAF to Air Surg, 16 Mar 43, sub: Airplane Amb (L-1A). AAF: 452.1 (Amb Planes). (2) Routing Slip, [Lt Col] C. W. G[lanz], Mil Reqmts Dir AAF to Col MJervin] E. Gross, 15 May 43. AAF: 370.05-A (Evac). 24 AAF Mil Reqmts Policy No. 41, 25 May 43, sub: Amb Airplanes—Provisions for Evac Wounded by Cargo Airplanes. AAF: 370.05-A (Evac). 25 Ltr, Aeronca Aircraft Corp to Hon John J. Mc- Cloy, Asst SecWar, 20 Apr 42, with inch SG: 452.1. A similar letter to the Commanding General, Army Air Forces is on file in AAF: 452.1-B (Amb Planes). 26 (1) Ltr, SG to Hon John J. McCloy, Asst SecWar, 5 May 42. (2) Memo, Col David N. W. Grant, Air Surg for Col H[oward] T. Wickert, SGO, 11 May 42. Both in SG: 452.1. 27 Ltr, Lt Gol F. I. Ordway, Jr, AC, Asst Exec Mat Comd to Aeronca Aircraft Corp, 5 May 42. AAF: 452.1-B (Amb Planes). 434 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR of the Air Surgeon and The Surgeon Gen- eral a small plane which he had converted into an ambulance. It was likewise con- sidered unsatisfactory because it also had room for only one patient and a pilot.28 Meanwhile, the Air Forces had begun the investigation, already mentioned, of small transport and liaison planes which train- ing centers might adapt to ambulance use. Apparently the Air Surgeon believed that this might result in discovery of an exist- ing plane that could be used in combat zones as well as in the zone of interior.29 Despite uncertainty about the avail- ability of a suitable plane for use in for- ward areas, the Air Surgeon continued to plan in those terms. One method of get- ting approval for his plans was to have airplane ambulances considered as or- ganic equipment of evacuation units. One could assume that upon activation of such units, planes authorized for them would be made available. When the Air Surgeon revised the table of organization for air evacuation units during 1942, he included twenty small planes along with an equal number of flight officers in the table for the air evacuation squadron, light.30 This table was approved by certain sections of the Air Staff and by the Chief of Air Staff, and one air evacuation squadron, light, was activated on 11 November 1942.31 When the matter of providing planes for it came up, the Directorate of Military Requirements objected. Not having been consulted in advance, it had made no plans for supplying evacuation units with either planes or pilots. It insisted that litter bearers and automobile ambulances could best move patients from divisional medical stations to rear areas, for pick-up by transport planes. It maintained, there- fore, that squadrons equipped with small planes, or “puddle jumpers,” were not re- quired and should not be provided.32 The commanding general, Army Air Forces, supported Military Requirements, and its position was subsequently announced as policy in May 1943.33 Consideration of Helicopters for Air Evacuation Announcement of this policy did not quash the hopes of many, including the Air Surgeon, The Surgeon General, and Army Ground Forces headquarters,34 that a suitable plane for evacuating patients from front-line areas might be found and its use approved. Late in 1942 a civilian doctor in Virginia had pressed upon the War Department the possibility of using 28 (1) Ltr, SG to Piper Aircraft Corp, 5 Jun 42. SG: 452.-1. (2) Memo by Lt Col Thomas N. Page, MG, SGO, 7 Nov 42, sub: Air Evac of Puts. HD; 370.05. 29 Memo by Lt Col Thomas N. Page, MG, SGO, 7 Nov 42, sub: Air Evac and Air Trans of Med Sups and Pers. HD: 580.1 Air Evac. 30 (1) R&R Sheet Comment 1, Air Surg to War Orgn and Mvmt Dir AAF, 15 Sep 42, sub: Air Evac, with inch AAF: 370.03. (2) Rpt of Mtg, ATC, 13 Oct 42, sub: Air Evac of Wounded. AAF: 370.05 (Evac). 31 (1) R&R Sheet Comment 3, Ground-Air Support Mil Reqmts Dir AAF to Mil Reqmts Dir AAF, 24 Nov 42, sub: Conversion of Airplanes to Evac Wounded. AAF: 370.05 (Evac). (2) Hubert A. Cole- man, Organization and Administration, AAF Medi- cal Services in the Zone of the Interior (1948), p. 689. 32 (1) R&R Sheet Comment 4, Dir Mil Reqmts AAF to AC of Air Staff for Tng, A-3, 31 Oct 42, sub; Conv of Liaison Type Airplanes. AAF; 370.05 (Evac). (2) R&R Sheet Comment 3, Ground-Air Support Mil Reqmts Dir AAF to Mil Reqmts Dir AAF, 24 Nov 42, sub: Conv of Airplanes to Evac Wounded. Same file. 33 (1) R&R Sheet Comment 1, C of Air Staff to Dir Mil Reqmts AAF, 12 Nov 42, sub; Conv of Airplanes to Evac Wounded. AAF: 370.05 (Evac). (2) Mil Reqmts Policy No. 41, 25 May 43, sub: Amb Air- planes—Provisions for Evac Wounded by Cargo Air- planes. AAF: 370.05-A (Evac). 34 For the Army Ground Forces’ viewpoint, see; 10th ind, CG AGF to CG ASF, 20 Nov 43, on Ltr, Dept of Air Tng Fid Artillery Sch to CG ASF thru Repl and Sch Comd AGF, 7 Sep 43, sub: Air Evac by Light Airplane. AAF: 452.-1 (Amb Planes). PROVIDING THE MEANS FOR EVACUATION BY AIR 435 helicopters in front-line medical service.35 Both the Air Surgeon and The Surgeon General quickly adopted the idea as a so- lution to the problem of evacuating pa- tients by air from inaccessible areas in combat zones and called upon the AAF Materiel Command for information in this connection.36 The Command reported early in 1943 that it had been testing heli- copters for a period of eight months. Al- though it had begun the procurement of several types, none of them were expected to be delivered before the middle of 1943. The Command had already given pre- liminary consideration to the use of heli- copters for evacuation and was requiring that they be fitted for the external attach- ment of “capsules” suitable for carrying litter patients. It was anticipated that this would enable each XR-5 and R-5 heli- copter to carry four litter patients and each XR-6 to carry two. In collaboration with the Aero Medical Research Labora- tory, the Materiel Command was study- ing the possibility of modifying XR-5 and XR-6 helicopters so they might carry four and two litters respectively within their fuselages, rather than in externally at- tached capsules. Meanwhile, it expected that an XR-5 helicopter, with capsules attached, would be ready for testing by September 1943 and that additional ones could be procured, after their use as am- bulances had been approved, in from ten to eighteen months.37 Progress in the general helicopter pro- gram was apparently not as rapid as had been expected. In the winter of 1943-44 the Air Forces had on hand only eight or nine serviceable helicopters and expected that few more would be delivered before the latter half of 1944.38 The development of an ambulance helicopter had also lagged. Believing that patients should not be transported in capsules beyond the reach of medical attendants except in emergencies, the Air Surgeon succeeded in having a “requirement” established early in March 1944 for a helicopter that could accommodate at least four litter pa- tients and an attendant within its fuselage. In conformity with established policy, the AAF Requirements Division directed that any helicopter developed to meet this re- quirement should be suitable for basic use as a cargo plane and should be equipped for carrying litters only if this did not in- terfere with such use.39 The Air Surgeon also apparently requested the procure- ment of 150 helicopters for use by his pro- posed air evacuation squadrons but he reconsidered the matter after discussion with the AAF Requirements Division. In view of the shortage of helicopters of all types and the lack of one that could trans- port patients within its fuselage, he agreed in March 1944 not to organize helicopter evacuation squadrons but instead to use 35 (1) Ltr, Dr Huston St. Glair to Maj Gen W[il- helm] D. Styer, CofS SOS, 23 Nov 42. Off file, Re- search and Dev Bd SGO, “Amb Airplanes.” (2) Ltr, same to Col G[ustave] E. Ledfors, Air Surg Off, 7 Dec 42. AAF: 452.1 (Helicopters). (3) Ltr, Mr. G. H. Dorr, Spec Asst to Sec War to Col W[ood] S. Woolford, Air Surg Off, 31 Dec 42. Same file. 36 (1) Ltr, SG to Chief Engr Div Wright Eld, 21 Dec 42, sub: Helicopter Dev. AAF: 452.1 (Helicopters). (2) Memo, Air Surg for Mat Comd Wright Eld, [22 Dec 42], same sub. AAF; 452.1 (Amb Planes). 37 (1) Memo, Mat Comd AAF for SG, 16 Jan 43, sub: Helicopter Dev — Util as Air Amb. (2) Memo, Mat Comd AAF for Air Surg, 3 Mar 43, sub: Heli- copter Dev for Air Amb Serv. Both in AAF: 452.1 (Helicopters). 38 (1) Memo, CG AAF for ACofS G-3 WDGS, [12 Dec 43], sub: Status of AAF Helicopter Program. (2) Ltr, CG AAF to GG Tng Comd AAF, 20 Jan 44, sub: Availability of Helicopter Aircraft. Both in AAF: 452.1 (Helicopters). 39 (1) Ltr, Mat Div AAF to Mat Comd Wright Fid, 3 Mar 44, sub: Dev of Large Type Helicopters. (2) R&R Sheet Comment 2, Oprs, Commitments, and Reqmts Div AAF to Air Surg, 23 Mar 44, sub: Status of Helicopters. Both in AAF: 452.1 (Helicopters). 436 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR LOADING A PATIENT ON AN L-5 PLANE for emergency evacuation helicopters or- dinarily employed otherwise.40 Soon afterward he stated that it was AAF policy to use C-64 and L-5 airplanes equipped to carry litters for the evacuation of pa- tients singly or in small numbers.41 Mean- while, the general helicopter program continued, and toward the end of the war there were indications that some might soon be modified to carry patients within their fuselages and that they would be available in sufficient numbers for assign- ment to overseas commands.42 Relaxation of the Policy Limiting the Use of Special Planes for Evacuation Despite AAF policy against the use of airplanes exclusively for evacuation, as- signment of additional transport planes to supply enough “lift” for evacuation in ad- dition to normal operations became an accepted practice in the zone of interior 40 R&R Sheet Comment 1, Air Surg to Oprs, Com- mitments, and Reqmts Div AAF, 4 Mar 44, and Com- ment 2, Oprs, Commitments, and Reqmts Div AAF to Air Surg, 7 Mar 44, sub: Use of Helicopters for Air Evac. AAF: 452.1 (Helicopters). 41 5th ind, CG AAF (Air Surg) to CG Air Serv Comd, 24 May 44, on Memo, 2d Lt William R. Kee, AC for Air Surg, thru Channels, 17 Apr 44, sub; Evac of Wounded by Air. AAF: 370.05 (Evac). Also see The Air Surgeon’s Bulletin, vol. I, No. 8 (1944), p. 19 and vol. I, No. 9 (1944), p. 16. 42 (1) R&R Sheet Comment 1, Reqmts Div AAF to Mat Div AAF, 31 May 45, sub: Litter Capsules for Helicopters. (2) Ltr AG 320.3 (11 Apr 45) OB-I- AFRTH, TAG to CG ETO, 5 May 45, sub: AAF Helicopter Program. Both in AAF: 452.1 (Helicop- ters). PROVIDING THE MEANS FOR EVACUATION BY AIR 437 during the later war years. This practice began in January 1944, when three C-47s were temporarily used to move 661 pa- tients from Stark General Hospital to other hospitals in the zone of interior. Sev- eral months later the Air Transport Com- mand temporarily assigned twelve C-47s to its Ferrying Division for a similar “spe- cial operation.” These operations were so successful that, after the Ferrying Division was made responsible for air evacuation in the zone of interior in May 1944, twelve planes were permanently assigned to that mission. They could, of course, be used for the transportation of other persons and of cargo when not carrying patients. The next month twelve additional C-47s were assigned to provide planes for evacuation. As the number of patients arriving from theaters increased and the calls for air evacuation became more frequent, the number of transport planes assigned to the Ferrying Division for evacuation oper- ations grew until it reached forty-nine by September 1944.43 As patients continued to be evacuated from theaters to the zone of interior in reg- ular transport planes, efforts were made during 1944 and 1945 to increase the number of patients they carried. The in- crease was accomplished in two ways. One was the installation of newly developed webbing-strap litter supports. More pa- tients could be accommodated in planes using these supports than in those equipped with metal-type supports. In the summer of 1944 the Air Forces installed webbing-strap litter supports in C-54s already in use and provided for their in- stallation in others during production.44 Another method of increasing the use of airplanes for evacuation was to modify the system of determining the number of pa- tients theaters would evacuate by air. In the spring of 1944, it will be recalled, the Air Transport Command authorized the- aters to ignore the old system of priorities for air transportation and determine lo- cally the proportion of space on returning transport planes that would be reserved for patients.45 Medical Flight Attendants Early Plans for Medical Personnel for Air Evacuation Since plans for air evacuation during the period before the war and well into its first year were tentative only, plans for units to be employed in such operations were of necessity also uncertain. In the prewar years The Surgeon General and the Medical Division of the Air Corps col- laborated in the development of an organ- ization—sometimes called a task force— that would be used exclusively for the evacuation of patients from forward to rear areas of theaters of operations and perhaps to the zone of interior. While there were differences of opinion on some points—such as the name of the organiza- tion, the number of subordinate units it should have, and the amount of personnel 43 (1) Organizational History of the Ferrying Divi- sion, June 20, 1942 to August 1, 1944, pp. 271-78. ATC: Hist Div. (2) Initial Medical History (11 Febru- ary 1943 to SOJune 1944), Headquarters Ferrying Di- vision, Air Transport Command. HD: TAS. (3) Quar- terly Medical History, Headquarters Ferrying Divi- sion, Air Transport Command, 1 July-30 September 1944. HD; TAS. (4) Memo, Air Surg for SG, 27 Jul 44. SG; 580. (5) Memo, Gomdt Sch of Air Evac for CG AAF, 16 Feb 44, sub: Air Evac. AAF: 370.05 (Evac). (6) The Air Surgeon’s Bulletin, vol. I, No. 4 (1944), pp. 10-11. 44 (1) 1st ind, GG ATG to AGofS OPD WDGS thru CG AAF, 15 May 44, on unknown basic Ltr. OPD: 580.81. (2) The Air Surgeon’s Bulletin, vol. I, No. 7 (1944), p. 17. 45 See above, p. 340. 438 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR required for each unit—there was general agreement on major issues. An air ambu- lance organization should be composed of both Air Corps and medical personnel, the former to maintain and operate ambu- lance airplanes and the latter to care for patients. This organization should operate under the control of theater headquarters, augmenting surface evacuation, and should perhaps be assigned on the basis of one unit per field army. Medical officers and enlisted men of the organization would not only serve as attendants to pa- tients during flights but would also oper- ate medical stations at large airfields, fifteen to fifty miles from the front, and at small emergency landing fields, two to ten miles from the front. They would collect and transport patients by motor ambu- lances to such stations, care for them as they awaited air evacuation, and load them on planes for transportation to the rear.46 Several tables of organization for an air evacuation unit were developed through the collaboration of the Surgeon, GHQ Air Force; the Medical Division of the Air Corps; and the Surgeon General’s Office. One submitted in July 1940 was disap- proved by the General Staff because air- plane ambulances were included as or- ganic elements of medical rather than Air Corps units of the evacuation organiza- tion.47 Another, submitted by The Sur- geon General in October 1940, apparently remained in the G-3 Division of the Gen- eral Staff without action until the late summer of 1941. It was then revised and resubmitted for approval in November.48 It was published shortly afterward as the table of organization for a medical air am- bulance squadron. This squadron was to be a companion unit for an Air Corps transport group composed of a headquar- ters squadron, a flight squadron, light, equipped with eighteen single-engine liai- son planes for front-line evacuation, and two flight squadrons, heavy, each equipped with twelve two-engine trans- port planes for intra-theater evacuation. The medical squadron was to consist of a headquarters section, a single-engine transport ambulance section, and two two-engine transport ambulance sections. It was to have 45 Medical Department officers, no nurses, and 218 enlisted men. One unit of this type, the 38th Medical Air Ambulance Squadron, was activated at reduced strength as a test unit in May 1942.49 After AAF was charged with responsi- bility for air evacuation in the summer of 1942, the Air Surgeon’s Office developed a new plan for an air evacuation unit, called an air evacuation group. This group was to be composed of a headquarters 46 (1) Ltr, SG to TAG, 1 1 Jul 40, sub: AC Med Trans Group. AG; 320.2 Med (7-11-40). (2) Memo, Chief Med Div OCofAC for SG, 3 Oct 40. SG: 320.3-1. (3) 2d ind, SG to TAG, 18 Mar 41, on Ltr, Dir Dept Extension Courses MESS to SG thru Comdt MESS, 31 Jan 41, sub; EM 8-5, Mobile Units of MD. AG; 300.7 (1-31-41) FM 8-5. (4) David N. W. Grant, “Airplane Ambulance Evacuation,” The Military Sur- geon, vol. 88, No. 3 (1941), pp. 238-43. (5) FM 8-5, Mobile Units of MD, 12 Jan 42, pp. 157-69. 47 (1) Ltr, Surg GHQ AF to Chief Med Div OCofAC, 20 Jun 40. SG: 320.3-1. (2) Memo, Chief Med Div OCofAC for SG, 2 1 Jun 40. Same file. (3) Ltr, SG to TAG, 11 Jul 40, sub: AC Med Trans Group. AG: 320.3 Med (7-11-40). (4) Memo, ACofS G-3 WDGS for CofSA, 7 Aug 40, sub: Air Amb Serv. Same file. (5) Memo, TAG to SG, 5 Sep 40, same sub. Same file. 48 (1) Ltr, SG to TAG, 29 Oct 40, sub: New T/O Med Bn, Airplane Amb, with 3 inds. (2) DF G-3/42108, ACofS G-3 WDGS to CofAAF, 15 Aug and 27 Oct 41, same sub. (3) R&R Sheet Comment 1, C of Air Staff AAF to CofAC (Med Div), 7 Nov 41, same sub. All in AAF: 320.3 L-l. (4) DF, C of Air Staff to TAG, 19 Nov 41, sub: T/O for Med Airplane Amb Sq. AG; 320.2 (11-19-41). 49 (1) T/O 8-455, 19 Nov 41, Med Air Amb Sq. (2) Guilford and Soboroff, op. cit. PROVIDING THE MEANS FOR EVACUATION BY AIR 439 squadron; an air evacuation squadron, light; and three air evacuation squadrons, heavy. While it was anticipated that the heavy squadrons would consist of medical personnel only and would use planes of either troop carrier or air transport com- mands, the light squadron was to have twenty small planes and twenty pilots as- signed as organic elements. The light squadron was to consist of only enlisted men and officers, but the heavy squadron was to have nurses also. The entire group was to have 49 Medical Department offi- cers, 20 Air Corps officers, 78 nurses, and 458 enlisted men. It was anticipated that air evacuation groups would be assigned as the situation required to air forces, the- aters, defense commands, task forces, or field armies.50 The Air Staff having ap- proved the plan for this organization, the I Troop Carrier Command activated such a unit in October 1942, using initially offi- cers and men transferred from the 38th Medical Air Ambulance Squadron. This unit—the 349th Air Evacuation Group— at first consisted of a headquarters squad- ron and one heavy squadron. In Novem- ber, when a light squadron and two addi- tional heavy squadrons were activated and assigned to it, the 349th Air Evacuation Group was given the mission of training personnel for air evacuation operations.51 Meanwhile, as already explained;the Air Staff had decided that transport planes would not be earmarked for evacuation only and that small ambulance airplanes would not be provided for use in forward areas. This decision cut short the life of the squadrons just activated because it de- stroyed the basic concept underlying their formation. With the decision to consider air evacu- ation as a secondary mission of planes engaged in general transport service, a different kind of organization was needed. The Air Surgeon therefore developed a smaller unit, the Medical Air Evacuation Transport Squadron (MAETS), whose table of organization was issued in advance form at the end of November 1942 and was published in regular format in Febru- ary 1943. This unit had no personnel for the movement of patients in motor ambu- lances or the operation of medical stations at loading points. It consisted of a head- quarters and four evacuation flights, each made up of six flight teams. A command- ing officer, a chief nurse, an administra- tive officer, and 29 enlisted men comprised the headquarters. Each flight, headed by a flight surgeon, consisted of 6 flight nurses and 8 enlisted men, of whom 6 were surgi- cal technicians. Flight teams, made up of one nurse and one technician, could be placed on transport planes as needed.52 In December 1942 members of the three heavy air evacuation squadrons already activated were used to form six medical air evacuation transport squadrons. The next month the light air evacuation squad- ron was disbanded and its personnel was absorbed by the 349th Air Evacuation Group. Subsequently, during 1943 and 1944, additional MAETS were organized, trained, and sent overseas.53 50 (1) Coleman, op. cit., pp. 685-87, 703. (2) R&R Select Comment 1, Air Surg to Dir War Orgn and Mvmt AAF, 15 Sep 42, with inch AAF: 370.03. (3) Rpt, Mins of Mtg, ATG, 13 Oct 42, Air Evac of Wounded. AAF: 370.05. 51 (1) Medical History, I Troop Carrier Command From 30 April 1942 to 31 December 1944. HD: TAS (2) Coleman, op. cit., p. 689. (3) Guilford and Sobo- roff, op. cit. 52 (1) An Rpt, FY 1943, Oprs Div Air Surg Off. DAF: SCO Hist Br. (2) T/O 8-447, Med Air Evac Trans Sq, 15 Feb 43. 53 (1) Guilford and Soboroff, op. cit. (2) Unit Cards, 801st thru 831st Med Air Evac Trans Sqs, filed in Orgn and Directory Sec Oprs Br Admin Servs Div AGO. 440 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR School of Air Evacuation Charging the 349th Air Evacuation Group with the mission of training per- sonnel for air evacuation operations indi- cated recognition by the Air Surgeon of the need for specialized training for such work. Despite the fact that it was not to be used in the theaters of operations as origi- nally anticipated, the 349th continued in existence as a training school until June 1943. At that time the Air Forces estab- lished a School of Air Evacuation at Bow- man Field, Kentucky. This school oper- ated under the Troop Carrier Command until August 1944. Then, after a short period of operation directly under AAF headquarters, it was merged in October 1944 with the School of Aviation Medicine at Randolph Field, Texas. During the period from June 1943 through September 1945 it trained in air evacuation duties 109 medical officers, 1,331 nurses, and 837 enlisted men.54 Method of Controlling and Supplying Flight Attendants Teams of one nurse and one Medical Department technician per plane contin- ued in use throughout the war. As air evacuation operations within the United States began to assume significant propor- tions early in 1944, ATC headquarters announced in April that additional nurses trained in air evacuation would be as- signed to ATC hospitals and would be used, along with enlisted technicians qual- ified to assist them, to form flight teams for planes transporting patients between hos- pitals in the United States.55 When the Ferrying Division took over domestic air evacuation soon afterward, it acquired flight surgeons, flight nurses, and enlisted technicians as part of its bulk allotment of Medical Department personnel for use in air evacuation only.56 For evacuation within theaters of operations and for flights between theaters and the zone of interior, flight teams were supplied by medical air evacuation transport squadrons. The table of organization for these squadrons was revised in July 1944, reducing the number of enlisted men in squadron headquarters from twenty-nine to twenty-four. Person- nel in the squadron’s four flights, each of which contained six flight teams, remained unchanged, but the rank of nurses was raised.57 Squadrons used for intra-theater evacuation were attached to troop carrier commands or to Air Transport Command divisions in theaters. Those for evacuation from theaters to the zone of interior were assigned to ATC wings until the end of 1944. Gradually thereafter the squadrons assigned to ATC wings were disbanded and flight teams used to accompany pa- tients from theaters to the United States were grouped under the 830th Medical Air Evacuation Squadron Headquarters, organized in the office of the ATC surgeon in Washington in November 1944. By the end of the year this squadron consisted of 44 flights; by April 1945 the number had been increased to 56; and by July, to 78. This centralization of administrative and 54 (1) Coleman, op. cit., pp. 691ff. (2) Guilford and Soboroff, op. cit. (3) An Rpt, FY 1943, Oprs Div Air Surg Off. DAF; SGO Hist Br. (4) AAF Reg 20-22, 22 Jul 43. 55 ATC Memo 25-6, 29 Apr 44, sub: Med Air Evac. AAF: 370.05. 56 (1) Organizational History of the Ferrying Divi- sion, June 20, 1942 to August 1, 1944. ATC: Hist Div. (2) Quarterly Medical History, Headquarters Ferry- ing Division, Air Transport Command, 1 July-30 September 1944. HD: TAS. 57 (1) T/O&E 8-447, 19 Jul 44. (2) DF, CG AAF to ACofS G-3 WDGS, 8 Jul 44, sub; T/O&E 8-447, Med Air Evac Sq. AG: 320.3 (2 Jun 44) (1). PROVIDING THE MEANS FOR EVACUATION BY AIR 441 operational control resulted in a saving of overhead personnel and permitted the rapid reassignment of flight teams to areas where they were needed most. It also per- mitted the establishment of a procedure in the spring of 1945 which enabled each flight team to accompany patients to the United States. Formerly, flight teams lo- cated along ATC routes had flown from their home stations to stations en route and then had returned to home stations.58 The economy of men made possible by air evacuation was a major factor in en- abling the War Department to meet the demands for large-scale transportation of patients in 1944 and 1945 with the limited number of attendants at its disposal. Early in 1944, when there was concern in Wash- ington lest there be not only insufficient shipping but also insufficient personnel to move the patient load anticipated for the latter half of the year, the Surgeon Gen- eral’s Office and ASF headquarters asked for an increase in air evacuation from the- aters as a means of saving manpower.59 The saving was possible, for one reason, because air evacuation was so much faster than surface evacuation that patients re- quired the care of only nurses and enlisted technicians. Moreover, for such short pe- riods, fewer attendants per patient were needed. The saving of personnel can be illustrated by comparing the number of attendants required for a trip by hospital ship with the number required for the same trip by planes that did not stop to change medical attendants or to give pa- tients treatment at hospitals en route. In such a case, the transportation of 500 pa- tients by hospital ship required eight doc- tors, eight other officers, thirty-four nurses, and 135 enlisted men. To transport a simi- lar number of patients by air in one con- tinuous flight required seventeen planes (assuming that each carried thirty pa- tients) with seventeen teams consisting of one nurse and one technician each, or a total of thirty-four persons, together with the personnel rounding out the flights to which these teams were attached—three doctors and six enlisted men. The economy is more strikingly realized if man-days are compared. For example, the transporta- tion of 500 patients across the Atlantic by hospital ship normally required approxi- mately seven days and therefore used about 1,295 man-days of medical attend- ance, while the same evacuation could be accomplished by airplane within from one to two days, depending upon whether or not an overnight stop was made in New- foundland, and required from forty-three to eighty-six man-days only.60 Efforts To Supply Appropriate Equipment for Air Evacuation Confirmation as policy during 1942 of the peacetime practice of using opera- tional planes instead of special airplane ambulances for the evacuation of patients required the development of special equipment that could be used easily and quickly to adapt cargo and transport planes to their secondary mission—the 58 (1) Guilford and Soboroff, op. cit. (2) History of the Medical Department, Air Transport Command, 1 January 1945-31 March 1946. HD: TAS. (3) AAF Manual 25-0-1, Flight Surgs Ref File, 1 Nov 45. HD: 321 (AAF). 59 Memo, CG ASF for ACofS OPD WDGS, 26 Apr 44, sub: Air Evac from ETO and NATO. HRS: ASF Planning Div Program Br file, “Hosp and Evac, vol. 3.” 60 This paragraph is based upon a comparison of the tables of organization of hospital ship complements and medical air evacuation transport squadrons and upon comments by Brig Gen. Albert H. Schwichten- berg on a first draft of this chapter. Also see Journal of the American Medical Association, Vol. 141, No. 8 (1949), pp. 540-41. 304244 0—55 30 442 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR evacuation of patients. Early in 1942 the Air Forces began to use Douglas remov- able metal-type litter racks, which had al- ready been designed for this purpose, to enable large cargo planes such as the C-47s to carry eighteen litter patients.61 These racks had important disadvantages. Their detachable parts frequently were lost or damaged in stowage, and replace- ments had to be stocked at various fields. Furthermore, it was discovered in the fall of 1942 that standard racks did not ac- commodate all types of American litters currently in use in combat theaters. The Materiel Center at Wright Field (Ohio) therefore undertook a series of experi- ments, and by the early part of 1944 it de- veloped litter supports made of webbing straps.62 They were superior to Douglas metal-type racks in many ways. The racks had to be disassembled after each evac- uation mission and stowed in floor com- partments while two sets of webbing straps could be spaced and anchored perma- nently along the roof and side walls of the interiors of planes. Douglas racks weighed nearly 200 pounds in comparison with 110 pounds for webbing-strap supports. Metal supports would accommodate only eighteen litter patients in certain aircraft, but webbing straps would hold twenty- four. Preparation of planes for evacuation with webbing-strap supports could be ac- complished in six to eight minutes, a frac- tion of the time needed to assemble and install metal-type racks. In March 1944, therefore, the use of metal-type racks was curtailed and airplane production was modified to require the installation of the new supports.63 The Air Forces later issued technical orders to guide those engaged in air evacuation operations in the use of webbing-strap supports in C-47, C-47A, C-46, C-64, and C-54 airplanes.64 Litters were important items because they served as patients’ beds during flights. Before the war the Air Corps had used a metal litter, based upon the best features of the Navy’s Stokes litter. It was noninflammable, easy to disinfect, and could be carried, with a patient strapped in, in either a horizontal or a vertical posi- tion, but it was costly, bulky, heavy, and difficult to carry.65 At the beginning of the war, therefore, the Air Corps substituted for it aluminum-pole litters which had been developed in 1937 especially for Air Corps use. In 1942 growing shortages of aluminum stimulated development of a straight carbon-steel-pole litter. A poten- tial steel shortage in turn brought about the development early in 1943 of both straight and double-folding laminated- wood-pole litters. The latter could be col- lapsed into a smaller space than others, and it soon came to be generally regarded as the best of Medical Department folding litters and ideal for Air Forces use.66 When aluminum and steel again be- came available in the summer of 1943, the S1 David N. W. Grant, “A Review of Air Evacua- tion Operations in 1943,” The Air Surgeon’s Bulletin, vol. I, No. 4 (1944), p. 1. 62 Tec Instruction 1255, Hq Mat Comd AAF Hq to Tec Exec Mat Ctr, Wright Eld, Ohio, 9 Sep 42, sub: Correction of Standard Type Litter Support Now Be- ing Installed in Army Trans Aircraft. AAF: 452.1-B (Amb Planes). 63 D. M. Clark, “Litter Support Installations for the C-47 Airplane,” The Air Surgeon’s Bulletin, vol. I, No. 4 (1944), p. 10. 64 AAF Tec Orders 00-75-1 (1 Jul 44); 00-75-2 (30 Nov 44); 00-75-3 (5 Jan 44); 00-75-4 (15 Jan 44); Air Evac Technique of Loading Pnts in C-47 and C-47A, C-46, C-64, and C-54 Airplanes respectively. AAF: AF Admin Ref Br, Air AG. 65John B. Johnson, Jr., and Graves H. Wilson, A History of Wartime Research and Development of Medical Field Equipment (1946), pp. 1-245. 66 Sup Plan 16, Procurement Div SGO, 20 Oct 43, sub: Litters. Off file, Sup Div SGO, 400.114/3815 (Litter, Steel, Folding). PROVIDING THE MEANS FOR EVACUATION BY AIR 443 Air Forces shifted procurement back to straight steel-pole and folding aluminum- pole litters. Those issued were unpopu- lar—the former because of its weight and the latter because it did not fold up well in field use.67 The folding laminated- wood-pole litter continued to be preferred until February 1944. At that time the Air Forces recommended that straight alumi- num-pole litters be procured for the re- mainder of the war. This change was due not so much to dissatisfaction with the special folding litter as to basic changes in aircraft construction. By the early part of 1944 doors and internal capacities of cargo and transport planes had been so enlarged that difficulties formerly encountered in loading, unloading, and stowing litters were no longer problems in air evacua- tion. Thus the litter which had been de- signed originally for Air Force use was supplanted, in Air Force procurement, by the standard Ground Force litter. In the summer of 1945, general preference for straight aluminum-pole and folding lami- nated-wood-pole litters was sanctioned by keeping only these two types classified as standard.68 Supplies and equipment for the care of patients during flight similarly had to be specially designed and selected because weight and space were important factors in air movements. At the beginning of the war, two medical chests had been devel- oped for the Air Corps as Medical De- partment items. A flight service chest, standardized before and improved during the war, was furnished each air evacuation transport squadron. An airplane ambu- lance chest, developed by the Air Corps and a plastics corporation in St. Louis, Mo., for issue to each flight team, was lighter and contained a minimum of sup- plies and equipment to care for the imme- diate needs of patients.69 The latter type of chest appears to have been satisfactory only for trips requiring six to nine hours. For shorter trips, like those in the North African campaign, the chest was too large and frequently was not used at all if a nurse had to provide medical care unas- sisted. For longer ones, medical evacua- tion personnel considered the chest too small for efficient use.70 Variation in dis- tances between theaters and the zone of interior and in the types of patients evac- uated was so great that standardization of a chest for universal use was impractical. Therefore, improvisations of cabinet-type containers for long trips and the develop- ment of experimental kits for short trips continued to the end of the war.71 The provision of adequate oxygen equipment and improvement of facilities to control and restrain psychotic patients were other problems the Air Forces faced. The availability of oxygen was essential to minimize physiological changes due to the altitude at which flight was maintained. The Air Forces developed and issued a portable continuous-flow therapeutic-oxy- gen kit to be used for both air evacuation and air and sea rescue. Beginning in the summer of 1944, each air evacuation team received four of these kits to augment the 67 See n. 66. 68 Johnson and Wilson, op. cit., p. 45. 69 (1) See documents in Off files, Sup Div SGO, 400.112/2642 (Chest, Fit Serv, Empty), and 400.114/3023 (Chest, Amb, Airplane, Empty). (2) T/E 8-447, 30 Nov 42. (3) Ltr, SC to GG SOS, 14 Jan 43, sub: Airplane Amb Chest, with 5 inds. SG; 428. 70 (1) Weekly Staff Rpts, Staff Mtgs ASO, 13 Sep 43. HD: TAS. (2) Daily Rpt, Sup Div ASO, 3 Oct 44. HD: TAS. 71 (1) An Rpt, Sup Div ASO, FY 1944. HD: TAS. (2) Daily Rpt, Sup Div ASO, 3 May 45. Same file. (3) Andres G. Oliver and Hampton C. Robinson, Jr., “Domestic Air Transportation of Patients,” The Air Surgeon’s Bulletin, vol. II, No. 11 (1945), p. 401. 444 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR standard oxygen system available for the crew and able-bodied passengers.72 A rather knotty problem developed from the transportation of psychotic patients. Since planes had no facilities for isolation, such patients constituted a potential danger to others during flight. Although the Air Transport Command returned several hundred of them from the Southwest Pa- cific to the zone of interior during 1944 and 1945, it was not until the end of the war that the Command produced a really suitable flexible restraint.73 Although feeding was a normal part of pre- and post-flight care, a serious prob- lem in feeding patients developed when flights extended over long periods of time. Cargo and transport planes had no facil- ities for cleaning or washing dishes, trays, or silverware; and their crews lacked ex- perience in preparing suitable meals for patients from a limited variety of available foods. Byjanuary 1944 this problem be- came serious and the Air Forces started a survey to find a solution. Nevertheless, provisions for feeding patients being evac- uated from theaters continued to be little more elaborate than sandwiches, hot cof- fee, and cold drinks carried in thermos jugs. Patients transported in the domestic air evacuation system, operated by the Ferrying Division of the Air Transport Command, were more fortunate. In No- vember 1944 Wright Field began testing and later approved for installation in planes of the Ferrying Division a galley unit containing four large cups to heat food, a container for coffee, and two “hot cups” for preparing chocolate, soup, and bouillon, as well as drawers for the storage of food.74 Both patients and medical attendants complained of fatigue on long flights, pa- tients because of lying on litters for sever- al hours and medical attendants because of lifting and changing the position of pa- tients frequently. An air mattress was therefore developed by the Air Forces to fit on Army litters. It took little space in stowage, weighed little, inflated easily, and could be washed with soap and water. Authority was granted in January 1945 to issue twenty-four air mattresses to each flight team.75 Patients transported by air along both tropical and arctic routes suffered from uncomfortable temperatures in planes when they landed for servicing. Early in 1944 the Air Forces collaborated with the Quartermaster Corps and other agencies in the development of portable air condi- tioners to cool planes’ interiors at stop- over points. By August 1944 the Supply Division of the Air Surgeon’s Office had issued forty-two air conditioners to the Air Transport Command for use both in the zone of interior and in overseas theaters.76 In arctic areas, large heaters that could be moved up to planes on the ground were used to warm cargo areas until planes were ready for flight.77 72 (1) The Air Surgeon’s Bulletin, vol. II, No. 3 (1945), pp. 78-79, and vol. II, No. 4 (1945), pp. 106-07. (2) T/O&E 8-447, C 1, 11 Dec 44. 73 History of the Medical Department, Air Trans- port Command, 1 January 1945-31 March 1946, pp. 91-97. HD: TAS. 74 (1) A mimeographed copy of a broad plan to study certain equipment problems in connection with air evacuation of patients, developed around January 1944, may be found in AAF; 370.05 (Evac Book 2). (2) Oliver and Robinson, op. cit., pp. 400-01. 75 (1) Ltr, CG AAF (Air QM) to CG ASF, 2 Jun 44, sub: Air Mattresses and Pillows. AAF: 427. (2) Rpt, Off of Air Insp (I. B. March) to Air Insp Hq AAF, 21 Aug 44, sub; Summary of Med Insp of ATC and Stas In CBI Wing. HD; TAS (ATC and Misc). (3) T/O&E 8-447, C 2, 25 Jan 45. 76 (1) An Rpt, Sup Div ASO, FY 1944. HD: TAS. (2) Daily Rpt, Sup Div ASO, 29 Aug 44. Same file. 77 The Air Surgeon’s Bulletin, vol. II, No. 10 (1945), pp. 330-31. PROVIDING THE MEANS FOR EVACUATION BY AIR 445 Until the fall of 1943 loading and un- loading litters in high-door planes were accomplished manually. When air evac- uation increased in the latter part of 1943, this method was discarded generally in favor of a fork-lift truck with a “litter adaptor” made from a simple wooden pallet platform used to move and store cargo. The mechanical loading and un- loading of patients proved to be rapid, safe, and comfortable and was adopted at most Air Transport Command installa- tions throughout the world by the end of the year.78 The exchange of property used in air evacuation constituted a difficult prob- lem. A patient was seldom separated from his litter and blankets until he reached a hospital. When the Air Forces released patients to Ground or Service Forces in- stallations, comparable equipment seldom was returned in exchange and the Air Forces sustained a gradual loss.79 This was particularly important in the case of litters in the first part of the war because the Ground and Service Forces were using straight-pole litters while the Air Forces preferred and used folding-pole litters. The Air Surgeon and The Surgeon Gen- eral were acquainted with the problem and by the middle of 1943 began to study means of solving it.80 A new procedure was established by directives issued by the Air Transport Command in April and the War Department in June 1944. Accord- ing to it, the Air Transport Command was to furnish necessary medical supplies for use in flight, while commanding officers of medical installations, through medical supply officers, were to be responsible for providing such equipment as litters and blankets. When a hospital requested air transportation for a group of patients, a shipping ticket was to be prepared by its medical supply officer listing necessary litters, blankets, splints, etc. The flight nurse was to turn in the shipping list to the medical supply officer of the receiving hospital where it would be signed and mailed to the originating hospital. Later, the equipment was to be turned in to a depot for return to the theater by boat. If the originating hospital was in the zone of interior, the equipment would be shipped directly to that hospital.81 This system did not work as well as anticipated. Shipping by water was slow and did not always re- turn property as fast as it was used. As a result, successive efforts were made during 1944 to increase the number of blankets and litters supplied to air evacuation squadrons so that a pool of this equipment could be established overseas.82 Changes in the table of organization and equipment for air evacuation squad- rons reflected both the development of special equipment for air evacuation oper- ations and attempts to eliminate shortages of equipment in theaters of operations. The table, first published on 30 November 1942, authorized the Air Forces to issue such items as flight clothes and equipment to nurses and enlisted technicians and the Medical Department to issue blankets, litters, and flight service medical chests. As revised in June 1943, this table doubled the allowance of blankets, undoubtedly to 78 John M. Collins, “Litter Loading Device,” The Air Surgeon’s Bulletin, vol. I, No. 9 (1944), p. 22. 79 Diary, SOS Hosp and Evac Br (Fitzpatrick), 27 Nov 42. HD: Wilson files, “Diary.” 80 Johnson and Wilson, op. cit., p. 152. 81 (1) ATC Memo 25-6, Air Evac, 29 Apr 44. AAF: 370.05 (Evac Book 2). (2) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd. AG: 704.11 (3 Jun 44). 82 Memo SPMOO 400.34 (15 Nov 44), GG ASF (Lutes) for CG AAF, 20 Nov 44, sub: Change 1 to T/O&E 8-447. AG; 320.3 (2 Jun 44). 446 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR cover shortages growing out of unsatisfac- tory operation of the property-exchange system.83 Medical supplies were to be requisitioned from medical depots oper- ated by the Air Service Command accord- ing to requirements determined by the Supply Division of the Air Surgeon’s Of- fice.84 A revision of the table in July 1944 authorized the Air Forces to issue four portable oxygen assemblies per air team, and it increased the number of litters per squadron from 432 to 576. Five months later, a further change reflected the sub- stitution of the Air Forces’ newly devel- oped therapeutic-oxygen kit for the port- able assembly. It also authorized an increase in straight aluminum-pole litters from 576 to 1,500, and the addition of 3,732 olive drab blankets for each squad- ron. The increase in litters and blankets was made to cover part of the shortages of these items in the theaters. Another change in the table, published 25 January 1945, added as Air Forces organizational equipment 576 pneumatic mattresses per squadron.85 83 T/E 8-447, 30 Nov 42, with C 1, 14 Jun 43. 84 Coleman, op. cit., pp. 635-36. 85 T/O&E 8-447, 19 Jul 44; G 1, 11 Dec 44; C 2, 25 Jan 45. CHAPTER XXV Evacuation Units for Theaters of Operations The evacuation units discussed in pre- ceding chapters were those used primarily in the movement of patients in and to the zone of interior, though some were used also within theaters of operations. Men- tion has been made earlier, in chapters showing how the zone of interior provided hospital units for overseas service,1 of other evacuation units that cared for and trans- ported patients from front-line areas rear- ward through combat zones to mobile hospitals. Certain aspects of these units— such as changes in their organization, per- sonnel, and equipment, and the manner in which they were activated, trained, and used in the United States—need to be considered at this point. Organization, Personnel, and Equipment Units designed for the care and trans- portation of patients in combat zones, as already pointed out,2 either were organic elements of larger nonmedical organiza- tions such as infantry regiments and divi- sions, or were separate units intended for assignment to corps and armies. Every regiment and every separate battalion of each arm or service, except medical, had a medical detachment as one of its organic parts. While the size and organization of medical detachments varied according to the size of the units to which they be- longed, their functions remained the same. Aid men of the medical detachment ac- companied troops into combat, giving casualties emergency medical care at the front lines. Its litter bearers then carried casualties, except those still able to walk, back to aid stations where medical techni- cians and medical officers treated them for return to duty or prepared them for further transportation. Units that were organic elements of divisions—medical regiments, battalions, or squadrons, de- pending upon the type of division con- cerned—collected casualties from aid stations and transported them first to col- lecting stations and then to clearing sta- tions farther to the rear, sorting them at each station for additional treatment and return to duty or for preparation for fur- ther evacuation. Units that were assigned directly to corps and armies, such as med- ical battalions and medical regiments, collected and treated for return to duty or prepared for evacuation the casualties of their respective areas. In addition, army evacuation units transported casualties from divisional clearing stations to mobile hospitals in army areas and supplied rein- forcements for divisional medical services. 1 See above, pp. 38-49, 144-66, 214-37. 2 See above, pp. 4, 38-39. 448 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR While the system of evacuating casualties through the combat zone was not altered in any significant respect during the war, certain changes occurred both before and during the war in the units operating this system. These changes were designed pri- marily to achieve mobility, flexibility, and economy. The medical battalion of the infantry division was developed in the prewar years, it will be recalled,3 as a result of the emergence of the triangular division to replace the square division. The latter’s organic medical unit was a medical regi- ment which consisted of a regimental headquarters and band, a headquarters and service company, a collecting bat- talion of three companies, an ambulance battalion of three companies, and a clear- ing battalion of three companies. It was authorized 66 officers and 980 enlisted men to serve a division of 946 officers, 12 warrant officers, and 21,314 enlisted men.4 The medical battalion, which served the triangular division of 624 officers, 6 war- rant officers, and 14,615 enlisted men, contained 34 officers and 476 enlisted men. It consisted of a headquarters and headquarters detachment, a clearing com- pany, and three collecting companies.5 Containing litter bearers, collecting-sta- tion personnel, and ambulances, each col- lecting company was capable of supporting a regimental combat team, whether it operated separately or in close conjunction with the division of which it was a part.6 Although not designed specifically for the purpose, this battalion was used also as the evacuation unit for corps troops. The med- ical regiment continued in existence, serv- ing National Guard divisions until they were reorganized as triangular divisions in 1942. Like the medical battalion, it also had a function for which it was not specifi- cally designed; that is, it served as an evacuation unit with army troops.7 Thus medical battalions and medical regiments could be either divisional or nondivisional units, depending upon their assignment and use. A nondivisional medical unit developed in the prewar years for use in the evacu- ation system, though not in the actual transportation of patients, was the medical gas treatment battalion. While other med- ical units had some means of treating at least small numbers of gas casualties, none was adequately equipped to treat the in- flux of casualties which might result from the use of gas on a large scale. The Sur- geon General’s Office therefore prepared a table of organization for a medical gas treatment battalion, and the General Staff approved it despite misgivings that such a unit might duplicate the functions of other medical units or of the quartermaster steri- lization and bath battalion. The medical gas treatment battalion was made up of a headquarters and three clearing compa- nies. Each of the latter, having two bath and four treatment sections, was expected to bathe and treat gas casualties and to provide them with noncontaminated clothing in preparation for return to duty or for further evacuation to the rear.8 3 See above, pp. 39-40. 4 T/O 8-21, Med Regt, 1 Nov 40, and T/O 7, Inf Div (Square), 1 Nov 40. 5 T/O 8-65, Med Bn, 1 Oct 40, and T/O 70, Inf Div (Triangular), 1 Nov 40. 6 T/O 8-67, Med Co, Collecting, Bn, 1 Oct 40. 7 FM 8-5, Med Fid Manual, Mobile Units of the Med Dept, 12 Jan 42. 8(1) Ltr, SG to TAG, 11 Jun41,sub: T/Os, with 2 inds. AG; 320.2 (6-1 1-41). (2) Memo, ACofS G-3 WDGS for TAG, 23 Aug 41, sub: T/O for Med Bn, Gas Treatment, with Memo for Record. Same file. (3) T/O 8-125, Med Gas Treatment Bn, 2 Oct 41, and T/O 8-127, Med Clearing Co, Gas Treatment Bn, 2 Oct 41. EVACUATION UNITS FOR THEATERS OF OPERATIONS 449 In the first few months after the United States entered the war, the tables of organ- ization of existing combat zone evacuation units were revised and new units were developed for use with new combat organ- izations. During 1942 the Army Ground Forces experimented with new types of divisions—mountain, jungle, airborne, and motorized.9 Although organizations of these types were used overseas little, or not at all, the fact that some of them were anticipated for use made it necessary for medical units to be prepared for them. Therefore, during 1942 tables of organiza- tion were developed for appropriate medi- cal units for service with new types of forces.10 Concurrently, changes were made in existing units. To indicate the nature of these changes, it will suffice to consider re- visions in the tables of organization of three of the more common types: the med- ical detachment of the infantry regiment, the medical battalion of the infantry divi- sion, and the medical regiment serving the field army. Unlike the infantry regiment which it supported, the medical detachment’s en- listed strength increased appreciably— from 96 to 126—when its table of organi- zation was revised in April 1942. The in- clusion of additional surgical technicians accounted primarily for this increase. The number of officers—eight physicians and two dentists — remained unchanged. Changes were made at the same time in the transportation authorized for the de- tachment. Seven 14-ton trucks (jeeps), seven 14-ton trailers, and one 2Vfe-ton truck replaced one motorcycle, fourteen l/2-ton trucks, and two ll/2-ton trucks.11 The infantry division’s medical battal- ion, according to early plans, was to re- ceive an increase in enlisted men and in vehicles as well. Its table of organization issued in April 1942 called for 8 additional enlisted men, an increase in Medical Ad- ministrative Corps officers from 5 to 8, a reduction in Medical Corps officers from 27 to 25, and no change in Dental Corps officers (2). The battalion’s vehicles, exclu- sive of trailers, rose from 87 to 93. The addition of trucks accounted for this in- crease, the number of ambulances—36— remaining the same.12 About the time this table was published, the War Department ordered a reduction in motor vehicles.13 The Surgeon General then decided to use the revised version of the table of organiza- tion of the medical battalion for motorized divisions being organized, and to develop a new table for the medical battalions of infantry divisions.14 The new table, sub- mitted for publication in July 15 but issued with an earlier date, reduced the number of motor vehicles by thirteen. None of the vehicles eliminated were ambulances, and trailers were added to replace some of the cargo space lost. Fewer motor vehicles re- quired fewer drivers and mechanics, and hence the new table provided for fourteen fewer enlisted men than formerly. In addi- tion, one Medical Corps officer was elimi- nated, reducing the total for the battalion from twenty-five to twenty-four. The number of Medical Administrative Corps 9 Kent R. Greenfield, Robert R. Palmer and Bell I. Wiley, The Organization of Ground Combat Troops (Washington, 1947), pp. 336-50, in UNITED STATES ARMY IN WORLD WAR II. 10 An Rpt, Plans Div Opr Serv SGO, 1942. HD. 11 T/O 7-11, Inf Regt, Rifle, 1 Oct 40 and 1 Apr 42. 12 T/O 8-65, Med Bn, 1 Oct 40 and 1 Apr 42. 13 Ltr SPXPC 320.2 (3-13-42), TAG to CGs AGE, AAF, and SOS, 3 1 Mar 42, sub; Policies Governing T/Os and T/BAs. AG: 320.2 (3-13-42)(5). 14 Memo, SG for CG SOS, 6 Jun 42, sub: Changes in T/Os. AG: 320.3 (10-30-41)(2) Sec 8. 15 Memo, CG SOS for TAG thru ACofS G-3 WDGS, 16 Jul 42, sub; T/Os, Med Bn. AG; 320.3 (10-30-41)(2) Sec 8. 450 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR officers (eight) and of Dental Corps offi- cers (two) remained unchanged.16 The revision of the table of organization of medical regiments early in 1942 pro- vided for an entirely new type of organiza- tion. Instead of having three battalions (collecting, ambulance, and clearing), the new regiment had two battalions that were similar to the medical battalions of infantry divisions, each having three col- lecting companies and one clearing com- pany. The collecting companies of battal- ions of medical regiments were almost identical with those of divisional medical battalions, but clearing companies of the former differed from those of the latter in having three instead of two clearing pla- toons in order to provide increased treat- ment facilities in army areas. This revision of the medical regiment was based on two of its functions as an army unit: the evacu- ation of divisional clearing stations and the reinforcement of divisional medical services. Having battalions and companies similar to those of divisional medical bat- talions, the new medical regiment would simplify the problem of supplying rein- forcing units to divisions in combat and, it was anticipated, would permit better ambulance evacuation of divisional clear- ing stations. This change in the organiza- tion of the medical regiment resulted in an increase of Medical Department officers from 66 to 76 and of enlisted men from 980 to 1,078. It also resulted in an increase in vehicles, the number of ambulances ris- ing from sixty to seventy-two.17 To provide even more ambulances for field armies, if they should be needed, and for communi- cations zones as well, The Surgeon Gen- eral developed about the same time a table of organization for separate motor Ambu- lance battalions. It was approved and published in April 1942.18 In the fall of 1942 the need for economy in personnel and vehicles—which, it will be recalled, affected the organization of hospital units 19—also resulted in changes in the tables of evacuation units. In re- sponse to a War Department directive to reduce personnel and equipment, espe- cially vehicles, in all Army organizations,20 AGE headquarters established a Reduc- tion Board in November 1942 to review all AGF-type units and to squeeze out the “fat.”21 In the process of shrinking the infantry division as a whole, the Board in March 1943 cut the personnel and vehi- cles of both the regimental medical de- tachment and the divisional medical bat- talion. In the detachment 1 medical officer and 23 enlisted men were eliminated, leaving 7 physicians, 2 dentists, and 103 enlisted men. This cut apparently proved too great, for about four months later twenty-three enlisted men were restored to the regimental medical detachment, bringing the total to 126 for the rest of the war. The only change made in the vehi- cles of the detachment was the replace- ment of its 21/2-ton truck with a IVfe-ton truck. As in the case of the cut in enlisted 16 T/O 8-15, Med Bn, 1 Apr 42. T/O 8-65, Med Bn, 1 Apr 42, was amended at the end of July to be- come T/O 8-65, Med Bn, Motorized (C 1,31 Jul 42). 17 (1) T/O 8-21, Med Regt, 1 Apr 42. (2) DF G-3/ 42108, ACofS G-3 WDGS to TAG, 5 Mar 42, sub: Med Regt, with Memo for Record and memos of ex- planation prepared by SGO. AG: 320.3 (10-30-41) (2) Sec 8. 18 (1) T/O 8-315, Med Amb Bn, Motor, 1 Apr 42. (2) DF G-3/42108, ACofS G-3 WDGS to TAG, 6 Mar 42, sub: T/Os, with Memo for Record and memos of explanation prepared by SGO. AG: 320.3 (10-30-41)(2) Sec 8. 19 See above, pp. 131-37, 146-49. 20 Ltr, TAG to CGs AGF, AAF, and SOS, 2 Oct 42, sub: Review of Orgn and Equip Reqmts. AG: 400 (8-10-42)(l) Sec 22. 21 Greenfield et al., op. cit., pp. 351-63, discusses the Reduction Board and its work. EVACUATION UNITS FOR THEATERS OF OPERATIONS 451 men, this change was reversed in July 1943.22 Reductions made in both the personnel and vehicles of the divisional medical bat- talion were more lasting. In March 1943 its Medical Corps officers were decreased from 24 to 22 and its enlisted men from 470 to 430, but its Medical Administrative Corps officers were increased from 8 to 11 and its dentists from 2 to 3. The clearing company of the medical battalion suffered the greatest decrease in enlisted men, twenty being eliminated, of whom twelve were orderlies who normally served in the clearing station. In each collecting com- pany the number of litter bearers was re- duced from thirty-six to thirty-one. The Reduction Board believed that the use of jeeps to evacuate casualties from the bat- tlefield warranted this action, but sup- ported the Ground Surgeon in opposing a reduction in the number of ambulances because it believed that twelve would be needed to evacuate casualties from each regiment and would not be available un- less included in the table of organization. Nevertheless, the commanding general, Army Ground Forces, directed a cut of two in each collecting company, thereby reducing the number in the entire medical battalion from thirty-six to thirty. Four other motor vehicles, three of which were command cars, were also eliminated.23 Cuts were made also in the personnel and vehicles of other organic medical units, but being similar in nature to those already described, they need not be discussed here. Although experience in maneuvers and in theaters of operations indicated that medical battalions and regiments, organ- ized under existing tables, were not en- tirely suitable for use with corps and army troops respectively, it remained for the Reduction Board of AGF headquarters to initiate a change in corps and army evac- uation units. The chief cause of dissatis- faction with existing units was their inflexibility. To provide greater flexibility, permitting the assignment of collecting, clearing, and ambulance companies in any combination required to fit a particular situation, and thereby to promote econ- omy of both personnel and equipment, the Reduction Board in February 1943 proposed the elimination of such large table-of-organization units as the medical regiment and the separate ambulance bat- talion, and the substitution of small ad- ministratively self-sufficient units, such as companies, which could be grouped for training and tactical use under separate battalion and group headquarters detach- ments.24 This proposal reflected a general trend in the Army Ground Forces “away from the organic assignment of resources to large commands according to ready- made patterns, and toward variable or ad hoc assignment to commands tailor- made for specific missions” 25—a trend that was to end during 1943 in the disap- pearance of type armies and corps. In accordance with the Reduction Board’s proposal, the Ground Surgeon’s Office 22 T/O 7-11, Inf Regt, 1 Mar 43 and T/O&E 7-11, Inf Regt, 15Jul43, 26 Feb 44, and 1 Jun 45. 23 (1) T/O 8-15, Med Bn, 1 Mar 43; T/O 8-16, Hq and Hq Det, Med Bn, 1 Mar 43; T/O 8-1 7, Col- lecting Co, Med Bn, 1 Mar 43; and T/O 8-18, Clear- ing Co, Med Bn, 1 Mar 43. (2) M/S GNRQT/24549, sub: T/O 8-16, 8-17, and 8-18, with following com- ments: CG AGF to Reqmts AGF, 5 Dec 42; Reduc- tion Bd to CG AGF, 8 Dec 42; and CG AGF to Reqmts AGF, 9 Dec 42. AGF: 320.3. 24 (1) M/S GNRQT/31566, Reduction Bd to Reqmts AGF, 10 Feb 43, sub; Med T/Os. AGF; 320.3. (2) An Rpt, Surg First Army, 1941. HD. (3) Memo, Ground Surg for CG AGF, 1 7 Jun 43, sub; [Anal of Rpts from North Africa]. Ground Med files: Chronological file, Folder 1. 25 Greenfield et al., op. cit., p. 280. See also pp. 279-99, 351-54. 452 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR prepared tables of organization for head- quarters and headquarters detachments of medical battalions and groups, and for administratively self-sufficient collecting, clearing, and ambulance companies. The Reduction Board, staff officers in AGF headquarters, and the Surgeon General’s Office approved these tables and they were published in May 1943.2(i Thereafter, instead of being rigid table-of-organization battalions and regiments, evacuation units of corps and armies were flexible battal- ions and groups made up of combinations of collecting, clearing, and ambulance companies that varied as the situation demanded.27 A further step in the trend toward the formation of small units that could be used in variable combinations was the develop- ment of tables of organization for teams or sections that could be grouped together to form platoons that could be further grouped to form companies. Like other technical services, the Medical Depart- ment prepared a table of organization for such units. The Medical Department table, issued in July 1943, provided for administrative, depot, motor ambulance, veterinary, and miscellaneous teams or sections. The three ambulance sections provided for by this table had 3, 6, and 10 ambulances respectively and could be assigned wherever required. One of the miscellaneous sections, the “attached med- ical section,” was designed to provide medical service for nonmedical battalions that were organic parts of larger units but were assigned alone to special missions.28 Early in 1944 the general movement already under way to replace Medical Corps officers with Medical Administra- tive Corps officers wherever possible affected the make-up of evacuation units also.29 In battalion and group headquar- ters, for example, administrative officers replaced physicians as operations officers (S-3s). Of perhaps more significance was the substitution in the medical detach- ments of combat battalions and regiments of Medical Administrative Corps officers for Medical Corps officers as battalion surgeons’ assistants. The Ground Surgeon concurred in The Surgeon General’s pro- posal to make this substitution in the med- ical detachments of coast artillery, anti- aircraft artillery, engineer, signal, and ordnance battalions, but he disapproved at first the recommendation that it be ex- tended to the medical detachments of infantry regiments and tank battalions. The latter organizations had such a high percentage of casualties, he stated, that a reduction of Medical Corps officers in their medical detachments would seriously im- pair the efficiency of their medical serv- ices.30 In February 1944, on the advice of the Fifth Army Surgeon in Italy, the Ground Surgeon reversed himself on this point. Thereafter, in the medical detach- 26 (1) M/S GNRQT/31566, sub: Med T/Os, Com- ment 5, Ground Med Sec to Reqmts AGF thru Re- duction Bd, 11 Mar 43; Comment 6, Reduction Bd to CG AGF, 3 [sic] Mar 43; Comment 7, Sec Gen Staff AGF to Ground Med Sec, 1 2 Mar 43; Com- ment 8, Ground Med Sec to Sec Gen Staff AGF, 16 Mar 43; Comment 10, Sec Gen Staff AGF to Reduc- tion Bd, 18 Mar 43. AGF; 320.3. (2) Memo for Rec- ord, 29 Mar 43, by Ground Med Sec. Ground Med files: Transfer Binder Journal, 1943. 27 T/O&E 8-22, Hq and Hq Det, Med Group, 20 May 43; T/O&E 8-26, Hq and Hq Det, Med Bn, Sep, 20 May 43; T/O&E 8-27, Med Collecting Co, Sep, 20 May 43; T/O&E 8-28, Med Clearing Co, Sep, 20 May 43; and T/O&E 8-31 7, Med Amb Co, Motor, Sep, 20 May 43. 28 T/O&E 8-500, Med Dept Serv Orgn, 26 Jul 43. 29 See above, pp. 250-51, 280. 30 (1) Memo, SG for CG ASF, 25 Nov 43, sub: Con- servation of MG Offs. (2) Memo, CG AGF (Ground Med Sec) for CofSA, 22 Feb 44, same sub. (3) DF, ACofS G-3 WDGS to TAG, 1 Mar 44, same sub. All in AG: 320.3 (10-30-41)(2). (4) WD Cir 99, 9 Mar 44. EVACUATION UNITS FOR THEATERS OF OPERATIONS 453 merit of the infantry regiment, for exam- ple, there were five Medical Corps, two Dental Corps, and three Medical Admin- istrative Corps officers instead of seven Medical Corps and two Dental Corps offi- cers. One Medical Corps and one Medical Administrative Corps officer, instead of two Medical Corps officers, served with each of the three battalion medical sec- tions. In the detachment’s headquarters there were two Medical Corps officers, in- stead of one as formerly, to insure a re- placement if needed for one of the battal- ion surgeons.31 Further changes were made in existing evacuation units, and new units were pro- posed and developed in the latter half of 1944 and the early part of 1945. Late in May 1944 a War Department circular directed a reduction in the number of basic privates in all but a few of the Army’s table-of-organization units.32 Basic pri- vates were soldiers in excess of the comple- ment of personnel needed to perform the functions for which units were designed and were provided to serve as replace- ments for losses occurring in the first phases of combat or, when in garrison, for men who would normally be absent be- cause of furloughs, sickness, and the like. Until May 1944 basic privates represented an addition of about 10 percent to the nor- mal operating strength of a unit. In May the War Department directed that they be reduced by approximately one-half. This led to a reduction in the number of basic privates in the medical battalion of an infantry division from thirty-nine to twenty-two.33 Separate medical units such as collecting, clearing, and ambulance companies were similarly reduced, but medical detachments serving with cavalry and infantry divisions were exempted.34 In the latter part of 1944 the Ground Surgeon proposed changes in the evacu- ation units of both divisions and armies. It had been recognized for some time, he stated, that the clearing companies of di- visional medical battalions needed three— instead of two—clearing platoons, in order to provide one clearing platoon to work with each of three collecting companies in support of the three regimental combat teams of each infantry division. Moreover, reports from theaters of operations, ac- cording to the Ground Surgeon, empha- sized that the collecting-station platoons of separate collecting companies were not needed in army areas of combat zones. There the need was for more litter bearers. Likewise, the ambulance platoons of sepa- rate collecting companies were not re- quired in army areas because separate ambulance companies were authorized as army units. The Ground Surgeon there- fore proposed to eliminate collecting com- panies as army evacuation units, and to substitute for them additional separate ambulance companies and separate litter bearer companies. For the latter he pre- pared a tentative table of organization. He further proposed that the men and officers formerly assigned to collecting-station pla- toons of army collecting companies should be used to form third platoons for the clearing companies of divisional medical battalions. Despite the fact that the changes recommended were expected not only to improve the organization of the 31 (1) M/S, Ground Med Sec to ACofS G-2 AGF, 8 Mar 44, sub: Proposed Changes in T/O. Ground Med files: Chronological file (Col W. E. Shambora). (2) DF, ACofS G-3 WDGS to TAG, 25 Mar 44, sub: T/O&E 8-500 and 8-550, with Memo for Record on change in WD Gir 99 (1944). AG: 320.3 (10-30-41) (2). (2) WD Gir 122, 28 Mar 44. 32 WD Gir 201, 22 May 44. 33 T/O&E 8-15, Med Bn, 15 Jul 43, with C 2, 3 Jul 44. 34 WD Gir 201, 22 May 44. 454 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR medical service in division and army areas of combat zones but also to save both com- missioned and enlisted personnel, the Deputy Chief of Staff of the Army Ground Forces disapproved the Ground Surgeon’s proposal in December 1944 because he considered it undesirable to make such changes “at this late date in the war.”35 The question of whether or not the medical gas treatment battalion should continue to exist arose in the latter part of 1944. Earlier its table of organization had been superseded by a table providing for a gas treatment team that was smaller and more restricted in its functions,36 but units already in theaters of operations continued in existence. The Technical Division of the Surgeon General’s Office contended in June 1944 that they were not needed be- cause oxygen and drugs could be adminis- tered to gas casualties by gas treatment teams and other medical units, the decon- tamination of equipment and clothing was not a proper function of the Medical De- partment, and the ability of gas treatment battalions to locate and decontaminate personnel as soon after exposure as neces- sary was doubtful.37 The Ground Surgeon also questioned the utility of such battal- ions and considered them wasteful of per- sonnel.38 Moreover, since gas warfare had not been used, medical gas treatment bat- talions in theaters of operations had not performed the functions for which they were intended. Nevertheless, because they had constituted a “convenient reserve,” theaters wished to retain them. So also did the Chief of the Chemical Warfare Serv- ice. In October 1944, therefore, The Sur- geon General requested and received per- mission to revise and reinstate the table of organization of the gas treatment battalion as an authorized unit.39 One of the uses which theaters had made of gas treatment battalions was to hold and care for patients awaiting evacu- ation at railheads and airports. No unit designed specifically for this purpose had been provided, despite information from North Africa as early as the fall of 1943 that they were needed,40 and theaters had had to use whatever means were available to meet their needs. This practice had been wasteful of both personnel and equipment. Early in 1945, therefore, after an inspection of the medical service of the European theater by one of his represen- tatives, the Assistant Chief of Staff, G-4, directed The Surgeon General to prepare a table of organization for a medical hold- ing unit.41 The resulting unit, a medical holding battalion authorized in May 1945, consisted of a headquarters and three holding companies, each capable of han- 35 (1) Memo for Record, on M/S, Comment 4, Ground Med Sec to ACofS G-l AGF, 15 Dec 44, no sub. (2) M/S, Comment 1, Ground Med Sec to Gen Staff AGF, 18 Sep 44, sub: T/O&E 8-29 (Proposed) Med Litter Bearer Co, Sep. Both in Ground Med files; Chronological file, Folder 2. (3) M/S, Comment 1, Ground Med Sec for ACofS G-3 AGF, 17 Jun 44, no sub. Ground Med files: Chronological file, Folder 1. (4) Memo, SG for CG ASF, 1 Oct 43, sub: Recomd for Changes in Med Dept Orgn, (SG: 320.3-1) pro- posed a third platoon for the clearing companies of the medical battalions of infantry divisions. After the war, the third platoon was added (T/O&E 8-18N, Clearing Co, Med Bn, 27 Feb 48). 36 T/O&E 8-500, Med Dept Serv Orgn, 23 Apr 44. 37 Diary, Tec Div SGO, 17 Jun 44. HD; 024.7 Oprs Serv. 38 Ltr, Brig Gen Frederick) A. Blesse to Col Calvin H. Goddard, 11 Feb 53. HD: 314 (Correspondence on MS) XI. 39 (1) Diary, Tec Div SGO, 7 and 14 Oct 44. HD: 024.7 Oprs Serv. (2) T/O&E 8-125, Med Gas Treat- ment Bn, 11 Nov 44. 40 (1) Memo, CG AAF for SG, 17 Sep 43, sub: Aerial Evac of Casualties. (2) Memo, Dir Hosp Admin Div SGO for Dir Plans Div SGO, 22 Sep 43, no sub. Both in HD: 705 “Hosp and Evac (Holding Unit) MTO.” 41 (1) 2d ind, SG to CG ASF, 3 Mar 45, on unlo- cated basic ltr. HD: 320.3-1 (T/O&E). (2) An Rpt, Tec Div SGO, FY 1945. HD. EVACUATION UNITS FOR THEATERS OF OPERATIONS 455 dling 300 patients. Had this battalion not been developed so late in the war, its use would have saved manpower, for it was authorized 26 officers and 404 enlisted men as compared with 45 officers and 411 enlisted men of the medical gas treatment battalions which some theaters used as holding units.42 Changes occurred during the war in the equipment as well as the personnel and vehicles of evacuation units. Changes in medical supplies and equipment reflected improvements in items already authorized or additions of items shown by experience to be needed. For example, early in 1944 an improved portable field autoclave re- placed an older item of that type in the clearing companies of medical battalions of infantry divisions. At the same time the number of chests of surgical supplies was increased, and portable electric suction apparatus was added to enable clearing stations to aspirate blood from pleural and abdominal cavities.43 Toward the end of that year and the early part of 1945 a combined otoscope and ophthalmoscope was added to the list of items furnished clearing companies, to permit clearing stations to make better examinations of patients with diseased or injured ears.44 Other changes were made at intervals in the lists of medical supplies and equip- ment of evacuation units in order to im- prove the standard of emergency medical service under combat conditions.45 Changes were also made in the equip- ment of evacuation units to increase their mobility. For example, early in the war the Medical Department developed a pack carrier for battalion medical equip- ment. This carrier—a canvas container mounted on a wooden frame—permitted the supplies and equipment used in bat- talion aid stations to be packed in loads (averaging about forty pounds each) that could be carried by individuals of battal- ion medical sections.46 Later in the war, after aluminum became available for the purpose, aluminum-pole litters were sub- stituted, it will be recalled, for heavier ones made of steel.47 Another change con- tributing to greater mobility in evacuation was the development of litter racks for jeeps, permitting in many instances the substitution of motor for pedestrian evac- uation in front-line areas. Although such racks were produced locally for use by evacuation units much earlier, they were not included in tables of equipment as standard items until 1945.48 4- (1) T/O&E 8-55, Med Holding Bn, 30 May 45. (2) Ltr, TAG to CinC USAF Pacific and CG USAF POA, 5 Jul 45, sub: T/O&E Med Holding Bn. SG: 320.3. 43 (1) Ltr, CG AGE to CG ASF thru SG, 10 Nov 43, sub: Proposed Changes in T/O&Es. AGF: 320.3. (2) T/O&E 8-18, Clearing Go, Med Bn, 15 Jul 43, with G 1, 17 Jan 44. 44 (1) M/S, Comment 1, Ground Med Sec to ACofS G-4 AGF and Reqmts AGF, 23 Aug 44, sub: Addi- tion to T/Es of Certain Med Units. Ground Med files: Chronological file, Folder 2. (2) T/O&E 8-138, Clear- ing Co, Mountain Med Bn, 4 Nov 44, and T/O&E 8-18, Clearing Co, Med Bn, 14 Feb 45, for example. 45 Examples of these changes may be found by com- paring the T/O&Es of various evacuation units. 46 (1) An Rpt, Equip Br Tng Div SGO, 1942. HD. (2) Memo, SG for Chief Surg SWPA, 1 Dec 42. SG: 705 (Australia)F. (3) Memo, [Maj] Aflfred] P. T[hom] for Col Shambora, 2 Mar 43, sub: Comments on Les- sons Derived from Oprs g,t Casablanca and Oran. Ground Med files; Chronological file, Training, 1943. (4) T/O&E 7-11, Inf Regt, 15 Jul 43. 47 (1) John B. Johnson, Jr., and Graves H. Wilson, A History of Wartime Research and Development of Medical Field Equipment (1946), pp. 75-80. (2) For example, T/O&E 8-16, C 1; T/O&E 8-17, C 3; T/O&E 8-18, C 2, all dated 3 Jul 44. 48 (1) Diary, Tec Div SGO, 3 Jun and 26 Aug 44. HD: 024.7 Oprs Serv. (2) The General Board, U. S. Forces, European Theater, Evacuation of Human Casualties in the European Theater of Operations. Study No. 92. HD. (3) T/O&E 8-16, Hq and Hq Det, Med Bn, 14 Feb 45, and T/O&E 7-11, Inf Regt, 1 Jun 45. 456 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Efforts to increase mobility by reducing the size and weight of equipment were made in the case of evacuation units, as in that of hospital units already discussed.49 During the winter of 1942-43 the cubage of the equipment (including vehicles) of the infantry division’s medical battalion was reduced from about 1,900 to about 1,475 ship tons, a ship ton being 40 cubic feet.50 Information about the cubage of the equipment of other evacuation units in the fall of 1942 is not readily available, but it is perhaps safe to assume that simi- lar reductions were made in the equip- ment of those units. After the reductions made in the winter of 1942-43, the cubage of equipment of evacuation units under- went little change until the early part of 1945. At that time there seems to have been a tendency for it to increase slightly. For example, the equipment of the infan- try division’s medical battalion increased in cubage from about 1,475 to about 1,600 ship tons in February 1945. Similar in- creases occurred early in 1945 in the equipment of other evacuation units.51 Another measure to increase the mobil- ity and improve the standard of combat zone medical service was the development by the Medical Department of certain ve- hicles for special purposes. The organiza- tion and growth of the Armored Force made it apparent during 1941 that new types of medical equipment would be needed. During the fall of that year the Armored Force itself began to experiment with the development of a surgical truck for use as a mobile clearing station. Soon afterward, the Surgeon General’s Office secured authority to initiate a research project in that field. During its course, the Medical Department Equipment Labora- tory co-ordinated its developmental work with the Armored Force, the Surgeon General’s Office, and the Quartermaster Corps. The pilot model of such a truck was delivered to the Laboratory in July 1942. Called a “truck, surgical,” this ve- hicle consisted of a van body mounted on a standard 2V2-ton (6 x 6) chassis. Within the body of the truck were a 50-gallon water tank; a sink with hot and cold water outlets; cabinets for supplies, equipment, and accessories; and three dome lights. Medical items such as those used in clear- ing stations were supplied and installed by the Medical Department. A tent, large enough to shelter twenty litter patients, was supplied to provide space outside the truck for patients awaiting evacuation farther to the rear. These trucks were de- livered on a basis of six per division to all armored divisions in the United States during late 1942 and early 1943.52 A surgical operating truck for use by auxiliary surgical groups was developed during the latter half of 1943. It differed from the surgical truck of the armored division largely in that it was supplied with greater quantities of more elaborate equipment. While the surgical truck of the armored division had only equipment and supplies for emergency medical treatment to be given inside the truck, the surgical operating truck carried enough surgical instruments and equipment to perform approximately 100 major surgical oper- ations. Surgery was not performed in the truck, but in a tent attached to its rear. The truck served only as a supply and 49 See above, pp. 146-48. 50 (1) Memo, CG AGF for AGofS G-3 WDGS, 16 Feb 43, sub: T/O&E, Med Bn. AG; 320.3 (10-30- 41 )(2) Sec 8. (2) FM 101-10, Staff Offs’ Fid Manual— Orern, Tec, and Loeristical Data, 10 Oct 43 and 21 Dec 44. 51 FM 101-10, Staff Offs’ Fid Manual—Orgn, Tec, and Logistical Data, 21 Dec 44 and 1 Aug 45. 52 Johnson and Wilson, op. at., pp. 295-339. EVACUATION UNITS FOR THEATERS OF OPERATIONS 457 sterilizing room. Such trucks, along with auxiliary surgical groups, often served as far forward as divisional clearing stations, supplementing them when the evacuation load was heavy. By the end of October 1945, 207 surgical operating trucks had been delivered for use by the Medical De- partment. In addition to surgical trucks, the Medical Department developed other special vehicles for use in theaters of oper- ations. They were a mobile dental labora- tory truck, mobile optical repair truck, a mobile dental operating truck, and ah army medical laboratory truck. Develop- ment of these vehicles contributed to the mobility and flexibility of medical service in a fast-moving war.53 Activation, Training, and Use in the United States The responsibility for activating, train- ing, and using in the United States the evacuation units that would operate in combat zones of theaters of operations be- longed almost exclusively to the Ground Forces. Before the reorganization of the War Department in March 194 2,54 all field medical units were trained under the supervision of General Headquarters. In the division of responsibility for medical units between the Ground and Service Forces that followed the reorganization,55 the Ground Forces (successor to General Headquarters) inherited the responsibility for training all medical units used in com- bat zones and gained in addition the responsibility for preparing their tables of organization and equipment, recommend- ing their inclusion in the troop basis, and activating such units. Planning for the troop basis during most of 1942 was conducted in terms of standard or fixed organizations. Medical units that were organic elements of com- bat forces whose structure was fixed by tables of organization, such as infantry divisions, were automatically included in the troop basis along with their parent units. While the structure of combat forces larger than divisions was not governed by tables of organization, corps and armies normally had standard numbers of units of various sorts early in the war. For ex- ample, for emergency medical care and evacuation each corps generally had a medical battalion; each army, three med- ical regiments.56 In the latter part of 1942 the Ground Surgeon proposed that each Army should have, in addition, a separate ambulance battalion to assist in the evac- uation of casualties from divisional clear- ing stations.57 Soon afterward, the stand- ard army and corps were abandoned as yardsticks for determining the number of service units needed.58 In addition, early in 1943, as mentioned above, non division- al medical units organized under inflex- ible tables of organization, such as medical regiments, were replaced by flexible bat- talions and groups made up of variable combinations of separate ambulance, col- lecting, and clearing companies. While these changes did not affect the automatic inclusion in the troop basis of medical units that were organic elements of com- 53 Johnson and Wilson, op. at., pp. 354-96, 407-35, 444-75, 534-66. 54 See pp. 54-55. 55 See above, pp. 58-59. 56 (1) Greenfield et al., op. cit., pp. 276-80, 352-54j (2) Orgn of Major Units, incl to Ltr, TAG to GGs AGF, AAF, and SOS, 31 Mar 42, sub: Policies Gov- erning T/Os and T/BAs. AG: 320.2 (3-13-42)(5). 57 M/S, Ground Med Sec to [ACofS] G-4 [AGF], 10 Aug 42, sub; Revision of Type Army and Type Army Corps Trps—Med. HD: 322 AGF (Units, Med) 1942. 58 Greenfield et al., op. cit., pp. 354-7 1. 304244 0—55 31 458 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR bat forces still organized under tables of organization, they did require the estab- lishment of a new basis for estimating the evacuation units that would be needed for service with corps and armies. Thereafter, this basis was a ratio of medical companies to divisions or to a certain number of troops. For example, it was considered that an army or task force needed a col- lecting company and a clearing company for each of its infantry divisions; and an ambulance company for every group of 12,000 soldiers.59 On this basis the Ground Surgeon proposed in November 1943 that a troop basis having 105 combat divisions should include 105 collecting, 105 clear- ing, and 105 ambulance companies.60 The troop bases subsequently approved did not follow this recommendation. For ex- ample, in April 1944, when planning was in terms of 89 divisions, the troop basis in- cluded 162 collecting, 104 clearing, and 75 ambulance companies.61 The discrep- ancy between the ratio recommended by the Ground Surgeon and that in which separate medical companies were author- ized can perhaps be explained by the fact that the troop basis was determined in the latter part of the war more by requests of theaters for units of specific types than by recommendations of staff officers in Wash- ington.62 In May 1945, just before the war in Europe ended, there were in the troop basis for the support of 89 divisions the fol- lowing corps and army evacuation units: 137 collecting companies, 75 clearing companies, 96 ambulance companies, and headquarters detachments for 80 medical battalions and 16 medical groups. All but one of these units, an ambulance com- pany, had already been deployed to the- aters of operations.63 The activation and training of medical evacuation units were so closely inter- twined with the activation and training of other Ground Forces units that any ac- count of them would reflect generally a larger picture already described in con- siderable detail elsewhere.64 Medical units that were organic elements of any of the combat arms or of any service other than medical were activated and trained along with their parent organizations. Corps and army medical units were activated according to a schedule based upon rec- ommendations of the Ground Surgeon. During most of 1942 they were trained under the supervision of division com- manders. In the latter part of that year and the early part of 1943, however, AGE headquarters established special local headquarters (Headquarters and Head- quarters Detachments, Special Troops) to supervise the training of all nondivisional AGF-type service units, including those of the Medical Department. At least one of these headquarters had a Medical Corps officer on its staff. The Ground Surgeon exercised general supervision over the technical training of all Ground Forces medical units and, on the basis of inspec- tions and reports, kept AGE headquarters 5«(1) Ltr, CG AGF to CofSA, 11 Jul 43, sub; Change to T/O 8-27 and 8-28, with incls. AGF: 320.3. (2) T/O&E 8-27, C 1, and T/O&E 8-28, C 1, both dated 5 Aug 43. (3) FM 101-10, 12 Oct 44. 60 M/S, Comment 2, Ground Med Sec to Plans [Div] AGF, 2 Nov 43, with 2 incls, Anal of 1944 Trp Basis and Summary of Trp Basis Study. Ground Med files; Chronological file, Folder 1. 61 Troop Basis, Calendar Year 1944, 1 Apr 44 Revision. AG: Ref Collection. 62 See above, pp. 219-22. 63 The War Department Troop Basis, 1 May 45. AG; Ref Collection. 64 Robert R. Palmer, Bell I. Wiley and William R. Keast, The Procurement and Training of Ground Combat Troops (Washington, 1948), pp. 426-560 in UNITED STATES ARMY IN WORLD WAR II. EVACUATION UNITS FOR THEATERS OF OPERATIONS 459 informed as to the state of their readiness for shipment to theaters of operations.65 Details of the training of Medical De- partment units will be included in a vol- ume on that subject planned for this series, but one aspect of their training needs to be considered here. Unlike station and general hospital units that were trained by the Army Service Forces, evacuation units trained by the Ground Forces were charged with actually providing medical service concurrently with their training in the zone of interior. To carry out this dual mission, they needed both personnel and equipment, but they suffered from a short- age of both. Lack of a sufficient number of Medical Corps officers in the Army Ground Forces prevented the assignment of full complements to units in training. Although the ratio of assigned to author- ized Medical Corps officers varied from time to time and from unit to unit, it was often less than 50 percent.66 Early in 1943 the shortage was so great that the Deputy Chief of Staff of the Army directed the Army Ground Forces to amend the tables of organization of medical units for which it was responsible by including in each a remark that medical and dental officers would be furnished “only as required and available within the continental limits of the U. S.”67 Early the next year the Ground Surgeon reported that with one exception—the 92d Division—it was pos- sible to assign only one Medical Corps officer, instead of the seven authorized, to each infantry regiment participating in maneuvers in Louisiana.68 The shortage of equipment did not last as long as the shortage of personnel. It was most severe during 1942 and the early part of 1943.69 At that time the Ground Surgeon reported that repeated requests of the Surgeon General’s Office to issue fuller allowances of supplies and equip- ment always met with the same answer— that production was great enough to meet only the needs of units scheduled for early shipment to theaters of operations.70 By the middle or latter part of 1943 the sup- ply situation had improved and by the end of the year some units reported that they had on hand approximately all of their equipment.71 Early in 1944 the Ground Surgeon reported that all med- ical units engaged in maneuvers in Louisi- ana had about 95 to 100 percent of their equipment with them.72 Despite shortages of equipment and personnel, evacuation units discharged their mission of furnishing medical service 65 (1) Memo, Asst Ground Surg for [ACofS] G-4 [AGF], 15 Nov 42, sub: Activation Plan for Non-Div Med Units. (2) M/S, Ground Med Sec to [ACofS] G-3 [AGF], 30 Jan 43, sub: Rpt on Readiness of Type Med Units. Both in Ground Med files: Chronological file, Folder 1. (3) An Rpt, Surg Third Army, 1942. HD. 66 For example, see An Rpts, Surgs Second and Third Armies, 1942, 67th Med Group, 1943, and 66th Med Group, 1944. HD. 67 Memo, Dep CofSA for CG AGF, 10 Mar 43, sub: Availability of Physicians. Ground Med files; Chrono- logical file, Folder 1. For an example of this remark see T/O&E 7-11, Inf Regt, 15 Jul 43. 68 Memo, Ground Surg for ACofS G-4 AGF, 26 Feb 44, sub; Rpt of Insp, Louisiana Maneuver Area, 22-24 Feb 44. Ground Med files: Chronological file (Col W. E. Shambora). 69 An Rpts, Surgs Second and Third Armies, 1942; Surg 4th Motorized Div, 1942; Surg 5th Inf Div, 1942; and 30th, 31st, and 65th Med Rgts, 1942. HD. 70 M/S, Comment 7, Ground Med Sec to Ordnance [Sec, AGF], 23 Dec 42, sub: Equip for Certain Units, Third Army. Ground Med files; Chronological file, Folder 1. 71 An Rpts, Surg Second Army, 1943; Surg 4th Inf Div, 1943; 31st, 67th, 69th, 341st, and 343d Med Groups, 1943. HD. 72 Memo, Ground Surg for ACofS G-4 AGF, 26 Feb 44, sub; Rpt of Insp, Louisiana Maneuver Area, 22-24 Feb 44. Ground Med files; Chronological file (Col W. E. Shambora). 460 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR while still in training. While in garrison, Ground Forces medical units were not de- pendent upon the issuance of their own organizational equipment for use in med- ical service, because The Surgeon General had established a policy before the war— and it was continued—of supplying dis- pensary buildings erected in training areas of Army camps with medical sup- plies and equipment from station stocks.73 Medical units of infantry divisions nor- mally supplied personnel for the operation of six to seven of such dispensaries in their own divisional areas. Each dispensary generally served a particular segment of a division. For example, each regimental medical detachment operated a dispen- sary for all persons in the infantry regi- ment to which it belonged. The medical service rendered by dispensaries consisted of routine immunizations, blood-typing, monthly physical inspections, and daily sick calls. Soldiers found by medical ex- amination at sick call to need hospital care were usually transported to station or regional hospitals in ambulances of divi- sional medical battalions. Ambulances and aid men also accompanied troops on long marches and on all training exercises of a dangerous nature, such as firing on ranges. In order to interfere with training formations as little as possible and to give as many men as possible experience in providing actual medical service, the per- sonnel of divisional medical units often served in dispensaries on a rotational basis.74 Nondivisional medical units, such as army medical regiments and groups, also operated dispensaries in garrison— sometimes for their own personnel only and sometimes for persons belonging to other units as well. In addition, units of these types were at times split up to sup- ply medical service for troops in widely separate areas. For example, during 1943 a detail of twenty-five enlisted men and twelve ambulances of the 1st Medical Regiment gave ambulance service to vari- ous infantry units stationed in northern California, while various collecting and clearing units of the Regiment handled the medical service of troops in southern California, and a platoon of one of its clearing companies served an artillery training center at Yakima, Wash.75 On maneuvers Ground Forces medical units used organizational equipment which had been issued to them for train- ing purposes or for later use in theaters of operations. It was the Ground Surgeon’s opinion that such experience was invalu- able and that no medical unit should be shipped to theaters of operations without having first become acquainted with its own equipment through use.76 Divisional medical units operated in support of the divisions to which they belonged, setting up aid, collecting, and clearing stations, and evacuating and caring for both actual and simulated casualties.77 Nondivisional units performed a variety of functions, in addition to caring for corps and army troops and evacuating casualties from di- visional clearing stations. For example, during maneuvers in 1942 the 68th Med- 73 The Annual Report, Surgeon First Army, 1941, spoke of the establishment of this policy. Its continu- ance was mentioned in the Annual Reports, Surgeons, Camp Hood (Texas) and Indiantown Gap Military Reservation (Pennsylvania), 1942. 74 An Rpts, Surgs, 4th Motorized Div, and 65th, 69th, 79th, 86th, 98th, and 99th Inf Divs, 1943. HD. 75 An Rpts, 1st and 31st Med Groups, 1943; 264th Med Bn, 1943; and 66th Med Group, 1944. HD. 7,i Interv, MD Historian with Col Shambora, 22 Apr 49. HD: 000.71. 77 An Rpts, Surgs, 4th Motorized Div, and 65th, 69th, 79th, 86th, 98th, and 99th Inf Divs, 1943. HD. EVACUATION UNITS FOR THEATERS OF OPERATIONS 461 ical Regiment operated the following in- stallations: a convalescent hospital, a medical supply depot, clearing stations for depot and army troops, and an infirmary for corps troops. During maneuvers in 1943 the 134th Medical Regiment estab- lished aid and prophylactic stations in towns within the area of operations, main- tained clearing stations for army troops, evacuated casualties from division and army clearing stations to evacuation hos- pitals and from the latter to named station hospitals, and provided personnel for the operation of a provisional medical supply depot.78 Regardless of the missions as- signed, Ground Forces medical units on maneuvers gained valuable practical ex- perience and at the same time supplied medical service for the troops with which they operated. 78 An Rpts, Surg Second Army, 1942; 1st, 31st, 67th, 69th, 134th, and 341st Med Groups, 1943. HD. Summary and Conclusions In concluding this volume with a brief review of the general subject it is pertinent to give first of all certain summary figures which indicate the Medical Department’s total accomplishment in the field of hospi- talization and evacuation during the war. In the period from January 1942 through August 1945, there were approximately 5,100,000 admissions to Army hospitals in theaters of operations and 8,900,000 to hospitals in the zone of interior.1 In the same period, more than 518,500 patients were debarked by the Army at ports plus 121,400 by aircraft in the United States for transportation to zone of interior hos- pitals. (Table 16) Meanwhile, evacuation units that were organized and trained in the United States transported many thou- sands of patients from front-line areas to medical stations and hospitals in theaters of operations. The number of patients on the registers of hospitals in theaters reached a peak of almost 266,500 at the end of January 1945.2 In a single month— May 1945—more than 57,000 patients were evacuated from theaters to the zone of interior. And by the end of June 1945 the number of patients on the rolls of Army hospitals in the United States rose to more than 318,000. (Table 13) The manner in which the Medical Depart- ment prepared for and discharged this unprecedented task of hospitalization and evacuation has been the subject of this volume. From the details already pre- sented, certain generalizations can be made and certain conclusions drawn to emphasize some of the problems involved in the accomplishment of this mission. Like the rest of the Army and the War Department, the Surgeon General’s Office and the Medical Department were in the midst of preparations and therefore not ready for a global war when it overtook them in December 1941. The partial mobilization that began with the passage of the Selective Training and Service Act in the fall of 1940 had caused only a par- tial adjustment from peacetime to what might be expected in wartime. Tables of organization, tables of equipment, and equipment lists of medical units had been revised, but more with considerations of desirability than possibility in mind. Data on hospitalization and evacuation in World War I had been analyzed and were available as a basis for estimating require- ments. They had already been used in the establishment of an authorized ratio of beds to troops for hospitals in the United States, but whether or not World War I experience would be applicable to World War II remained to be seen. Hospitaliza- tion and evacuation units had been or- ganized and were being trained, but they were few in number. Also, there was un- certainty as to the role of these particular units—whether they would remain in the 1 These figures are “preliminary pending publica- tion of final tabulations based on the individual med- ical records.” Memo, Eugene L. Hamilton, Chief Med Statistics Div SCO for Clarence Smith, Histor- ical Unit AMS, 3 Mar 53, sub; Hosp Admissions during World War II. HD: 705. 2 Statistical Review, World War II, App R, p. 237. 464 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR United States as training units or be sent overseas as functional units. Plans had been made to call others into active service in the event of war, that is, reserve hospital units affiliated with civilian schools and hospitals. With regard to hospital service in the United States and its territories, experience in expanding hospital facilities had shown the undesirability of depend- ing upon existing buildings and had re- vealed many unsatisfactory features in plans for cantonment-type hospitals. Blue- prints were drawn, therefore, for hospitals of a new type, to be of two-story semi- permanent construction. An improved general-service ambulance had been de- veloped and put into use; but plans for motor vehicles of other types, such as multipatient ambulances, were still in the experimental stage. Two unit and four ward cars for hospital trains had been delivered, but they had not yet been used in the actual transportation of patients. Although the ships’ hospitals of some transports had been enlarged and im- proved, it was uncertain whether the Army or Navy would operate transports, and therefore evacuate patients from over- seas areas during wartime. Moreover, basic decisions as to whether hospital ships would be authorized or not, and as to whether the Army or the Navy would operate them, remained to be made. Evac- uation from theaters and transportation of patients from ports to general hospitals in the United States proceeded according to peacetime procedures, with little indica- tion of changes that would be required for a wartime load. Plans for air evacuation were in the hopeful more than the practi- cal stage. And plans for the internal ad- ministration of hospitals and the global operation of a system of hospitalization and evacuation were in terms of expand- ing peacetime procedures rather than of substituting new procedures designed for the task that lay ahead. Finally, a shortage of medical supplies and equipment plagued medical officers from the highest to the lowest levels of command. Reasons for the unpreparedness of the Medical Department for war—or at least some of them—are reasonably clear. Plan- ning of the Army for many years had been in terms of defending the United States against sudden attack, and even during the period of peacetime mobilization there was uncertainty as to whether United States troops would be employed overseas. Furthermore, appropriations for prepared- ness were meager, and there was hesitancy even on the part of the President to appear aggressive in planning for a possible war. Finally, the Surgeon General’s Office— and perhaps the entire Medical Depart- ment—found it difficult, apparently, to break peacetime habits of thought and action and to plan imaginatively for the accomplishment of its mission during a possible future war. For the Medical Department, as for the rest of the Army, the first year and a half of the war was a time of meeting emergen- cy needs and completing mobilization, while at the same time preparing for full scale war. Needs of the moment received first consideration. As they were met, em- phasis gradually shifted to evaluating ex- perience as it accumulated and to plan- ning more effectively for the future. Despite many difficulties, sufficient hospitals were constructed and placed in operation to meet the Army’s requirements during its rapid growth and training in the United States. The necessity of speed and econo- my, however, dictated abandonment of new plans for hospitals of semipermanent construction and the erection of canton- SUMMARY AND CONCLUSIONS 465 ment-type hospitals on unsatisfactory ex- isting plans, with attendant alterations, additions, and repairs. Eventually, avail- ability of materials and general dissatisfac- tion with the hospitals under construction resulted in the erection of buildings of a third type—one-story buildings of brick or tile—considered by the Surgeon General’s Office to be the best for emergency con- struction. Toward the completion of the construction program, efforts were made to co-ordinate plans of the Army for hos- pital construction with those of other agen- cies and with postwar needs. Concurrently with the establishment of additional hospi- tals in the United States, hospitalization and evacuation units were sent overseas, and others were organized and placed in training for later service. Contrary to earlier plans, standard Army hospital units rather than affiliated reserve units constituted the primary means of meeting the first needs for hospitals overseas. Some of the latter—as well as nonaffiliated hos- pital units—remained in training in this country for long periods after their activa- tion, and the question arose of whether or not they might be used—as evacuation units were—to provide medical service concurrently with and as a part of their training in the United States. The Sur- geon General withstood the demands of higher headquarters to plan toward that end, and the problem of making effective use of numbered hospital units in the United States remained unsolved. By the spring of 1943, after the most urgent needs of theaters had been met, measures were taken to evaluate their existing facilities for hospitalization and evacuation and to plan more effectively to meet their future needs. The early part of the war was also a time of establishing basic policies and proce- dures that were to endure throughout the conflict. An early decision of importance was that the Army would operate trans- ports and evacuate patients aboard them. A corollary decision toward the middle of 1943 was that the Army would also oper- ate hospital ships to supplement the space available for evacuation on transports. Procedures that required only minor ad- justments later in the war were established to co-ordinate the activities of theaters, ships’ surgeons, ports of embarkation, and corps areas (later called service com- mands) in the evacuation of patients from theaters to hospitals in the zone of interior. In addition, a procedure for evacuating patients from theaters in regularly sched- uled transport airplanes was also estab- lished, but it was policy during this period to keep air evacuation to a minimum. De- spite the wishes of The Surgeon General and the Air Surgeon, AAF headquarters ruled that airplanes would not normally be set aside or built for evacuation only. Hopeful plans for forward-area air evacu- ation were thereby shelved. Procedures were also developed—albeit directives an- nouncing them were unclear and in some instances contradictory—for the move- ment of patients by hospital train in the United States. While hospitals and the hospital system in the zone of interior con- tinued for the most part to operate under peacetime procedures, the designation of general hospitals as centers for specialized treatment and the establishment of a pol- icy of hospitalizing patients near their homes occurred early in 1943. These ac- tions came too late to influence the loca- tion of general hospitals, and had not had time by the middle of 1943 to affect appre- ciably procedures for evacuation in the zone of interior. The desirability of short- ening the length of time patients stayed in 466 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR hospitals was recognized and efforts to- ward that end were begun. They per- tained primarily to procedures in admin- istrative channels outside Army hospitals. Finally, attempts of the Air Surgeon to set up separate convalescent facilities for Air Forces patients, along with an awareness by the Surgeon General’s Office and other Medical Department officers of the desir- ability of convalescent-reconditioning pro- grams, caused the establishment early in 1943 of convalescent centers and an- nexes—the forerunners of convalescent hospitals of later years. The early period of the war also afforded an opportunity to review plans already made and to adjust them to the new situ- ation. The mobility of war on land masses and the character of operations in island areas highlighted the necessity of modify- ing existing hospitalization and evacuation units. In some instances, new units were developed. In others, theaters were left to adapt existing units to new uses. Several conditions—shortages of personnel and shipping space, and the nature of combat operations—combined to initiate a trend that was to be carried to greater lengths later—the reduction of personnel and equipment authorized for units and instal- lations of all types and sizes. In this con- nection, certain other practices began: the substitution of Medical Administrative for Medical Corps officers in administrative positions in theater of operations units and in zone of interior installations, and the replacement of general service men with limited service men, civilians, and enlisted women in hospitals in the United States. Experience with unit cars for hospital trains revealed their impracticability, and the Surgeon General’s Office substituted for them a new type of car, called a ward dressing car. The Office successfully op- posed a proposal to develop at this time a fourth type of car—one that would include not only a dressing room and berths for patients but also a small kitchen. The Sur- geon General’s recommendation for the development of a forward-area ambulance was disapproved by higher authority, but the general-service ambulance was modi- fied to facilitate its shipment to and use in theaters of operations. Experiments with multipatient ambulances were unsuccess- ful, but other vehicles—such as surgical trucks—were developed for use in the evacuation system in theaters. The task of providing hospitalization and evacuation in the first year of the war was complicated by the fact that it had to be accomplished while a major reorgani- zation in the War Department was taking place. The creation of three major com- mands — Ground, Air, and Service Forces—required delineations of responsi- bility for hospitalization and evacuation, and raised questions concerning the extent of The Surgeon General’s authority. Re- sponsibility for units to be used in theaters of operations was readily divided between The Surgeon General and the Ground Surgeon, but the Air Surgeon’s responsi- bility and authority, and his relationship with The Surgeon General, were not suffi- ciently delineated to prevent recurring instances of friction between them, par- ticularly when the Air Surgeon attempted to set up a completely separate hospital system for the Air Forces. The establish- ment within ASF headquarters of a group concerned with hospitalization and evacu- ation and headed by a Medical Corps offi- cer had a variety of effects. This group assumed the lead in planning and in co- ordinating the activities of the many agen- cies involved in evacuation operations, with the full concurrence, apparently, of SUMMARY AND CONCLUSIONS 467 the Surgeon General’s Office. When it en- tered the field of hospital operations it encountered opposition. Whether the good it accomplished in this field counterbal- anced the ill-feeling and friction which it engendered is difficult to determine accu- rately even now. Progress had been made by the middle of 1943 in composing differ- ences and solving problems arising from the reorganization, but further adjust- ments in relations and authority remained to be made in the latter part of the war. The last two years of the war were characterized by the necessity of providing hospitalization and evacuation for an all- out war with more limited resources than had been anticipated. The problem of estimating requirements therefore de- manded continual and increasing atten- tion. By the latter half of 1943 it began to be evident that estimates based on World War I statistical data were too high for World War II. In the fall of 1943, when evacuation policies were established and bed ratios were authorized for theaters for the first time, there occurred the first at- tempt to use World War II experience as a source of data for estimating requirements. Soon afterward the Surgeon General’s Office completed an estimate of the patient load for 1944 for use in planning evacu- ation from theaters and in determining hospitalization for both theaters and the zone of interior. Facilities provided on the basis of this estimate seemed excessive dur- ing 1944 and, as the personnel situation became more restrictive, various agencies of the War Department urged retrench- ment. Reductions followed in the ratio of beds (to troops) authorized for station hos- pitals in the United States and for fixed hospitals in most theaters of operations. Early in 1945, when requirements in- creased, general and convalescent hospi- tals in the United States had to be ex- panded rapidly, more hospital train cars had to be procured, and additional hospi- tal ships had to be rushed to completion. Experience in estimating requirements during 1944 and 1945 pointed up the im- portance of collecting casualty and disease data early in the war for planning pur- poses. It also highlighted the necessity and difficulty of correlating far in advance estimates of requirements with estimates of the time when they would occur. Fur- thermore, it emphasized the importance of co-ordinating plans for hospitalization in theaters with plans for evacuation and for hospitalization in the zone of interior in order to avoid duplication and the un- economical use of limited resources. Limited resources affected hospitaliza- tion and evacuation in more ways than in demanding repeated estimates of require- ments. Shortages of personnel led to wide- spread application in the latter half of the war of practices already begun on a small scale. Further reductions occurred in the relative amounts of personnel authorized for hospitalization and evacuation units as well as for named hospitals in the United States. Medical Administrative Corps offi- cers were used more extensively to replace Medical Corps officers in administrative and semiprofessional positions; and lim- ited service enlisted men, civilians, and enlisted women replaced the major por- tion of able-bodied enlisted men in zone of interior installations. The extent to which reductions and substitutions of personnel were made supports the belief that hospi- talization and evacuation organizations were overgenerous in their use of person- nel at the beginning of the war. It also suggests that the Medical Department might have avoided many difficulties in adjusting to changes eventually required 468 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR by circumstances and higher authorities if it had been more realistic in the first place, reducing amounts of personnel authorized for various units and installations to that actually required and using from the start greater proportions of Medical Adminis- trative Corps officers, limited service en- listed men, civilians, and enlisted women. Personnel shortages also required the adoption of new practices in the latter half of the war, such as the use of provisional platoons to care for patients on transports, the employment of enemy protected- personnel in the medical service of theaters and the zone of interior, and the substitu- tion of small units that could be used in flexible combinations for larger rigid table- of-organization units, such as regiments and battalions, in combat areas. Restrictions on new construction in the latter part of the war led to the practice of expanding existing hospitals by using medical-detachment barracks for hospital patients, theater-of-operations-type bar- racks for detachments, and post barracks for convalescent patients. While several station hospital plants were converted into general hospitals, earlier plans and pro- posals to meet in the same manner a grow- ing need for general hospital beds in the latter part of the war proved impractical because of a shortage of specialists to man additional general hospitals. Toward the end of the war, the removal of restrictions on the use of certain materials formerly in short supply permitted a program of hos- pital improvement to correct some of the deficiencies in cantonment-type buildings erected earlier. Although hospital con- struction was curtailed about the middle of 1943, the major portion of the program of constructing hospital cars and ships oc- curred after that time—primarily because the need for them was either not fully comprehended or not recognized in the form of authorizations earlier. Demands from theaters in the Pacific in the latter part of the war focused attention upon the need for prefabricated hospital buildings for use in overseas areas. The war ended before this need could be satisfactorily met. Important changes were made in the zone of interior hospital system in the lat- ter part of the war—partly because of lim- itations upon available resources but also for other reasons, such as competition between the Air Surgeon and The Sur- geon General for the control of segments of hospitalization, the desirability of pro- viding a helpful psychological atmosphere for convalescent patients, and the emer- gence of new needs. The existing program of specialization in general hospitals was extended to promote the effective use of scarce specialists. The development of re- gional hospitals represented an attempt to eliminate duplication inherent in the operation of dual sets of hospitals (Air and Service Forces) by providing hospitaliza- tion on a regional or geographic instead of a command basis. The establishment of convalescent hospitals not only provided a better psychological environment for convalescent patients but also permitted their care in less expensive facilities than general hospitals. The operation of specific general hospitals solely for prisoner-of-war patients reduced administrative and se- curity problems and contributed eventu- ally to personnel economy. Although there were no significant changes in the system of hospitalization and evacuation in over- seas areas, efforts were made to provide theaters with additional types of units, such as medical holding battalions, mo- bile army surgical hospitals, and conva- lescent camps, in order to meet existing and emerging needs effectively. Changes SUMMARY AND CONCLUSIONS 469 did occur in the system of evacuation from theaters to the United States. Aside from improvements in procedures already es- tablished, the most important modifica- tion was the creation of a Medical Regu- lating Unit in Washington to centralize control over the use of hospital beds and over the flow of patients and to co-ordinate the movement of patients by sea, rail, and air. This step reflected a growing use of hospital ships, airplanes, and government- owned hospital cars in the evacuation process, contributed to stricter observance of the policies of caring for patients in specialized centers and in hospitals near their homes, and revealed the desirability of locating general and convalescent hos- pitals in relation to population density rather than troop concentrations. In connection with changes in the hos- pitalization and evacuation system came changes in the internal organization and procedures of zone of interior hospitals. They occurred near the end of the war and came largely as a result of emphasis by ASF headquarters on the achievement of efficiency and economy through man- agement engineering. Attempts to stand- ardize hospital organization—a prerequi- site to the simplification of administrative procedures—amounted to conformance with the standard organization of ASF posts more than improvements and inno- vations in hospital organization as such. The introduction of management engi- neering led to work-load studies, work- simplification measures, and the stream- lining of certain administrative proce- dures, especially those affecting the length of time patients remained in hospitals and, consequently, the number of beds re- quired. Another factor affecting bed re- quirements—the performance of adequate diagnostic procedures to permit the admis- sion to hospitals of only those patients needing hospital care—was not touched, and the work of dispensaries in this respect remained “one of the weakest links in the whole medical program.”3 Growth of the patient load in the later war years, coupled with changing policies, procedures, and circumstances, led to the development of new transportation facili- ties for evacuation. Despite its earlier ob- jection to a proposal for a hospital car with a dressing room, berths for patients, and a small kitchen, the Surgeon General’s Office adopted the idea when its necessity became obvious. That Office also pro- moted the procurement of kitchen cars for hospital trains when it became apparent that railroad companies would be unable to supply the Army with sufficient dining cars. To assist in the movement of patients from ports to near-by hospitals, The Sur- geon General proposed, and higher au- thority approved, the development of a multipatient ambulance. A front-line am- bulance was developed experimentally, but it was not authorized for procurement because ASF headquarters and the War Department General Staff insisted upon the use of standard Army vehicles only. Toward the end of the war litter racks that could be attached to jeeps to enable them to evacuate patients from forward areas were standardized for issuance to evacu- ation units. While airplane ambulances were never authorized or developed, im- provements in litter supports permitted increases in the capacities of transport planes for evacuation. Eventually, an in- crease in the availability of planes led to a modification of existing policy and the as- 3 Comment by Dr. Eli Ginzberg, formerly Dir, Re- sources Anal Div SCO, incl to Ltr to Col Calvin H. Goddard, 5 Nov 51. HD: 314 (Correspondence on MS) V. 470 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR over the entire hospitalization and evacu- ation system of the Army. Perhaps an im- portant reason for this was that, as a result of the dual position he held, he seemed at times to be bidding against himself. As The Surgeon General of the entire Army, he was responsible—to some extent, at least—for apportioning medical resources among major commands (Air, Ground, and Service Forces) and between the zone of interior and theaters of operations. On the other hand, as surgeon on the staff of the commanding general, Army Service Forces, he was responsible for providing as good a medical service in the zone of inte- rior as possible. This required him to act in a disinterested manner on matters in- volving him as an interested party. Never- theless, despite difficulties caused by its organizational structure, the War Depart- ment and its agencies, including the Sur- geon General’s Office, managed success- fully with limited resources to provide adequate hospitalization and evacuation for an Army of over 8,000,000 men engaged in a global war. signment to several commands of planes for use primarily in the movement of patients. Further adjustments to the new organi- zation of the War Department occurred in the latter half of the war. The Surgeon General expanded and strengthened his Office, particularly the divisions concerned most immediately with hospitalization and evacuation. Concurrently, ASF headquar- ters abolished its Hospitalization and Evacuation Branch and transferred many of its functions and some of its personnel to the enlarged and strengthened Surgeon General’s Office. Eventually, The Surgeon General was restored to his former posi- tion of having direct contact with the War Department General Staff. Meanwhile, though still under ASF headquarters, his Office developed means of exercising closer supervision over service command hospital activities, and limits of the respective juris- dictions of the Air Surgeon and The Sur- geon General gradually evolved. The Surgeon General was never in a position, though, to exercise a controlling influence List of Abbreviations AAF Army Air Forces AAR Association of American Railroads AC Air Corps ACofS Assistant Chief of Staff Act Acting Add Additional, addition Admin Administration, administrative, administrator AFPAC U. S. Army Forces, Pacific AG The Adjutant General, Files of AGF Army Ground Forces; Army Ground Forces, Files of AGO Adjutant General’s Office AG WAR Adjutant General, War Department Almt Allotment Amb Ambulance AML Army Medical Library An Annual Anal Analysis AR Army Regulations ASF Army Service Forces Asgmt Assignment ASO Air Surgeon’s Office ATC Air Transport Command; Air Transport Command, Files of ATS Army Transport Service Auth Authority, authorized, authorization AWC Army War College, Files of Bd Board Bn Battalion BPE Boston Port of Embarkation Br Branch C Chief CA Corps area CASU Corps Area Service Unit CBI China-Burma-India CCS Combined Chiefs of Staff CDD Certificate of disability for discharge CE Chief of Engineers, Files of; Corps of Engineers 472 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR CG Commanding General CinC Commander in Chief Cir Circular Civ Civilian CMTC Combined Military Transportation Committee Cmtee Committee CO Commanding Officer Co Company CofAC Chief of the Air Corps CofEngrs Chief of Engineers CofF Chief of Finance CofOrd Chief of Ordnance CofSA Chief of Staff, U. S. Army CofT Chief of Transportation Comd Command ComZ Communications zone Conf Conference Cons Construction, constructing, consultant Conv Convalescent, conversation, conversion Co-ord Co-ordination CPA Central Pacific Area CPE Charleston Port of Embarkation DAF Department of the Air Force Def Defense Dep Deputy Det Detachment Dev Development DF Disposition form Dir Directorate, director Distr Distribution Div Division Dom Domestic D/S Disposition slip EM Enlisted men Engr Engineer, engineering Equip Equipment Est Estimate Estab Establish, establishment ETOUSA European Theater of Operations, U. S. Army Evac Evacuation, evacuating Fac Facility, facilities Fid Field FM Field manual LIST OF ABBREVIATIONS 473 FY Fiscal year Gen General GHQ General Headquarters GO General Order HD Historical Unit, Army Medical Service, Walter Reed Army Medical Center (formerly Historical Division, Office of The Surgeon General) Hist History Hosp Hospital, hospitalization Hq Headquarters HRPE Hampton Roads Port of Embarkation HRS Historical Records Section, Departmental Records Branch, Adjutant General’s Office IAS Informal action sheet IG The Inspector General; The Inspector General, Files of Incl Inclosure, inclosed Ind Indorsement Indiv Individual Info Information Init Initialed Insp Inspection Instl Installation Interv Interview JAG The Judge Advocate General JCS Joint Chiefs of Staff JMTC Joint Military Transportation Committee JPS Joint Staff Planners Lab Laboratory LAPE Los Angeles Port of Embarkation Ltr Letter MAC Medical Administrative Corps Mar Comm Maritime Commission Mat Material, Materiel MC Medical Corps MD Medical Department MFSS Medical Field Service School MHSP Medical hospital ship platoon Mil Military Min Minute Misc Miscellaneous Mob Mobilization MOOB Mobilization and Overseas Operations Branch, Office of The Surgeon General 304244 0—55 32 474 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR MOOD Mobilization and Overseas Operations Division, Office of The Surgeon General MPD Military Personnel Division MR Mobilization Regulations MRO Medical Regulating Officer MRS Memo routing slip MRU Medical Regulating Unit M/S Memorandum sheet or slip MSO Medical Supply Officer MTOUSA Mediterranean Theater of Operations, U. S. Army Mvmt Movement NATOUSA North African Theater of Operations, U. S. Army n d No date NOPE New Orleans Port of Embarkation NP Neuropsychiatric, neuropsychiatry NYPE New York Port of Embarkation OCE Office, Chief of Engineers OCofAC Office, Chief of the Air Corps OCS Office, Chief of Staff, U. S. Army OCT Office of the Chief of Transportation Off Office, officer OO Office Order OPD Operations Division, War Department General Staff OPMG Office of The Provost Marshal General Opr Operation Ord Ordnance; Chief of Ordnance, Files of Orgn Organization OSW Office, Secretary of War, Files of PE Port of embarkation Pers Personnel, personal Plat Platoon PMC The Provost Marshal General PMP Protective Mobilization Plan Pnt Patient POA Pacific Ocean Area Procmt Procurement Prov Provisional, provision Ptbl Portable PW Prisoner of war QMG The Quartermaster General Rad Radiogram Recomd Recommendation Reg Regulation, regulating LIST OF ABBREVIATIONS 475 Regt Regiment Repl Replacement Req Required Reqmt Requirement Res Reservation, resolution, reserve Rev Revision Rpt Report R&R Sheet Routing and record sheet RR Railroad Ry Railway SCSU Service Command Service Unit Sec War Secretary of War Sep Separate Serv Service SFPE San Francisco Port of Embarkation SG The Surgeon General; The Surgeon General, Files of SGO Surgeon General’s Office SHAEF Supreme Headquarters, Allied Expeditionary Forces SOS Services of Supply SPA South Pacific Area SPE Seattle Port of Embarkation S/S Summary sheet Sta Station Str Strength Sup Supply Supp Supplement Surg Surgeon, surgical Surv Survey SvC Service command SWPA Southwest Pacific Area Syst System TAG The Adjutant General TAS The Air Surgeon’s Historical Division, Files of T/BA Table of basic allowances TC Transportation Corps; Chief of Transportation, Files of T/E Table of equipment Tec Technical Tel Telephone Temp Temporary Tfc Traffic TM Technical manual Tn Train Tng Training 476 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR T/O Table of organization; theater of operations T/O&E Table of organization and equipment TofOpns Theater of Operations Trans Transportation; transports Trf Transfer Trp Troop T/S Transmittal sheet USAF United States Air Forces USAFBI U. S. Army Forces in the British Isles USASOS U. S. Army, Services of Supply USFET U. S. Forces, European Theater Util Utilization, utilities Veh Vehicle WAAC Women’s Army Auxiliary Corps WAC Women’s Army Corps WD War Department WDCSA Office, Chief of Staff, U. S. Army, Files of WDGS War Department General Staff WDMB War Department Manpower Board WPB War Production Board WRGH Walter Reed General Hospital ZI Zone of interior Bibliographical Note Primary Sources The most important collections of source material for this volume were the central files of the Surgeon General’s Office and the files of the Historical Unit, Army Med- ical Service, Walter Reed Army Medical Center. The central files of the Surgeon General’s Office for the war period have been retired and are now in the custody of The Adjutant General. They contain offi- cial correspondence, memoranda, and re- ports originating in the Surgeon General’s Office, as well as numerous documents received by this Office from other sources, both military and civilian. These files, like those of most Army agencies, are arranged by subject under a numerical or decimal system. For example, documents on the construction of hospitals are filed under 632; of cars for hospital trains, under 531.4; and of hospital ships, under 560. To include here all of the numerical classi- fications of documents used in the prepa- ration of this volume, or even those used most often, is both undesirable and unnec- essary because the list would be too long and would duplicate information readily available in footnotes throughout the volume. The files of the Historical Unit are extensive, having been built up by the Historical Division, Office of The Surgeon General (predecessor of the Historical Unit) during the war years. Of particular importance in the Historical Unit files are the annual reports submitted during the war by The Surgeon General, divisions of the Surgeon General’s Office handling hospitalization and evacuation matters, surgeons of large commands, and com- manding officers of hospitalization and evacuation units and installations that ranged from 3,000-bed hospitals to sepa- rate ambulance companies. Although these annual reports obviously must be used with caution, because surgeons and commanders in some instances undoubt- edly attempted to present the most favor- able view possible of their activities, they contain a wealth of information not other- wise available. In addition, many of them contain excellent discussions of Medical Department shortcomings, because they afforded surgeons and commanders an opportunity to complain about matters over which they were disturbed but had no control. The absence of complete sets of annual reports of the Air and Ground Surgeons for the war years is regrettable. The Historical Unit also has custody of wartime working files of several divisions of the Surgeon General’s Office. The most important among them for this volume were those of the Mobilization and Over- seas Operations Division, the Medical Regulating Unit, and the Resources Anal- ysis Division. To supplement these papers, the Unit periodically borrowed wartime documents from current office files of the Medical Facilities Planning Branch (form- erly Hospital Construction Branch), Med- ical Statistics Division, Resources Analysis Division, Supply Division, and Medical Research and Development Board of the Surgeon General’s Office. The Historical 478 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR Unit also has a large decimal file; most of the papers in it, however, are carbon copies of those in The Surgeon General’s central files. Supplementing these files and sometimes serving as a clue to the location of other important documents are the diaries of divisions of the Surgeon Gen- eral’s Office covering the period from the fall of 1943 to the end of the war. In addi- tion, the Historical Unit has a copy of the testimony and report of the Committee to Study the Medical Department (1942) and a compilation of recommendations of the Committee and actions on them by the Surgeon General’s Office. Portions of these documents were extremely useful for in- formation on relations between the Sur- geon General’s Office and the SOS Hos- pitalization and Evacuation Branch and on developments in hospitalization and evacuation up to the end of 1942. Also of interest for this volume, the Historical Unit has microfilm of The Adjutant Gen- eral’s unit cards (large cards giving in abbreviated form the chronology and his- tory of individual military units) of Medi- cal Department organizations, including hospitalization and evacuation units. (The original cards are filed in the Organiza- tion and Directory Section, Operations Branch, Administrative Services Division, Adjutant General’s Office.) Other docu- ments and materials belonging at present to the Historical Unit were used in this study, but it is unnecessary to mention them specifically. When this volume was written, the His- torical Unit had in its custody, on indefi- nite loan, three blocks of files of consider- able significance. The Wilson files—so called because they were built up and used by Col. William L. Wilson, M. C.—were on loan from the Historical Records Sec- tion, Departmental Records Branch, Ad- jutant General’s Office. Covering a period from May 1941, when Colonel Wilson was in G-4, until June 1943, shortly after he left ASF headquarters, these files are actually unofficial records of the ASF Hospitaliza- tion and Evacuation Branch. They contain a full set of staybacks, a diary, a decimal file, a subject file, and a file of operational plans submitted by medical installations in the United States. The Ground Medical Section files, containing papers from the Ground Surgeon’s Office, were on loan from Headquarters, Army Field Forces, Fort Monroe, Va. Important but not as extensive as would be desired, these files contain several sets of staybacks and many annual reports of Army Ground Forces medical units. On loan from the Air Forces, but recently returned to the His- torical Division, Office of The Surgeon General, Department of the Air Forces, were files of the Air Surgeon’s Historical Division. In addition to annual reports and wartime histories of many AAF medi- cal installations and commands, these files contain several folders of the Air Surgeon’s correspondence, including interoffice memos, on hospitalization and evacuation. Next in importance to the files of the Surgeon General’s Office and the Histori- cal Unit for this study were certain files of ASF headquarters and the War Depart- ment General Staff, which are in the cus- tody of the Historical Records Section, Departmental Records Branch, Adjutant General’s Office. The most useful ASF files were those of the Control and Planning Divisions, and the folders dealing with Medical Department activities that were kept and used during the war by Generals Somervell, Styer, and Lutes. Of the Gen- eral Staff files, those of G-4 were naturally most rewarding, but those of G-l, G-3, and OPD were also consulted with success BIBLIOGRAPHICAL NOTE 479 in many instances. Conclusive informa- tion, particularly about controversies or disputes that reached high levels of author- ity for decision or solution, could be found often only in the hies of the Chief of Staff, U. S. Army, the Assistant Secretary of War for Air, and the Secretary of War. Other hies in the custody of The Adjutant General which it was frequently necessary to use were those of the technical services that assisted the Medical Department in its hospitalization and evacuation opera- tions; among them were the Quartermas- ter Corps, the Corps of Engineers, and the Transportation Corps. While the wartime hies of AAF and AGF headquarters were available and useful, it was particularly disturbing to be unable to hnd among them anything resembling central hies of the offices of the Air and Ground Sur- geons. Finally, and certainly not of least importance, were the hies maintained by The Adjutant General during the war. Because his Office was the War Depart- ment’s office of record, all official commu- nications to and from the General Staff found their way into the AG hies. Printed primary sources were also used in the preparation of this volume, but be- cause of the wide circulation they enjoyed it is unnecessary to indicate the deposi- tories in which they are located. Obvious- ly Army regulations, War Department circulars, held manuals, technical manu- als, tables of organization and equipment, and the like, are basic sources for any mili- tary history. Of interest because they helped the writer ht the history of hospi- talization and evacuation into a larger picture are the biennial reports of the Chief of Staff of the Army and the annual reports of the Secretary of War. Although no systematic search was made of Con- gressional committee reports, a few were used when they appeared to have a direct bearing on the subject under considera- tion. As noted at greater length in the pref- ace, the writer also derived much informa- tion from interviews and correspondence with persons active in Medical Depart- ment affairs during the war. Secondary Sources While there are no published mono- graphs or special studies on Army hospi- talization and evacuation during World War II, there are a number of unpub- lished preliminary histories and historical monographs on Medical Department ac- tivities that have been helpful to the writer of this volume. Among them are a group of studies prepared by the Historical Divi- sion, Office of The Surgeon General, im- mediately after the end of the war. They are the following: [Samuel M. Goodman], A Summary of the Training of Army Serv- ice Forces Medical Department Personnel, I July 1939-31 December 1944; Harold P. James, Transportation of the Sick and Wounded; John B. Johnson, Jr., and Graves H. Wilson, A History of Wartime Research and Development of Medical Field Equipment; Richard L. Laughlin, [History of] Reconditioning [in the U. S. Army in World War II]; Edward J. Mor- gan and Donald O. Wagner, The Organi- zation of the Medical Department in the Zone of the Interior; and Richard E. Yates, The Procurement and Distribution of Medical Supplies in the Zone of Interior during World War II. Two unpublished histories prepared by Florence A. Blanch- held and Mary W. Standlee, Organized Nursing in the Army in Three Wars (1950) and The Army Nurse Corps in World War II (1950), supplied background informa- 480 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR tion for the discussion of the “shortage” of nurses in zone of interior hospitals. Hubert A. Coleman, Organization and Administration, AAF Medical Services in the Zone of Interior (1948), was particu- larly helpful in the preparation of sections on AAF hospitalization and evacuation. Parts of this work are essentially copies of histories or reports submitted by AAF medical installations to the Air Surgeon’s Office and like all such documents must be used with care. The chapters actually prepared by Coleman and his assistants are scholarly and reliable. The Historical Unit has copies of all of the works named above. Two of my colleagues, Blanche B. Armfield and John H. McMinn, deserve special mention because they not only made available drafts of chapters of vol- umes which they are preparing on Medi- cal Department organization and person- nel, respectively, but they also gave the author full benefit of their knowledge both through frequent discussions and through criticisms of his manuscript. A variety of other unpublished histories were consulted, often with unexpectedly good results. Wartime histories of the Plan- ning and Control Divisions of ASF head- quarters supplied information that un- doubtedly existed in documents which could not be located in ASF files. Histories of Medical Department activities of the Air Transport Command, its Ferrying Di- vision, I Troop Carrier Command, and the Fourth Air Force were used to supple- ment information found in the files of AAF headquarters. Wartime histories of Medi- cal Department activities in overseas com- mands, on file in the Historical Unit, sup- plied information that occasionally threw light upon some aspects of zone of interior hospitalization and evacuation. Another group of documents which the author used, but with caution, needs to be mentioned. While some purport to be his- tories, all of them are in fact final reports of the offices concerned. On file in the His- torical Unit, they are as follows: Margaret D. Craighill, History of Women’s Medical Unit [Office of The Surgeon General]; History of Medical Liaison Office to the OCT and Medical Regulating Service, Office of The Surgeon General; History, Office of the Surgeon, Second Corps Area and Second Service Command, from 9 September 1940 to 2 September 1945; Historical Record, Laundry Section, Hos- pital Division, [Office of The Surgeon General]; History of the Organization and Equipment Allowance Branch, [Office of The Surgeon General]; Rene M. Juchli, Record of Events in the Treatment of Pris- oners of War, World War II; and Achilles L. Tynes, Data for Preparation of Histori- cal Record of Construction Branch of the Surgeon General’s Office during the Ex- pansion Period of the Army and World War II. Published histories, or those well along in the publication process, used in the preparation of this volume need only to be listed. Among them are several volumes (including three in manuscript form) of the UNITED STATES ARMY IN WORLD WAR II: Ray S. Cline, Wash- ington Command Post: The Operations Division (Washington, 1951); Stetson Conn and Byron Fairchild, Defense of the Americas, Vol. I (MS.); Kent R. Greenfield, Robert R. Palmer and Bell I. Wiley, The Organi- zation of Ground Combat Troops (Washington, 1947); Ulysses Lee, The Employment of Negro Troops (MS.); Maurice Matloff and Edwin M. Snell, Strategic Planning for Coalition Warfare, 1941-42 (Washington, 1953); John D. Millett, The Organization and Role of the Army Service Forces (Washing- BIBLIOGRAPHICAL NOTE 481 ton, 1954); Robert R. Palmer, Bell I. Wiley and William R. Keast, The Procure- ment and Training of Ground Combat Troops (Washington, 1948); Jesse A. Remington and Lenore Fine, The Corps of Engineers: Construction in the United States (MS.); Erna Risch, The Quartermaster Corps: Or- ganization, Supply and Services, Vol. I (Wash- ington, 1953); Mattie E. Treadwell, The Women’s Army Corps (Washington, 1954); Chester Wardlow, The Transportation Corps: Responsibilities, Organization, and Operations (Washington, 1951); and Mark S. Watson, Chief of Staff: Prewar Plans and Preparations (Washington, 1950). Use was also made of Wesley F. Craven and James L. Cate (eds.), The Army Air Forces in World War II (Chicago, 1948 and ff). Other published histories consulted were: Percy M. Ash- burn, A History of the Medical Department of the United States Army (Boston, 1929); Ro- land W. Charles, Troopships of World War II (Washington, 1947); Engineer, Office of the Chief, General Headquarters Army Forces, Pacific, Engineers in Theater Opera- tions in ENGINEERS OF THE SOUTH- WEST PACIFIC, 1941-45, Vol. I. (1947); Logistical History of NATOUSA-MTOUSA (Naples, Italy, 1945); The Medical Depart- ment of the United States Army in the World War, Vol. I (Washington, 1923), Vol. V (Washington, 1923), Vol. VIII (Washing- ton, 1925), and Vol. XIII (Washington, 1927); William C. Menninger, Psychiatry in a Troubled World (New York, 1948); and Howard A. Rusk, “Convalescence and Rehabilitation,” in Morris Fishbein (ed.), Doctors at War (New York, 1945). Various useful historical articles were found also in The Air Surgeon’s Bulletin, the Army Medical Bulletin, the Journal of Aviation Medicine, and The Military Surgeon. UNITED STATES ARMY IN WORLD WAR II The multivolume series, UNITED STATES ARMY IN WORLD WAR II, consists of a number of subseries which are tentatively planned as follows: The War Department, The Army Air Forces, The Army Ground Forces, The Army Service Forces, The Defense of the Western Hemisphere, The War in the Pacific, The European Theater of Operations, The War in the Mediterranean, The Middle East Theater, The China-Burma-India Theater, Civil Affairs, The Technical Services, Special Studies, and Pictorial Record. The following volumes have been published or are in press:* The War Department Chief of Staff: Prewar Plans and Preparations Washington Command Post: The Operations Division Strategic Planning for Coalition Warfare: 1941-1942 Global Logistics and Strategy: 1940-1943 The Army Ground Forces The Organization of Ground Combat Troops The Procurement and Training of Ground Combat Troops The Army Service Forces The Organization and Role of the Army Service Forces The War in the Pacific Okinawa: The Last Battle Guadalcanal: The First Offensive The Approach to the Philippines The Fall of the Philippines Leyte: The Return to the Philippines Seizure of the Gilberts and Marshalls Victory in Papua The European Theater of Operations The Lorraine Campaign Cross-Channel Attack Logistical Support of the Armies, Volume I The Supreme Command The Middle East Theater The Persian Corridor and Aid to Russia The China-Burma-India Theater Stilwell’s Mission to China Stilwell’s Command Problems *Volumes on the Army Air Forces, published by the University of Chicago Press, are not included 484 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR The Technical Services The Transportation Corps: Responsibilities, Organization, and Operations The Transportation Corps: Movements, Training, and Supply The Quartermaster Corps: Organization, Supply, and Services, Volume I The Quartermaster Corps: Organization, Supply, and Services, Volume II The Ordnance Department: Planning Munitions for War The Signal Corps: The Emergency The Medical Department: Hospitalization and Evacuation, fpne of Interior Special Studies Three Battles: Arnaville, Altuzzo, and Schmidt The Women’s Army Corps Pictorial Record The War Against Germany and Italy: Mediterranean and Adjacent Areas The War Against Germany: Europe and Adjacent Areas The War Against Japan Index Adjutant General, The, 8, 124, 127, 128, 243, 245, 263 Administration, hospital prewar period, 25, 26-37 7 Dec 1941-mid-1943, 121-39 mid-1943-1946, 170, 198-99, 238-78, 344, 345 Admissions, hospital. See Hospitalization statistics; Patients. Air ambulance squadrons, medical, 438 Air base commanders, responsibility for transferring debarked patients to hospitals, 341-42 Air conditioning for airplanes, 444 for hospital ships, 414 for hospitals, 97-99, 295-96 Air Corps. See also Air Surgeon, Office of the; Army Air Forces, control of hospitals, 11 control of patient-reassignment, 130 fire prevention in hospitals, 23 helps develop air evacuation unit, 437-38 and special airplanes for evacuation, 427, 428 Air evacuation group, 438-39 Air evacuation transport squadrons, medical, 339, 439 Air Surgeon, Office of the. See also Grant, Maj. Gen. David N. W. agrees on procedures for air evacuation in ZI, 358 approves new hospital admission procedure, 263 and bed requirements, 206-07 develops air evacuation units, 438-39 establishes bed credits in regional hospitals, 240 favors convalescent hospitals for AAF, 118, 119 favors using regional hospitals for patients from overseas, 186, 188, 210 initiates reconditioning programs in hospitals, 118 plans special planes for evacuation in combat areas, 433, 434, 435 proposes specialized and regional hospitals, 184 recommends establishment of AAF general hos- pitals, 107 responsibility for air evacuation, 338, 339, 357 urges separate hospitals for AAF overseas, 174- 76 Air Transport Command agrees on procedure for air evacuation in ZI, 358 announces increased medical personnel for air evacuation, 440 assignment of air evacuation personnel to sub- ordinate commands of, 440-41 dispensaries of, 175 encourages evacuation to ZI by air, 326 responsibility for air evacuation, 338-39, 340, 357, 358 Air Transport Command—Continued responsibility for medical supplies used in air evacuation, 445 Airplanes for evacuation, 338, 346, 358, 426-37. See also Evacuation, air. Alaska, 3, 142,337-38, 429 Ambulance battalions, 450, 451, 457 Ambulance Body Manufacturers Industry Advisory Committee, 365 Ambulance companies, 38, 452, 453,458 Ambulance ship companies, medical, 424 Ambulance transports, 396, 398. See also Evacu- ation to zone of interior by sea; Hospital ships. Ambulances, 321, 360-69 American Car and Foundry Company, 385, 388 American theater, bed requirements of, 217, 227, 233, 302 Apartment houses, converted to hospitals, 66 Armored Force, special medical equipment for, 456 Army Air Forces, 11, 54, 119, 133, 136, 326, 338, 358. See also Air Corps; Air Surgeon, Office of the; Air Transport Command; Medical Regulating Service, AAF. agrees to creation of regional and convalescent hospitals, 184-85 and bed requirements, 205-06 converts trucks to ambulances, 367 defense command patients in hospitals of, 104 designates hospitals for debarkation, 193—94 designates regional hospitals, 184 establishes all-Negro hospital, 110 establishes convalescent centers, 120 and evacuation equipment for airplanes, 326, 441-44 jurisdiction over station hospitals, 103 operates convalescent centers, 108 plans to establish holding facilities, 193-94 policy on special airplanes for evacuation, 357, 426, 431-37 reassigns AAF patients, 124, 242-43 relinquishes buildings for hospital use, 87 responsibilities for hospitalization and evacuation, 57-58, 287, 320, 321, 338, 358, 445-46 scope of treatment in station hospitals of, 183-84 separate hospitals, 12, 106-09, 174-76, 181 Army Ground Forces. See also Ground Surgeon, conference on establishment of separate con- valescent facilities, 119 consulted on medical equipment lists, 59 criticizes method of packing hospital equipment, 147 directed to substitute MAC for MC officers, 133 establishment, 54-55 486 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR Army Ground Forces—Continued favors delaying establishment of separate con- valescent facilities, 119 and hospital bed requirements, 301 hospitals in ZI for, 104-06 and issue of equipment to T/O hospitals in ZI, 152, 155 jurisdiction over medical units, 58-59, 173, 457, 458-59 recommends modification of field ambulance, 365 reduces transport of evacuation hospitals, 146 responsibilities for hospitalization and evacu- ation, 57 responsibility for medical T/O’s, 59 revises hospital T/O’s, 149 supports activation of training units at half strength, 141 supports special airplanes for evacuation in com- bat areas, 434 Army Medical Center. See Installations and units, medical. Army Nurse Corps deficiencies in training, 32 draft of, proposed, 252-53 duties assigned to Wacs, 258 ratio to patients, 251-52, 280 shortages, 31, 251-52 substitutes for, 249-50, 252-53 Army Service Forces, 119, 182, 183, 192, 197, 222, 230, 236-37, 248, 266, 314, 325-26, 390, 416. See also Adjutant General; Chief of Staff, ASF; Command Installation Branch; Control Divi- sion ; Hospitalization and Evacuation Branch; Medical Regulating Unit; Mobilization Divi- sion; Plans and Operations, Director of; Pro- vost Marshal General; Reduction Board; Requirements Division; Services of Supply; Somervell, Lt. Gen. Brehon B. agrees to creation of regional and convalescent hospitals, 184 approves convalescent facilities, 120, 189 attitude toward use and equipment of T/O hospitals in ZI, 156 authority over SGO, 171-72 and bed requirements, 200, 201, 202, 203, 205, 207, 211, 217, 225, 229, 231, 233, 301 believes SGO should be more active in planning hospitalization and supervising hospital oper- ations, 176-77 complains of hospitals’ delay in diagnosis, 242 considers separate general hospitals for AAF, 108 control of T/O hospitals in ZI, 173 delegates authority to make minor changes in hospital construction program, 288-89 and development of hospital trains and cars, 382, 383, 384-85, 387 directs changes in hospital program, 87 Army Service Forces—Continued establishes procedure for closing surplus hospitals, 314 and evacuation policy, 229 and improvement of hospital facilities, 289—90, 291-92, 293, 294, 295-96 jurisdiction over station hospitals, 103 and method of reporting hospital beds, 207, 208 modifies retirement and disability discharge pro- cedures, 243, 244, 245 orders precut hospital buildings for Pacific, 298 personnel policy, 111, 222-23, 249, 253, 254, 261, 265 and procurement of ambulances, 367, 368 and procurement of hospital cars, 385, 387 proposes changes in SCO, 176 provides hospitals for AGF patients in ZI, 105 publishes accounting procedure for hospital cars, 354 responsibility for hospital construction, 286 responsibility for selecting hospital locations, 88 supports air evacuation, 326, 358 supports standard organization for hospitals, 271 transfer of personnel to SCO from, 177 Australia, hospitals for, 143. See also Southwest Pacific Area. Autogiros for evacuation, 428. See also Helicopters for evacuation. Baehr, George, 81, 82, 83 Barracks for housing hospital beds, 20, 288 Battalions, medical. See Field medical units. Bed credits, hospital, 35, 115, 240, 321, 322, 346-47 Bed requirements, hospital. See also Dispersion factor; Hospitals, general; Hospitals, station, agencies determining, 200 estimates of, 13-14, 39, 40, 48, 78-87, 102, 109, 113, 149-51, 200-207, 208-12, 214-37, 300, 301-02, 463 general course of, 170 Beds, shortages of hospital, 24-26 Blesse, Brig. Gen. Frederick A., 9, 55 Bliss, Brig. Gen. Raymond W., 176, 261 Budget, Bureau of the, 86, 291, 293-94, 396 Buildings, hospital. See Hospital construction; Repair and maintenance, hospital. Burma, 429. See also China-Burma-India theater. California-Arizona Maneuver Area, 105-06, 156 Central Pacific Theater. See also Hawaii, hospitals in; Pacific Ocean Areas, absorbed in Pacific Ocean Areas, 230 bed requirements, 217, 218, 227, 230, 233, 235 bed statistics, 220-21 enlarges hospitals, 219 evacuation policy for, 235 hospital ships for, 327 hospitals for AAF in, 175 hospitals sent to, 143 hospitals from South Pacific sent to, 228 INDEX 487 Central service systems for hospitals, 292-93 Chemical Warfare Service, 268, 454 Chief of Staff, ASF, 107, 230 Chief of Staff, War Department announces air evacuation policy, 338 approves SG’s recommendation on hospital con- struction, 18 decides publication date for hospital manning guide, 31 directs ETO to use transports for evacuating pa- tients, 209, 328-29 directs full use of air evacuation by ETO, 329 grants increased hospital train personnel to serv- ice commands, 391 notes delay in retirement procedure for officers, 36 orders organization of WAC companies for hos- pitals, 258 plans to require double-bunking in barracks in emergency, 81 and project for emergency hospitalization, 81, 82, 83 promotes demobilization of medical personnel, 301 requests IG to investigate disagreement on hos- pital construction, 17 restricts transfer of prisoner-of-war patients to U. S., 197 suggests mission to study ETO hospitals, 237 China-Burma-India theater. See also Burma; China theater; India-Burma theater; India, hospitals for. agrees to accept Negro hospital, 224 bed requirements, 217, 218, 227, 233, 235 bed statistics, 220-21 evacuation policy for, 215, 216, 235 hospitals from South Pacific sent to, 228 uses mobile as fixed hospitals, 218 China theater, 233, 234, 235. See also China- Burma-India theater. Chinese Army, hospital bed requirements for, 218, 227, 233 Civilian Conservation Corps, 26 Civilian Defense, Office of, 66, 81, 82, 83 Civilian employees, 31, 32, 33, 40, 109, 249-50, 252, 253, 255-56 Civilians, Army hospitals for, 112 Clearing companies, separate, 451-52, 453, 458 Collecting companies, separate, 451-52, 453, 458 Combined Chiefs of Staff, 404 Combined Military Transportation Committee, 412 Command Installation Branch, ASF, 294 Committee to Study the Medical Department approves SG’s position on planning, 64 considers problem of convalescent patients, 118 criticizes inadequacy of certain facilities in hos- pitals, 99 effect of recommendations on policies and proce- dures of Medical Department, 61 Committee to Study the Medical Department—Con. gives causes for shortcomings of hospital con- struction, 93-94 proposal of separate convalescent accommoda- tions opposed by SG, 118 proposes changes in hospital administration, 122, 123, 127, 268 recommends maximum hospitalization for pa- tients, 129 recommends use of Waacs in hospitals, 136 Congress, 85, 91, 95, 111, 294 Construction Planning Branch, SOS, 79 Consultants, 123, 289 Contract surgeons, 109 Control Division, ASF authority over hospitals, 172 collaborates in drawing up subsistence procedures for hospital trains, 354 considers problem of limited personnel, 181 helps revise hospital administrative procedures, 262, 263 investigates complaints against railroads concern- ing reservations for patients, 355 lends statistician to OTSG, 177 revises disability-discharge procedure, 244 supports SG’s sole authority to estimate overseas bed requirements, 86 Convalescent annexes. See Hospitals, convalescent. Convalescent camps, 279 Convalescent centers. See also Hospitals, convales- cent. theater-of-operations-type, 148, 279-80 zone of interior functions, 188 operated by AAF, 108, 120, 188 operated by ASF, 189 retiring boards at AAF, 246 transfer of patients to, 109 Corps areas, 30, 55, 97, 133. See also Service commands. arrange movement of patients by train, 321—22 authorize transfer of patients from station to gen- eral hospitals, 35 control of hospitals, 11 given authority to procure civilian employees for station hospitals, 33 inspect hospitals, 30 jurisdiction over numbered hospitals, 47 reassignment of patients, 124, 130 report expenditures for repair and maintenance of hospitals, 95 responsibility for hospitalization and evacuation plans, 66 responsibility for training, 11-12, 47 review medical supply requisitions, 137-38 share responsibility for selecting hospital sites, 20 Cox and Stevens (naval architects), 405 Crews, hospital-ship civilian, 420, 421, 422 488 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR Defense commands, 104 Defense Health and Welfare Services, Office of, 82. See also Health and Medical Committee. Defense Plant Corporation, 388 Demobilization. See Redeployment and demobili- zation. Dental assistants, civilian, 40, 256 Dental clinics, 295 Dental Corps, 31 Dental laboratory trucks, 457 Dentists. See Dental Corps. Dependents of military personnel, 26 Depots, medical supply, 38, 39, 43 Deputy Chief of Staff, War Department approves creation of regional and convalescent hospitals, 184 approves separate general hospitals for AAF, 107 authorizes expansion equipment for hospitals, 222 and bed requirements, 203, 216, 217, 227, 228- 29, 229-30, 233 and evacuation policy, 229—30 failure to meet his authorizations, 222 more favorable to SC’s policy, 210 orders preparation of plan for combined use of hospitals, 184 orders reduced ratio of nurses to hospital beds, 252 and proposed use of regional hospitals for patients from overseas, 186 restricts transfer of patients, 240 and staffing the MD, 154, 155 Desert Training Center. See California-Arizona Maneuver Area. Detachments, medical, 4, 447, 449, 450 Dietitians, civilian, 33, 40 Dietitians, civilian apprentice, 256 Discharges for disability. See Patients. Dispensaries, 460, 469 Dispersion factor, 187n Disposition boards, 245-46 Divisions, hospitals for combat, 217 Doctors. See Contract surgeons; Medical Corps. Donald, Maj. Howard A., 409 Dormitories, converted to hospitals, 66 Eisenhower, Gen. Dwight D., 401-02 Emergency expansion of hospitals planning for ZI, 80-84 for theaters, 216, 217, 219, 222, 225, 227, 232 Engineers, Corps of control of hospital by, 11 corrects defects in hospital construction (ZI), 294 defects of overseas hospitals erected by, 296-97 and development of hospital trains and cars, 370, 371,372, 375, 379,380-81, 383 develops new-type hospital buildings for theaters, 298-99 Engineers, Corps of—Continued directed to reduce planned hospital construction, 79 follows established bed ratios in constructing station hospitals in ZI, 78 helps formulate guides for use of air-conditioning equipment, 98-99 helps plan modified type-A hospitals, 76 and improvements to hospitals (ZI), 98, 100, 289, 293, 294, 295 responsibility for hospital construction and main- tenance in ZI, 9, 21, 45, 92-96, 176, 288, 289 responsibility for selecting sites and locations for hospitals in ZI, 90, 91 types of ZI hospital construction favored by, 68- 69, 75-76 England, hospitals for, 143. See also European theater. Enlisted men attitude toward Wacs, 258 disagreement between SG and WDGS over pro- portions on hospital staffs, 31-32 efforts to secure additional, 5, 42-43 key technicians kept in ZI, 253-54 limited service men, 134-35, 249, 253, 254-55 replacement of able-bodied men, 131, 134-37, 254-55, 257 specialists, changes in T/O’s affecting, 40 strength less than authorized, 32 T/O allowances for, 281, 282 training deficiencies, 32-33 training programs, 33 Equipment. See Supplies and equipment. European theater. See also Iceland, hospital for; Ireland, Northern, hospitals for; England, hospitals for. agrees to use Negro medical personnel, 224 asked for information to assist in estimating medi- cal requirements for ZI, 202 authorized to expand general and station hospi- tals, 236 bed requirements, 217, 218, 225, 226, 227, 228- 30, 232, 233, 234-37, 300 estimate of evacuation by air from, 326 estimates of evacuation from, 329 evacuation by air from, 326, 339 evacuation policy for, 215, 216, 225, 229, 232, 233, 234, 235, 236, 300,330 evacuation by sea from, 205, 209, 326, 327, 329- 30, 401 hospital centers in, 282 hospital trains for, 380, 381 hospitalization for AAF in, 175 hospitalization statistics, 220-21, 300 length of patients’ stay in hospitals of, 229 mission to, for improving use of hospitals, 237 prisoner-of-war hospitals in, 236 short shipment of hospitals to, 228, 234 INDEX 489 European theater—Continued shortage of evacuation facilities from, 328 uses field hospitals for surgical hospitals and holding units, 235 Evacuation, air. See also Airplanes for evacuation; Autogiros for evacuation; Helicopters for evac- uation, equipment for, 441-46 estimates of, theaters to ZI, 226, 325, 326 ETO directed to make full use of, to ZI, 329 number of patients evacuated to ZI by, 324, 326, 327, 328, 329, 330, 337 number of patients moved in ZI, 322, 346, 357, 358, 359 personnel for, 437-41 procedures, theaters to ZI, 338 procedures in ZI, 322, 357—59 Evacuation, chain of. See Hospitalization and evac- uation, doctrine of. Evacuation policy definition, 165 effects of, 214-15 SG recommends an official, 165 theaters to ZI, 214-16, 219, 225, 227, 229-30, 232-33, 234, 235, 236, 300, 301, 330 Evacuation procedures. See also Hospitalization and evacuation, general directives on. theaters to ZI, 331-45, 465 in ZI, 346-59, 465 Evacuation requirements, theaters to ZI, 226, 234, 323-30 Evacuation statistics, 210, 324, 463. See also Re- ports; Evacuation, air; Evacuation to zone of interior by sea; Trains and cars, hospital; Trains, passenger, movement of patients in zone of interior by. Evacuation in zone of interior by rail, 349-57. See also Trains and cars, hospital; Trains, passenger, movement of patients in zone of interior by. Evacuation to zone of interior by sea, 324, 331—37. See also Ambulance transports; Hospital ships; Transports, troop. Exchange of equipment and supplies, 393, 445 Expansion capacity of hospitals. See Emergency expansion of hospitals. Federal Security Administration, 86 Field medical units. See also Air ambulance squadrons, medical; Air evacuation group; Air evacuation transport squadrons, medical; Ambulance ship companies, medical; Hospital ship complements; Hospital ship platoons; Installations and units, medical; Tables of organization and equipment; Train units, hospital. ambulance battalions, 450, 451, 457 Field medical units—Continued ambulance companies, 38, 452, 453, 458 ambulances for, 360—65 battalions, gas treatment, medical, 448, 454 battalions, medical composition, 448, 449, 450, 451, 452, 453 equipment, 449, 451, 455, 456 functions, 447, 448 number, 457 number of headquarters detachments for, 458 Protective Mobilization Plan provides for, 38 replace medical regiments, 39 clearing companies, separate, 451—52, 453, 458 collecting companies, separate, 451-52, 453, 458 destinations overseas changed, 163 detachments, medical, 4, 447, 449, 450 groups, medical, 452, 458 holding battalions, medical, 454-55 hospital centers, 281-82 hospitals. See also Hospitals: affiliated, convales- cent, evacuation, field, general, portable surgi- cal, station, surgical. bed requirements in, 214—37 definition of “fixed hospitals,” 5 definition of “mobile hospitals,” 4 enlargement, 219, 279 equipment, 5, 41-42, 45, 46, 48, 49, 140-42, 146-48, 151-60, 163, 216-17, 283-86 expansion of, 219 functions in ZI, 44, 45, 47-48, 49, 151-60, 465 housing overseas, 296—99 housing in ZI, 152, 153, 156, 159 jurisdiction over, 12, 46—47, 172, 173 modernizing hospital assemblages, 42 Negro, 162 new types of, 143-46 number, 149-51, 160, 222, 231, 233, 234 sent from ZI, 143, 160, 218, 234 staffing, 44—45, 49, 140, 141 summary of developments, 165-66 training, 32, 44, 46-47, 151-60 use of, as training and filler units, 160 use overseas, 48-49 laboratories, medical, 38-39, 43 litter bearer companies, separate, 453 mobilization plans for, 38—39 number in 1939, 5 personnel of, used to supplement enlisted men in hospitals, 32 regiments, medical composition, 39, 448, 450 elimination proposed, 451 equipment list revised, 41, 450 functions, 447 304244 0—55 33 490 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR Field medical units—Continued regiments, medical—Continued number, 5, 457 part of field army, 38 Protective Mobilization Plan provides for, 38 replaced by medical battalions, 39 squadrons, medical, 39, 40, 447 teams, medical, 452 training, supply, and use of nonhospital medical units by AGF in ZI, 457-61 troop, medical, 38 Finance, Chief of, SOS, 126 Fire hazard existence of, 16, 100 protection against, 14, 23, 24, 96 Fitzpatrick, Col. John C., 56, 180, 320, 403-04, 416 Flight surgeons, 108 G-l Division, War Department, 9, 171 directs revision of T/O’s, 148 directs study of patients’ discharge procedure, 127 and hospital bed requirements, 301 and manning guides for hospitals, 30-31 orders equal work-hours for Wacs and nurses, 257 recommends establishment of convalescent facili- ties, 119 G-3 Division, War Department, 9, 219 approves agreement as to responsibility for hos- pitalization and evacuation, 57 approves air evacuation unit, 438 approves, conditionally, establishment of hospital centers, 198 approves procurement of hospital equipment, 151 approves quota of hospitals for troop basis, 150, 151 authorizes increase in general hospital beds for mobilization, 39 and bed requirements, 217, 231,233 suggests affiliating numbered with named hospi- tals, 32 G-4 Division, War Department, 9, 55, 171. See also Moore, Brig. Gen. Richard C. approves prisoner-of-war hospitals, 197 and bed requirements, 205-06, 208, 210, 211, 217, 225, 227, 231-32, 233, 302 certain members advocate hospital ships and troop transports owned and operated by Army, 396 and construction and repair of hospitals, 15-16, 17, 18, 19,22,68, 69 criticizes SOS plan for hospitalization and evac- uation, 65 and establishment of convalescent facilities, 119, 202 and expansion of hospital capacity, 78-79 favors separate hospitals for AAF, 107 and issuance of hospital assemblages, 141-42 G-4 Division, War Department—Continued limits improvements to hospitals, 294 notes deficiency of hospital assemblages, 46 orders holding of equipment for medical units, 46 orders planning for ships’ medical personnel, 415 proposes use of hotels for convalescents, 119 and question of using regional hospitals for pa- tients from overseas, 186 questions propriety of allotting funds for modern- ization of hospital assemblages, 42 and reconditioning facilities, 292 requests development of island-type hospital, 144 requests procurement of ships, 396-97 requires reports on closing surplus hospitals, 314 sends representative to study ETO hospitals, 237 Gas treatment battalions, medical, 448, 454 General Headquarters, 9s 10, 11, 55 approves troop transports and hospital ships for evacuating patients, 396 expects enemy violation of Hague Convention, 396 medical units for, 38 General Headquarters Air Force, 427, 438 General Staff, War Department. See also Chief of Staff, War Department; Deputy Chief of Staff; G-l Division; G-3 Division; G-4 Division; Inspector General; Operations Division; War Department Manpower Board, advises on fixing responsibility for reassignment of patients, 130 advocates use of numbered hospitals as operating units in ZI, 44, 45 agreement on use of hospital ship platoons, 416 agrees to continuing in hospitals Wacs unassigned to companies, 258 approves air evacuation policy, 338 approves changes in number and capacity of station hospitals, 182 approves facilities for reconditioning, 291 attitude toward ZI hospitals for AGF patients, 105 authorizes attachment of technical-service teams to units of other technical services, 284 authorizes hospital personnel desired by SG, 31 authorizes hospitals to order officers to appear before retiring boards, 246 authorizes issue of medical equipment, 45 authorizes new type of construction for hospitals, 24 authorizes selection of hospital sites, 20 authorizes speedier transfer of officers’ records to hospitals, 246 and bed requirements, 200, 203, 206, 207, 209, 227, 231, 301-02 begins drive for more efficient use of personnel, 153 considers separate hospitals for AAF, 107 and development of hospital trains and cars, 371 INDEX 491 General Staff, War Department—Continued directive on hospitalization and evacuation, 65 directs incapacitated officers to appear before retiring boards, 243 directs use of civilian buildings for hospitals when practicable, 72 disagreement with SG over proportion of enlisted men on hospital staffs, 32 disapproves additional T/O hospitals, 150 disapproves air evacuation unit, 438 effect of WD reorganization on, 54 encourages evacuation to ZI by air, 326 forbids more housing for T/O hospitals in ZI, 159 functions in relation to SG and the MD, 8-9, 171- 72 insists on simplicity in hospital construction, 68 and manning guides for hospitals, 30-31 orders activation of hospital ship platoons, 416 policies affecting admissions to hospitals, 238—39 policy on use of hospital ships, 403, 404 refuses higher ratio of Wacs in hospitals, 257 requires revision of T/O and E’s, 49 responsibility for hospital construction, 286 reverses decision against establishing all-Negro hospitals, 110 and special plans for evacuation, 427 standardizes types of automobile chassis, 361 and substitution of MAC for MG officers, 133, 251 urges use of Waacs, 136 Geneva Convention, 112-13, 197, 394-95 Ginsberg, Eli, 177, 180 Grant, Maj. Gen. David N. W., 11, 175. See also Air Surgeon, Office of the. Greenleaf, Lt. Col. Henry C., 56 Ground Surgeon. See also Army Ground Forces, attitude toward replacement of MG by MAC officers as battalion surgeons’ assistants, 452 and bed requirements, 217 estimates evacuation units required, 458 proposes changes in evacuation units, 453-54 questions value of gas treatment battalion, 454 schedules activation of medical units, 458 supervises training of medical units, 458-59 supports transfer of responsibility from T/O convalescent hospitals in ZI to AGF, 173 Groups, medical, 452, 458 Hague Convention, 394, 395, 396, 397, 402, 403 Hall, Col. John R., 9, 21, 22, 23, 24, 75-76, 99 Hawaii, hospitals in, 3, 4, 142 Hawley, Maj. Gen. Paul R., 327, 401 Health and Medical Committee, 31, 82 Helicopters for evacuation, 434-36. See also Auto- giros for evacuation. Hines, Frank T., Administrator of Veterans Affairs, and Chairman, Federal Board of Hospitaliza- tion, 86 Holding battalion, medical, 454-55 Holding facilities, 194 Hospital centers T/O type, 40, 281-82 zone of interior, 39, 198-99, 270, 273-78 Hospital commanders, 66, 97, 123, 136, 244, 314 Hospital construction, overseas, 48, 296-99 Hospital construction, zone of interior. See also Repair and maintenance, hospital, amount, 24, 211 conversion of existing buildings, 14-16, 18, 66, 70-73, 90, 93, 287-88 co-ordination of Federal hospital construction- planning proposed, 86 curtailment of, 85-87, 159, 169, 201, 287 defects of, 23, 293 delaying factors, 100 improvement of existing hospital plants acoustic clinics, 289 administration activities, more space for, 99, 292-93 air conditioning, 97-99, 295-96 brace shops, 289 constant-temperature rooms, 289 deaf, centers for, 290 eye, ear, nose, and throat clinics, more space for, 99 flooring, replacement of, 96, 288, 293, 294 garages, ambulance, 23 hardware, improved, 294 heating corridors, 96-97 housing for Wacs, 136, 288 kitchens, enlargement of, 22 lawns and grounds, improvement of, 294 mess halls, enlargement of, 22 neuropsychiatric-social therapy clinics, 290 neuropsychiatric treatment, centers for, 290 nurses’ call systems, 295, 296 occupational therapy, more space for, 99, 290 painting, 288, 294 paraplegics, centers for, 290 plaster and dressing rooms, 289 plastic surgery, centers for, 290 post exchanges, 23, 99 recreation, more space for, 99, 290-91 rheumatic fever treatment, centers for, 290 roofing, replacement of, 96 safety devices, 22, 96, 100 service activities, more space for, 99 space, better utilization of, 22 storehouses, 22 strong rooms, 23 surgeries, enlargement of, 22 walkways, inclosed, 288, 294 walls, sealing, 288, 294 wards, additional, 22 X-ray work, more space for, 99, 289 necessity for, 4 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR 492 Hospital construction, zone of interior—Con. plans defects, 21 revision, 22, 23 standardization, 21 policy, summary of, 76-78, 87 responsibilities for, 14, 18, 20-21, 22, 60-61, 92-94, 286-87 tentage, use of, 70 types of cantonment, 14-15, 16, 18, 22, 23-24, 68, 69, 96, 97, 99-100 one-story semipermanent (Type A), 73—76, 77, 78 theater-of-operations, 68, 69, 70, 105 two-story semipermanent, 23-24, 68, 69 two-story semipermanent (Type A modi- fied), 76, 78 Hospital ship complements, 408-09, 419-22, 424 Hospital ship platoons, 335, 336, 415-19 Hospital ships. See also Ambulance transports; Evacuation to zone of interior by sea; Trans- ports, troop, added functions, 422 advocated, 396-97 air-conditioning for, 414 British, transport U.S. patients, 402-03 delays in conversion to, 409-10 estimates of evacuation by, 325, 326, 328 facilities, 403, 405-08, 414 list of, 406 medical personnel for, 419-22 names for, 410-11 Navy, 330 number, 326, 327, 328,410 number of patients evacuated by, 324, 326-27, 330 procurement, 396-97, 401-05, 414 responsibility of commanders of, 337 responsibility for operating, 395-98, 403, 404 shortage of, 236, 328 speed, 403, 405 supplies and equipment for, 423-25 where used, 401-02 Hospitalization and Evacuation Branch, SOS (ASF). See also McDonald, Brig. Gen. Rob- ert C.; Wilson, Col. William L. abolished, 159-60, 172 aids SG in getting information on operational plans, 165 attitude toward use and equipment of T/O hospitals in ZI, 151 changes proposed location of general hospitals, 90 concurs in limitation of TC’s control of hospitals, 115 controversy over planning, 63-67 delimits responsibilities for evacuation to ZI, 335, 339 Hospitalization and Evacuation Branch—-Con. and development of hospital trains and cars, 379, 380 established, 56 favors ship-to-hospital movement of patients, 114 functions, 56, 172, 320 obtains increase in bed ratios, 83 orders report on evacuation, 333-34 position reduced, 172 proposes medical T/O’s for ships, 415 relations with SCO, 61, 466-67 reviews recommendations for construction and alteration of hospitals, 60 secures reports on hospitalization and evacuation overseas, 164, 165 supports activation of training units at full strength, 141 on type and use of hospital ships, 403 Hospitalization and evacuation, doctrine of, 4-5 Hospitalization and evacuation, general directives on, 65-67, 83 Hospitalization, Federal Board of, 76, 86, 87, 129 Hospitalization statistics. See also Bed require- ments ; Reports, overseas admissions to hospital, 463 beds authorized, 220-21 beds available, 300, 301, 302 beds occupied, 220-21 T/O beds, 220-21 zone of interior admissions to hospital, 463 beds authorized, 25, 204, 211, 212, 213 beds available, 3, 25, 68, 80, 102, 211-12 beds occupied, 25, 80, 102, 204, 211, 212, 213, 463 patients remaining, 211 patients reported, 212, 213 Hospitals, affiliated activation of, 141 departure from ZI, 144, 160-61 establishment, 42, 49 list of evacuation hospitals, 158 list of general hospitals, 157 method of staffing, 44, 140 number, 140, 156 proposed, 5-6 a secondary means in emergency, 465 transfer of personnel to other units, 228 Hospitals, civilian, 104. See also St. Elizabeth’s Hospital; Veterans Administration. Hospitals, convalescent. See also Convalescent centers; Installations and units, medical, theater-of-operations-type number, 150, 151, 217 part of field army, 38, 150 Protective Mobilization Plan provides for, 38 responsibility for, in ZI, 173 sent from ZI, 160 INDEX 493 Hospitals, convalescent—-Continued zone of interior advantages, 190 antecedents, 117, 119-20, 189 authorized, 189 barracks for added space in, 209, 287 bed requirements, 202, 208, 209, 211, 302, 303 bed statistics, 211, 213, 315 closure of surplus, 315 construction, 286 equipment, 190 establishment considered, 103, 117, 118 form part of hospital centers, 198-99 functions, 5, 189, 211, 244 improvements to, 294, 295 location, 348 number, 189, 208, 315 organization, 270, 273-75 reconditioning facilities at, 291 retiring boards in, 246 transfer of patients to, 348 urged to speed disposition of patients, 240 Hospitals, debarkation. See Hospitals, port and debarkation. Hospitals, efficiency of, 107 Hospitals, evacuation affiliated, 6, 158 authorized at half-strength, 43 beds allotted in, 218 defects of, 145 deployment of, 163 development of new-type, 145-46 equipment, 140-41, 145, 146, 285 functions, 4-5 increase authorized, 42 number, 140, 150, 151, 217 part of field army, 38 Protective Mobilization Plan provides for, 38 revisions of T/O, 148, 149 sent from ZI, 143, 144, 160 Hospitals, field development, 143-45 number, 145, 151, 222, 223, 231, 233, 234 revision of T/E, 285 sent from ZI, 160, 218 transport reduced, 146 use as mobile hospitals, 218, 236 Hospitals, fixed, definition of, 5 Hospitals, general. See also Installations and units, medical, theater-of-operations-type affiliated, 6, 157 for AGF in ZI, 105 conversion of, to convalescent facilities, 280 deployment, 161 equipment, 140, 147, 157 expansion, 236 Hospitals, general—Continued theater-of-operations-type—Continued functions, 5 neuropsychiatric, 282 number, 39, 42, 140, 150, 151, 156, 222, 223-31, 233, 234 revisions of T/O, 40, 149, 280, 281 sent from ZI, 142, 143, 144, 160, 218 zone of interior AAF tries to obtain separate, 106-09 administration and organization, 26, 28, 29, 123, 125, 126-27, 128, 267-73 air evacuation from, 358 barracks converted to wards in, 288 bed credits in, 35, 115, 321, 346-47 bed requirements, 14, 40, 78-79, 84, 85, 86, 87, 102, 200, 201-02, 205, 206, 208, 209, 210-11, 212, 302, 303 bed statistics, 3, 25, 68, 101, 102, 204, 211, 213 civilian buildings for, 70-72, 73, 287 civilian employees, 255 commanders of, relation to post commanders, 191 commands served by, 106 construction and repair, 19, 68-69, 201, 286, 294, 295, 296 convalescent annexes, 119, 120, 188—89 convalescent center to perform some of same functions as, 108 conversion of station hospitals to, 86, 87, 288 decline in number of ZI patients in, 346 disposition of patients in, 130, 240 enlargement, 80, 86, 87 flight surgeons in, 108 form part of hospital centers, 198—99 functions, 3, 108, 184, 185—88, 211 furloughs for patients in, 187 hospital train personnel assigned to, 389-90 increase authorized, 87 jurisdiction over, 60, 184 list of, 304-13 manning guides for, 131—32, 248-49, 250 merger with station hospitals, 190—91 method of reporting beds in, 207-08 number, 3, 68, 101, 106, 116, 286 occupational therapy in, 99 organization, 29, 125, 269, 272, 276 personnel allowances, 132 for prisoner-of-war patients, 195—98 prisoner-of-war patients in, 113 proposed closure of, 205 reconditioning facilities in, 291 reductions in staff, 249, 250 removal of convalescent patients from, 181 retiring boards at, 246 revert to command of SG, 314 siting and location, 88-90, 91,92, 348 494 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR Hospitals, general—Continued zone of interior—Continued specialty centers at, 116-17 training T/O units at, 151-52 transfer of patients between, 347 transfer of patients to, 35, 109, 183, 348 use of Negroes in, 111 use as port and debarkation hospitals, 113, 114, 115, 191-93 use of prisoners of war in, 112-13 welfare services in, 267 Hospitals, joint use of by Army and Navy, 85, 86 Hospitals, port and debarkation, 103, 113-16, 191-94, 288, 295, 344-45, 347, 358 Hospitals, portable surgical, 146, 151, 173, 217, 218 Hospitals, prisoner-of-war overseas, 236 zone of interior, 103, 112-13, 195-98, 200 Hospitals, receiving and evacuation, 192 Hospitals, regional. See also Installations and units, medical, bed credits in, 240 bed credits in general hospitals for, 348 bed requirements, 200, 203, 205, 206, 208, 211-12 bed statistics, 182, 204, 211, 213 closure of, 314-15 establishment of, 183-84 functions, 185-88, 192, 210, 244 improvements to, 294-95, 296 jurisdiction over, 184, 185 manning tables, 248-49 merger of, with station hospitals, 190 method of reporting beds in, 207 number, 185 organization, 271 for prisoner-of-war patients, 197 reconditioning facilities at, 291 retiring boards at, 246 transfer of patients to, 209 use of Negroes in, 111 welfare services in, 267 Hospitals, short-shipment of, 228, 234 Hospitals, station. See also Installations and units, medical, theater-of-operations-type for AGF in ZI, 105 conversion to convalescent facilities, 280 deployment, 162 equipment, 140, 141, 147, 156, 285 expansion, 236 ineffectiveness of 250-bed type for island service, 144 new varieties, 145 number, 39, 140, 150, 151, 222, 223, 231 revision of T/E, 285 revisions of T/O’s, 149, 280, 281 sent from ZI, 142, 143, 144, 160, 218 staffing, 141 Hospitals, station—Continued zone of interior administration and organization, 26, 28, 127-29, 270, 271 bed credits in general hospitals for, 35, 115, 346, 348 bed requirements, 13-14, 40, 78, 83, 84, 85, 102, 200, 201, 205, 206-07, 208 bed statistics, 3, 25, 85, 101, 102, 182, 204, 211, 213, 315 commanders of, relation to post commanders, 191 construction and repair, 18, 68, 69, 73 convalescent centers equipped and staffed as, 108 conversion to general hospitals, 86, 87, 106, 209, 288 designation of some as regional hospitals, 185 disposition of patients, 130 functions, 3, 108, 182-85 hospital train personnel assigned to, 389-90 jurisdiction over, 103-06 manning guides, 30, 131-32, 248-49 merger with regional and general hospitals, 190-91 method of reporting beds in, 207 number, 3, 68, 101, 104, 315 for Negroes, 110-12 for prisoners of war, 113, 195, 196, 197 reconditioning facilities in, 291 reduction, 181-82, 286 retention for postwar use, 303 reversion of regional hospitals to, 314-15 size, 103-04 training T/O units at, 151-52 transfer of patients from, 35, 108-09, 209, 240, 348 use by AAF for general hospital purposes, 106-07 use for debarked patients, 115, 192-94 use of Negroes in, 111 use of vacated, 170 for Waacs, 109-10 Hospitals, surgic.JL See also Hospitals, portable surgical; Installations and units, medical, affiliated, 6 authorized at half strength, 43 conversion of, to evacuation hospitals, 146 defects of, 145 equipment, 1 4 i increase authorized, 42 numbers, 140, 150 part of field army, 38 Protective Mobilization Plan provides for, 38 revisions of T/O, 41, 148, 149 sent from ZI, 143. 144, 160, 164 Hospitals, total capacity and number of zone of interior, 25, 68, 80, 204, 211, 212 INDEX 495 Hotels for conversion to hospitals, 66, 81-82, 87, 90, 287 Iceland, hospital for, 143 India-Burma theater, 233, 234, 235. See also China-Burma-India theater. India, hospitals for, 143. See also China-Burma- India theater. Infantry, Chief of, 11 Inspection of hospitals, 17-18, 172-73. See also Inspector General, War Department. Inspector General, War Department. See also Snyder, Maj. Gen. Howard McC. considers problem of limited personnel, 181 considers quality of hospital construction too high, 80 hears of idle MC officers, 152-53 influences hospitalization, 171 inspects hospitals, 30 medical representative in office of, 9 and question of using regional hospitals for pa- tients from overseas, 186, 187 recommends use of AAF station hospitals as general hospitals, 183-84 reports on duplication of hospital facilities, 185, 203 reports slight use of staging area hospitals, 192 requested to investigate disagreement between SG and G-4, 17-18 Installations and units, medical named AAF Regional Station Hospital, 73 AAF Station Hospital, Atlantic City, 73 AAF Station Hospital, Chicago, 73 AAF Station Hospital, Palm Beach, 73 Army hospitals for civilians at Ordnance depots, 112 Army Medical Center, 283 Army and Navy General Hospital, 3, 34-35, 73, 116, 304 Ashburn General Hospital, 304 Ashford General Hospital, 73, 266, 304, 357 Barnes General Hospital, 19, 115, 190, 304 Battey General Hospital, 304 Baxter General Hospital, 125, 267-68, 304 Bermuda Hospital, 48 Billings General Hospital, 19, 191, 304 Birmingham General Hospital, 191, 193, 249, 304, 367 Borden General Hospital, 108, 305 Boston POE Station Hospital, 193 Bronx Area Station Hospital, 73 Brooke General Hospital, 305, 358 Brooke Hospital Center (Fort Sam Hous- ton), 199 Bruns General Hospital, 305 Bushnell General Hospital, 129, 305 Camp Beauregard Station Hospital, 34 Installations and units, medical—Continued named—Continued Camp Blanding Station Hospital, 34 Camp Bowie Station Hospital, 28 Camp Butner Hospital Center, 199 Camp Carson Hospital Center, 199 Camp Claiborne Station Hospital, 34 Gamp Crowder Station Hospital, 119 Camp Custer Station Hospital, 21 Camp Edwards General Hospital, 193 Camp Edwards Hospital Center, 199 Camp Edwards Station Hospital, 192, 193, 269, 343 Camp Forrest Station Hospital, 197 Camp Haan Regional Hospital, 193 Camp Jackson Station Hospital, 15 Camp Kilmer Station Hospital, 192, 193 Camp Leonard Wood Station Hospital, 21 Camp Livingston Station Hospital, 110 Camp McCoy Station Hospital, 196 Camp Maxey Station Hospital, 121 Camp Myles Standish Station Hospital, 192, 343 Camp Ord Station Hospital, 16 Camp Patrick Henry Station Hospital, 192, 193 Camp Pickett Hospital Center, 199 Camp Roberts Station Hospital, 21 Camp Shanks Station Hospital, 73, 192, 193 Camp Wallace Station Hospital, 21 Charlotte, N. C., Station Hospital, 73 Crile General Hospital, 305 Cushing General Hospital, 305 Dante Station Hospital, 73, 191 Darnall General Hospital, 37, 73, 116, 129, 305 Deshon General Hospital, 73, 306 DeWitt General Hospital, 306 Dibble General Hospital, 289, 306 England General Hospital, 73, 188, 306 Finney General Hospital, 306 Fitzsimons General Hospital, 3, 34, 116, 306 Fletcher General Hospital, 307 Fort Belvoir Station Hospital, 105 Fort Benjamin Harrison Station Hospital, 191 Fort Benning Station Hospital, 15, 17, 119 Fort Bliss Station Hospital, 117, 121, 191 Fort Bragg Station Hospital, 28, 110 Fort Des Moines Station Hospital, 110 Fort Devens Station Hospital, 191 Fort Dix Station Hospital, 191 Fort Francis E. Warren Station Hospital, 20 Fort George G. Meade Regional Hospital, 289 Fort Huachuca Station Hospital, 110, 111 Fort Jackson Station Hospital, 260 Fort Knox Station Hospital, 28 496 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR Installations and units, medical—Continued named—Continued Fort Lewis Station Hospital, 28, 367 Fort McClellan Station Hospital, 15 Fort Oglethorpe Station Hospital, 110 Fort Rosecrans Station Hospital, 21 Fort Sam Houston Station Hospital, 19 Foster General Hospital, 307 Gardiner General Hospital, 73, 307 Glennan General Hospital, 196, 197, 307 Halloran General Hospital, 73, 115, 136, 191, 193, 262, 303, 307, 342, 343, 344, 345, 366, 390 Hammond General Hospital, 307 Harmon General Hospital, 307 Hoff General Hospital, 19, 73, 307 Jefferson Barracks Station Hospital, 117, 119 Kennedy General Hospital, 308 LaGarde General Hospital, 19, 113, 114, 115, 191, 193, 308 Lawson General Hospital, 19, 29, 116, 308, 341, 357 Letterman General Hospital, 3, 34, 113, 114, 115, 191, 192, 193, 308, 343, 345, 366, 367 Los Angeles Station Hospital, 73 Lovell General Hospital, 19, 115, 117, 126, 191, 192, 303, 308 McGaw General Hospital, 309 McCloskey General Hospital, 309 McGuire General Hospital, 191, 193, 309 Madigan General Hospital, 193, 308, 343 Madigan Hospital Center (Fort Lewis), 199 Mason General Hospital, 73, 129, 191, 193, 303, 309, 343 Mayo General Hospital, 268, 269, 309 Medical Department Equipment Laboratory, 360, 361,364, 365, 456 Medical Field Service School, 41 Moore General Hospital, 309 New Haven Station Hospital, 73 Newton D. Baker General Hospital, 266, 309 Nichols General Hospital, 310 Northington General Hospital, 310 Oakland Area Station Hospital, 73 Old Farms Convalescent Hospital, 189, 314, 315 Oliver General Hospital, 73, 310 O’Reilly General Hospital, 19, 119, 262, 310 Pasadena Area Station Hospital, 73 Percy Jones Convalescent Hospital, 198 Percy Jones General Hospital, 73, 198, 310 Percy Jones Hospital Center (Fort Custer), 199, 276 Presidio of Monterey Station Hospital, 16 Prisoner of War General Hospital No. 2 (Camp Forrest), 197, 310 Installations and units, medical—Continued named—Continued Prisoner of War No. 2 Hospital Center (Camp Forrest), 199 Ream General Hospital, 73, 311 Rhoads General Hospital, 73, 311 St. Petersburg (Fla.) Station Hospital, 73 Schick General Hospital, 262, 311 School of Air Evacuation, AAF, 357, 440 School of Aviation Medicine, 440 Seattle Area Station Hospital, 73 Stark General Hospital, 19, 28, 113, 115, 191, 192, 193, 311, 343, 345, 358, 390 Staten Island Station Hospital, 73 Sternberg General Hospital, 3 Thayer General Hospital, 311 Tilton General Hospital, 19, 114, 116, 191, 303, 311 Torney General Hospital, 73, 108, 311 Trinidad Hospital, 48 Tripler General Hospital, 3 Tuskegee Station Hospital, 110 U.S. Army General Hospital, Camp Butner, 311 U.S. Army General Hospital, Camp Carson, 312 U.S. Army General Hospital, Camp Edwards, 312 U.S. Army General Hospital, Camp Pickett, 312 Valley Forge General Hospital, 129, 136, 312 Vancouver Barracks Station Hospital, 190 Vaughan General Hospital, 312 Wakeman General Hospital, 312 Wakeman Hospital Center (Camp Atter- bury), 199 Walter Reed General Hospital, 3, 19, 34, 37, 41,60,73, 116, 266,312,357 William Beaumont General Hospital, 3, 42, 191, 313 Winter General Hospital, 313 Woodrow Wilson General Hospital, 313 numbered. See also Tables on 144, 157, 158, 161, 162, 163, 164. 11th Station Hospital, 49, 162 15th Evacuation Hospital, 147, 163 25th Station Hospital, 162, 224 38th Medical Air Ambulance Squadron, 438 73d Evacuation Hospital, 104, 158 167th Station Hospital, 49, 162 168th Station Hospital, 49, 162, 224 268th Station Hospital, 162, 223, 224 335th Station Hospital, 223, 224 349th Air Evacuation Group, 439, 440 383d Station Hospital, 224 830th Medical Air Evacuation Squadron, 440 INDEX 497 Interstate Commerce Commission, 356-57 Ireland, Northern, hospitals for, 143. See also European theater. Joint Chiefs of Staff approves conversions to hospital ships, 328, 404 decision on use and control of ships for evacuation, 397, 402, 404 estimate of evacuation, theaters to ZI, 328 and procurement of hospital ships, 402, 404, 414 Judge Advocate General, SOS, 128, 403 Keller, Lt. Col. William C., 56, 378 Kenner, Maj. Gen. Albert W., 181 Kenner Board, 181 Kirk, Maj. Gen. Norman T., The Surgeon General advocates more hospital train personnel for service commands, 391 arranges compromise on AAF hospitalization, 108 becomes SG, 170 gets approval for higher maintenance standards for hospitals, 294 inspects theater medical services, 283 member of committee to investigate hospitaliza- tion for AAF in UK, 175 opposes separate AAF station hospitals, 183 orders program for establishing convalescent an- nexes, 119 policies, 170 pushes program for more hospital beds, 210 requests reduction of scope of treatment in AAF station hospitals, 183 secures restoration of service command surgeons to staff position, 172 stops development of multipatient ambulance, 366-67 views on use and equipment of T/O hospitals in ZI, 157-59 Kramer, Col. Floyd, 21 Laboratories, medical, 38-39, 43 Laboratory truck, dental, 457 Laundry service of hospitals, 284 Liberia, hospital in, 162 Linen-control procedure, 264—65 Litter bearer companies, separate, 453 Litters, 442-43, 455 Location. See Sites and locations, selection of. Love, Brig. Gen. Albert G., 15, 22, 31 Lutes, Lt. Gen. LeRoy B., 55, 56, 63 McDonald, Brig. Gen. Robert C., 156-57, 158 MacLean, Lt. Col. Basil C., 122, 176, 261 McGibony, Lt. Col. James T., 176 Magee, Maj. Gen. James C., The Surgeon General appointment, 9 appoints adviser on hospital administration, 122 asks for authority over hospital construction, 92 Magee, Maj. Gen. James C., The Surgeon General—Continued asks for funds to modernize hospital assemblages, 42 asks G-4 for increased bed ratio, 13-14 conception of sphere of Hospitalization and Evac- uation Branch, SOS, 56 conservative tendencies, 53 criticizes suggestions for changes in hospital ad- ministration, 122, 123 defends plan for hospitalization and evacuation, 64 ends term as SG, 156 opinion on effect of WD reorganization on MD, 55 opposes establishing special hospitals for convales- cents, 118 and project for emergency hospitalization, 81, 82- 83 recommendation on hospital construction ap- proved by CofS, 18 resists attempt of AAF to obtain separate general hospitals, 107, 118 secures approval of policy on hospitalization for task forces, 58 trip to North Africa, 165 Manning guides and tables. See Personnel. Maritime Commission, 396—97, 400, 412 Marshall, Gen. George C. See Chief of Staff, War Department. Medical Administrative Corps allowance for hospitals, 132, 280 shortages, 133, 251 substitutes for MG officers, 31, 133—34, 148, 228, 250-51, 259, 280, 452-53 Medical Corps allowances for hospitals, 132, 250, 280 deficiencies in training, 32 female, 109, 110 flight surgeons, 108 replacement of, 131, 133—34, 148, 228, 250—51, 259, 452-53 shortages, 31, 132, 151, 223, 250 specialists, 40, 106, 183, 194, 250 Medical Department Board, 371 Medical Department Technical Committee, 364 Medical Regulating Service, AAF, 320-21, 358-59 Medical Regulating Unit, SGO. See Surgeon Gen- eral, Office of the. Mediterranean theater. See also North African theater. authorized to expand general and station hospi- tals, 236 bed requirements, 233, 235, 300 bed statistics, 220-21 evacuation policy for, 235, 300, 330 hospital ships for, 326 number evacuated by sea from, 326 498 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR Mediterranean theater—-Continued opposes air evacuation of mental patients to ZI, 339 Meiling, Col. Richard L., 338 Middle East theater, 217, 227, 233. See also Liberia. Military Personnel Division, ASF, 253 Military Police, Corps of, 281 Mobilization, 19, 38-43 Mobilization Division, ASF, 172, 178 Moore, Brig. Gen. Richard C., 14, 17 Named installations. See Installations and units, medical. National Association of Colored Graduate Nurses, 111 National Research Council, 283, 429 Navy, 85, 86, 104, 395-97, 403, 424 Negroes, 110-12, 223-24 Nelson, Col. Harry J., 56 Neuropsychiatric patients, accommodations for aboard ships, 327, 331-32, 398-99, 400, 406-07, 408, 409, 412, 413 neuropsychiatric centers, 290 neuropsychiatric social therapy clinics, 290 security and safety devices, 22, 99, 100, 380-81, 407, 413, 444 in special TJO hospitals, 283 at ZI general hospitals, 37 Newfoundland, 174, 338, 429 Normal beds, definition of, 101 North African theater. See also Mediterranean theater. asked for information to assist in estimating bed requirements for ZI, 202 bed requirements, 217, 218, 219, 225-26, 227, 233, 235 evacuation policy for, 215-16, 219, 227, 235 evacuation by sea from, 226 expands hospitals, 219 hospital laundry service, 283 hospital ship assigned to, 404 hospital train for, 381 hospitals for, 143, 160 housing for hospitals, 296 length of patients’ stay in hospitals of, 229 needs medical holding units, 454 rejects troop transports for evacuating patients, 402 reports defects in field ambulance, 363 requests hospital ships, 402 uses mobile for fixed hospitals, 218 Numbered units. See Field medical units; Instal- lations and units, medical. Nurses’ aides, 250, 256, 257 Nurses, Army. See Army Nurse Corps. Nurses, cadet, 252 Nurses, civilian, 31, 252, 255 Office of Strategic Services, 201 Officers, Medical Department. See Army Nurse Corps; Dental Corps; Medical Administrative Corps; Medical Corps. Offutt, Col. Harry D., 10,41, 66, 67, 97, 130 OPD. See Operations Division, War Department. Operations Division, War Department approves procurement of hospital equipment, 151 and bed requirements, 216, 225, 226, 231 changes destination of units, 162-63 considers hospitals for AAF in Central Pacific, 175 difficulty in supplying hospital assemblages, 143 grants hospital ship to North Africa, 404 issues forecast of units needed overseas, 219 lacks figures on beds available overseas, 164 responsibility, 171 Optical repair truck, 457 Ordnance Department, 268, 365, 366, 367-68 Organization, hospital. See Administration, hospital. Organization, tables of. See Tables of organi- zation and equipment. Organizations, medical. See Installations and units, medical. Pacific Ocean Areas, 220-21, 230, 232, 233, 235. See also Central Pacific theater; South Pacific theater. Pacific theater, 235, 301, 330. See also Central Pacific theater; Pacific Ocean Areas; South- west Pacific Area. Panama Canal Zone, hospitals in, 4, 142 Patients. See also Neuropsychiatric patients, ac- commodations for. admission procedure, 263-64, 344-45 admission rate of, to hospitals, 232 classification for transport to ZI, 331-32, 338, 339-40 disability discharges and retirement procedures, 36, 126-28, 262 length of stay in hospitals, 35-37, 124-31, 214, 229, 232 limiting admissions to hospitals, 238-39 priority for travel on passenger trains, 355-57 reassignment of, 242-43 transfer between hospitals, 34, 35, 108-09, 115, 183, 185, 198, 209,240-41 Personnel. See also Army Nurse Corps; Civilian employees; Dental Corps; Enlisted men; Medi- cal Administrative Corps; Medical Corps; Negroes; Prisoners of war; Tables of organi- zation and equipment; Women’s Army Corps, changes in hospital system to economize on, 170 manning guides and tables, 30—31, 248—49, 250, 251, 389, 415 shortages, 31-32, 222-23, 227 INDEX 499 Personnel—Continued size and composition of hospital staffs, 131—37, 248-60 uneconomical use of, 467-68 Philippines, hospitals in, 3, 4. See also Southwest Pacific Area. Physical therapists, civilian, 33, 40 Pilgrim State Hospital, 87 Planning Division, ASF, 172, 173, 178, 226, 284 Plans Branch, SOS, 154-55 Plans and Operations, Director of, ASF, 203-05 PMP. See Protective Mobilization Plan. Port commanders assign medical personnel to ships, 415 control hospital ship platoons, 335-36, 418 control of hospitals, 113 control of movement of patients, 114, 321 furnish personnel for evacuation, 321 instructions for combat surgeons, 336—37 report on evacuation to ZI, 333-34 responsibility for evacuation from theaters, 331, 334-35 responsibility for hospitalization plans, 66 responsibility for transferring debarked patients to hospitals, 341-44, 346 President to approve or reject hospital construction plans, 86 interest in rehabilitating casualties, 189-90 orders inquiry into adequacy of hospitalization for AAF in UK, 175 orders retention of patients in hospitals until full recovery, 241 and project for emergency hospitalization, 82 Prisoners of war, 112-13, 234, 250, 260. See also Hospitals, prisoner-of-war. Protective Mobilization Plan, 38-39, 43 Provost Marshal General, 112, 176, 196 Public Health Service, United States, 83, 86 Pullman Company, 371-72, 374, 381 Quartermaster Corps approves use of flies with hospital tents, 297 collaborates to improve laundry service, 284 collaborates in planning construction of new-type hospital, 23 complains that changes of plans delay hospital construction, 22 considers 2/a-ton truck chassis unsuitable for ambulance body, 366 develops new-type hospital tent, 297 helps develop air conditioning for evacuation air- planes, 444 helps develop ambulances, 361 helps develop hospital cars, 371-72 helps plan cantonment-type hospitals, 14, 22 Quartermaster Corps—Continued hospital assemblages not to include item supplied by, 154-55 laundry teams for hospitals overseas, 284 opposes expanding existing hospitals instead of new construction, 15 provides for fire-protection in hospitals, 23 recommends conversion of troop transports to hospital or ambulance ships, 396 responsibility for construction and maintenance of buildings transferred to Engineers, 60 responsibility for hospital construction, 20-21 selection of hospital sites, 20 supplies ambulances, 361 Railroad Interterritorial Military Committee, 356 Reclassification procedure, physical, 243, 246 Reconditioning programs, 117—19, 290—92. See also Rehabilitation of patients. Redeployment and demobilization, 208, 300-15 Reduction Board, ASF, 450-52 Regiments, medical. See Field medical units. Rehabilitation of patients, 189-90. See also Re- conditioning programs. Repair and maintenance, hospital, 60-61, 94—96. See also Hospital construction. Reports Essential Technical Medical Data, 165, 283 of evacuation to ZI, 332—35, 340 of hospital beds, 164, 165, 182, 207-08, 240, 347 of patients in debarkation hospitals, 347-48 sanitary, 165 telegraphic, from overseas, 222 Requirements Division, SOS (ASF) accepts SG’s estimate of bed requirements, 86 approves hospital program, 86-87 considers improved facilities in hospitals, 99-100 considers quality of hospital construction too high, 80 and development of hospital trains and cars, 380 insists on speed in selecting hospital locations, 90 refers decision on light field ambulance to AGF, 365 ' suggests improvements in field ambulance, 363 suggests reduction of hospital construction re- quirements, 86 Resources Division, SOS, 98 Retiring boards, 243, 245, 247 Reynolds, Maj. Gen. Charles R., The Surgeon General, 5-6, 9 Rogers, Col. John A., 67 Roosevelt, Franklin Delano. See President. Roosevelt, Mrs. Franklin Delano, 111 St. Elizabeth’s Hospital, 37, 129 Sams, Brig. Gen. Crawford F., 237 School buildings, converted to hospitals, 66, 287 Schwichtenberg, Col. Albert H., 176, 177 500 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR Secretary of War. See also Separation Board, Office of the Secretary of War. approves affiliated hospitals, 6 approves agreement on hospitalization, 108 authorizes hospitals for civilians at Ordnance depots, 112 considers separate hospitals for AAF, 107, 108 directed to provide hospitalization for WAAC, 109 directs exemption of Air Corps stations from corps area control, 11 favors liberal estimates of bed requirements, 209- 10 fixes responsibility for reassigning patients, 130 orders appointment of retiring boards at all gen- eral hospitals and AAF convalescent centers, 246 promotes demobilization of medical personnel, 301 SG given direct access to, 172 Secretary of War, Civilian Aide to, 111 Separation Board, Office of the Secretary of War, 243 Service commands. See also Corps areas. allotments of hospital train personnel to, 390-91 alteration of service command surgeons’ relations with SG, 60 inspection of hospitals in, 172-73 jurisdiction over hospital train personnel, 390-91 make personnel authorizations, 248 report substitution of MAC for MC officers, 133 responsibilities for hospitalization and evacuation, 59-60, 92, 113, 286-87, 314, 342-43, 349-53, 389 surgeons of, restored to staff positions, 172 Third Service Command operates temporary hospital for AGF, 105 urged to speed disposition of patients, 240, 242 and use of Waacs in hospitals, 136 views on use of T/O hospitals in ZI, 159 Services of Supply. See also Army Service Forces; Construction Planning Branch; Finance, Chief of; Hospitalization and Evacuation Branch; Judge Advocate General; Lutes, Lt. Gen. Le- Roy B.; Plans Branch; Requirements Division; Resources Division; Training, Director of. approves air evacuation from Newfoundland Base Command, 338 approves system for furnishing medical supplies on transports, 423 and bed requirements in hospitals, 80, 84 and change in patients’ discharge procedure, 128 conference on converting nonhospital buildings to hospital use, 92 created, 54, 55 delays publication of directive on reconditioning, 119 Services of Supply—Continued and development of hospital trains and cars, 377- 78 directs reduction in size and weight of hospital equipment, 147 directs revision of T/O’s, 148 directs SG to act on recommendations of Wad- hams Committee, 122 disapproves light ambulance, 364 establishes procedure for movement of patients by rail, 350 favors delaying establishment of separate con- valescent facilities, 119 and hospital facilities on troop transports, 398 lacks figures on beds available overseas, 164 and medical complements for ships, 415, 416, 418, 420 orders classification of patients for transport to ZI, 331 orders evacuation reports, 332 permits air conditioning for hospital cars, 377 personnel policy, 133, 134, 135, 136 plans to require double bunking in barracks in emergency, 81 policy on lost personnel records, 126 and project for emergency hospitalization, 81, 82, 83 promotes planning for hospitalization and evacua- tion, 63-67 requests procurement of hospital ships, 397 responsibility for hospitalization and evacuation, 55-61, 63, 320 responsibility for selecting hospital locations, 90 suggests civilian buildings for general hospitals, 70 and use and equipment of T/O hospitals in ZI, 152, 153, 154, 155 SHAEF. See Supreme Headquarters, Allied Expe- ditionary Forces. Shambora, Col. William E., 55 Ships’ hospitals. See Transports, troop. Signal Corps, 281 Sites and locations, selection of, 19-20, 60, 88-92, 195 Snyder, Maj. Gen. Howard McC., 9, 84, 117, 127, 131, 183, 216 Somervell, Lt. Gen. Brehon B., 55, 64, 92, 93, 141, 205, 226, 261-62, 294 South Pacific theater. See also Pacific Ocean Areas. absorbed in Pacific Ocean Areas, 230 bed requirements, 217, 218, 219, 230, 234, 235 bed statistics, 220-21 evacuation from, by Navy, 333 evacuation policy for, 215—16, 235 hospital ships for, 327 hospitals sent to, 143 hospitals sent to other theaters from, 228 INDEX 501 South Pacific theater—Continued proposed transfer of hospitals to Central Pacific from, 175 Southwest Pacific Area. See also Australia, hospi- tals for; Philippines, hospitals in. advocates issue of equipment to units in training, 152 bed requirements, 217, 218, 227, 228, 230, 233, 235 bed statistics, 220-21, 301 converts mobile to fixed hospitals, 218 develops portable surgical hospital, 146 estimates of evacuation from, 329 evacuation policy for, 215-16, 235 expands hospitals, 219, 227 favors air evacuation of mental patients to ZI, 339 hospital centers in, 282 hospital ships for, 327, 402 hospitals from South Pacific sent to, 228 housing for hospitals, 296, 297-99 laundry service for hospitals, 283-84 Negro hospital in, 162 neuropsychiatric patients evacuated from, 327 reports defects in field ambulance, 363 use of hospital ship platoons, 418-19 Specialty centers. See Hospitals, general. Squadron, medical, 39, 40, 447 Strecker, Edward A., 175 Supplies and equipment. See also Ambulances; Evacuation, air; Hospital ships; Trains and cars, hospital ; Transports, troop, for theaters of operations, 456-57. See also Emergency expansion of hospitals; Field medi- cal units; Tables of Organization and Equip- ment. for zone of interior medical installations 1939-7 Dec 1941, 33-34 7 Dec 1941-1946, 137-39 Supreme Headquarters, Allied Expeditionary Forces, 239 Surgeon, duties of, 8 Surgeon General, The, 8, 107. See also Surgeon General, Office of the; Kirk, Maj. Gen. Nor- man T.; Magee, Maj. Gen. James C.; Rey- nolds, Maj. Gen. Charles R. Surgeon General, Office of the attitude toward expanding the medical service, 6 attitude toward use and equipment of T/O hos- pitals in ZI, 151-60 comes under jurisdiction of SOS, 55 controversy over planning hospitalization, 63-67 opposes general-hospital-type care in AAF hos- pitals, 182-88 opposes separate hospitals for AAF overseas, 174 organization for hospitalization and evacuation, 9-10, 61-63, 176-80 Surgeon General, Office of the—Continued responsibility for hospitalization and evacuation, 10-12, 20-21, 30, 55-61, 88, 92-96, 106-09, 164,171-76, 286-87, 320, 346-48, 351 subordinate elements AAF Liaison Unit, 177 Administration Branch, 177 Construction Branch, 173, 176, 177 Control Division, 177, 180, 181, 262—63 Dental Division, 10 Evacuation Branch, 177, 180, 351 Facilities and Personnel Utilization Branch, 177, 180, 182, 191, 194, 201-03, 225, 239 Finance and Supply Division, 10 Hospital Administration Division, 176, 182, 257, 358 Hospital Construction Branch, 286, 288, 294, 295, 298, 383, 405 Hospital Construction Division, 61, 62, 75, 94, 96, 119, 154, 176, 394, 399 Hospital Construction and Repair Subdivi- sion, 9, 18, 35 Hospital Division, 177, 180, 181, 200, 262, 263 Hospitalization Division, 10, 35, 61, 62, 136, 154 Hospitalization and Evacuation Division, 176 Hospitalization Subdivision, 10 Inspection Branch, 178 Liaison Branch, 176 Medical Regulating Unit, 180, 209, 240, 314, 328, 329, 334, 347-49, 351, 352, 358-59, 469 Medical Statistics Division, 263 Military Personnel Division, 10 Mobilization and Overseas Operations Branch, 222, 225 Mobilization and Overseas Operations Divi- sion, 178, 228, 230, 232 Nursing Division, 10 Operations Service, 153, 176, 177, 180, 198 Organization and Equipment Allowance Branch, 283 Personnel Division, 136 Personnel Service, 153, 173, 180 Planning Division, 61, 62-63 Planning and Training Division, 9, 39, 371, 373 Plans Division, 214, 219-22 Policies Branch, 176 Preventive Medicine Service, 283 Prisoner of War Liaison Unit, 177, 197 Professional Administrative Service, 180 Professional Consultants Divisions, 173 Professional Service, 153 Professional Service Division, 10 502 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR Surgeon General, Office of the—Continued subordinate elements—Continued Reconditioning Consultants Division, 180, 291 Resources Analysis Division, 180, 187, 208, 210,239,241,303,314,333 Special Planning Division, 178 Strategic and Logistic Planning Unit, 178, 226 Supply Division, 41 Supply Service, 153, 173, 180, 222 Technical Division, 178, 281, 381, 392, 454 Theater Branch, 178 Training Division, 61, 62, 63, 136, 153, 159 Training Subdivision, 26 Transportation Liaison Unit, 177, 180 Troop Units Branch, 178 Veterinary Division, 10 Women’s Medical Unit, 177, 180 Surgical trucks, 456-57 Tables of distribution for Women’s Army Corps, 258 Tables of organization and equipment. See also Personnel, manning guides and tables, additions to list of, 143-45, 146, 282-83, 391-92, 408-09, 415, 419, 438, 439, 445, 448, 450, 451-52, 454-55 definition, 5 question of including certain items in, 283-85 responsibility for preparing, 10, 59, 457 revision, 39-42, 49, 145-47, 148-49, 280-82, 285, 297, 392-93, 408, 416, 420-22, 440, 445- 46,449-51, 452-54, 455, 463 used as manning guides for ZI general hospitals, 131 for ZI installations, 30, 254-55 Task forces, hospitals for, 143 Teams, medical, 452 Technical manuals hospitalization TM 8-260, 26, 27, 29, 122 TM 8-262, 263-64, 265 reclassification and retirement TM 12-245, 246 Theater commanders control of hospital ship platoons, 418-19 directed to form provisional hospital ship platoons, 417 responsibility for air evacuation to ZI, 335-36, 338-39, 340 responsibility for medical personnel on ships, 415 Train units, hospital, 388-90 Training, Director of, SOS, 155 Training for hospital and evacuation units, 9-10, 11—12, 32, 47, 440. See also Field medical units. Trains and cars, hospital. See also Evacuation in zone of interior by rail, accommodations for, at piers, 114 air conditioning, 354-55, 375-77 conversion of commercial to hospital cars, 369- 70, 372-73, 378, 385 medical personnel for, 388-91 number of cars, 346, 373, 374, 375, 388, 389 number of patients moved by, 346, 355 number of trains, 349, 369, 373, 375 procedures for operating, 349-55 procurement of hospital cars, 372, 373, 374, 375, 379, 380, 382, 383, 385, 387-88 supplies and equipment for, 391-93 types for overseas, 370, 371-72, 380-81 types for ZI, 369-75, 377-80, 381-88 Trains, passenger, movement of patients in zone of interior by number of patients moved, 346 priority for, 355-57 procedure, 320-21, 349, 350, 351, 352-53, 354-57 Transportation Corps. See also Port commanders, and accommodations for patients on troop trans- ports, 327, 328, 329, 332, 398, 399, 400 agreements with railroads on operation of cars for patients, 353-54 agrees to convert staging-area hospitals to de- barkation hospitals, 192 and air conditioning for hospital cars, 375-77 asked for opinion on use of Waacs in hospitals, 136 and bed requirements, 202 concurs in establishment of evacuation reports, 332 confers on plans for hospitalization and evacu- ation, 63, 65 control of hospitals, 113, 115 and development of hospital trains and cars, 379, 381, 382, 385 draws plans for conversion of cargo vessels to hospital ships, 405 estimates evacuation from theaters, 325 favors air conditioning on hospital ships, 414 and hospital ship civilian crews, 420, 421 and hospital ship procurement, 401, 403, 405 instructions for transport surgeons and hospital ship commanders, 336-37 and medical personnel for ships, 416,418 personnel assigned to hospitals, 268 prepares technical bulletin for maintenance of hospital cars, 354 and priority for patients on passenger trains, 356 procures hospital cars, 380, 382, 383, 388 proposes conversion of troop transports to hos- pital or ambulance transports, 398 raises standards for ships’ hospitals, 413-14 INDEX 503 Transportation Corps—Continued responsibility for equipping ships’ medical per- sonnel, 424 responsibility for evacuation, 320 responsibility for evacuation to ZI, 331, 334—35 responsibility for medical supply on hospital ships and transports, 423 responsibility for moving patients by rail in ZI, 349, 350, 351-53 Transports, troop. See also Evacuation to zone of interior by sea. conversion to hospital ships, 328, 394—414 enlargement of patient capacity, 329 estimates of evacuation by, 226, 325, 328 medical personnel, 414-19 medical supplies and equipment, 423, 424 number evacuated by, 324, 326, 327, 330 number used for evacuation, 394 patient capacity of, officially established, 327, 329 recommended for evacuating patients from large theaters, 396 responsibilities of surgeons of, 336-37 responsibility for operating, 395, 396, 397 ships’ hospitals on, 398-401, 412-14 sole means of evacuating patients by sea, 321-22 use for evacuating patients opposed, 205, 235, 236 use for evacuation required, 209, 236 Troop, medical, 38 Tynes, Col. Achilles L., 96, 176, 409 United States Army Forces, Pacific, evacuation policy for, 235 Units, medical. See Field medical units; Installa- tions and units, medical. Veterans Administration confers on change in patients’ discharge pro- cedure, 128 hospital at Los Angeles taken over by Army, 104 Veterans Administration—Continued objection to construction of hospitals unsuitable for postwar use, 74-75 ordered to submit all hospital construction plans to Federal Board of Hospitalization, 86 participates in planning modified type-A hospital, 76 patients in Army hospitals restricted, 26 proposed use of VA hospital plans by Army, 76 transfer of patients from Army hospitals to hos- pitals of, 129, 241 transfer of surplus Army hospitals to, 303 treatment of Army patients in hospitals of, 25, 34, 37, 115 WAAC (Women’s Army Auxiliary Corps). See Women’s Army Corps. WAC. See Women’s Army Corps. Wadhams Committee. See Committee to Study the Medical Department. Walson, Col. Charles M., 26 Walter Reed General Hospital. See Installations and units, medical. War Department Manpower Board and bed requirements, 203, 205, 206, 231 improved relations with Office of SG, 210 influences hospitalization, 171 proposes closing some general hospitals, 205 and reduction of hospital staff's, 248, 249, 259 War Production Board, 75, 86, 93, 98, 365 Welsh, Col. Arthur B., 31, 178 Western Defense Command, requests air evacuation, 429 Wickert, Col. Howard T., 62 Wilson, Col. William L., 9, 56, 63, 64, 65, 67, 152, 156 Women’s Army Corps hospitals for, 109-10, 176 use in hospitals, 135-37, 249, 255, 256-59 Woolford, Col. Wool S., 338 Work-measurement and work-simplification pro- grams, 265-66 U. S. GOVERNMENT PRINTING OFFICE; 1956 O-F—304244