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 

CENTER OF MILITARY HISTORY 

UNITED STATES ARMY 

WA SfIINGTON, D.C., 1989 





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 wellestablished 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 immediate and strong protest from a people able and willing to criticize. The successful conduct of a military medical service therefore requires not only a knowledge 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 enlightening 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.

25 June 1954

ix

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 hospitalization and evacuation are of course striking. The Army provided—at a maximum—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 hospitalization 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 purpose, 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, Zone 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

xi
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.

GEORGE E. ARMSTRONG

Major General, U.S. Army

The Surgeon General

Washington, D. C.

11 January 1955

xii
Preface

This volume is one of several planned for a series on the history of the Medical 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 soldiersl 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 professional 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 hospitalization and evacuation operations, but not a discussion of the plans and preparations 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 complicated 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 duplication 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—overlooked. 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 Medical Department, but was of small dimensions and is not dealt with in this volume.

xiii
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 Washington, and of surgeons of local commands elsewhere; the headquarters of the

Army Ground, Air, and Service Forces; and the offices of chiefs of various technical 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 conscious 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 General's Office is a very useful means of limiting the scope of this work and of giving 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 complaints 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 comment 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 classification 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 members of the military establishment but not by general readers. As a rule, technical terms and general terms given a special meaning by the Army are exxiv
plained when they are first introduced in the text. Abbreviations have been

used freely, especially in the footnotes. In most instances they are those authorized 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 investigation by statisticians may eventually result in figures that are somewhat different. 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. McIlvain and Mr. Hubert E. Potter for their

assistance. Miss McIlvain 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 important, 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 Administrative Branch spent many weary hours making extracts from documents and

typing drafts and final copies of chapters. Editorial clerks of this Branch prepared 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 assistants 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 Surgeon 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 experiences. Others made excellent critical comments on drafts of chapters

submitted to them for review. The information which they thus furnished was

xv
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. CLARENCE McK. SMITH

10 March 1953

xvi
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 HOSPITALIZATION ..................... . 8

The Surgeon General's Position in the War Department ..... . 8

T h e 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 ................... . 1 3

Hospital Construction .................. . 1 3

Hospital Administration ................. . 2 6

III. PLANS AND PREPARATIONS FOR HOSPITALIZATION IN

OVERSEAS AREAS .................. . 3 8

Mobilization Planning .................. . 3 8

Preparing Hospitalization for Overseas Areas During a Peacetime Mobilization ...................... . 4 3

PART TWO

Hospitalization in the Early War Years,

7 December 1941—Mid-1943

INTRODUCTION .................... . 5 3

IV. CHANGES IN ORGANIZATION AND RESPONSIBILITIES

F O R HOSPITALIZATION ............... . 5 4

Reorganization of the War Department ............ . 54

The Surgeon General's New Position ............. . 55

T h e Wadhams Committee ................. . 6 1

Changes in the Surgeon General's Office ............ . 61

A Dispute About General Planning for Hospitalization and Evacuation. . 63

xvii
Chapter Page

V. HOSPITAL PLANTS IN THE UNITED STATES ..... . 68

Types o f Construction ................... . 6 8

Estimates of Hospital Capacity Needed ............ . 78

Location, Siting, and Internal Arrangement of Hospital Plants ... . 88

Maintenance o f Hospital Plants ............... . 9 4

Conformity of Hospital Construction to Needs. ......... . 100

VI. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR HOSPITAL SYSTEM .................... . 10 3

Command Relationships of Hospitals ............. . 103

Special Types of ASF Station Hospitals ............ . 109

Port an d Debarkation Hospitals ............... . 11 3

Designation of General Hospitals for Specialized Treatment .... . 116

The Question of Establishing Convalescent Hospitals ....... . 117

VII. MINOR CHANGES IN HOSPITAL ADMINISTRATION . . 121

Question of Simplified Organization and Internal Administrative Procedures. ....................... . 12 1

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 OPERATIONS ...................... . 14 0

Meeting Early Emergency Needs .............. . 14 0

Modification of Hospitals for Overseas Areas . ......... . 143

Hospital Units in the Troop Basis. ............. . 149

The Question of Equipping and Using Numbered Hospitals in the Zone

o f Interior ...................... . 15 1

Preparing for the Support of Offensive Warfare ......... . 160

PART THREE

Hospitalization in the Later War Years, Mid-1943—1946

INTRODUCTION .................... . 16 9

IX. FURTHER CHANGES IN ORGANIZATION AND RESPONSIBILITIES FO R HOSPITALIZATION ......... . 17 1

Relationship of The Surgeon General With Other War Department Agencies ......................... . 17 1

Expanding and Strengthening the Surgeon General's Office ..... . 176

xviii
Chapter Page

X. ADJUSTMENTS AND CHANGES IN THE ZONE OF INTERIOR HOSPITAL SYSTEM .............. . 18 1

Closure of Surplus Station Hospital Facilities. ......... . 181

Establishment o f Regional Hospitals ............. . 18 2

Development o f Convalescent Hospitals ............ . 18 8

Merger o f Adjacent Hospitals. ............... . 19 0

Attempts To Limit the Use of General Hospitals as Debarkation Hospitals ........................ . 19 1

Extension of the Practice of Establishing Specialized Centers .... . 194

General Hospitals for Prisoners of War ............ . 195

Establishment o f Hospital Centers .............. . 19 8

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 THEATERS FO R HOSPITAL BEDS. ............ . 21 4

Factors Influencing Be d Requirements ............. . 21 4

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

O F INTERIOR .................... . 23 8

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 O F INTERIOR HOSPITALS .......... . 24 8

General Nature o f Changes. ................ . 24 9

Wider Us e 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

Us e 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 ........................ . 26 1

Simplification o f Administrative Procedures. .......... . 26 2

Work-Measurement and Work-Simplification Programs ...... . 265

Additional Activities and Their Place in The Organizational Structure of

Hospitals ...................... . 26 6

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

N ew Hospital Units ................... . 28 2

Changes i n Supplies an d Equipment ............. . 28 3

XVII. HOSPITAL CONSTRUCTION AND MAINTENANCE. ... 286

Providing Housing for Additional Beds in General and Convalescent Hospitals i n th e United States ................ . 28 7

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 Zone of Interior Hospital System ....... . 302

PART FOUR

Evacuation to and in the Zone of Interior

INTRODUCTION .................... . 31 9

XIX. ESTIMATED AND ACTUAL REQUIREMENTS FOR EVACUATION FROM THEATERS OF OPERATIONS ... . 323

XX. DEVELOPMENT OF PROCEDURES FOR EVACUATION

FROM THEATERS TO THE ZONE OF INTERIOR ... 331

Procedures fo r Se a Evacuation. ............... . 33 1

Procedures fo r Air Evacuation. ............... . 33 7

Procedures for Debarkation ................. . 340

XXI. MOVEMENT OF PATIENTS IN THE UNITED STATES . . 346

Regulating the Flow of Patients .............. . 346

Procedures for Rail Evacuation ............... . 349

Procedures fo r Air Evacuation. ............... . 35 7
Chapter Page

XXII. PROVIDING THE MEANS FOR EVACUATION BY LAND. . 360

Motor Ambulances .................... . 36 0

Hospital Trains. .................... . 36 9

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 ................ . 41 9

Problems in Providing Supplies and Equipment for Hospital Ships and

Transports ...................... . 42 2

XXIV. PROVIDING THE MEANS FOR EVACUATION BY AIR. . . 426

Aircraft ........................ . 42 6

Medical Flight Attendants ................. . 43 7

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 AN D CONCLUSIONS ............ . 46 3

LIST O F ABBREVIATIONS ............... . 47 1

BIBLIOGRAPHICAL NOTE ............... . 47 7

INDEX ......................... . 48 5

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. ........................... . 7 3

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 ........................ . 13 2

5. Hospital Units Shipped Overseas, 7 December 1941 to 1 July 1942 ... 144

6. Affiliated General Hospital Units ................ . 157

7 . Affiliated Evacuation Hospital Units ............... . 15 8

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

a n d 1941 .......................... . 16 3

11. Use of Nonaffiliated Surgical Hospital Units Activated during 1940 and

1941 ............................ . 16 4

xxi
No. Page

1 2. ASF Debarkation Hospitals . .................. . 193

13. Hospitalization Data as of 29 June 1945 .............. . 211

14. Evacuation Policies and Authorized Bed Ratios, Major Theaters of

Operations ......................... . 23 5

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 Ca r 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 ................. . 2 5

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 ............... . 8 5

5. Status of Station and General Hospital Beds in Continental United States:

December 1941-June 1943 .................. . 10 2

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 Continental 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. ........... . 21 3

11. Fixed Hospital Bed Capacity and Occupancy in Overseas Theaters:

March 1943-December 1945 ................ . 220, 22 1

12. Organization of Mayo General Hospital, 1944. .......... . 269

13. Comparison of Standard Plans for Organization of ASF Posts and ASF

General Hospitals, 1945 ................... . 27 2

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

xxii
Illustrations

Page

Plan fo r Cantonment-type Hospital ................. . 1 6

Lawson General, a Cantonment-type Hospital ............ . 1 7

Valley Forge General, a Semipermanent-type Hospital ......... . 24

Plan fo r Theater-of-Operations-Type Hospital. ............ . 7 1

Oliver General Hospital ...................... . 7 2

Plan fo r Type A Hospital ..................... . 7 4

Birmingham General, a Type A Hospital. .............. . 75

McGuire General, a VA-Type Hospital ............... . 7 9

Location of General, Convalescent, and Regional Hospitals During World

W a r II . .......................... . 8 9

Placing the Fourth Litter Patient in a Field Ambulance ........ . 362

Field and Metropolitan Ambulances Used in 1942. .......... . 363

Motor Ambulances ........................ . 36 4

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 Car ....... . 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

T h e USAHS Larkspur ....................... . 41 1

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.

xxiii

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 September 1939, just one week after Germany

invaded Poland, the Medical Department

of the United States Army was operating

7 general hospitals and 119 station hospitals. Five of the general hospitals were located 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 possessions—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 Philippine Islands, the Hawaiian Islands, and

the Panama Canal Zone. Each station hospital 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, station 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 receiving patients from stations where located

and treating those with minor ills and injuries only. General hospitals, on the other

hand, were designed to serve general and

special needs. By transfer from station

hospitals they received patients who suffered from severe or obscure diseases as

well as those who needed complicated

surgery.

Capacities of named hospitals depended largely upon troop populations served.

Other factors also influenced their capacities, such as climate, prevalence of disease, 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 hospital 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 hospital 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 unusual situation resulted from the fact that

civilian Canal Zone hospitals—Gorgas,

Colon, and Corozal—staffed with Army

Medical Corps officers but under the control 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 longrange program in 1934 to improve and expand them but funds appropriated by

Congress for Medical Department construction 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 number of permanent Army posts. Erected

twenty-five to thirty years before, many

lacked facilities for the separation of patients according to grade, sex, and disease,

and for such modern diagnostic and treatment procedures as basal metabolism,

X-ray, and oxygen and physical therapy.

Of the entire number, The Surgeon General considered only twenty-five as modern, fire-resistant buildings and only fifty

of the remainder as worth modernization.

The others, he believed, should be replaced with new buildings.2

For the care of patients in theaters of

operations in wartime the Medical Department 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 assigned to field armies. They were of three

types: surgical hospitals, evacuation hospitals, and convalescent hospitals. Surgical

hospitals were planned for use in either division 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 hemorrhage, and fixation of complex fractures,

in order to prepare men with serious injuries 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 (Washington, 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 admission 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

Cmtee on Mil Approps (1939). HD: 321.6-1. (4) Preliminary Estimates, QMC, 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 returned some patients to duty after short

periods of treatment, transferred others

with prospect of early recovery to convalescent 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 function was to restore to physical fitness patients 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 evacuation 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 several 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 numbers rather than by names and locations,

and hence were called "numbered hospitals."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 supplies and equipment, laboratory supplies

and equipment, X-ray supplies and equipment, and operating-room equipment.

These were included under one heading as

an "assemblage." Items for hospital assemblages were listed individually and by

amounts in Medical Department equipment 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. According to The Surgeon General, failure

to have other units in training resulted

from a shortage of Medical Department

enlisted men. Congress limited their number to 5 percent of the strength of the

Army, and use of more than 4 percent in

named hospitals and other peacetime installations 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 hospitals—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 approved in principle The Surgeon General'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 operating-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 Moreover, with few exceptions, tables of organization 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 Department 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 Department a time of partial preparation for

war through the provision of the hospitalization actually required for an expanding

Army. Its steps in this direction were

sometimes painful and often halting. Several factors accounted for this. Formal

mobilization planning of the Medical Department, like that of the rest of the Army,

was based upon a belief that the anticipated 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 nature. Moreover, there was uncertainty

about the nature of increases of the

Army—whether rises in the authorized

strength of the Regular Army were temporary 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 General 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 revival of affiliated units see John H. McMinn and Max

Levin, Personnel (manuscript for a companion volume 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 Departments displayed in adjusting to planning for a global

war.
INTRODUCTION 7

The war in Europe had almost immediate effects upon the Army and the Medical

Department. In September 1939 the authorized 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 Channel, 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 mobilization. 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 expanded and additional ones provided for

new Atlantic defense bases. While a regular system of field hospitalization and

evacuation was as yet unnecessary, medical units had to be organized and prepared

for such service.10

The expansion of hospital facilities in

the United States involved many considerations. Decisions had to be made as to the

types of housing to be used and the number of beds that would be needed. Means

had to be found for providing suitable hospital plants in as short a time as possible.

New hospitals had to be manned and the

staffs of old ones augmented. "Green" officers had to organize hospitals and establish

procedures for their administration. Supplies and equipment had to be placed in

hospital plants at appropriate times.

Finally, it was necessary to develop procedures 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 demanded 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 determined. After they were organized they

needed to be trained. Before most of these

steps could be taken, tables and lists governing their organization, manning, and

equipment had to be revised and modernized.

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 Accounting 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 nonmedical military organization, from headquarters 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 medical 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 personnel 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 General, The Surgeon General was subject to

supervision by the War Department General Staff.

The General Staff, while it had no

authority to command, in actual practice

did so, issuing directives and orders and

approving or disapproving recommendations of The Surgeon General. In such instances it acted in the name of the Chief of

Staff or the Secretary of War. The Staff

had five divisions, each of which repre1

 (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 Personnel (G-1), 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 construction and supply. The Personnel Division

handled matters pertaining to personnel

that were Army-wide in scope; the Organization and Training Division, those relating to the organization, training, and use

of field units. Direct communication between divisions of the General Staff and

any chief of service (such as The Surgeon

General) was authorized by Army regulations, 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 mobilization began, medical officers were assigned

to several War Department agencies having 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 succeeded Maj. Gen. Charles R. Reynolds

the preceding June. Most divisions of his

Office had something to do with hospitalization and evacuation. Particularly concerned was the Planning and Training

Division, headed by Col. (later Brig. Gen.)

Albert G. Love. It had three subdivisions:

Planning, Training, and Hospital Construction 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 subdivision handled all of The Surgeon General'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 architects, 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) FM 101-5, Staff Officers'

Field Manual, 19 Aug 40. 4

 (1) Armfield, op. cit. (2) Kent R. Greenfield, Robert 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 Historical 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.
10 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

estimated the number that would be required 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 established policies for medical care and treatment and issued technical directives to

maintain professional standards.7

In recognition of the growing importance of problems of hospitalization during

mobilization, a Hospitalization Subdivision 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. Established with one officer and one clerk, this

division expanded to three officers and

three clerks by the end of June 1941. Although it was charged with the development of plans and policies for hospitalization 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 coordinate 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 technical 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 Department. For administrative purposes the

United States was divided into nine corps

areas, each in charge of a corps area commander under the jurisdiction of the Chief

of Staff. Overseas possessions were organized into three departments that corresponded administratively to corps areas in

the United States. All stations in departments and most in corps areas were under

the command-control of department and

corps area commanders respectively. Located 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 stations."

Hospitals classified as War Department

field installations were subject to the greatest amount of control by The Surgeon

General because they were under his command. 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 general hospital commander. Walter Reed

General Hospital was under the jurisdiction of the commandant of the Army Medical Center (Washington, D. C.), who was

in turn under the command of The Sur7

 Armfield, op. cit. 8

 SG OOs 32, 13 Feb 41; 87, 18 Apr 41. In an interview on 15 November 1949 Brig Gen H. D. Offutt

stated that he never felt handicapped by a lack of personnel 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 overlordship. HD: 314

(Correspondence on MS) III.
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 example 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 surgeons 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 hospitals of exempted stations. Corps area

hospitals, under the command-control of

corps area commanders, were supervised

by corps area surgeons in their dual capacities as local staff officers and technical

representatives of The Surgeon General.

Hospitals furthest removed from the latter's influence were those in overseas departments, not only because of their distance 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 somewhat 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 considerable authority over Air Corps station

hospitals. During 1940 and 1941, as the

Air Corps expanded, the number of such

hospitals increased. Soon after a reorganization 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 Medical Division, Col. (later Maj. Gen.) David

N. W. Grant, was assigned to AAF headquarters 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 medical 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 commanders 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 GHQ in Washington. GHQ and army

headquarters were charged with the training 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-of9

 (1) 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 CofAAF and ACofS G-4 WDGS, 12

Sep 41, sub: Trf of Gen Staff Functions . . . to AAF.

Both in AG: 322.2 (6-18-41)(1) 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 Department, 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 development of a separate set of hospitals,

the establishment of medical officers in

headquarters on a higher level of authority than The Surgeon General, and the

latter's partial loss of authority over medical field units. Understanding something

of these changes and of responsibilities and

relationships of various War Department

agencies, one may now turn to a consideration of the manner in which the Army

provided hospitalization during the emergency period.

12

 (1) Greenfield et al., op. cit., pp. 3-4, 6-9. (2)

Armfield, op. cit. (3) Ltr, TAG to CGs 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 hospitals, plus housing for commissioned and

enlisted personnel, storage for medical

and military supplies and equipment, and

administrative space for nonmedical military activities—demanded a simple

method of estimating requirements and

authorizing beds. Such expansion also demanded that additional housing be provided as rapidly and inexpensively as

possible.

The method prescribed by mobilization

regulations for estimating bed requirements was one that Colonel Love had devised 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 accumulation of patients in hospitals by 15-day

periods, and increases and decreases in

troop strengths during these periods.

When hospitals were expanded for the September 1939 increase in the Army, this

method proved too complicated for general use and The Surgeon General included in his Protective Mobilization Plan

of December 1939 a simpler one, also devised by Colonel Love—the multiplication

of troop strength by a predetermined percentage 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 percentage to use in estimating and authorizing

station hospital beds. The Surgeon General used 4 percent in calculating requirements in the fall of 1939, and G-4 began

to use this figure in planning for mobilization in August 1940. Experience of the

previous winter made some surgeons believe 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 Medical 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) MD-M, TAG to C of Arms and Servs, CGs 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 McClellan. 13 Aug 40, sub: Expansion of Hosp 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 approved this ratio, but the Assistant Chief

of Staff, G-4, Brig. Gen. Richard C.

Moore, later reversed this action, authorizing station hospital beds for only 4 percent 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 command 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 construction should be avoided and a fear

that sudden attack would require mobilization 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 constructed.7

For all new buildings the War Department planned to use one-story frame construction, called "cantonment-type." It

required The Quartermaster General to

keep on file standard plans for such buildings.8

 Those for hospitals had been prepared in 1935 in collaboration with The

Surgeon General's Hospital Construction

and Repair Subdivision. They consisted of

forty-nine drawings: forty-five for administrative offices, clinics, wards, messes,

quarters for personnel, and service buildings, and four for twenty different combinations of these buildings to make hospitals 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 hospital 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

3

 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, 11 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, AWC, 1939-40. 7

 MR 4-3. 2 Apr 34; MR 4-3, G-1, 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 construct it. Its most obvious disadvantages

were the danger of fire and the administrative difficulties caused by the wide area

covered.9

The hospital construction policy enunciated 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 apparently no attempt was made to use nonArmy 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 Jackson (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 unsatisfactory. At Fort Benning, for example, the

surgeon had to enlarge a 230-bed hospital, 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 explained, "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 Regular 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 importance, 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 cantonment-type hospitals. On 24 May 1940,

therefore, Colonel Love, Acting The Surgeon General, recommended that all additional beds should be housed in new

cantonment-type hospitals. G-4 disapproved this recommendation, perhaps because of shortages of funds and uncertainty 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.12

9

 (1) Floyd Kramer, "Mobilization Type Hospitals," Army Medical Bulletin, No. 31 (1935), pp. 1-19.

(2) Tynes, Construction Branch, HD. 10

 See correspondence in SG: 632.-1 (Cp Jackson) D. 632.-1 (Ft McClellan) N, and 632.-1 (Ft Benning) 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 Accommodations. (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

CAs, COs of Exempted Stas, and CofArms and Servs,

7 Jun 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 constructed for Camp Ord, G-4 directed on 6 June 1940 that the camp continue 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 construction would be necessary. In addition, both

the barracks and the hospital were old

and in need of repairs, were potential firetraps, 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 cantonment-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 surgeons 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. Referring 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 Gen14

 For example, see: Memo, SG for ACofS G-4

WDGS, 11 Sep 40, sub: Hosp, Ft McClellan. SG:

632.-1 (Ft McClellan) N. 15

 Memo, Maj Gen J[ames] C. Magee for Brig Gen

R[ichard] C. Moore. 6 Sep 40. SG: 632.-1 (Ft Benning) 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) Synopsis 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

17749-225. 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 General's position, for soon afterward the

Chief of Staff personally approved General Magee's recommendation "that the

erection of cantonment hospitals be announced as the normal procedure" for all

large posts, whether Regular Army or

not.18

The revised policy on hospital construction, issued by the War Department on 26

September 1940, discarded the longestablished plan to construct additional

buildings for hospitals as a last resort only.

Thereafter peacetime hospitals were to be

expanded only on small posts where clinical facilities were generally sufficient for

additional patients. Cantonment-type

hospitals were to be constructed elsewhere.19

 Without this change hospitals on

Regular Army posts would have consisted

of a hodgepodge of small permanent hospitals, permanent barracks, and temporary 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 location depended almost entirely upon a

constantly changing troop distribution. In

the fall of 1940 the Surgeon General's Office prepared two studies showing the additional beds that would be required by

June 1941 at each post in the United

States,21 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 construction plans for a single post.22

 As information about stations and their strengths became available, the Construction and Repair 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 recommendations. Final decisions on hospital construction were made by G-4 for ground

force stations and by the Chief of the Air

Corps for air stations. Because of the dayto-day type of planning and the lack of

information about action on his recommendations, 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. C. M[arshall]. (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 Emergency. HRS: G-4/31757. 20

 SG: 632.-1 (Ft McClellan) N; 632.-1 (Ft Benning) 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. 23

 (1) Ltr, CofAC to SG, 17 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 distribution, the fact that general hospitals

would serve more than one post and

would operate directly under The Surgeon General gave him considerable latitude 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 construction often 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 Hospital as a general hospital, since it was

already performing the functions of both

types.25 Plans had already been made to

increase the capacity of Walter Reed General 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 provided a total of over 15,000 general hospital beds in the United States for an expected Army strength of 1,400,000.

The expansion of general hospitals during 1941 followed basically The Surgeon

General's plan. On 25 September 1940

G-4 approved the construction often general hospitals, with a total capacity of

10,000 beds, in locations substantially the

same as those recommended by The Surgeon General.27

 Objections of the commander of the Eighth Corps Area to redesignation of the Fort Sam Houston

Station Hospital caused The Surgeon

General to withdraw that proposal.28

During 1941, therefore, the following general 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.; Billings at Fort Benjamin Harrison, Ind.;

O'Reilly at Springfield, Mo.; Hoff at

Santa Barbara, Calif.; and Barnes at Vancouver 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 proportionate increase in the number of general 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 construction. 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)(1). 26

 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)(1) 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 CA to

TAG, 7 Nov 40, and 4th ind, SG to QMG, 9 Dec 40.

AG: 322.3 Gen Hosp (8-10-40)(1). 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 moderately level and properly drained. The accessibility of good highway and railroad

nets was especially important for general

hospitals, whose function was to receive

patients from other hospitals. The availability of good water supplies and of adequate utilities connections had also to be

considered. The Quartermaster General's

chief interest in hospital sites lay in their

suitability from an engineering and construction standpoint.

During the emergency period The

Quartermaster General selected construction sites in collaboration with other interested War Department agencies. For

hospitals, this meant both The Surgeon

General and corps area commanders.31 In

the early phases of mobilization the selection of sites for station hospitals was left in

many instances to local authorities, for

The Surgeon General's Hospital Construction and Repair Subdivision had

little personnel to spare for such activities.

Sites so selected were generally satisfactory but sometimes had undesirable features, 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 representatives to stations where hospital construction 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 Department directed corps area commanders

to appoint boards, with medical representatives, to make investigations and

recommendations. Their surveys required

considerable time and their recommendations in some instances were deemed unsatisfactory. In such cases, the Secretary

of War appointed other boards representing The Surgeon General, The Quartermaster 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 Quartermaster General disagreed about the

manner in which the Medical Department as the using agency should exercise

advisory supervision over hospital construction. 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 appropriate 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 delayed 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)(1) 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-4/29135-11. (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 quartermaster and medical officers erected a twostory 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 unsatisfactory by The Surgeon General.34

Hoping to speed construction, The

Quartermaster General proposed standardization 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 officers 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 referring 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 without prior approval of the Surgeon General's Office.36

Centralization of the Medical Department'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 "off the 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 October 1940 Colonel Hall, of the Hospital

Construction and Repair Subdivision, indicated that he was "by no means certain"

that they would "suit our 1940 ideas."37 It

soon appeared that they did not. Hospitals 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 medicine. Administration buildings had insufficient 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. General hospitals needed more space for quartermaster activities. Inadequate kitchens

and mess storerooms became the source of

frequent complaints. Offices for the medical supply officer and the medical detachment 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

to QMG, 14 Feb 41. SG: 632.-1. (2) 1st ind, SG to

QMG, 17 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 

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 CofEngrs, 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." 3 7

 (1) Lessons Learned from Planning and Constructing 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, MC, 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 required 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 existing plans completely or to make piecemeal changes arose in the fall of 1940.

General Love, Chief of the Planning and

Training Division, advocated their complete revision, but Colonel Hall demurred

on the ground that he would encounter

delays and difficulties in securing approval of G-4 and co-operation of The

Quartermaster General.39 That his position had some basis in fact is indicated by

a controversy from August through October over proposed changes for separate

buildings. After The Quartermaster General complained that requests of The Surgeon 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 cantonment-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 rearrange 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 obtained additional wards.42

 Another method 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 construction.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 Gen Hosp. 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, 17 Dec 40. SG:

632.-1. 42

 (1) An Rpts, 1941, Sta Hosps at Ft Bragg and

Gp Roberts and O'Reilly Gen Hosp. HD. (2) Ltr, SG

to TAG, 7 May 41, sub: Request for Urgent Emergency 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 CA. 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 problems without assuring adequate fire protection. 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 buildings of hospital plants, as a fire-protection

measure.47 In May the Chief of the Air

Corps secured appropriations for the installation of automatic fire-sprinkler systems 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 hospitals 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-resistant materials.49

 Soon afterward his Office

began to collaborate with the Quartermaster General's in designing such a plant.

It consisted of buildings that were generally 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 permitting one diet kitchen and one ward office

and examining room to serve two wards.

Two-story corridors connected the buildings 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)(1) 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 al., 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 SecWar, 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 Layouts. CE: 632 Pt I. 47

 Memo, SG (Hall) for QMG, 29 Jan 41. SG:

632.-1. 48

 (1) Synopsis Ltr, CofAC to CofEngrs, 9 May 41,

sub: Fire Prevention in Hosps, with 1st ind, CofEngrs

to CofAC, 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 (10-2 1-41) MO-D, TAG

to CofEngrs, 26 Dec 41, on Ltr QM 671 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) (1).
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 lacking 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 normal beds (that is, those for which 100

square feet of space each was provided in

ward buildings) in station hospitals increased from 7,391 to 58,736 and in general 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 Department used emergency and expansion beds

(that is, those set up on the basis of seventy-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 (7-7-41) 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 Constructing Army Hospitals, speech by Col Hall, 16 Sep 43.

HD: 632.-1.

26 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

wards but also in porches, halls, barracks,

and tents) and sent some patients to nearby civilian and Veterans Administration

hospitals.53 It also continued a policy, begun early in 1940, of reducing the number

of Civilian Conservation Corps and Veterans Administration patients in Army

hospitals and in December secured War

Department approval of a policy of limiting sharply the hospitalization of dependents 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 administration of Army hospitals was an Army regulation 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 necessary. In October 1940 the Medical Department 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 "Station Hospital Organization Chart, Regulations, and Medical Department Questionnaire." 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 organization in considerable detail, advocating

the separation of activities into two major

categories, administrative and professional, and the grouping of professional

activities into services composed of subunits called sections. For example, the

surgical service of a station hospital might

contain sections devoted to general surgery, orthopedics, obstetrics and gynecology, urology, eye-ear-nose-and-throat disorders, anesthesia, roentgenology, and

physiotherapy; the medical service, sections for general medicine, contagious diseases, 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 administrative procedures, and contained checklists for chiefs of services to use in measuring the efficiency of operations. While it

was somewhat more specific than the

Army regulation governing hospital administration, 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 Leonard 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.-1 (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 (11-28-40) 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)(1).

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 separate genitourinary and eye-ear-nose-andthroat services; and that at Fort Bragg

(North Carolina), a separate neuropsychiatric 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 LaGarde, 14; while the number proposed in

the manual was 12. Station hospitals likewise varied. On some posts they were

under the supervision of station surgeons,

who supplied certain administrative services. In one such instance the station surgeon 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 commanders for each unit, but possessed a

central registrar's office, medical supply

section, nursing section, mess and hospital

fund, military and civilian personnel divisions, and medical detachment. General

hospitals not located on Army posts usually had administrative sections not found

in station hospitals, such as the finance

and provost marshal's offices.

Neither Army regulations nor the manual on organization limited the number of

officers a hospital commander could supervise directly. Thus the number of individuals reporting to him varied as did the

organization of administrative and professional 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 professional 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 varied from hospital to hospital. Since there

was no manual covering hospital operations 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

Gp 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.

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 officers 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 instructions, but he exercised little direct

control during this period over their administrative activities. Rather he depended 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 otherwise been the case was not discussed during the period under consideration. Arguments might have been raised in favor of

flexibility which permitted accommodation to local situations. Later on, lack of

uniformity in organization and administration became a subject of much discussion 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-todate guide for manning named hospitals.

Since they were then small, few in number, and widely different in construction

none was needed, for personnel requirements of each installation could be determined 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 requirements and distributing personnel.

The only available one was a 1929 table

of organization for wartime station hospitals 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 permission to use this table as a guide, pending

the publication of a "table for converting

bed requirements into personnel requirements." 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, especially officers and enlisted men, than did

the old one. For example, a 500-bed station hospital under the old table was to

have 25 officers, 60 nurses, and 200 enlisted men; under the new guide, 37 officers, 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-1 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 Historian 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 CG 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 Determining 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 expressed requirements in terms of military

personnel only and called for more enlisted men than the number already allotted 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 enlisted 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 Medical Department Personnel" was published on 9 April 1941 with the understanding 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 apparently had no trouble in getting the General Staff to authorize the number of physicians, dentists, and nurses whom he desired, but he encountered difficulty in procuring 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 Administrative Corps officers filled a few

administrative positions, but the Army

had few such officers and their substitution for Medical Corps officers in administrative work gained little headway prior

to the war years. By the spring of 1941 the

procurement situation had apparently improved 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 employees and the training of medical personnel. The Surgeon General contended

that the Medical Department needed proportionately 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 civilians than 20 percent of the total enlisted

63

 (1) Memo, Act SG for ACofS G-1 WDGS, 1 Apr

41, sub: Approval of T/O for Sta Hosps in the ZI.

HD: 322.052-1. (2) Memo G-1/13308-291, ACofS

G-1 WDGS for ACofS G-4 WDGS, 14 Feb 41, sub:

Guide for Determining Pers Reqmts, Sta Hosp, ZI.

AG: 381(11-3-37) Sec 1-12. 64

 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-1/13308-291, ACofS

G-1 WDGS for ACofS G-4 WDGS, 8 Jan 41, same

sub. AG: 381(11-7-37) Sec 1-12. 65

 Rpt, Conf of SG with CA Surgs, 10-12 Mar 41.

HD: 337. 66

 (1) Memo G-1/13308-291, ACofS G-1 WDGS

for ACofS G-4 WDGS, 14 Feb 41, sub: Guide for Determining 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-1 WDGS, 11 Mar

41, same sub. (4) Memo G-4/31697, ACofS G-4

WDGS for CofSA, 22 Mar 41, same sub. All in AG:

381(11-3-37) Sec 1-12. The Chief of Staffs stamp of

approval for publication was dated 28 March 1941.

(5) MR 4-2, Hospitalization, G-1, 9 Apr 41. 67

 John H. McMinn and Max Levin, Personnel

(MS for companion vol. in Medical Dept, series), HD. 68

 An 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 constitute 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 understudies of their opposite numbers. Repeatedly, therefore, he asked for greater allotments of enlisted men for fixed installations 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 received 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 personnel 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 experience to care for the sick and injured, but

most who entered the Army after September 1940 knew little about the administration 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 hospitals, The Surgeon General authorized a

program in November 1940 to train fifty

Reserve and National Guard officers each

month for such positions as registrar, detachment commander, receiving and disposition 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.73

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 Department 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-1 WDGS, 1 Apr 41, sub: Increase in

Auth for MD EM for ... Overhead. HD:

322.052-1. 70

 Memo G-1 /15081 Med, ACofS G-1 WDGS for

ACofS 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-1 WDGS, same sub. AG: 381

(1-1-40) Sec 3. 71

 (1) For example, see: Memo, Act SG for ACofS

G-1 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, Forrest, J. T. Robinson, and Claiborne, Fts Jackson,

Bragg, and Knox, and O'Reilly, Lawson, Hoff, Billings, 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 enlisted men from hospitals already in operation formed the cadres of enlisted detachments 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 preferred 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 normally 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 dietitians and physical therapy aides were in

civilian status. The chief problem in the

use of civilians was procurement. To reduce difficulties in that connection The

Surgeon General in September 1940 decentralized 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 hospitals in isolated areas, inadequate transportation to such hospitals, absence of

labor markets in some places, and competition of other government agencies for

available civilians.77

Shortages of Supplies and Equipment

Another difficulty encountered in opening new hospitals was a shortage of suitable supplies and equipment, and complaints 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 hospitals received, such as surgical instruments, 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 Department 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 Employees 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 paragraphs 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 November 1950, General Magee disagreed with the interpretation given here, stating that he personally

found a high state of satisfaction with supplies when

he inspected hospitals. (Notes filed in HD: 314 [Correspondence 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 assemblages 50- to 60-percent complete.79

Hospitals thus failed initially to receive

many critical items. Most frequently lacking were sterilizers, X-ray equipment,

orthopedic equipment, dental operating

units, cystoscopic instruments, and catheters.

To make up for shortages hospitals resorted 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 equipment by borrowing from the University of

Florida and the Florida State Board of

Health, while the Camp Claiborne Station Hospital borrowed an X-ray developing tank from a dealer in Shreveport,

Louisiana. In other instances Army authorities arranged locally to use the facilities of neighboring hospitals. For example, 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 neuropsychiatric 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 hospital's construction. Thus the improvisation and ingenuity of local personnel compensated 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 considerable time was required both for industry to convert to the production of

goods on the scale demanded and for the

Medical Department to modify its peacetime methods of requirements-computation, 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 became necessary and The Surgeon General's Hospitalization Division concentrated 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 sufficiently "serious, complicated, or obscure"

to require treatment in the five general

hospitals then in operation. Few restrictions 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 Distribution 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 surgeons of responsibility for selecting patients to be transferred, it provided generally that all requiring more than sixty

days of hospitalization as well as those

needing specialized treatment not available at station hospitals should be sent to

general hospitals. Major elective

 84

 operations 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 hospitals 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 General requested authority to set aside specific numbers of general hospital beds to

which station hospitals might transfer

patients without reference to corps area

headquarters. The General Staff approved this request and on 21 June 1941

authorized the establishment of a system

of bed credits. This permitted the Hospitalization Division to allot a certain number 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 reference to higher authority. When stations

needed changes in allotments, they ordinarily requested them through corps area

surgeons. In emergencies, they were authorized to communicate directly with

The Surgeon General.86

The procedure for transferring patients

from station to general hospitals was further 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 histories, 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 General then secured approval of a change

which permitted station hospital authorities 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 Hospitalization Division was the disposition of patients. It concerned the Hospital Construction and Repair Subdivision also, for

prompt disposition of patients reduces

total bed requirements by making available 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 Col H. W.

Doan, 10 Jun 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 considerable local dissatisfaction with difficulties 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 certificates 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 discharges. 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 authority 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 became concerned about delays in the retirement 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 recommendations. Soon afterward he directed general

hospital commanders to "personally assure themselves that the disposition of

officer patients is expedited insofar as this

can be done without prejudice to the interest of the individual or of the Government."

 91

 Further steps to speed the disposition 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 possible, toward relieving Army hospitals of

patients who were unnecessarily occupying 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 President approved a recommendation of the

Federal Board of Hospitalization that

members of the armed forces who were injured 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 Administration. Accordingly the Surgeon

General's Office secured approval in

March 1941 for the transfer to the Veterans Administration of most enlisted men

who were permanently disabled by the

development of pulmonary tuberculosis.

Two months later this provision was extended to all classes of chronic disability

cases. Three classes of tuberculous patients—those nearing retirement after

thirty years of service, those in the first

three noncommissioned grades whose recovery 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 Veterans Administration because their disabilities had existed before induction.

State institutions were often reluctant to

accept those who required care in locked

wards. As a result psychotic patients began to accumulate in Army hospitals.

Early in the mobilization period a large

three-story section of Walter Reed General Hospital was converted into closed

wards and the Medical Department arranged 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 constructed at each new general hospital

erected during 1941. In the summer of

that year, after Walter Reed General Hospital had demonstrated the rather elementary fact that transfer of psychotic patients to state institutions was expedited

by addressing requests to proper state

agencies or authorities, The Surgeon General issued a circular letter naming those

in each state. About the same time his

Office arranged to establish a special neuropsychiatric 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 Harbor.93

Starting almost from scratch in September 1939, the Medical Department

reached a state of partial preparation for

war by December 1941. To provide hospitals for a rapidly expanding Army in the

United States, a simple method of computing requirements was adopted and

ratios of beds to troop strength—smaller

than The Surgeon General considered desirable—were officially established. Experience 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 resistant was developed. As new hospitals

opened, the Surgeon General's Office

evolved general guides for their organization and administration but left hospital

commanders with much autonomy in this

field. Attention was focused not upon internal hospital administration but upon

simplifying procedures affecting the hospital system in general. In this connection

attempts were made to reduce unnecessary 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 General's Office was also concerned with plans

and preparations for overseas hospitalization, 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, 11 Dec 41. 93

 (1) Ltr, Brig Gen H. D. Offutt to Col H. W.

Doan, 10 Jun 48, incl. 1. HD: 322. (2) Ltr, SG to

QMG, 17 Dec 40, sub: Add Fac for the Care of Insane, 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 determination 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 Department mobilization planning combined with limitations upon available

funds to hold Medical Department activities 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 division 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 patients 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 standardized. On recommendation of The Surgeon 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 laboratory, 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 horsedrawn 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 estimate 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 hospitals should equal 15 percent of a theater's

strength. Others believed a lower ratio

would suffice.2 The Surgeon General indicated 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 Department Plan provided for only 35,000—in

32 general hospitals, 4 station hospitals,

and 2 hospital centers. The Surgeon General 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 submitted a study showing that a minimum

of 115,000 fixed beds would be required,

but because G-3 believed that the majority of troops to be mobilized should be allotted 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 hospitals 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. Although these projects had been started

earlier, only the equipment list for medical regiments and the tables of organization for medical regiments and squadrons

had been completed by the fall of 1939.

After the President declared an emergency 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 patients 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. Likewise, the medical battalion eventually be1

 (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 II. (2) 1st ind,

SG to TAG, 11 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)(1). (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, GLM [Col Garfield L. McKinney] for

Col [Albert G.] Love, 6 Feb 40. HD: McKinney files. 3

 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

Source: Study accompanying ltr, SG to TAG, 14 Feb 40, sub: Hosp under WD PMP 1939. AG: 381 (5-10-40) G-4/20052-134.

came the organic unit of a corps. Plans

for the organization of armored divisions

required the preparation of tables of organization 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 tendency to increase the personnel in medical

units of all sizes and to replace animaldrawn 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 specialized 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 enlisted men having specialists' ratings and

correspondingly fewer having only basic

military training. For the first time, they

provided for civilian dietitians, physicaltherapy aides, and dental hygienists. In

many cases the total number of officers

and enlisted men was increased. For example, 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 developed 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 casualties 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 respects to the "mobile hospital" adapted

from the French auto-chir during World

War I,8 the new hospital comprised a

headquarters and three subordinate elements: 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 independent 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 hospitalization unit or to supplement the facilities 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 organization, 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 medical and surgical treatment, it was necessary 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 transportation 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 Offutt, assigned to the Army Medical Center

in January 1939 and later transferred to

the Surgeon General's Office. He collaborated 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

683W (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 283W (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, MC, C&GS Sch, Ft Leavenworth, 11

Feb 41. SG: 322.3-1. (2) For documents on the experimental development of these vehicles see SG: 322.15-

17.
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 General Magee requested funds for this purpose. 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 Department's disposal for any emergency one

complete, modern 1,000-bed general hospital 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 Department alone. Hence the Staff only

promised "consideration" of Medical Department 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 included in the War Department's budget

requests.13

To provide professional staffs for hospitals included in the Protective Mobilization Plan, The Surgeon General early in

1940 began to arrange with civilian medical institutions for the organization of

authorized affiliated units. By June 1940

he requested an increase in their number,

stating that the response of sponsoring institutions was more enthusiastic than he

had expected. The next month the General Staff raised the numbers authorized to

68 general, 30 evacuation, and 23 surgical

hospital units. About a year later the Surgeon General's Office reported success in

the organization of affiliated units for 41

general, 11 evacuation, and 4 surgical hospitals—approximately the number originally authorized in 1939.14

Attempts to secure enlisted men for

training in hospital units were only partially successful. Although draftees could

be used to fill units scheduled for activation 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. Increases 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 percent of Army's strength afforded some

additional men. Since most of them were

needed for organic medical units of divisions 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 numbered hospitals. Insisting upon the necessity 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 tableof-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 mobilization 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 equipment. 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 hospitals. Nevertheless, medical units had to be

organized and trained along with the

combat forces they were designed to support.

Activation of Field Medical Units

When mobilization began in September

1940 the Army had, aside from the medical units that were organic parts of existing divisions, only the following field medical units: 2 surgical hospitals, 2 evacuation hospitals, 2 medical regiments, 1 medical supply depot, and 1 medical laboratory.16

 Additional organic medical units

would be activated and trained along with

their parent units, such as infantry divisions. 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 serving with armies, corps, and General Headquarters—that would be activated for

training might differ from the number

needed for combat operations. In anticipation of the passage of the Selective Service

Act, The Surgeon General had recommended 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 recommendation 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 hospitals, 22 general hospitals, and 22 station

hospitals.18 Approximately half of these

15

 (1) Memo, ACofS G-1 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 7947 (1941), p. 153. (2) Unit cards

of the 1st and 3d Evac Hosps, 6th and 7th 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 (11-15-40) 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 battalion and two additional medical regiments. By the end of June 1941 all of the

units authorized had been activated. The

next month two additional station hospital units were provided when two provisional 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 situation were perhaps responsible for this.

Under the Selective Service Act, Reservists and draftees could not legally be made

to serve outside the United States except

in its territories and possessions. Nevertheless, 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 regarded authorized hospital units as primarily 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 hospitals that would be called up in case of

war—that is, the affiliated units. Along

with shortages of personnel and equipment and demands of named hospitals for

both, this view undoubtedly influenced his

recommendations and plans for supplying 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 complete officer staffs were not available for

numbered hospitals. Therefore, The Surgeon General planned to issue only field

training equipment to numbered hospital

units and he recommended that few

officers, from two to five, should be assigned 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 maneuvers) 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 shortage of men and officers to meet various

needs and demands.22 Those formed dur19

 (1) Annual Report . . . Surgeon General, 1941

(1941), pp. 153-54. (2) An Rpt, 1941, Surg GHQ.

HD. (3) Ltr AG 320.2(5-14-41) MC-C-M, TAG to

CofS 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) 1st ind 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 MC Units to be Activated with

Sel Serv Men. SG: 322.3-1. 22

 Ltr AG 111 (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 obtain complete issues of authorized equipment, except controlled items (that is,

those in short supply and issued only on

special instructions by the War Department), by submitting requisitions to corps

area headquarters. Two weeks later it

issued another directive making this policy

applicable specifically to Medical Department 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 complements 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 informed G-3 that he was having considerable 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 hospitals from which personnel was drawn. He

therefore asked G-3 to authorize full complements of officers, nurses, and enlisted

men for seventeen of the hospitals activated 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 withhold from such units all supplies and

equipment, except training equipment,

individual equipment, motor transportation, and controlled items, until their assignment 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 withhold 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 Procedure. AG: 475 (8-12-40) (1) Sec 1. (2) 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. 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 for Med 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 thirtyone, 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 completed 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. Accordingly 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 permission to hold assemblages in depots until 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 equipment, storage for it in the field was inadequate, 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 Surgeon 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 confusion existed about the command that

was responsible for their training and use.

With the separation of field forces from 28

 (1) Ltr, TAG to CGs 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, CGs of Armies et al.,

20 Aug 41. sub: Units for Emergency Expeditionary

Forces. SG: 322.3-1. 29

 (1) Memo, Act ACofS 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 ACofS 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 ACofS 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 ACofS 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 CGs 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 attached to the four field armies all numbered 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 hospital units, and it forbade army commanders to assume control over such units

without the approval of corps area commanders. Furthermore, while one directive stated that the personnel and units of

field forces on duty with corps areas would

be controlled entirely by corps area commanders, another forbade the same commanders 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, wellplanned on-the-job training programs

were established in named hospitals and

were co-ordinated with unit field training.

In others, the commanders of named hospitals assigned men from numbered units

to vacant jobs regardless of their training

value. In such cases technical training suffered because many men did only menial

work, and controversies developed between hospital commanders responsible

for post medical care and unit commanders 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 hospital units, The Surgeon General suggested that the personnel of some should

be used to augment the staffs of named

hospitals and to assist medical detachments, battalions, and regiments engaged

in maneuvers. He proposed that other

units should be employed in giving medical care as they would in theaters of operations.35

 Their use in this manner was limited 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 commanders then had to improvise mobile

hospitals by using personnel and equipment of medical regiments. Generally

armies had to rely upon corps areas for

32

 (1) Ltr AG 320.2(9-27-40) 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 Fld 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,

MC, to Col Roger G. Prentiss, Jr, MC, 10 May 51.

HD: 314 (Correspondence on MS) III. (2) An Rpts,

1940 and 41, 222d , 213th , 215th, and 183d Gen

Hosps. HD. 34

 (1) Memo, Lt Col 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, MC, to Col Roger G. Prentiss, Jr, MC, 10

May 51. HD: 314 (Correspondence on MS) III. 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 operation of hospitals, station, general, evacuation, and surgical hospital units were attached 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 organizations.36

Furnishing Hospitalization

for Overseas Areas

Even before war actually began, additional hospitalization had to be supplied

for troops in garrisons in territorial possessions 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 expanded as in the United States and additional increments of supplies and personnel 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 Surgeon 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 percent 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 equipment 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, Newfoundland. They operated a 40-bed hospital aboard the transport Edmund B. Alexander 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 medical officers and 164 enlisted men, accompanied the garrisons bound for Trinidad

and Bermuda. The detachment which

accompanied the Trinidad base force established a hospital in a temporary, singlebuilding 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 officers 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, 11th, 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, SG

to CofEngrs, 25 Feb 41, sub: Floor Plans for MD Fac

at Antigua, Bahama, British Guiana, and Saint

Lucia. SG: 632.-1. (3) Memo, SG for Maj [Henry I.]

Hodes, G-3, 28 Nov 40, sub: MD Pers for Atlantic

Bases. HD: Atlantic Bases file folder. (4) Ltr, SG to

CofEngrs, 10 Mar 41, sub: Med Sups and Equip

. . . , and 1st ind, CofEngrs to SG, 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 construction 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 Government, 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 expedition 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 volunteering for three-year enlistments before sailing. 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 hospitalization 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 General 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 medical care, the tables governing their organization and equipment were revised. Although personnel authorized by such revisions was often increased, the General

Staff began a practice—to be carried to

greater lengths later—of requiring reductions 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 General 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 General 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 equipment. This dispute was to continue unabated 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: Atlantic Base file folder. (2) A History of Medical Department Activities in the Caribbean Defense Command in World War II, vol I, pp. 245-46, 281-82,

311, 314, and 320. HD. (3) An Rpt, 1941, Surg Bermuda Base Comd. 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 forthcoming 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 Comd. HD.

PART TWO

HOSPITALIZATION

IN THE EARLY WAR YEARS

7 DECEMBER 1941—MID-1943

Introduction

Despite its year of peacetime mobilization the United States was not prepared

for the offensive when war came on 7 December 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 mobilized 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 transition 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 preparation 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 evident in the field of hospitalization. Few

hospital units were in training and equipment 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 rapidly 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, during 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 meeting immediate needs in the quickest possible fashion and of preparing at the same

time for future operations. Under General

Magee's leadership, the Department exhibited 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 reorganization 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 understand that difficulties in hospitalization

and evacuation resulting from the reorganization were aspects of a larger problem 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 interior by the creation of three major commands—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 general supervision of matters for which they

were traditionally responsible, and to the

strategic direction offerees 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. Marshall. 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 protecting and regularizing its current position.

Colonel Grant continued as the Air Surgeon. The Army Ground Forces comprised the arms (such as Infantry, Cavalry, 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, Washington Command Post: The Operations Division (Washington, 1951), pp. 61-74, 90-95, 111-19, 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 Administration (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 liquidated and much of its personnel was

transferred to AGF headquarters. Colonel

Blesse then became Chief Surgeon of the

Army Ground Forces (or the Ground Surgeon). He remained in that position until

December 1942, when he was succeeded

by Col. William E. Shambora, and returned 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 Commanding General, Services of Supply.

Under his jurisdiction was The Surgeon

General, the head of the Medical Department.

The Surgeon General's New Position

Uncertainty developed about the effect

the reorganization had or should have on

responsibilities and authority for hospitalization 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 Department," he did not believe that the reorganization had altered the responsibility

of The Surgeon General for the health

and medical care of the entire Army.2 Apparently he did not comprehend at the

outset the full impact on his office of the

interposition of an intermediate headquarters between himself and the General

Staff. According to SOS doctrine General

Somervell was responsible for all activities,

including hospitalization, within the Services of Supply and was at the same time

staff adviser to—and in some instances

spokesman for—the Chief of Staff on supplies and services, including medical, for

the entire Army.3 In his new position, The

Surgeon General was an adviser to General Somervell. In this capacity the extent

to which General Magee could discharge

what he considered to be his responsibilities 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 hospitalization and evacuation in particular

were concerned, it depended—partially,

at least—upon the role of a medical section in SOS headquarters.

When SOS headquarters was established in March 1942 a medical officer,

Lt. Col. William L. Wilson,4 was transferred 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 Administrative 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 attention 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-ordinate activities related to, and insure the

means for hospitalization and evacuation—was subject to different interpretations. General Magee believed that his

Office was best equipped to decide upon

medical matters and that his advice

should be given preponderant weight. Accordingly, in his opinion any medical officer in a staff position of a higher headquarters should be a representative of The

Surgeon General and should receive his

instructions and advice from the Surgeon

General's Office. He interpreted establishment of the Hospitalization and Evacuation Branch as representing a desire in

SOS headquarters for a section to coordinate activities of various Army agencies in the transportation (or evacuation)

of patients.6

The SOS viewpoint was different. In

July 1942 General Lutes informed corps

area commanders that the "Hospitalization 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 evacuation required supervision by a higher

headquarters than the Surgeon General's

Office. In explaining his position as chief

of the SOS Hospitalization and Evacuation 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 responsibility to gather and evaluate information

on such matters and to present it, along

with recommendations for action, to Generals 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 conceptions of their respective responsibilities, it

was perhaps inevitable that conflicts

would develop between the SOS Hospitalization 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 C. Magee in conf in HD

AML, 10 Nov 50. HD: 314 (Correspondence on MS)

III.

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) III. 9

 See below, pp. 63-67, 151-60.
CHANGES IN ORGANIZATION AND RESPONSIBILITIES 57

The extent to which The Surgeon General could discharge his responsibility for

the health and medical care of the Army

depended also upon willingness of commanders of the Ground and Air Forces to

admit that the Commanding General,

Services of Supply, or one of his subordinates, 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 headquarters readily accepted the dictum that the

"Medical Department under the command of the Commanding General, Services of Supply," would furnish all of its

hospitalization and evacuation in the

United States except that provided by

field medical units operating under tactical control. On the other hand, it will be

recalled that the Air Forces already had a

separate set of hospitals and the reorganization placed them, along with stations

they served, under command of the Commanding General, Army Air Forces.

Several documents issued after the reorganization purported to clarify the respective responsibilities of the commanders

of the Air and Service Forces and the relationships of the Air Surgeon and The

Surgeon General. A General Staff directive charged all commanders with "command responsibility for the operation of

all medical facilities under their control

and for future planning in connection

therewith." It also charged the Commanding General, Army Air Forces,

"with development and operation of air

evacuation," and the Commanding General, Services of Supply, with providing

"for the evacuation of sick and wounded

delivered to his control," and with "administrative responsibility for the coordination of the plans of all commands for

evacuation of the sick and wounded to be

delivered to his control, and for coordination of plans for hospitalization within the

continental United States." An SOS directive on 18 June 1942 charged The Surgeon

General with "the initial preparation and

the maintenance of basic plans for military hospitalization and evacuation operations, and the coordination of the plans

therefor of all commands concerned." An

announcement of an agreement between

the Air Surgeon and The Surgeon General, 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 technical activities with the Air Forces." It

had also stated that the Air Surgeon

would not duplicate activities of the Surgeon General's Office, "with the exception

of those procedures necessary for the

proper control of Medical Department

personnel and activities under the jurisdiction 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

ACofS 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 incl. SG: 705.-1.
58 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

exercise authority over AAF hospitalization and all of them were sufficiently

vague to permit a variety of interpretations. Difficulties that arose from Air

Forces' resistance to SOS claims of authority and from the Air Surgeon's strivings for completely separate AAF hospitalization will be discussed later.11

The division of responsibility for hospital 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 approval of a policy of "providing over-all

hospitalization for task forces, instead of

attempting to provide separate hospitalization 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, responsibility 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 communications 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 communications 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.16 On the recommendation of its Hospitalization and Evacuation Branch, SOS headquarters first

requested that only general and station

hospital units be placed under SOS control but later adopted The Surgeon General'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 Surgeon'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 acti11

 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) 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: 320.3 (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 incl. SG: 320.3-1. 17

 (1) Memo for Record on Draft 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." (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 Robert R. Palmer, Bell I. Wiley, and William R. Keast,

The Procurement and Training of Ground Combat Troops

(Washington, 1948), pp. 499-511, 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 "Activation, 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 responsible for activating and training communications 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 battalions, medical detachments, and medical supply depots.

With division of responsibility for activating and training service units, AGF

headquarters assumed responsibility for

recommending the number of mobile

units to be included in the troop basis,

while The Surgeon General and SOS

headquarters concentrated on units for

fixed hospitals. Subsequently, responsibility for preparing tables governing the

organization and equipment of hospital

units was also divided. Since mobile hospitals were designed for use in combat

zones, AGF headquarters felt that it should

be free to make such changes in personnel and equipment of these hospitals as it

found desirable for tactical reasons.

In September 1942 G-4 proposed that

AGF headquarters should be given responsibility for the preparation of tables

for all AGF service units.20 General Somervell 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 preparing 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 hospital 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 hospital, was packed according to Medical

Department equipment lists, and was

issued by Medical Department depots as a

single item. While he customarily consulted 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 discharge his responsibility for the medical

care of the Army occurred as a result of

the reorganization of the Services of Supply in the summer of 1942. At that time

corps areas were renamed service commands and authority formerly concen19

 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.

HRS: 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 Governing T/Os and T/Es. HD. 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 Deleting 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 hospitals, except Walter Reed, was transferred from The Surgeon General to commanding 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 generals of service commands.24

 The reorganization also diminished the authority

of service command surgeons and altered

the Surgeon General's relationship with

them. They no longer occupied the position of staff advisers to their commanders

but were now subordinated as chiefs of

medical branches to the chiefs of personnel or supply divisions of service command headquarters. Moreover, since command responsibilities were emphasized in

the field, as in Washington, they could no

longer be considered as field representatives of The Surgeon General and could

therefore exercise no authority over hospitals not under service command control.

Finally, The Surgeon General could—in

theory at least—communicate with service

command surgeons and hospital commanders only through command channels—that is, through General Somervell

and the commanding generals of service

commands. This indirect method of intercourse 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 occurred, 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 previously shared with The Surgeon General for

the maintenance of hospital plants.27 After

the War Department reorganization, recommendations of The Surgeon General

for construction of new plants and for

major alterations of existing plants were

subject to review by both the Hospitalization and Evacuation Branch and the Construction Planning Branch of SOS headquarters. 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 directives of the War Production Board. The

selection of sites and the internal arrangements of new hospitals, as well as alterations 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(1)(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 Mar 42) (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 Professional 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 decentralization to the field of as much construction 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 authority he had previously exercised over

the erection and alteration of hospital

plants.28

The Wadhams Committee

Late in 1942 responsibilities and organization for hospitalization, along with

many other aspects of Medical Department work, were the subject of review and

comment by a civilian committee appointed 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 Committee (from the name of its chairman, Col.

Sanford Wadhams, a retired medical officer), was constituted to "make a thorough

survey of professional, administrative, and

supply practices of the Medical Department."

 29

 It probed the relation between

the Surgeon General's Office and the SOS

Hospitalization and Evacuation Branch,

and testimony presented in that connection placed on record information summarized 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 responsibility of either the Surgeon General's

Office or major commands for hospitalization. This subject, along with an account

of the Committee's background and investigation as a whole, is discussed fully elsewhere.31

 Recommendations of the Committee 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 Surgeon General's Office as well as in higher

headquarters, but they affected the divisions 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 Training Divisions, in a newly formed Operations Service. In August, to describe its

functions more accurately, the Hospitalization Division's name was changed to

Hospitalization and Evacuation.35

The Hospital Construction Division

continued to exercise The Surgeon General's advisory supervision over the construction, leasing, and maintenance of all

establishments for the care and treatment

of the sick and wounded. Colonel Hall remained at its head. To handle wartime 28

 (1) Army Hosp Program in Continental US, extract from sec 6, Analysis, Monthly Progress Rpt, data

as of 31 Mar 43. SG: 632.-1. (2) See below, pp. 92-93. 29

 SecWar 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 civilian 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 hospital construction program neared completion.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 Maintenance 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 subdivided, becoming the Ground Troop Facilities 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, foreshadowing the transfer of its activity to the

Hospitalization and Evacuation Division.

By August, then, the Hospital Construction Division consisted of the Maintenance

and Repair, Civilian Facilities Conversion,

Ground Troop Facilities, and Air Corps

Facilities Branches. This organization continued until July 1943.37

The Hospitalization Division, under

Col. Harry D. Offutt, limited its activities

largely to the development of hospitalization 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 gradually took on another function, the periodic revision required by SOS headquarters of a basic directive for hospitalization

and evacuation operations.40 In September 1942 it also took over the job of estimating 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 Division'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 recommendations for the troop basis, for activation schedules, and for medical support

for task forces and overseas theaters. It

also prepared and revised tables of organi3 6

 (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 SGO. HD. 39

 Morgan and Wagner, op. cit., Orgn Charts VI,

VII, and IX. 40

 An Rpt. FY 1943, Hosp and Evac Div SGO. 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: 6S2.-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 equipment lists. After separation of responsibility for nonorganic service units between

AGF and SOS headquarters, this Division

limited itself primarily to SOS medical

units but occasionally extended its activities to others when called upon to participate in conferences with the Operations

Division of the General Staff on the formation of task forces or the deployment of

additional troops to established theaters.

After SOS headquarters was given responsibility for training SOS service units, the

Training Division (separated from the

Operations Service in August 1942) established 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 Department 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 inspection trip which he had undertaken while

assigned to G-4 and which he had initiated 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 hospitalization 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 recommended that SOS headquarters give further 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 publication "for the guidance of all concerned."

 45

 General Lutes approved the

proposal, and on 14 March 1942 directed

The Surgeon General to submit such

plans.46 The Surgeon General's Hospitalization Division conferred with the Office

of the Chief of Transportation and on

31 March 1942 submitted a plan for hospitalization and evacuation operations.47

Considering it unacceptable, Colonel Wilson 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-4/24499-178, Col W. M. Goodman, 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, 31 Mar 42, sub: Basic

Plan for Hosp Oprs and Evac of Sick and Wounded,

with incl. 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 Committee, 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 maintained. 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 possibilities of expansion by setting up wards in

barracks (a method that was almost traditional 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, sub: 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 Somervell, 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, 1 2 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 contending 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 Somervell 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 occurred, the latter statement can be made

with less certainty than the former. Moreover, the Surgeon General's Office was

collaborating with the Chief of Transportation in planning facilities, personnel, and

equipment for the evacuation of patients

from theaters of operations. But the Medical Department had not prepared a basic

directive for hospitalization and evacuation such as SOS headquarters required,

nor was any one division in the Surgeon

General's Office charged with the preparation of comprehensive Army-wide

plans for hospitalization and evacuation.

Certainly confusion existed as to responsibilities 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 Hospitalization 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 information, pertaining chiefly to established

policies and procedures, which The Surgeon General's draft contained. Greatest

change was the addition of statements outlining the responsibilities of various commanders for hospitalization and evacuation and requiring them to submit plans,

in specified forms at specific times, to The

Surgeon General, who in turn was to review and co-ordinate them and then submit them along with his own "plan" to

SOS headquarters. Reviewing the SOS

draft, G-4 called it "an 'omnibus document' which undertakes to do a number of

things," and suggested that two documents

should be issued in its place: one, a statement 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 collaboration between G-4 and SOS headquarters, two documents were issued on

18 June 1942. One was a General Staff

directive stating in general terms the responsibilities of major commanders for

hospitalization and evacuation. This remained 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 agencies need to be considered here. Responsibilities which they delineated and policies

and procedures which the SOS "plan" announced 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 AGF, 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 COs 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 dormitories; 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 include estimates of persons of all types to be

evacuated, both normally and in emergencies, along with statements about the

status of personnel and equipment required for the transportation and care en

route of patients being evacuated.

Hospital, port, and corps area commanders complied with this directive, and

on 30 August 1942 The Surgeon General

transmitted their plans, along with his own

"comprehensive plan," to SOS headquarters.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 hospitalization and evacuation up to date and

changing the wording to require The Surgeon General to submit a directive, rather

than a "plan," thus making the terminology conform more closely with the fact.

The revised edition of the hospitalizationand-evacuation-operations-planning directive was issued by SOS headquarters

in November 1942, although it was dated

15 September 1942.60 To make subsequent

revisions as required, The Surgeon General on 7 November 1942 appointed a

board of officers, with Colonel Offutt as

chairman.61 Although it submitted a revised 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 controversial atmosphere in which it was prepared. 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 received from overseas commands and cared

for and transported ultimately to a general hospital in the United States."63

 Considered 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 responsibilities. 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 Department 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 Cir

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 valuable reference document, for it assembled in one place statements of several policies 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 during the periods between revisions. In September 1942 Colonel Offutt stated that his

Division could operate effectively under

the current version.64 The following February, when Colonel Wilson visited field

installations to evaluate operations under

the directive, he found that each headquarters visited, with one exception,

thought it clear, understandable, practicable, and of definite benefit.65

The value of the subordinate plans submitted in compliance with the basic directive 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 sections of both the Surgeon General's Office

and SOS headquarters? They were then

filed for future reference.67 That no emergency 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 personnel, equipment, hospital beds, and transportation 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 hospitalization 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 directive counterbalanced the friction and

bad feeling which its issuance engendered

between SOS headquarters and the Surgeon General's Office. Similar results

might have been achieved more harmoniously if the principals in both agencies

had been more considerate and understanding 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 controversy that developed in this instance

illustrated dangers and difficulties inherent in the new structure of the War Department and the new position of The

Surgeon General.

64

 Diary, Hosp and Evac Br SOS, 22 Sep 42. HD:

Wilson files, "Diary." 65

 (1) Résumé of Conf, SvCs and Ports, Feb-Mar

43, incl 1 to Memo SPOPI 337, CG 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 III, 1 Jan 43-15 Mar 43." (Col

Robert C. McDonald succeeded Colonel Wilson as

Chief, Hospital and Evacuation Branch on 6 February 1943.) 66

 Notes on tel conv between Col E. C.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 42-31 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. 69

 (1) For example, see 1st ind SPOPH 322.15 (8-

30-42), CG 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 Cir 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 construction 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 twostory 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 warehouses and utility shops, and all buildings

used for housing, feeding, and entertaining 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 patients and as quarters, messes, and recreation 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 because this hospital did not open until March 1942. 2

 Gen Hosp Sta Hosp

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. 3

 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 Engineers: Construction in the United States, a forthcoming 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: FireResistant 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 al., 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 lowering of standards brought quick protests

from The Surgeon General.

The decision to abandon two-story semipermanent construction for general hospitals 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 involved.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, including those already begun before the war,

were constructed on the semipermanent

plan.10 Subsequently the Engineers found

that the initial cost of semipermanent hospitals 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-operations-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 fiberboard. Plumbing was omitted from barracks 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-patients, and that kitchens had inadequate

refrigeration and dishwashing facilities.13

The Chief of Engineers admitted that it

would be difficult to use theater-of-operations-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 reiterated 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] H[arvey] 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 (JRH) to CofEngrs, 7 Feb 42, sub: Fireresistant 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 Hosp (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), Campbell (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 AGF, 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 required construction to be reduced to the

minimum in both quantity and quality.15

In conformity with this directive the General Staff decided to move units in advanced 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 Surgeon 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 construction. 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-ofoperations-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 civilian 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 officers 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 headquarters suggested the acquisition of civilian

buildings to house additional general hospital 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 civilian-facilities-conversion method. He gave

up that idea after The Surgeon General's

Construction Division and SOS headquarters 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 Cir 278, 21 Aug 42. (2) Mil Hosp and

Evac Oprs, 15 Sep 42, par 13b (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 Fld Cp. SG: 632.-1. 20

 (1) See below, pp. 104-06. (2) Tynes, Construction Branch, p. 36. 21

 Memo. Act ACofS G-4 WDGS for CofS, 12 Nov

40, sub: Gen Hosp Program. HRS: G-4/29135-11. 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 Wilhelm 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 CofSA, 3 May 42. (3) Memo, JTM[cNarney]

for CofSA, 5 May 42. (4) D/S 632 (5-3-42), DepCofSA for SG, n d. All in SG: 632.-1. (5) Ltr, SG to

CG SOS, 3 May 42. SG:601.-1.

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 buildings into hospitals whenever practicable

and of constructing new buildings otherwise.25

Difficulties involved in the civilian-facilities-conversion method restricted its

use. Of hundreds of buildings which civilians 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 elevator service. Still others were in undesirable locations.27

 In some instances, where

both the buildings and locations were suitable, local politicians and owners tried to

get higher prices than the War Department was willing to pay. In others, local

citizens banded together to prevent Army

acquisition because they feared a depreciation 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 Depart25

 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. 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 CG 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 Col Don [G.]

Hilldrup, 21 Apr 42. SG: 6S2.-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

Sources: (1) Ltr, SG to Sec War thru CG ASF, 18 May 43, sub: Gen Hosp Program. 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. (5) An Rpt, 27 Nov 44, Hq AAF Reg Sta Hosp No. 1, pp. 1-6. HD.

ment could move in and set up functioning 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
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 semipermanent 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 Administrator of Veterans Affairs protested

against the repetition of a World War I

2 9

 (1) 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 Cantonment Type Hosps. (2) Ltr, UnderSecWar to

Kelch, 19 Mar 42. (3) Ltr, CofEngrs to Kelch, 6 Mar

42. All in CE: 632 Pt 1.
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 surpluses of brick and tile had begun to accumulate. In some places, therefore, the

Engineers began to build cantonmenttype hospitals of tile and brick instead of

lumber.31 Then, on 10 August 1942, the

War Production Board informed The Surgeon General of the availability of tile and

brick and urged their use in hospital construction. The Surgeon General replied

that he had always preferred noninflammable materials for hospital construction.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 hospital, which the Chief of Engineers proposed on 26 August 1942, was a difference

of opinion between his Office and The

Surgeon General's over the internal characteristics of various buildings. Feeling it

necessary to hold the cost of construction

as near as possible to that of cantonmenttype 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 CG 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, Col

John R. Hall for SG, 13 Jun 42, sub: Rpt of Fld 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 example, he wanted larger and more efficiently arranged clinical buildings, stronger and safer neuropsychiatric wards,

increased administrative space, and better-equipped messes. After numerous conferences and what must have seemed to

the Engineers an uncompromising attitude

on the part of the Surgeon General's Office, they composed their differences and

during the winter of 1942-43 a civilian

architectural firm employed by the Engineers completed drawings for the new

type of hospital.33

The Type A hospital, as plants constructed according to the new design were

called, came to be considered by the Surgeon General's Office as the best for emergency construction in the zone of interior.

Basically, it was the two-story semipermanent hospital reduced to one-story

form. Being only one story high it was

safer for patients and did not require expensive 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 onestory plants. Its chief disadvantage was

that it was designed on the dispersedpavilion principle. Before the war's end,

twelve hospitals were constructed on this

plan.34 (Table 3)

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 attempts to co-ordinate wartime hospital

construction with postwar needs. On 31

March 1943 the President directed the

Federal Board of Hospitalization to review 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 responsibility for justifying and defending this proposal.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 substituted 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, Ill.—be constructed on that plan.37

Many factors thus shaped the kinds of

hospital plants which the Army acquired

33

 (1) Ltr, CofEngrs to SG, sub: One-Story Masonry Wall Gen-Hosp, 26 Aug 42, with 3 inds. (2) Ltr,

SG to CofEngrs, 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, De Win, Dibble, Glennan, Madigan,

Mayo, Baker, and Northington General Hospitals,

and Waltham Regional Hospital. 35

 Ltr, President of US to Sec War, 31 Mar 43.

SG: 632.-1. 36

 Memo, CG SOS for SG 17 Apr 43, sub: Completion of Gen Hosp Program in U.S. SG: 632.-1. 37

 (1) Memo, SG for CofEngrs, 3 May 43. SG:

632.-1. (2) Ltr, CofEngrs to CG ASF, 10 May 43, sub:

VA Type Ward Bldgs, with 1st ind SPRMC 600.12

(5-10-43), CG ASF to CofEngrs, 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 CofEngrs, 1 Jun 43, sub:

Hosp Cons. SG: 632.-1. (4) Ltr, SG to CofEngrs, 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

Covered walks and exit ramps are included in the plan. A number of supplementary buildings may also be added to this type of hospital construction. The basic plan is shown on the opposite page.

Source: Tynes, Construction Branch, p. 49. HD:314.7-2 (Hosp. Const. Br.).
78 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

or constructed during World War II. Such

forces as necessity for speed in construction, availability of building materials,

pressure of civilian groups, and co-ordination of Army wartime construction with

postwar needs of other Federal agencies

often seemed stronger than medical considerations. The Surgeon General's Office

therefore frequently found itself in conflict 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 hospitals, better plants were designed and the

Army erected 10 two-story and 12 onestory semipermanent hospitals on new

plans as well as 2 designed specifically for

postwar use by the Veterans Administration.

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 hospital capacities abreast of the Army's

growth that there was little time for reexamining the basis already established

for estimating requirements. Hence, conservation of building materials was at first

achieved by lowering the quality rather

than the quantity of construction. Moreover the need for speed, along with uncertainty 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 immediate normal requirements. In addition,

plans for emergencies were needed because it was feared that sneak attacks,

sabotage, or severe epidemics might require 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—normal, 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 different. 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 periodically 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 December 1941 recommended the construction of four new general hospitals and

annexes to two existing hospitals to provide 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 authorized only 14,000, to be completed by

30 September 1942, advising The Surgeon

General informally to include further requirements in longer-range planning.40

By June 1942 it was possible to project requirements 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 addition to those already available or authorized, to make a total of 66,000.41

Although the SOS Hospitalization and

Evacuation Branch agreed to this number

for planning purposes, the SOS Construction Planning Branch directed the Engineers 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-4/29135-11. 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

WLW[ilson]) 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,

CG 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 personnel to beds, and after Pearl Harbor he began to recommend the construction of

1,500-bed hospitals.43 During 1942 hospitals of this size gradually superseded those

of 1,000-bed capacity.44 With this beginning, the tendency to enlarge general hospital 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 momentarily 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 hospitals, but only about 73,285 were occupied.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 construction to the essential minimum, SOS headquarters called upon The Surgeon General

for an analytical study of bed requirements 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 available, since approximately 20 percent of

the total was lost through "dispersion"—

the separation of patients into wards according to disease, rank, and sex. He

believed that a higher proportion of men

would require beds during war than during 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 strenuous training programs.49

 By the time of

this reply higher authorities were considering 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 Surgeon 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 hospitalcomplements 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." 46

 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 percent 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 hospitalization 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 unnecessary—the requirement that subordinate

commanders plan to double hospital capacities 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 diseases.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 representatives of the General Staff, and of AGF,

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 hospitalization of civilians, earmarking hotels and

organizing "affiliated units" of civilian

physicians and nurses to staff them if

needed.53 Realizing the possibility of conflict between OCD plans and General

Marshall's directive, General Magee discussed 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 Marshall's directive to service commands.

They were already listing hotels that could

50

 (1) AR 40-1080, C 2, 16 Mar 40. (2) The Surgeon 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 Conc

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) Statements 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 accordance with the SOS directive of 18 June

1942. To comply with the new directive,

they had merely to review those lists, itemize the medical property that would be

required, and arrange with a local physician 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 hospitalization for civilians and posed the

danger of transferring epidemics from

Army camps into cities. The Office of Defense Health and Welfare Services then

informed the President of the Army's plan,

suggesting that the War Department rescind its directive and plan to provide

emergency hospitalization for military

personnel entirely within the confines of

Army camps and with military professional 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 explanation, General Marshall assured him

that this was not so, but assumed full

responsibility for having directed the earmarking of hotels and the organization of

civilian staffs for emergency use. The

President apparently considered this explanation satisfactory, for he passed General Marshall's letter on to the Office of

Defense Health and Welfare Services with

the single comment, "for your information."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 Defense to use civilian staffs in emergency

hospitals. At first SOS headquarters took

the position that "any plan to utilize civilian medical personnel for military hospitalization is entirely a planning matter to

establish a potential means to meet major

emergencies. . . ." 56 When this assurance 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 compro54

 (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. 55

 (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[oosevelt] for Gen Marshall, 14 Sep 42. WDCofSA: 632

(14 Aug 42). (5) Memo, CofSA for the President, 21

Sep 42, sub: Reply to your Memo. . . . Same file. (6)

Memo, FDR[oosevelt] 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. 56

 (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: Planning 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 ACofS for Oprs SOS (init WLW[ilson]) for Chief
HOSPITAL PLANTS IN THE UNITED STATES 83

misc 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 military 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. Although SOS headquarters had disavowed

the use of civilian staffs shortly before, it

now approved a letter to service commands on 11 January 1943 explaining the

compromise just mentioned.58 On 22 February 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 expansion of Army hospitals went on concurrently 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 goahead 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 cantonmenttype hospital barracks into wards and constructing theater-of-operations-type barracks for the displaced enlisted personnel

or by constructing additional cantonmenttype wards wherever a medical detachment already lived in theater-of-operations-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 evacuation 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 percent authorization proved sufficient for

the winter's needs.

In the course of the Army's controversy

with the Office of Civilian Defense, General Marshall directed General Snyder,

the medical officer on The Inspector General'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

Admin Serv SOS, 20 Oct 42, same sub. HD: Wilson

files, "Book 2, 26 Sep 42-31 Dec 42." (5) Memo

SPOPH 632 (11-17-42), 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.

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: Wilson files, "Book I, 26 Mar-26 Sep 42." 62

 Memo SPRMC 632 (9-9-42), CG SOS for

CofEngrs, 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.
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 quarters; 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 substantial number, by improving administrative procedures and limiting the performance of elective operations. In case of

an unusually severe epidemic, all barracks, he believed, could be converted into

hospitals and troops could be moved into

warehouses, regimental recreation buildings, and chapels.64

 Under an SOS directive, 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 insisted that each service forecast its normal

needs as far ahead as possible.66 The Surgeon General found it difficult to anticipate station hospital requirements because they depended, as always, upon

troop distributions unknown by him. In

addition, records of existing station hospitals 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 hospital 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 evacuated from theaters of operations.68

 The

Surgeon General therefore added .7 percent 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 requirements. On 26 September 1942 he recommended that a total of 96,000 general hospital beds be provided by the end of 1943

and of 124,800 by the middle of 1944.

About two months later, when the projected 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 number of beds authorized for planning purposes, but not for construction.69

 (Chart 4)

64

 Ltr, IG per Brig Gen Howard McC. Snyder to

CofSA, 10 Nov 42, sub: Surv of Hosp Fac and their

Util. HRS: WDCSA 632. 65

 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

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 circumstances pointed toward intensified efforts

by the General Staff and SOS headquarters to limit construction. In January a

study of hospital bed occupancy, prepared

by the Surgeon General's Office for inclusion in the SOS Monthly Progress Report,

showed that estimated requirements had

been higher than actual needs. While

there was a close correlation between estimated 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 Surgeon General explained that this resulted

from better health and fewer combat

casualties than anticipated.70 In March

1943 certain members of Congress threatened to investigate the use of all hospital

beds, both civilian and military, in the

United States.71 Soon afterward the Secretary 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 Hospital 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, calling 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-ordinating the hospital construction planning 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 approval.74

Meanwhile, despite a discrepancy between estimated and actual requirements

in 1942 and in the face of growing interest

in limiting hospital construction, The Surgeon 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 Requirements Division directed The Surgeon

General to review the proposed ratio in

the light of recent war experience and to

consider a reduction of construction requirements 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 suggested 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 nowhere. The director of the ASF Control

Division agreed with The Surgeon General 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 hospitalization and evacuation as giving The Surgeon General alone the authority to estimate bed requirements for overseas

casualties.78 Hence, the ASF Requirements Division accepted The Surgeon

General's estimate of requirements and

turned to the remaining means of reducing general hospital construction—the use

of station hospital beds and the expansion

of existing general hospitals.

In a conference attended by representatives of the Surgeon General's Office on

8 April 1943, the ASF Requirements Divi73

 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 Mar 43, sub: Hosp, Gen Hosps. SG: 323.7-5. 77

 (1) 2d ind, SG to CG ASF, 31 Mar 43, on Ltr,

SG to CG SOS, 11 Mar 43, sub: Hosp, Gen Hosps.

SG: 323.7-5. (2) 1st ind, SG to CG ASF, 12 Jun 43,

on Memo, CG 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: Situation 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 movements, 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 hospital beds would need to be constructed.

Additional general hospital requirements

during 1944 could be met by using increasingly large numbers of surplus station hospitals for that purpose. ASF headquarters therefore approved the expansion 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 provide 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 headquarters decided that adjustments in the

military program would make possible a

reduction in authorized beds by approximately 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 additional 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 pattern that was to be repeated later in the

war—increases in estimated bed requirements by The Surgeon General, publication of statistics showing relatively low occupancy 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 additional hospitals precluded doubts about

estimated requirements as well as coordination of hospital construction programs of various federal agencies, both

military and civilian. When such coordination was finally undertaken, the

Army program had been virtually completed. Experiences encountered in planning for emergency hospitalization revealed the difficulties involved in co-ordinating plans of the Army with those of

other agencies and in permitting several

War Department agencies to work independently 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 Program. 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 capacity needed but also to the location, siting,

and internal arrangements of hospital

buildings. After war was declared the selection of locations and sites, especially for

general hospitals, became more complicated, while the need for speed in construction 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 General's Office, but selection of sites within

those camps was a joint enterprise of The

Surgeon General and the Chief of Engineers. 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 connections, transportation systems, and communications networks. Moreover the

growth of war industries and military installations necessitated more careful investigation than before of available labor,

housing, and commodity markets. Furthermore 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 housing, 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 general 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 general hospitals to be located between the

Atlantic and Pacific coast ranges as a

safety masure.84 It was immediately evident that this policy conflicted with the

necessity of placing hospitals near ports of

debarkation where they could readily receive 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 numerous 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 (Correspondence on MS) III. 85

 Ltr, SG to TAG, 14 Feb 42, sub: Add Gen Hosp

Beds. SG: 632.-1.

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 verbally abrogated both the G-4 and SOS

restrictions.87 Of the 51 general hospitals

authorized, acquired, or constructed between 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 engineering 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 latter case a satisfactory site still had to be

selected. Existing buildings were sometimes chosen simply because they were

suitable for conversion into Army hospitals, 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 locations for general hospitals had to be reviewed by SOS headquarters before the

Engineers could investigate specific sites

for their construction. Of eighteen locations which The Surgeon General proposed in June 1942, the SOS Hospitalization 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 concentrations and evacuee loads in that area.91

About the same time, the SOS Requirements 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 CGs 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, Hammond, 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, Kennedy, Mayo, Nichols, Percy Jones, Prisoner-of-War

General Hospital No. 2, Schick, Thayer, Vaughan,

Wakeman, and Winter; those on the edge were Baxter, Crile, McCloskey, and Northington. 89

 (1) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1.

(2) Memo CE 632 (Hosps) SPEOT, CofEngrs 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 sometimes complicated the process of selecting hospital locations and sites but apparently did not often sway the judgment of

those responsible for making the choice.

In their attempts to lure additional wartime 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 selected 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 authorities banded together to prevent the

establishment of hospitals in their areas.94

Sometimes United States Senators and

Representatives also attempted to influence the selection of certain locations. Generally 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 insistent upon the establishment of hospitals

near LeGrande and Hot Lake, Oreg.,

rather than at Spokane and Walla Walla,

Wash., but after appropriate investigations 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 Surgeon General's representative recommended that Jaspar not be selected, and

the place finally chosen for the one hospital in Alabama was Tuscaloosa.96

 On the

other hand, a hospital was located at Martinsburg, W. Va., a city commended for

that purpose by Rep. Jennings Randolph;97

 and, as a rule, after The Surgeon

General's Construction Division made

tentative selections of locations and sites,

it discussed them with appropriate Senators 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 selection was slow and gave rise to considerable 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, 31 Dec 41,

sub: Rpt of Insp Trip Made for the Purpose of Locating Add Gen Hosp ... in North Texas Area, with

12 inds. SG: 632.-1. (2) D/S, ACofS G-4 WDGS to

TAG, SG, and CG 8th CA, 19 Jan 42, sub: Site for

Gen Hosp, Temple, Tex. HRS: G-4/29135-11. 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 Col Achilles L. Tynes for

SG, 22 Aug 42, sub: Rpt on Site Bd Surv for Location 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 Martinsburg, W. Va. HD: Hosp Insp Rpts. 98

 Info furnished by Col Hall (Ret), 2 Dec 50. HD:

314 (Correspondence on MS) III.
92 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

evacuated from overseas theaters to be

cared for near their homes. It was generally forgotten—or ignored—that most of

the general hospitals were located to facilitate the transfer of patients from station

hospitals in training camps and that the

War Department did not establish a policy of hospitalizing overseas evacuees near

their homes until most of the general hospitals had been established.

Control over Internal

Arrangement of Hospitals

The Surgeon General continued to insist that building schedules, hospital layouts, and floor plans of all new hospitals,

plans for all "major" alterations to existing buildings, and all subsequent changes

in such plans should be referred to his

Office for approval.99 On the other hand,

the Chief of Engineers attempted, as did

The Quartermaster General before him,

to decentralize as much authority as possible in order to save time. Beginning in

February 1942, he again raised the question of having The Surgeon General approve standard building schedules and

layouts for use in the field, without further

reference to the latter's Office, but apparently 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 followed that practice.100

The extent of The Surgeon General's

authority over hospital construction was

discussed but not defined after reorganization 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 approval of hospital floor plans and layouts,

plans for the conversion of civilian buildings into Army hospitals, and all major

alterations to existing hospital buildings.101

 General Somervell's reply was inconclusive. 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 General's Office in them. Plans for the conversion 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 General could not trust service command surgeons 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 apparent that local changes in approved

plans for converting civilian buildings into

hospitals needed to be more strictly controlled. 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 conversions. 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 Somervell 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 General and the Chief of Engineers agreed

upon a partial decentralization of authority to approve alterations of existing hospitals. On 5 October 1942 the War

Department delegated to service commanders the authority to approve alterations costing up to $10,000 on any building, 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 convert 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 reluctantly agreed and on 3 December 1942

the Chief of Engineers issued a letter authorizing local alterations costing up to

$10,000 on hospital buildings, without

prior approval of The Surgeon General.106

In November 1942 the Wadhams Committee attributed what it considered to be

shortcomings in hospital construction partially to the limited extent of The Surgeon

General's authority but also to the inadequacy of his own construction staff. Stating 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 construction. At the same time the committee proposed that The Surgeon General strengthen his construction staff by adding to it outstanding civilian hospital architects and

by placing at its head a nonmedical man

103

 (1) Memo for Record, on DF, CG SOS to SG,

17 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: Conversion 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 authority over the expenditure of funds for

hospital repair and maintenance. At the

beginning of 1942 funds from three appropriations were used for hospital maintenance. 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) appropriation, was made to the Medical Department. Funds from the B&Q appropriation and from the M&HD appropriation were controlled exclusively by the

Engineers and the Medical Department

respectively. Those from the C&RofH appropriation were controlled jointly by the

Chief of Engineers and The Surgeon General. B&Q funds paid for such things as

firing boiler plants of hospitals and repairing 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 purchase 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 distinctions sometimes had to be made in

applying the C&RofH fund rather than

the M&HD fund and vice versa. For example, carpenters were employed from

both. Those paid with M&HD funds

could repair hospital furniture and noninstalled 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 Surgeon 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 officers 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 SGO, 3 Dec 42. SG: 632.-1. 108

 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

C&RofHA Funds, with 1st ind, SG to CofEngrs, 1

Mar 42. (2) Ltr CE 121.2 (Funds) CUC, 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 F[rancis] 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 bookkeeping, he proposed on 31 January 1942

the abandonment of a practice of subdividing 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' recommendations.113

 Then he directed district engineers to prepare estimates of C&RofH

funds in the same way they did those of

B&Q funds.114 The Surgeon General went

along with these changes, but insisted that

corps area surgeons be informed of allotments made to hospitals and that they

continue to report to him on all expenditures made from such allotments.115

The next month the merger of the

C&RofH appropriation with either the

B&Q or the M&HD appropriation came

up for consideration. The Chief of Engineers wanted the C&RofH fund merged

with the B&Q fund under his control.

Hearing of pending legislation to that

effect, The Surgeon General recommended to the Budget Officer of the War Department on 22 March 1942 that the

C&RofH and the M&HD appropriations

be combined into one, under Medical Department control. In support of this

recommendation he pointed out unsatisfactory features of having a fund controlled 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 appropriation called Engineer Service, Army,

had already occurred on 5 March 1942.117

The Surgeon General protested against

this "radical departure" from accepted

practices, maintaining now that joint control of the C&RofH fund had been satisfactory, 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 maintenance of Army posts.118

 He failed, however, 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 Surgeon General's former authority over hospital maintenance.119

 With the reorganization of the Services of Supply, the Chief

of Engineers requested The Surgeon General on 17 August 1942 to close out all fiscal 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) CUC, 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 CA) 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

. . . to M&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 Procedures 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 T[homas] 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 anticipated. The surgeons of several service

commands reported favorably on the performance of maintenance work under the

new system.121 As late as 1945, Col.

Achilles L. Tynes, of the Hospital Construction Division, pointed out that hospitals had experienced no difficulty in getting repairs during the war and that it

could not be proved that retention of control of funds by the Medical Department

would have been more satisfactory than

control by the Engineers.122

Reflooring and Reroofing

Throughout the war, maintenance programs of magnitude had to be carried on

concurrently with new construction programs, largely as the result of the use of

cantonment-type construction in the majority 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 roofing. 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 unsightly, insanitary, and dangerous. Beginning late in 1941 and continuing

through 1942, The Surgeon General and

the Chief of Engineers initiated and carried through extensive programs of reroofing 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 hospital 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 Department tried to increase the safety and comfort of patients in hospitals. The practice

of installing automatic sprinkler systems

as protection against fire in cantonmenttype 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: Trf of

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 Engineers 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 Constructing 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 decision and request the installation of heating facilities.125

 On 4 February 1942 the

Secretary of War authorized their installation in the corridors of all cantonmenttype hospitals then under construction or

planned.126 Getting approval for the installation of air-cooling systems in hospitals in hot southern areas was considerably 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 unbearable.127

 The attic space above the lowceilinged cantonment-type buildings collected 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 humidity in those sections of hospitals.128

Colonel Offutt, Chief of The Surgeon

General's Hospitalization Division, promised 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 manufacturing concerns in working out systems

employing mechanical air conditioners,

evaporative coolers, and forced-air ventilation. 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 humidity 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 Southeast, 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 during the spring of 1942.131

Before this program had gotten very far

it encountered a directive, on 20 May

125

 Ltr, SG to QMG, 29 Oct 41, sub: Heating of

Enclosed Corridors. CE: 632, Pt I. 126

 Ltr SGO 674.-1, SG to CofEngrs, 7 Jan 42, sub:

Instl of Heating Fac in Corridors of Cantonment-type

Hosps, with 1st ind, CofEngrs to TAG, 27 Jan 42, and

2d ind, TAG to CofEngrs, 4 Feb 42. CE: 632, Pt I. 127

 For example, see: (1) Synopsis Ltr, AF Combat

Comd Hq to CofAC, 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.-1. 129

 Ltr, SG (per Col H. D. Offutt) to Surg 4th CA,

10 Sep 41, sub: Comfort and Welfare of Pnts in Cantonment Hosps. SG: 632.-1 (4th CA)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-Conditioning and Ventilative Equip for Cantonment-Type

Hosps. SG: 673.-4. 131

 (1) 1st ind, SG to CofEngrs, 14 Feb 42, on Ltr,

Carrier Corp to SG, 12 Feb 42. (2) Ltr, SG to

CofEngrs, 6 Apr 42, sub: Special Features for Ventilation 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 mechanical and electrical equipment in

Army construction.132 The Chief of Engineers, who by now controlled funds for the

purchase of cooling equipment and was

responsible for its installation, sought approval of the War Production Board for

installing the apparatus recommended by

The Surgeon General.133 The Board approved the use of air conditioners in operating rooms, X-ray clinics, and recovery

wards, but failed to deal with The Surgeon General's proposal to install exhaust

fans or evaporative coolers in other hospital 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 limited program.136

 Early in 1943 a practice

of transferring equipment from nonessential to military uses developed and the

War Production Board ascertained that

dealers had considerable stocks of airconditioning and mechanical-ventilating

equipment on hand.137 When The Surgeon

General resubmitted his proposal in January 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 inventories or from recaptured stocks was permitted in areas where the average July

temperature exceeded 75° Fahrenheit.

Depending upon humidity of the area in

which a hospital was located, either evaporative coolers or exhaust fans were permitted 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 recovery wards. In desert areas, evaporative

coolers might also be used in quarters occupied by personnel on night duty.139

Installation of the long-desired equipment now began. Since authority to approve jobs amounting to $10,000 or less

had been decentralized to service commands, 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 informed 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, CofEngrs to Refrigeration Sec and Fan

and Blower Sec WPB, 20 Jun 42. CE: 673, Pt 3. (2)

Ltr, SG to CofEngrs, sub: Ventilation and Air Conditioning for Cantonment-type Hosp Bldgs, 13 Jun 42.

SG: 673.-4. 134

 Ltr, WPB to CofEngrs, 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 between 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 CofEngrs, 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-cooling systems in time for both patients and

operational personnel to benefit from reduced temperatures during the summer of

that year.141

Correction of Errors

in Cantonment-Type Hospitals

While improvements already mentioned 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 providing 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 established a policy of giving eye examinations

and spectacles to all soldiers who required

them. Existing EENT clinics were enlarged or were abandoned in favor of new

ones set up in ward buildings.143

In the fall of 1942 the Wadhams Committee found fault particularly with shortage of occupational therapy facilities, inadequacy 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 recreational facilities were too small but stated

that War Department construction policies were responsible for that fault. He

believed that it was unnecessary and impractical to have occupational therapy

facilities in station hospitals, because in

his opinion all patients needing occupational therapy should be sent to general

hospitals.145 Nevertheless, in compliance

with an SOS directive, The Surgeon General submitted a comprehensive program

on 17 January 1943 for the construction of

additional occupational therapy buildings, recreation buildings, detachment

dayrooms, post exchanges, libraries,

chapels, officers' and nurses' recreation

buildings, and theaters in all hospitals of

two hundred or more beds.146 SOS headquarters apparently considered this program 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, Repairs, 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

Fld 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 Professional Serv SGO, 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 Conversion 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 SGO,

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, 17 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 Surgeon 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 revised during 1941. Faults that continued

to exist, he said, resulted either from failure of construction officers to follow specifications closely or from the difficulty of

constructing wards in wooden buildings

so that patients could not escape or commit suicide yet at the same time could be

easily removed in case of fire.148 On his

advice, The Surgeon General recommended 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 recommendation.150

In the spring of 1943, in order to eliminate the need for alterations and additions

to hospitals after completion, plans for

some cantonment-type buildings were redrawn. This may have resulted from a

report made by the Seventh Service Command'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 collaborate with the Surgeon General's

Office in revising plans for cantonmenttype 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 savings in hospital alterations, for the major

portion of the hospital construction program 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 especially 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 SGO,

3 Dec 42. SG: 632.-1. (2) Extract from 1st ind SG to

CG SOS, 14 Dec 42, on Memo, CG 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[all]) 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 CG 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

SvC)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 outstripped hospital construction, The Surgeon General set aside additional beds in

general hospitals and local medical officers 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 considerably 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 throughout the United States was continuously

lower than the total number of normal

beds provided. From December 1942 to

March 1943, when the incidence of respiratory diseases increased and the transfer of

patients from station to general hospitals

was restricted to save places for anticipated 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 patients 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, however, 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 by June 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 occupied beds exceeded the number of normal 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 hospitals, 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 equipment as well as full complements of personnel before patients could be transferred to them in large numbers. By June

1943, as more new general hospitals

opened, the number of available normal

beds outnumbered by a comfortable margin 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, CO 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, 31 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.

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 combination of hospitals of different types operating 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 characteristics or were given functions which made

them differ from the normal. For example,

special hospitals were required for prisoners 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 considered. Expansion of the Army, along

with reorganization of the War Department, also raised questions as to which

commands should be served by and

should operate hospitals of different types.

Therefore, before discussing the development of special characteristics and functions of some hospitals, an explanation of

the command relationships of station and

general hospitals with higher headquarters is in order.

Command Relationships of Hospitals

Station Hospitals

Classified according to major commands 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 furnished 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 hospitals. 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 capacity of 643 beds each. AAF station hospitals

were as numerous as ASF station hospitals, 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 February 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 commands had no "named" station hospitals

under their jurisdiction, but in a few cases

they established what amounted to hospitals of that type in the United States.

Defense command troops were generally dispersed over extensive areas to

guard the coasts of the United States. Receiving only emergency medical care in

their own installations, they were ordinarily 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 concentrated to ward off a sneak Japanese attack,

difficulties arose. Delays in the Defense

Command's decision on troop distributions, as well as overlapping jurisdictions

of the Defense Command, the Ninth Service Command, and the Army Air Forces,

impeded attempts of The Surgeon General, the Service Command, and SOS

headquarters to provide adequate facilities.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 patients were being evacuated inland. The

73d Evacuation Hospital, a Western Defense Command unit, then moved in and

established a 750-bed hospital, which became the station hospital for all troops,

Service Forces as well as Defense Command, in the area. In the fall of 1942, at

the request of the Western Defense Command, the Ninth Service Command took

over the operation of this hospital. Although a Defense Command unit, it had

actually served as a named station hospital for approximately six months.4

The hospitalization of AGF troops on

maneuvers continued to be provided during the early war years essentially as before 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 comparatively short time, but The Surgeon General 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.-1 (Cp Haan)C and 632.-1 (Cp Callan)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 III 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 Sawtelle, 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 responsible for providing fixed hospitalization for troops in that area. AGF headquarters maintained that the reservation

was being used only temporarily. The

Ground Surgeon believed that it was satisfactory to give emergency care in a

temporary hospital, operated by personnel of numbered units under service command control, and to evacuate patients

with serious illnesses and injuries to the

Fort Belvoir Station Hospital fifty miles

away. Supporting the Service Command

Surgeon, The Surgeon General maintained 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 facilities less than those provided in cantonment-type buildings were unsatisfactory

for the hospitalization of troops in the

United States. The War Department General Staff supported the position of the

Ground Forces, while SOS headquarters

gave wavering support to the Medical Department, alternately approving and disapproving recommendations of The Surgeon General. The upshot of the whole

matter was that the Third Service Command, 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 numbered 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 AGF and ASF headquarters 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 hospitalization 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 patients evacuated to ASF hospitals decreased. Supplied with equipment authorized by tables of basic allowances and

manned by numbered hospital units

which had their own nurses with them,

these communications zone hospitals continued to provide station and general hospital types of care until the CaliforniaArizona Maneuver Area closed in the

spring of 1944. This plan of hospitalization not only gave participating units invaluable practical experience but also

demonstrated the possibility of using num5

 Documents dealing with this extended controversy

may be found in the following files: SG: 701.-1 (Cp

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 [Correspondence on MS] III.)
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 patients from the Ground, Air, and Service

Forces alike. This arrangement was seriously threatened in the fall of 1942 by an

attempt of the Air Forces to establish its

own general hospitals. Although unsuccessful at the time, this attempt was a forerunner 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. Having received authority to recruit its own

physicians, the Air Forces manned some

of its station hospitals with specialists normally assigned only to general hospitals.

In the winter of 1942-43 smaller AAF station 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 development of such practices certain AAF station hospitals requested the Surgeon General'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 centers in neurosurgery, orthopedic surgery,

thoracic surgery, and deep X-ray therapy

in AAF station hospitals.8

The Air Surgeon found legal justification 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 hospitals 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, required specialized care which only AAF

hospitals could give. He believed that

fliers were often lost to further combat

duty because general hospitals unnecessarily reclassified them for limited service.

Furthermore, he insisted that Air Forces

hospitals were more efficiently operated

6

 (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, 11 Mar 43, sub: Insp of La and DTC Maneuvers. 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 general hospitals under any guise, for he

wished to maintain a unified medical service 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. Permitting AAF hospitals to perform the functions of general hospitals would make it

more difficult, he stated, to supervise and

co-ordinate professional practices and

procedures. It would also result in duplication 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 submission 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 initiated by the ASF Chief of Staff to reaffirm 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 recommended, 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 hospitals 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 conversion of AAF station hospitals and two

9

 (1) Memo, Air Surg for CG AAF, n d, sub: [Comments on Gen Somervell's Memo of 30 Apr 43 for

CofSA], with 2 inds. 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 Conv Homes." (3) Hubert A. Coleman, Organization and Administration, AAF Medical Services in the Zone of the Interior (1948), pp.

93-94. HD. 10

 (1) Memo SPMCB 701.-1, SG for CG SOS, 13

Oct 42, sub: Specialized Hosp and Recuperative Fac

for AAF Pers. AAF: 354.-1 "Rest Ctrs and Conv

Homes"(1). (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 incl.

HRS: G-4 file, "Hosp and Evac Policy." 13

 Memo WDCSA/320(5-26-43), DepCofSA 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 Hospitals to Air Forces' jurisdiction.14

 By this

time a new Surgeon General, Maj. Gen.

Norman T. Kirk, was in office. 15 He attacked 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 proposed a compromise which the commanders 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' establishment of convalescent centers. The Air

Forces for its part agreed that all general

hospitals would continue to operate under

The Surgeon General and the commanding general, Army Service Forces, and

that patients evacuated from theaters of

operations would be sent to general hospitals. The only exception to the latter

point was that combat crew members suffering from operational fatigue alone

would be sent directly to AAF convalescent 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 recommendation for their appearance before

retiring boards. These terms of agreement

were issued on 9 July 1943, with a statement that they had been personally approved by the Secretary of War.17

 On the

same day, the authority which had been

granted to the Air Forces to establish separate 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 hospitals, 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 Department 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 delivered 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: Hosp. 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 incl. 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,

CG AAF for CG ASF, 5 Jul 43, sub: Hosps. AAF:

354.-1 "Rest Ctrs and Conv Homes." (3) Memo, CG

ASF for CG 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 treatment of the types for which general hospitals 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 directive combined with the agreement already

discussed to resolve for a time in The Surgeon General's favor the question of the

Air Forces' establishment of separate general 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 respects 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 Auxiliary Corps in May 1942 emphasized certain problems such as the segregation of

women from men in hospitals, the establishment 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 establishing the WAAC directed the Secretary

of War to provide hospitalization for its

members "to conform as nearly as practicable 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 believed that additional wards should be

constructed at established hospitals to

supply enough beds to permit the segregation 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 procurement 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. Otherwise, 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 (WAC). (4) Memo, Maj

Margaret D. Craighill, MC, Liaison Off for WAC 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 (Georgia)—the station hospitals became predominantly WAAC hospitals, staffed

largely by women and caring mainly for

women. This was especially true at Daytona 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 surgeons were assigned for duty with the

Waacs. At first the development and

supervision of special professional services

for women were left largely to local hospital 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, approximately a year after the WAAC was established 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 handling of medical problems peculiar to female personnel.24

All-Negro Hospitals

The establishment of two all-Negro station hospitals in the United States came

not as a result of any policy of The Surgeon General to segregate patients racially

for medical care and treatment, but

rather as a result of The Surgeon General's opposition to the integration of

Negro doctors and nurses with white professional personnel in the operation of hospitals 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 Livingston (Louisiana). Perhaps because of

unencouraging reports from these experiments, 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 hospitals be established to employ additional

Negro doctors and nurses. The Staff reversed its earlier decision, and during 1942

an all-Negro station hospital was organized at Fort Huachuca (Arizona), a post at

which Negro troops were being trained. A

separate hospital, manned by white doctors 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 abandonment of the Army's long-established policy

of nonsegregated treatment. Other hospitals 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 CG SOS, 4 Jan

43, sub: Util of Women Doctors. HRS: Hq ASF Gen

Styer's files, "Med Dept 1943." (4) Mattie E. Treadwell, The Women's Army Corps (Washington, 1954),

Ch. XXXI, in UNITED STATES ARMY IN

WORLD WAR II. (5) Margaret D. Craighill, History 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 Department, see John H. McMinn and Max Levin, Personnel (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-1 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 enlisted 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 hospitals. While many were employed in

housekeeping and maintenance operations, 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 National 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. Roosevelt) 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 headquarters directed The Surgeon General to

procure and use additional Negro nurses.30

Accordingly, Negro nurses on duty with

the Army increased from 218 in December 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 nonsegregated basis in 4 general hospitals, 3

regional hospitals, and at least 9 station

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 declined, the patient load decreased and

professional staffs of the two station hospitals at that post were reduced accordingly. 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 hospiArthur 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-1 WDGS for

CofSA, 4 Aug 41, sub: Almt of Negro MD Res Offs

and Female Nurses. HRS: G-1/15640-46. (7) Memo,

P. W. Clarkson, Off ACofS G-1 WDGS for Record,

8 Aug 41. Same file. (8) An Rpt, 1942, Post Surg Ft

Huachuca. HD.

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 following files: SG: 211 "Nurses, Negro"; OSW: Civ Aide to

SecWar, "Nurses"; and AG: 211 "Nurses, Negro."

See also Florence A. Blanchfield and Mary W. Standlee, The Army Nurse Corps in World War II (1950),

pp. 161-205. HD. 30

 (1) Memo, CG ASF for SG, 14 Dec 43, sub: Utilization 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: 211 "Nurses,

Negro." (3) Facts about Negro Nurses and the War,

prepared jointly by the National Association of Colored 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 hospital and exercised at the same time considerable

authority over the commanding officer of the allNegro 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 patients—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 developed which required the establishment

in the United States of several hospitals

for civilian employees and their families.

During 1941 the Army had initiated industrial hygiene programs in Army-owned

plants and depots. Under Medical Department supervision, these programs expanded rapidly during 1942 to keep pace

with wartime industrial growth. Designed

to give only emergency medical care, industrial 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 employee procurement and increased absenteeism. 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 December 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 (Oregon), 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 having a minimum of military personnel assigned to them, in providing family medical care, including gynecologic and obstetric services, and in requiring payment

for services rendered. Despite recommendations of The Surgeon General, similar 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 political pressure and partly because the community itself, after an extended period of

time, provided additional hospital accommodations. 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 combat operations demanded preparation for

the internment of prisoners of war, The

Provost Marshal General and The Surgeon 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-Operated 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 (9-17-41) (1). (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 compatriots. Promulgated in tentative regulations published in April 1942 and reiterated in September 1943, these policies

governed the hospitalization of prisoners

throughout the war. For separate prisoner-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 service command supervision and, except for

the use of captured enemy personnel and

civilian registered nurses, were similar to

other service command hospitals. Prisoners 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 awaiting shipment overseas as well as patients

being returned to general hospitals in the

United States. In accord with SOS directives, hospitals for ports and staging areas

were exempt from service command jurisdiction 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 adequate 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 Hospital 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 hospitals. During 1942 and 1943 special port

and staging area hospitals were constructed and opened to care for port personnel and transient troops. They differed

from other station hospitals primarily in

that their surgical services were considerably 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 returning 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, Capt 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) (1). (3) PW Cir 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 Florence, 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, (LaGarde 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 Francisco 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 patients brought in on ships. After war

began he continued this system, granting

unlimited bed credits in near-by general

hospitals to ports receiving overseas casualties.41

 He also located some of the general hospitals planned early in 1942 in

coastal areas, though not in close proximity 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 hospital, 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 therefore presented themselves, namely, shipto-train movements, in which patients

would be transferred directly from ships

to trains for transfer to distant general hospitals, and ship-to-hospital movements, in

which they would be moved from ships to

near-by hospitals before undertaking further travel.44

 The possibility of using shipto-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 procedure, 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 position, both felt that some ship-to-hospital

movement would be unavoidable. Some

patients would require immediate hospital 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,

CG 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). 45

 (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: Wilson 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 reasons 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 Kecoughtan, Va., for debarkation purposes.47

This action made it clear that some hospital, whatever its kind, would be established 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 control.48

 The Chief of Transportation, on the

other hand, wished to keep ports free of

the burden of administering large hospitals 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 Concurrence of the SOS Hospitalization and

Evacuation Branch in this interpretation

placed an official stamp of approval on

The Surgeon General's plan to use general hospitals under service command

control, rather than special hospitals

under port control, for debarkation activities.

Most general hospitals located near

ports performed dual functions—providing definitive treatment for some patients

and processing others for further travel—

until late in the war. This created complications. 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 headquarters.50

 Investigation showed that Halloran

General Hospital kept a list of patients

earmarked for transfer to other general

hospitals when the evacuation load required it.51

 Stark, LaGarde, and Barnes

General Hospitals simply waited until the

necessity arose and then transferred patients receiving definitive care to other

general hospitals located farther away

from ports. Others, notably Letterman

and Lovell, kept beds vacant while awaiting the arrival of evacuated casualties.

This system occasionally caused the transfer 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, CG

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 CG

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 Col 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: Availability 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 debarkation hospitals.53

Designation of General Hospitals

for Specialised Treatment

Early in 1943 The Surgeon General

initiated a formal program of specialization 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 specialization had continued on a limited scale. By

January 1942, for example, deep X-ray

therapy had been established as a specialty 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 existing 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 limited 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 specialized care in different branches of surgery.60

 Simultaneously with the opening

of the new general hospitals, a transition

from defensive to offensive warfare presaged the arrival of large numbers of combat casualties requiring complicated surgery. 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 particular 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 Wo

(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. ..................... . 1 5

September 1942................... . 1 7

October 1942. .................... . 1 9

November 1942................... . 2 2

December 1942. .................. . 2 6

January 1943. .................... . 3 1 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 SvC)AA. 61

 (1) Draft memo, TAG for CofS 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) (1). (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 several weeks afterward The Surgeon General's Hospitalization and Evacuation

Division worked on this problem,64 and on

6 March 1943 the War Department designated nineteen general hospitals for the

following specialties: chest surgery, maxillofacial 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 surgery 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 accommodations for convalescent patients should be

provided either as separate hospitals or as

annexes to existing hospitals. Among civilians 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 "reconstruction" programs in general hospitals and convalescent centers both in the

United States and France.68 In the latter

half of 1942 several widely separated hospitals—the Fort Bliss Station Hospital in

Texas, the Jefferson Barracks Station Hospital in Missouri, and the Lovell General

Hospital in Massachusetts—established

programs to harden patients for return to

duty, to reduce the period of their convalescence, and to salvage for full field duty

those who might otherwise be either discharged from the Army or placed in the

limited service category.69 In January 1943

the surgeon of the Eighth Service Command recommended the organization of

casual detachments to recondition convalescent patients and salvage psychoneurotic soldiers for full duty.70

 The surgeon

of the Ninth Service Command proposed

the establishment of "overflow installations" to free hospital beds of patients no

longer needing hospital care but not yet

ready for full military duty.71 In this connection, 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. 65

 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 W

(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 Jefferson Bks, and Lovell Gen Hosp. HD. Similar action

was being taken in the European Theater of Operations 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 necessary, to release hospital beds for patients

requiring close medical supervision.72

While medical officers in the field were

becoming aware of the convalescent problem, it was also receiving attention in

Washington. In September 1942 it came

up in the hearings of the Wadhams Committee.73

 A month later the Air Forces

requested authority "to establish and operate specialized hospital and recuperative

centers for individualized treatment, rehabilitation, 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 disapproved 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 convalescent patients often needed observation

and sometimes "active therapeutic management" 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 convalescent hospitals would lead to duplication of buildings and a waste of personnel

and equipment. Hence, he refused to concur 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 convalescent 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. . . ."7

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 hospitals. In November 1942 the Wadhams

Committee recommended this step as well

as the establishment of convalescent hospitals.77

 The next month, the commanding general, Army Air Forces, published a

directive, prepared by the Air Surgeon,

requiring all Air Forces hospitals "to institute recreation and reconditioning programs for convalescent patients."78

 In

January 1943 The Surgeon General pro72

 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 Conv 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 Conv

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: Specialized Hosp and Recuperative Fac for AAF Pers.

AAF: 354.1 "Rest Ctrs and Conv Homes" (1). (3) 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 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: Recreation and Reconditioning for Conv Pnts in AAF

Hosps. AAF: 300.6. (2) Howard A. Rusk, "Convalescence 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 reconditioning programs. Fearing that such

programs would require additional personnel and construction and doubting its

own authority to order their establishment, SOS headquarters delayed publication of this directive until 11 February

1943.79 Both the Air Forces and War Department 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 (Georgia), Jefferson Barracks (Missouri), and

the O'Reilly General Hospital, developed

effective programs.80

Meanwhile the Air Forces' persistence

in demanding separate convalescent facilities 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 immediate 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 viewpoint82

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-1 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 1943.85 The viewpoint of

G-1 prevailed and on 14 June 1943 G-4

directed ASF headquarters to investigate

the proposal to establish convalescent facilities, to determine the requirements of

the Army as a whole, and to take whatever 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 convalescent annexes at general hospitals. On

79

 (1) Ltr SPMCB 300.5-1, SG to TAG, 7 Jan 43,

sub: WD Cir, with atchd corresp from various offs in

SOS. AG: 701(1-7-43) (1). (2) AG Memo W40-6-43,

11 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-1 WDGS, 6 Feb 43, sub: Rest and Recuperation of Mil Pers. AAF: 354.1 "Rest Ctrs and

Conv Homes." 82

 (1) Memo 720 GNGAP-A, CG AGF for ACofS

G-1 WDGS, 25 Feb 43, sub: Rest Cps for AGF Pers.

AAF: 354.1 "Rest Ctrs and Conv Homes." (2) DF

SPGAM/720/Gen (2-8-43)-16, CG SOS for ACofS

G-1 WDGS, 27 Feb 43, sub: Rest and Recuperation

of Mil Pers. HRS: G-1/354.7(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 Recuperative 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-1 WDGS for CofSA, 24 May

43, sub: Specialized Treatment for Aircraft Combat

Crew Pers. HRS: G-1/354.7(2-8-43). 85

 Coleman, op. cit., pp. 384-86, citing Memo,

ACofS G-4 WDGS for ACofS G-1, G-3, OPD

WDGS, and CGs AGF, AAF, ASF, n d, and Memo

WDGAP/354.7(3-8-43), ACofS G-1 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 presented.87

 Neither mentioned separate facilities for the Air Forces, hoping apparently

to keep the convalescent care of all patients under their own control. The day

before, however, a short-lived memorandum (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 medical 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 convalescent centers in the latter half of 1943,89

while the Service Forces established convalescent 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 planning, greatest attention seemed to be devoted to physical plants, while the internal

organization and administration of hospitals 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 procedures outside Army hospitals that affected

the length of time patients occupied hospital 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 supplying and equipping new and expanded hospitals, 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 commanders 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 Hospitals,

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 initiative, organizing and arranging customary

services in numbers and relations which

they considered desirable. Thus, in the

absence of specific organizational directives and standard administrative proce1

 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.
122 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

dures, efficient organization and smooth

functioning depended largely upon the administrative capabilities of hospital commanders and their staffs and upon the

supervision and advice they received from

higher authorities.3

In the fall of 1942 the Wadhams Committee had stated that Army hospital

organization and administration needed

improvement. It recommended the procurement of trained hospital administrators for assignment to key positions on the

staffs of hospital commanders and as consultants to The Surgeon General and service command surgeons. It also recommended 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 Committee 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 reporting directly to him and asserted that

the hospital organization outlined in Technical Manual 8-260 was the result of

many years of medico-military hospital

administration and represented the opinion of able officers of the Medical Department. "No advantage would appear to

accrue," he stated, "for [from?] any major

change at this time." He was equally opposed to the proposal to assign special hospital administrators to key positions in

station and general hospitals. "Lay" administrators were used in civilian hospitals, 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 hospitals either were lacking in military hospitals or were handled by other Army

agencies, such as the Corps of Engineers.

He admitted that specialists in hospital

administration were useful in some positions, 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 command 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 C. MacLean, Superintendent of Strong Memorial

Hospital, Rochester, N. Y, regarding a

commission and assignment to his Office

to make a comprehensive survey of military hospital organization and administration and to advise him on the procurement and assignment of additional hospital administrators from civilian life.6

 Dr.

MacLean was unable to accept a commission immediately, but on 23 April 1943

he was made a lieutenant colonel and assigned to The Surgeon General's Hospitalization 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 another of the Wadhams Committee's recommendations further exemplified his

reluctance to interfere with the internal

administration of hospitals. Finding that

some diagnostic procedures which required 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 effectively 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 because of the paper work involved, and

indicated that he preferred to depend

upon professional consultants "inquiring

into unnecessarily long periods of hospitalization with a view to corrective action."

 8 To supplement their efforts The

Surgeon General issued a circular letter

on 9 November 1942, urging hospital commanders 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 examinations.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 hospital functions, and their commanding

officers were both post and hospital commanders. Duties of such officers as post

commanders were relatively unimportant

compared with their duties as hospital

commanders, for post functions of a general hospital existed only to serve the hospital. 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 Organization Manual, 30 September 1942.

It grouped post activities functionally in

seven divisions: Administrative, Personnel,

Operations and Training, Supply, Repairs

and Utilities, Internal Security and Intelligence, 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 instances 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, CG 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

 (1) 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 (Chart 6)

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 governed the disposition of patients after completion of treatment—either by return to

duty or separation from the Army—and

were hence essentially personnel procedures.

Attempts To Speed the Disposition

of Officer-Patients

Two problems arose during the early

war years in the disposition of officer-patients after hospitalization. The first resulted 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 officers qualified for full duty should

return.11

The procedure for the assignment of officers qualified for limited service only, in

effect in January 1942, required hospital

commanders to hold officers after completion 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 service 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 belonging to the Air Forces. The latter, like

AAF limited service officers, could be assigned only by the commanding general,

Army Air Forces.14 These changes reduced but did not eliminate entirely difficulties of hospital commanders in procuring assignments for officer-patients.15

A further revision of directives governing 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 belonged 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 (1-17-42) (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, 31 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

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 patients as soon as their medical treatment
126 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

had been completed, without waiting for

higher headquarters to make assignments.16

 Nevertheless, some hospital commanders continued to hold officer-patients

until higher headquarters had acted upon

the recommendations of hospital disposition 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 resulted 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 simplifying procedures within the hospitals themselves.

Failure to receive service records and allied papers, such as individual clothing

and equipment records, of enlisted patients 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 complained about this situation.18

 To correct

it The Surgeon General secured the issuance 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 patients whose records had been lost or destroyed. 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, therefore, the War Department published a directive permitting hospital personnel officers to prepare payrolls, final pay statements, 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 decided that this policy should be broadened

to include all lost records, whether or not

they had disappeared as a result of military action.22

 This was done by a new War

Department directive published on 24

July 1942.23 Its provisions helped to speed

16

 WD Cir 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, MC for [Brig] Gen [Raymond W.]

Bliss thru Col [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 stupidities 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 (1-23-42) (8). 19

 Ltr, TAG to CGs Armies, Army Corps, et al., 29

Jan 42, sub: Delay in Trf of S/R. AG: 201.3

(1-23-42) (8). 20

 (1) Ltr, CG Lovell Gen Hosp to TAG, 21 May

42, sub: Lost S/R. HRS: G-1/10381. (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) (1). (2) WD Cir 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-1/10381. (2) Memo SPFDR 300.3/360354

(WD Cir), CofF for C of Admin Servs SOS, 21 Jul 42,

sub: Proposed WD Cir. AG: 240 (1-3-42) (1). 23

 WD Cir 244, 24 Jul 42.
MINOR CHANGES IN HOSPITAL ADMINISTRATION 127

the discharge of enlisted men on certificates of disability by making it unnecessary to hold patients in hospitals while

missing records were located or until new

ones were issued by The Adjutant General.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 enlisted man's immediate commanding

officer had to initiate the certificate required for this purpose (WD AGO Form

40), and an authority higher than the station hospital commander, either the post

commander or the service commander,

had to approve the certificate and the recommendations 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 general.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 patients were awaiting disability discharges.

To free beds for other patients, he recommended that measures be taken to require

organization commanders to initiate disability certificates promptly and to permit

commanders of all posts having a strength

of 5,000 or more to approve disability discharges.28

 Accordingly, The Surgeon

General prepared a memorandum, published by the War Department on 30

November 1942, requiring "all concerned" to insure prompt action by unit

commanders in initiating disability certificates. In December he also secured a

modification of Army regulations to permit commanders of all stations with housing capacities of 5,000 or more to grant

disability discharges.29 These actions, particularly the latter, simplified the disposition of such patients and in at least one

hospital reduced the average period of

their stay by almost two thirds, from fiftyeight to twenty-one days.30

 Causes for delay still existed for papers still had to be

transmitted between unit and hospital

commanders and between hospital and

post commanders.

Early in 1943 G-1 directed SOS to

make a study of War Department regulations 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, GO Tilton Gen Hosp to TAG, 31 Jul 42,

sub: Discharge of EM, with 1st ind, TAG to CG Tilton Gen Hosp, 25 Aug 42. AG: 220.8 (8-1-34) (1). (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, CG 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 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) WD Memo W40-

9-42, 30 Nov 42, sub: Delays in Processing WD AGO

Form 40. Same file. (3) WD Cir 404, sec III, 14

Dec 42. 30

 An Rpts, 1942, Sta Hosp at Sheppard Fld, and

Surg 7th SvC. HD. 31

 Memo, ACofS G-1 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 discharges. He therefore requested a conference of representatives of his own Office

and of The Adjutant General, The Judge

Advocate General, the commanding general of Services of Supply, and the Veterans Administration, to consider the entire question.32

 As a result a revision was

worked out which eliminated some channels 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 transferred (on paper) from their own units to

the station complement of the post on

which the hospital treating them was located within forty-eight hours after hospitals decided to discharge them. Thus, all

steps leading up to discharges for disability

were to be under the control of post commanders, 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 recommendations, to post commanders within fortyeight 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 responsibility, 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 approximately eighteen to five days.35

 Here, as in

other instances, the post commander eliminated even the transmission of records

from station complement headquarters to

hospitals and from hospitals to post headquarters. He accomplished this by placing 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 commanders to approve disability discharges.

In this way, the entire process of granting

discharges on certificates of disability was

centralized under station hospital commanders.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 disability. Further simplification of procedures within hospitals themselves remained to be done during the later war

years.

The disposition of psychotic patients involved problems not ordinarily encountered 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-1 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 Conf with 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 impossible altogether.37

 To relieve other hospitals 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 Bushnell (Utah) General Hospitals in the fall

of 1942, and on 12 June 1943 activated

Mason General Hospital in buildings acquired 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 encountered less difficulty in disposing of

psychotic patients, since they could transfer any of them to the Veterans Administration.

More than a year before this Congress

had taken action which might have resulted in delaying the disposition of patients. On 12 December 1941 Congress

authorized the Army to retain in its hospitals, rather than transfer to the Veterans

Administration, patients whose terms of

service had expired but who needed continuing 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 considerably.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 possible, The Surgeon General appealed to a

policy which the Federal Board of Hospitalization had established in 1940: the

early transfer to the Veterans Administration of patients who could not be salvaged

for further service.42 The Wadhams Committee, on the other hand, responsive perhaps to a feeling among the public that

the Army should do everything possible

for its sick and wounded men, recommended that the Army keep all patients,

except those who were neuropsychiatric,

until they had received maximum therapeutic benefits.43

 This might have proved

embarrassing for The Surgeon General

had not the Federal Board ruled, in February 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 patients 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 Conf 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 Conc 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 reconditioning and rehabilitation during the later

war years.

Delays in the disposition of enlisted patients occurred also, as in the case of officers, 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 injuries and required longer periods of medical care. Both the men whose organizations had moved and those qualified for

only limited service required new assignments. To prevent their being held in hospitals awaiting assignment by higher

headquarters, meanwhile occupying beds

needed for other patients, The Surgeon

General's Hospitalization Division recommended 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 patients 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 temporarily, pending permanent assignments.47

 This procedure worked well in

some corps areas. In others, where corps

area commanders failed to establish

casual detachments under such "permissive 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 Surgeon General instituted measures of that

type. Among them were the treatment of

patients with uncomplicated cases of gonorrhea on a duty status and the curtailment of elective operations.

Although the majority of patients with

gonorrhea in civilian life were treated on

an out-patient basis, the Army had customarily 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 Snyder, occupied approximately 6,000 beds.

During 1942, some posts in the Fourth

Service Command had begun to use sulfonamide 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 considera45

 Ltr, SG to TAG, 22 Jan 42, sub: Disposition of

Pnts. SG: 705.-1. 46

 (1) 1st ind AG 220.31 (1-22-42) EA, TAG to SG,

30 Jan 42, on Ltr, SG to TAG, 22 Jan 42, sub: Disposition of Pnts. SG: 705.-1. (2) WD Cir 24, 27 Jan 42. 47

 Ltr, TAG to CGs of all CAs, 29 Jan 42, sub: Disposition of Pnts in Gen Hosps. AG: 322.3 Gen Hosp

(1-28-42) (1). 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 CA 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 throughout the Army.50

 The Surgeon General

then requested the appointment of a

board of medical officers to review accumulated experience to determine the wisdom of extending on-duty treatment of

gonorrhea patients.51 By January 1943 the

board had completed its work. It recommended that the policy of treating patients

with uncomplicated cases of gonorrhea on

a duty status be encouraged, but not required.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 conformity with this recommendation, The

Surgeon General directed hospitals to consider 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 operations, 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 available 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 reductions 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 ablebodied enlisted men by personnel in other

categories began at that time.

Throughout 1942 the personnel guide

that had been issued in April 1941 remained effective for station hospitals, and

the Surgeon General's Office instructed

general hospitals to use tables of organization of corresponding numbered units as

their guide.58 During the year, his Office

not only revised such tables but in December presented for Staff approval new

guides for manning both station and general hospitals in the zone of interior.59

Made partly at the instance of the General 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 Treatment of VD on Duty Status. Same file. 52

 WD AGO Memo W40-2-43, 19 Jan 43, sub:

Treatment of Individuals with Uncomplicated Gonorrhea 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

DepCofS WDGS thru Mil Pers Div SOS, 14 Dec 42,

sub: Availability of Physicians. SG: 322.051-1. 60

 Memo, ACofS G-1 WDGS for SG thru Pers Div

SOS, 1 Apr 42, sub: Availability of Physicians. HRS:

G-1/16331-16335. 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

a

 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 authorized for hospitals of various sizes and to

increase the use of Medical Administrative Corps officers in administrative positions.

Throughout 1942 allowances of Medical 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 officers. High allotments were somewhat offset by the fact that in most cases the number of Medical Corps officers actually

assigned failed to equal the allowance.

Hospital commanders therefore complained of shortages, but their complaints

seem to have been based on this discrepancy 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 Department 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, 1st-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, Blanding, and Chaffee. HD.
MINOR CHANGES IN HOSPITAL ADMINISTRATION 133

Replacement of physicians in administrative jobs by Medical Administrative

Corps officers began in 1942. At the beginning of the war the personnel guide for

named hospitals permitted but did not require 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 positions.63

 Early in 1942, therefore, physicians, sometimes with Medical Administrative Corps assistants, held such positions

as executive officer, registrar, adjutant,

mess officer, medical detachment commander, 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 Administrative 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 commanders 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 Immaterial 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, medical supply officer, adjutant, and registrar.68

 By the end of 1942 service commands reported that administrative officers had replaced physicians in administrative 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 throughout 1942 70

 and their widespread substitu63

 (1) Ltr, Act SG to the Hon D. Lane Powers,

Mem of Gong, 29 Mar 41. SG: 210.2-1. (2) Ltr, Lt

Col John M. Welch to Dr Wilburt G. 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 W[illiam] L.

Sheep, CG Lawson Gen Hosp to Col H. D. Offutt,

12 Feb 42. SG: 323.7-5 (Lawson GH)K. 64

 (1) Memo, ACofS G-1 WDGS for SG thru Pers

Div SOS, 1 Apr 42, sub: Availability of Physicians.

(2) Memo, ACofS G-1 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(1-14-42) (2) Sec 2A. 66

 Memo, SG for COs Sta Hosps at Sheppard Fld,

Fts Lewis, Ord, Sam Houston, Leonard Wood,

Devens, Indiantown Gap Mil Res, Cp Lee, and Fitzsimons, Army and Navy, Wm. Beaumont, Walter

Reed, and Lawson Gen Hosps, 29 Jun 42, sub: Conservation of Available MC Offs. SG: 322.051-1. 67

 Ltr, TAG to CGs AGF, AAF, all CAs, 13 Jul 42,

sub: Relief of MC 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: Relief of MC 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 Col 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 Col
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 enlisted staffs of hospitals were more general.

Experience in the employment of civilians

had already demonstrated that ablebodied 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 shortages for Medical Department activities.

Large numbers were needed for the many

new hospitals opening in the zone of interior. 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 requisitions.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 commanders complained of shortages,75

 but

generally, complaints were less of shortages than of difficulties in using limited

service men and civilians.

Hospitals had had experience with limited service enlisted men as early as

December 1941, when the War Department began to transfer physically unfit

men from field force units to zone of interior installations.76

 At first hospitals absorbed 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 ablebodied 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

Basil C. MacLean for Gen Bliss thru Col Schwichtenberg, 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.

71

 (1) Memo, SG for Dir Mil Pers SOS [10 Oct 42].

SG: 322.051-1. (2) DF WDGAP 322.051, ACofS G-1

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 (7-11-42)EC-SPMCP-PS-M,

CG SOS to CGs SvCs and CGs Gen Hosps, 28 Jul 42,

sub: Filler Repls for Units Ordered Overseas. SG:

220.31-1. 73

 SOS Cir Ltr 25, 10 Jul 42, sub: Asgmt of Limited

Serv EM. SG: 220.31-1. 74

 An Rpts, 1942, Hoff, Ashford, Billings, Lovell,

Tilton, Hammond. Bushnell, Torney, O'Reilly, and

Lawson Gen Hosps and Sta Hosps at Cps Wheeler,

Murphy, Young, Croft, Roberts, Chaffee, McCoy,

Sheppard Fld, and Fts Knox and Riley. HD. 75

 An Rpts, 1942, Sta Hosps at Jefferson Bks and

Cp Lee. HD. 76

 Ltr AG 220.31 (1 2-18-41) EA-A, TAG to all

Army, CA, and Exempted Sta Comdrs other than AC

and C of Armored Force, 23 Dec 41. sub: Clearing Fld

Force Units of Pers not Physically Qualified for Fld

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:

220.31-1. (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.
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—actions 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—operating around the clock—found it difficult to

assign all of them to special jobs within

their physical limitations. Of equal importance, such men had often had no Medical

Department training. Hospitals therefore

had to maintain continuous training programs for newcomers. Even so they could

not always train enough technicians, for in

many instances physical incapacity happened 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 commitment 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 establishment in April 1943 of special regiments to

train whatever limited service men the

Medical Department might receive.81

As limited service men came to constitute a larger part of the enlisted force, hospitals 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 problems they had experienced in 1941. In

addition, they found it increasingly difficult to maintain stable civilian forces. As

able-bodied civilian employees were inducted 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 hospitals in growing numbers to take better

paying jobs elsewhere. Competition with

war industries and other government

agencies was keen and hospital wagescales were frequently lower than those

prevailing in surrounding areas. As a result, hospital commanders found the use

of civilians "very vexatious, time consuming, 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 Auxiliary Corps.83

When the question of using Waacs in

Army hospitals was first raised in the

spring of 1942, The Surgeon General expressed opposition because, he said, their

use would conflict with civilian personnel

employment, would interfere with training of enlisted men, and would create diffi78

 (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: Clearing Fld Force Units of Pers Not Physically Qualified

for Fld 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, Cps

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 Cps Atterbury, Blanding, Chaffee, Croft, Howze,

Lee, Maxey, Roberts, Wheeler, Wolters. and Young.

HD.
136 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

culties centering around housing and recreation.84

 During 1942, as civilians became

increasingly hard to get and keep and as

limited service men replaced those qualified for overseas service in growing numbers, the idea gradually gained currency

among hospital commanders, service command surgeons, and members of the Surgeon 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 enlisted 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 Department, to use Waacs extensively to

release men for combat duty.86 About the

same time, the Wadhams Committee recommended their employment in hospitals.87

 Accordingly, early in 1943 the Surgeon 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 Training Divisions, to study the problem. Soon

afterward he requested reports from service commands, the Air Forces, the Transportation Corps, and the Army Medical

Center on hospital jobs which Waacs could

fill, the numbers needed, and the construction 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 C. Mudgett, SOS for SG,

31 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 (WAC). 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 Fld Sta

Hosps, and Chief Med Br 3d SvC. HD. (3) Ltr, CO

Valley Forge Gen Hosp to SG, 19 Jan 43, sub: Request 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

MRTC, 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, CofS 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. HD: 322.5-1. The same letter was sent to all Service 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 supply.91

 The Surgeon General then sent each

service commander a tabulation of Waac

requirements for hospitals in his command, for inclusion in the Waac requisition which it was anticipated SOS headquarters 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 unprecedented rapidity, as well as for dispensaries, infirmaries, induction stations, and

medical units destined for overseas service,

presented the Medical Department a

problem of great magnitude.94 It was partially simplified by the practice of issuing

hospital assemblages as single items. Using

equipment lists prepared during the emergency 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 general 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 officers 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 required 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 operational needs became imperative as soon

as the wartime expansion began. Before

the war, hospitals were permitted to make

only quarterly and emergency requisitions, 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 emergency 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 requisitioning 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.
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 hospitals most frequently failed to receive were

dental supplies and equipment, surgical

instruments and operating room equipment, laboratory equipment, X-ray developing-tanks and cassettes, hospital furniture including beds, and food carts. New

hospitals suffered most from these shortages. 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 borrowed 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 developing-tanks and food carts. Many had

their own "utilities" personnel build missing items of hospital furniture. Sometimes,

when money was available, hospitals purchased 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 undoubtedly taxed the ingenuity of hospital commanders 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 improvement of depot operations, are outside 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 separate monthly requisitions for standardexpendable, standard - nonexpendable,

and nonstandard items. They could still

submit "special" and emergency requisitions.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 supply 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 stock97

 SG Ltr 11, 10 Feb 42, sub: Direct System of Sup

for Posts, Cps, 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, Bushmen,

Billings, Deshon, Harmon, Hoff, and Percy Jones Gen

Hosps; and Sta Hosps at Fts Belvoir and Bliss, Sheppard Fld, and Cps 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 completion of the hospital expansion program

during 1943, resulted in a greatly improved supply situation. During the rest of

the war hospitals and service command

surgeons reported generally that requisitions were promptly filled and that the

supplies and equipment which they received were of good quality and of sufficient quantity to meet their needs.101

100

 For example, see the following: An Rpts, 1943,

Surg 7th SvC, and Sta Hosps at Cps 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 Accomplishments 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 defensive-offensive operations against the

enemy. Meanwhile it had to organize,

train, and equip other units for use when

the Army should become engaged in fullscale 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 thereafter hospitals went to those theaters in increasing 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 theaters 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 Harbor the Medical Department had 22 general, 24 station, 17 evacuation, and 8

surgical hospital units that had been activated as training units. Of these, 3 station

hospitals were already overseas and 9 station, 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 According 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 assemblages for 2 general, 11 station, 4 evacuation, 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 hospital 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 approximately one half of its authorized enlisted

strength from a training unit. The rest of

its personnel would be supplied by reception centers, zone of interior installations,

and other medical units. Each training unit

which transferred personnel to an affiliated unit would retain a cadre, in order to

train additional "fillers" for other affiliated units. Some training units, especially

station hospital units, would be sent overseas 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 equipment, clothing, and motor transport at its

home station. Only those going overseas

would receive hospital assemblages, preferably at ports of embarkation.3

Soon after he had proposed this system

The Surgeon General realized that modifications would be necessary. The activation 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 additional 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 'Tillers" were

drawn suffered from resulting personnel

and training problems. To obviate these

difficulties The Surgeon General recommended in February 1942 that all training units be activated at full table-of-organization 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 partial approval of his stand in opposition to

the issuance of hospital assemblages before the departure of units for theaters.

After completing a survey of storage space

in corps areas, G-4 in December 1941 disapproved a request that General Magee

had made in November to hold assemblages in depots until units were assigned

missions involving medical care.6 General

Magee then sought approval of his position in a personal conference with General

Somervell, who was at that time the Assistant Chief of Staff, G-4. On the basis of

his understanding of the agreement

reached then, General Magee resubmitted 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. 3

 Memo, SG for AcofS G-3 WDGS, 13 Jan 42, sub:

Activation . . . Med Units, with inds. HD: 326.01

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 following Sta Hosps: 10th, 12th, 13th, 17th, 151st, 166th,

and 172d. HD. 5

 (1) Memo G-4/24499-178, Maj William L. Wilson 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 AGF 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 AGF, 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 Policies 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 requisition but would be issued directly as the

War Department determined. Meanwhile, The Surgeon General would make

fractional issues of unit equipment for

training purposes.8

Although he concurred in this compromise, 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 operational missions. Once they were declared

controlled items, the most practical method of achieving this end would be to secure War Department agreement not to

require their issuance prior to that time.

This might be done indirectly. Consequently, on 24 January 1942 The Surgeon

General requested G-4 to include in

movement orders for numbered hospital

units ordered overseas a paragraph directing The Surgeon General to ship appropriate assemblages to ports of embarkation 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 orders settled the controversy over the issuance 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 existing facilities could be expanded and additional "provisional" hospitals could be

established by spreading thin the personnel 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 following 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 improvised hospitals in those areas.12

 In addition, troops sent to garrison new bases included 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 supplementary personnel and equipment.14

Troops deployed to protect shipping

lanes and to hold the enemy while preparations for the offensive went forward re8

 Memo for Record on D/S, ACofS 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 ACofS G-4 WDGS, 17 Jan

42. SG: 475.5-1. (2) Ltr AG 400 (1-16-42)MDD-M, TAG to SG, 21 Jan 42, sub: Equip for MD

Units. HRS: G-4/33344. 10

 (1) Memo, SG for ACofS G-4 WDGS, 24 Jan 42,

sub: Proposed Modification of Mvmt Orders. SG:

475.5-1. (2) D/S, ACofS 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 Hawaiian 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 immediate need was in the South and Southwest Pacific. During the period from 1

January to 1 July 1942, inclusive, 2 evacuation, 2 surgical, 4 general, and 14 station

hospitals were sent to Australia; 2 evacuation, 2 general, and 2 station hospitals to

islands in the South Pacific; and 2 station

hospitals to islands other than the Hawaiian group in the Central Pacific. During the same period, 1 general and 1 station 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 being earmarked for task forces, especially

for the GYMNAST (North Africa), MAGNET

(Northern Ireland), and BOLERO (England) operations. These demands drew

heavily upon available units and assemblages and sometimes made it impossible

for The Surgeon General and OPD to

meet without modification requests of

theater commanders.15 (Table 5)

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 training units in meeting overseas needs between Pearl Harbor and 2 July 1942. At

any rate, all station hospitals and the two

surgical hospitals dispatched during this

period were nonaffiliated units. Of the

thirty-seven station hospitals sent out, seventeen had been activated during 1941

and the rest after war began. Both surgical hospitals were nonaffiliated units that

had been activated in 1941. Of the fifteen

general hospitals shipped, nine were affiliated units supplied (except for one) with

enlisted personnel from training units activated 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 training of normal Army units proved more

valuable in meeting emergency hospital

needs than did the formation and organization of units affiliated with civilian hospitals or schools.

Modification of Hospitals

for Overseas Areas

Development of New Types of Units

Early in the war it was necessary to develop new types of hospitals to meet the

needs of island-type warfare and of motorized 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 Planning 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 OVERSEAS, 7 DECEMBER 1941 TO 1 JULY 1942

a

 Affiliated units. b

 This unit returned from 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 HD

Pacific revealed the need for hospitals

that were smaller and more mobile than

the only hospital available for that purpose—the 250-bed station hospital. As a

result, the Surgeon General's Office and

the medical section of General Headquarters 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 develop 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 patients. Staffed to care for minor ills and injuries 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 isolated areas, or at air bases distant from

other facilities. Having sufficient transportation 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 transported by air—an assertion supported by

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 ACofS G-1 and

G-4 WDGS, 17 Feb 42, sub: T/O and E for a Fld

Hosp Unit, with incl. 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, authority was granted for the activation of twenty-two by the end of 1942.

During the months following the development of the field hospital, the Surgeon

General's Office revised the table of organization 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 provided only for those of 250-, 500-, and

750-bed capacities.19 When station hospital units of smaller capacities were

needed, The Surgeon General had to prepare 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 hospitals of seventeen different sizes, ranging in

capacity from 25 to 900 beds.21 The inclusion of station hospital units of various

sizes in the 1943 troop basis simplified

The Surgeon General's problem of recommending hospital support for small garrison forces.

At the same time that small fixed-hospital units were being supplied for garrison forces scattered throughout the world,

the Surgeon General's Office was developing 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 movement and could be used only in relatively

stable situations. The surgical hospital, developed in 1940, was only partially mobile. 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 combat zone hospital, The Surgeon General

developed a 400-bed motorized evacuation 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 surgical unit and two ward units. The motorized 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 hospitals. 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-1 and

G-4 WDGS, 17 Feb 42, sub: T/O and E for Fld

Hosp Unit. AG: 320.2(10-30-41) (2). (2) Ltr, SG to

CG USAFIA, 26 Jun 42, sub: Fld Hosp, T/O 8-

510. HD: Wilson files, 400 "Med Equip and Sups."

(3) Memo, SG for CG SOS, 3 Oct 42, with 2d, 5th,

and 6th inds. SG: 704.-1. 18

 Memo, SG for CG SOS, 22 Mar 42, sub: Activation of Fld Hosp Units, with 1st ind, CG SOS

to SG, 1 Apr 42. SG: 322.3-33. 19

 T/O 8-508, Sta Hosp, ComZ, 25 Jul 40. 20

 T/O 8-560S, Sta Hosp (150-bed), 23 May 42. 21

 T/O 8-560, Sta Hosp, ComZ, 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 commissioned 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 organization of the latter was not rescinded

until August 1944.25 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 November 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 available at the beginning of the war or developed 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 surgeon 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 prepare 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 hospitals. Receiving reports of this development, The Surgeon General soon afterward 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 headquarters 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 developed which tended to cancel some of the

results of earlier attempts of The Surgeon

General to increase the mobility of hospitals. 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 respective 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-MEDC. (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. 2 7

 (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 Reductions in allotments of motor vehicles to

other hospital units had insignificant effects 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 began, equipment lists of all hospitals contained 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 reduction had been made in station hospital

assemblages and that it would be made in

others at an early date.33 During the following summer special boards appointed

by The Surgeon General reviewed equipment lists of all hospitals, making reductions 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 hospitals 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 Surgeon 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 supervision of the Ground Surgeon.36

 The Surgeon General learned that this hospital

29

 (1) T/O 8-510, Fld 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 CGs AGF, AAF,

and SOS, 2 Oct 42, sub: Review of Orgn and Equip

Reqmts. AG: 400 (8-10-42) (1) sec 22. (3) Ltr, SG

to CG SOS, 14 Dec 42, sub: Changes in Fld 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 Confidential 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 Fld 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: Observations on Med Serv in NATO. HD: Wilson files,

"Experience in Med Matters from Overseas Forces." 36

 Comment by Brig Gen Frederick A. Blesse on

first draft of this chapter. HD: 314 (Correspondence

on MS) III, 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 contained items used in one particular section

of a hospital only.37 In November 1942

General Magee appointed a board of officers to study this accomplishment and

submit recommendations for more practical methods of packing and assembling

equipment than those being used by medical depots.38

 As a result of this investigation, The Surgeon General's Supply Service drew up specifications for the standardized 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 section of a hospital only. This system

speeded unpacking and repacking for

movement in the field by making it possible 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 equipment and motor transport, were required

by other than medical considerations.

During the early part of 1942 both G-1

and SOS headquarters put considerable

pressure on The Surgeon General to save

commissioned personnel, especially Medical 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 organization, both to reduce the number of officers authorized and to substitute Medical Administrative Corps for Medical

Corps officers.41 Having already begun

the process of revision, The Surgeon General replied that he would continue it.42

 In

April the revised tables for general, surgical, and convalescent hospitals and hospital 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 Administrative 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, CG 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 

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 Distribution of Medical Supplies in the Zone of the Interior during World War II (1946), p. 146. HD. (2)

An Rpt, Med Assembly Unit Atlanta ASF Depot,

1943. HD. 41

 (1) Memo, ACofS G-1 WDGS for SG thru Pers

Div SOS, 1 Apr 42, sub: Availability of Physicians.

HRS: G-1/16331-16335. (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-1/16331-16335. (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 Ctr, 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 administrative positions. The revised tables also reduced the number of nurses authorized

for some hospitals. In general, greatest

changes were made in large communications zone units, such as 1,000-bed general

and 750-bed station hospitals. In the former, 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 replacements for some of the Medical Corps officers eliminated. In smaller communications zone units, such as the 250-bed station 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 physicians 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 revise downward their tables of organization.46

 By then responsible for tables of

combat zone hospital units, AGF headquarters 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 militarization of hospital dietitians and physical

therapists, who until December 1942 had

served as civilian employees.47 Cuts in the

personnel of communications zone hospital units did not occur at this time, because 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 increased significantly with each of its revisions but always remained smaller than

The Surgeon General considered adequate for the Army being mobilized. Using World War I casualty and evacuation

experiences as a basis, The Surgeon General 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 AGF, AAF, and SOS, 2 Oct

42, sub: Review of Orgn and Equip Reqmts. AG:

400(8-10-42) (1) 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 AGF for ACofS G-3 WDGS, 1 Jan 43, sub:

T/O and T/E 8-581, Evac Hosp, Semimobile. AG:

320.3 (10-30-41) (1) sec 8D. (3) Memo 321/732(Med)

GNRQT 3/37444. CG AGF for ACofS 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

ACofS G-3 WDGS, 7 Dec 42, sub: Review of Orgn

and Equip Reqmts. AG: 400(8-10-42) (1) 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 evacuation 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 mobilization 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 January 1942, which provided for a 71-division, 3,600,000-man Army by the end of

the year, there were included only 2 convalescent, 28 evacuation, 8 surgical, 45

general, and 40 station hospital units.51

The Surgeon General urged that additional 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 adequate 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 overseas 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 representatives of SOS and AGF headquarters and

the Surgeon General's Office, and on 23

May 1942 SOS headquarters recommended 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 recommended 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 Medical Bulletin No. 24 (1931), pp. 53-68. (2) Off Diary of

Col Albert G. Love, Chief HD SGO, 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., 17 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 Maurice 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

 (1) Memo WDGCT 320.2(5-23-42), ACofS G-3

WDGS for CGs AGF and SOS, 25 May 42, sub:

Reqmts of Serv Units. . . . SG: 475.5-1. (2) Me

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 hospital 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 general, and 327 station hospital units—was

less than The Surgeon General recommended.57

 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 recommendation should be disapproved, to procure

adequate equipment for overseas hospitals

regardless of the troop basis.58

 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 Zone of Interior

Throughout 1942 and most of 1943 the

Surgeon General's Office and SOS headquarters 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 hospitalization already discussed, exemplified

difficulties resulting from misunderstanding about the respective responsibilities of

the Surgeon General's Office and the SOS

Hospitalization and Evacuation Branch.

Of more significance, it involved the following 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 hospitals 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 construction of housing for a hospital unit near

each of twenty-two general hospitals and

56

 Greenfield et al., 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: G32.-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 CG SOS, 6 Mar 43, sub: Adequacy 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: Adequacy of Plans for Overseas Hosp. HD: Wilson files,

"Book III, 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 requested,60

 caused units to be grouped on

posts wherever troop housing was available. 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 alongside 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 headquarters 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 recommended that all hospital units scheduled

for maneuvers and all newly activated

units be given full issues of equipment for

permanent retention.63 The Surgeon General was willing to make some concessions

to the Ground Forces but not to issue complete 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 assemblages until units were assigned to operational 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 becoming restless from long periods of training without opportunities either to function as hospitals or to assist in zone of interior 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) Consolidated Rpt, SGs Observers for 1942 Maneuvers, transmitted to ASF Hq by Memo, SG for Dir Tng ASF, 16

Jun 43. Ground Med files: "Rpt of Maneuver Observers, SGO, 1942." (3) Memo, Dir Planning Div

ASF for Gen Lutes, 4 Aug 43, sub: Sta Hosp in Maneuver 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, CG SOS to SG. 22 Jun 42; 4th ind, SG to Dir

Oprs SOS, 30 Jun 42; 5th ind, CG 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 CG

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 Units. 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 Wilson 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 utilization.67

 The chief of the SOS Hospitalization and Evacuation Branch believed that

personnel required for zone of interior

hospitals could be reduced by using numbered hospital units to help operate such

installations. Furthermore, he believed

that a reserve of hospital beds for emergencies could be provided by issuing

equipment to numbered units.68 In addition, some of the obstacles to assemblageissuance and unit-use were being removed. Although equipment was still in

short supply, the Surgeon General's Office

and SOS headquarters were making renewed 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 September 1942 and January 1943.69

 Finally the

Wadhams Committee was appointed early

in September 1942, and SOS headquarters 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 medical service and on 17 September 1942

requested his comments on the draft of a

policy requiring the issuance of assemblages to all hospital units in training.71

Receipt of these communications caused

confusion and consternation in the Surgeon General's Office. The Operations

Service called for comments from other

sections—the Supply, Professional, and

Personnel Services and the Hospital Construction, Hospitalization, and Training

Divisions. After several conferences to discuss 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 Surgeon 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 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) 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 CG 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: Fld 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 Problems. 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,

12 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.
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 training could get experience with equipment

in zone of interior hospitals and equipment required for emergencies could be

shipped from depots when needed. Units

were not qualified either to repack equipment for overseas shipment or to determine deletions and substitutions to reduce

total weight. The former should be done

by depots to prevent breakage and the latter could be done properly only by qualified 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 adequate reserve of hospital facilities for

emergencies; and their use as units would

not reduce zone of interior personnel requirements 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 training was deficient. In requesting that existing 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 Surgeon 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 submitting 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 General when he had orders from the Deputy

Chief of Staff of the Army to present a

"plan." Perhaps it resulted from the apparent inclination of the Wadhams Committee toward The Surgeon General's

position rather than that of the SOS Hospitalization and Evacuation Branch.73

 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 assemblage-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 hospitals but supplied by other services, such

72

 (1) 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. Numerous memos from chiefs of various sections of SGO

giving these arguments are in HD: 632 "Hosp-Housing."

73

 Cmtee to Study the MD, 1942, Testimony, pp.

1869ff. HD. After the war General Lutes stated that

General Somervell personally directed a "lenient attitude" toward the Surgeon General's Office because

of the Wadhams Committee's report. He was proceeding 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 (Correspondence on MS) III. 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 issued 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. Assemblages for station and general hospitals

under SOS control would be located in

Medical Department depots so that delivery 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 headquarters delayed announcing it officially

until the medical supply situation had improved. Then, on 18 January 1943, SOS

headquarters had the new policy published.76

At the beginning of the new year a combination 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 commands.77

Soon afterward, in January 1943, the

SOS Director of Training received criticism from at least one service command of

deficiencies in unit training. About the

same time the chief of the SOS Hospitalization and Evacuation Branch reported

that failure to use units while in the

United States was being criticized publicly. He then requested and received

authority from his superior officer in SOS

headquarters to collaborate with the SOS

Training Director and the Surgeon General's Office in working out a plan to

answer such criticism.78 In a subsequent

conference of representatives of the Surgeon General's Office AGF headquarters,

and SOS headquarters, it was "unanimously 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 numbered units to operate such hospitals under

the supervision of permanent staffs.79 The

chief of the SOS Hospitalization and

Evacuation Branch then took a trip

around the country and found, he reported, that each service command surgeon agreed that he could operate a satis75

 (1) Draft memo SPOPH 475(9-26-42), CG SOS

for SG, 23 Oct 42, sub: Equip for Fld 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 Fld Med Units. HD: Wilson files, "Book

III, 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 MC Pers. SG: 353.-1. (2) Memo SPOPH

320.2, Chief Hosp and Evac Br SOS for Gen Lutes,

16 Jan 43, sub: Asgmt, Tng, and Util of TofOpns

Med Units. HD: Wilson files, "Book III, 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 Pentagon 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 TRAINING."81

By this time seventy-eight general hospitals were reported "back-logged" in the

United States, with no immediate prospect of employment overseas. Both the

chief of the ASF Hospitalization and Evacuation Branch and the ASF Director of

Training feared that the General Staff

would reduce the number of Medical Department 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 interior hospitals made it possible to train

more personnel than before on a "parallel" basis;83

 and year-round use by the

Ground Forces of the A. P. Hill Military

Reservation and the Desert Training Center 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 revised policy permitted them to train with

full equipment and work out a system of

functional packing to increase unit mobility.85

 Yet as a rule general and station hospital units still lacked assemblages in the

United States and had infrequent opportunities to function as hospitals before going overseas. Meanwhile, the time which

some of them spent in training lengthened

considerably. For example, although affiliated units had been intended for prompt

shipment overseas, the fifty-one affiliated

general hospital units that were eventually 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 assemblageissuance and unit-use faced Surgeon General 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 unalterably committed to the position of his

predecessor. In addition, despite his ASF

position, Colonel McDonald identified

himself closely with the Medical Department 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 43-17 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), ACofS Oprs

SOS (init WLW[ilson]) 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 ACofS 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 MC 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, 110th, and 145th.

HD.
HOSPITALIZATION FOR THEATERS OF OPERATIONS 157

a

 This unit returned from Nova Scotia to Boston on 4 March 1942 and embarked again at New York on 12 May 1942. b

 The professional and enlisted personnel of this unit was used to staff the 233d and 237th Station Hospitals, which embarked for Aus- tralia on 5 January 1944. The 233d Station Hospital was reorganized and redesignated the 247th General Hospital on 15 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 in HD; and miscellaneous AG and SG files pertaining to individual 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 separated ports.87

 In July 1943, therefore, he

requested its reconsideration. First he proposed 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

a

 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 equipment for hospital units until they reached

ports of embarkation—and then a compromise between that and the existing

policy. Ultimately he withdrew both proposals. After an investigation of split shipments, Colonel McDonald reported that

the current policy seemed to have little

effect in causing such a problem. Furthermore, representatives of The Surgeon

General agreed that a change in policy

might produce a six-to-twelve month period 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 Fld 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 Fld

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 Surgeon General's Office had formerly opposed, 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 service in his first conference with service command surgeons. They agreed that the

existing situation was deplorable. For example, one stated that it was difficult,

when several units were located on a single 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 proposal to use numbered units in the operation of zone of interior hospitals, but several feared that administrative difficulties

might arise unless units and their commanding officers were placed under the

control of station surgeons. Others believed that professional problems might

develop if numbered units were withdrawn from named hospitals either for

field training or for overseas service without adequate personnel being left behind

to operate zone of interior hospitals.90 To

avoid such a situation, the Surgeon General'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 McDonald 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 Training Division lacked enthusiasm for this

proposal but agreed to investigate its possibilities.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 General Staff forbade the use of War Department 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) Rpt of Subcmtee 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 C[arl] C. 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 addressee, 10 Nov 43, sub: Comments on Col Wakeman'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 H[oward] 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 proposal in the first place. From the middle

of 1943 onward the pressing need for hospitals 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 disposed of the argument that services of personnel, 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 began 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 controversy between the Surgeon General's Office and ASF headquarters over the equipment and use in the United States of numbered hospital units reached an inconclusive end.

Preparing for the Support

of Offensive Warfare

Shift of Emphasis Away From the Pacific

By about the middle of 1942, when emphasis in providing hospitalization for

theaters shifted from the Pacific to other

areas of the world, emergency needs resulting 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 Kingdom and subsequent successful North

African operations, hospitals went in increasing 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 service 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 station more than general hospitals. For example, by 15 March 1943 the War Department 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 convalescent, 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 during 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 previously 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 recommendation, many did not go overseas

immediately. For example, although fortytwo 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 remain94

 (1) See below, pp. 218-23. (2) Memo, Dep Chief

Oprs Serv SGO for Dir Hosp Div SGO, 17 Feb 44,

with incl. 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

a

 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 activation and use, like the establishment of allNegro wards and hospitals in the United

States,96 resulted from The Surgeon General'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 violation 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

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 activated during World War II. An advanced

detachment of the 25th Station Hospital

embarked in May 1942 for Liberia to support a force of construction engineers, personnel 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 Station Hospital, was activated at Fort

Huachuca (Arizona). After a period of

training, it embarked for the Southwest

Pacific theater in October 1943 and arrived in Australia in November.98

Establishing a Basis for Future Planning

Toward the end of 1942 the shift in emphasis from defensive measures to preparations for the offensive made it necessary to take stock of hospitalization

already supplied in order to plan effectively for the future. Records of the number 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

a

 Converted from 750- 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 operations. At other times assemblages were

shipped as expansion units, for theaters to

issue as needed to numbered hospitals that

were already operating, to overseas hospitals that had operated during peacetime

and were now being expanded, or to provisional hospitals that were being established with theater personnel. Furthermore, 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 assemblages for accurate information about

beds available overseas. Nor could he depend upon statistical health reports (Medical Department Form No. 86ab). Designed to supply his Office regularly with

information about admissions and dispositions 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 instances from other available

records.99

99

 Memo, SG for Oprs Div SOS, 31 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

Sources: Unit cards filed in Orgn and Directory Section, Oprs Br AGO, and annual reports filed in HD.

In July 1942, therefore, to get more accurate and more current information than

he had, The Surgeon General called upon

SOS headquarters for assistance.100 Finding 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 reports came in, the Surgeon General's Office, the SOS Hospitalization and Evacuation 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 capacities 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 concerning overseas hospitalization, in view

of the hospitalization and evacuation

policy which was published on 18 June

1942 making overseas commanders responsible for "the operation of all medical

facilities under their control and for future

planning in connection therewith" (italics

added).103 Despite this policy, SOS headquarters assured him that he could make

recommendations about hospitalization

and evacuation in theaters whenever appropriate. The Surgeon General also felt

that he received insufficient information,

both from higher authorities in the War

Department and from surgeons in thea100

 (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 Overseas. 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. 103

 Ltr AG 704 (6-17-42)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 security reasons, the SOS Hospitalization and

Evacuation Branch attempted to provide

him with more information about operational plans than he had previously received.104

 Furthermore, in collaboration

with the Surgeon General's Office that

Branch took action which led to the establishment in January 1943 of a system of

monthly 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 evacuation rates, availability of hospital beds,

suitability of hospital units and their

equipment, and other factors of importance 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 overseas areas in order to gain firsthand information about their medical services.106

Further obstacles to planning were lack

of sufficient experience with battle casualties 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 patients 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 assumed 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 recommended in the spring of 1943 the establishment of an official evacuation policy

but such action was not taken until later

in the year.107

In providing hospitals for overseas service early in the war, the Medical Department 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 emergency hospital needs than the formation

and organization of units affiliated with

civilian hospitals and schools. Moreover, it

soon appeared that units planned for theaters of operations were not suitable for all

situations encountered in a modern global

war and units of new types had to be de104

 (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 (11-16-42),

CG SOS for ACofS OPD WDGS, 24 Nov 42, same

sub. (3) Memo OPD 701 (11-24-42), 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-SSPOPH-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 incl. 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 evacuation hospitals, and portable surgical

hospitals. The size and weight of equipment of all hospital units had to be reduced and new methods of packing had to

be developed in order to increase the mobility and transportability of hospitals.

Shortages of Medical Corps officers appeared and required reductions in the

number authorized by tables of organization developed during the emergency

period. Shortages of equipment continued

to plague the Medical Department and

partially accounted for The Surgeon General's insistence upon withholding its issuance until hospital units were assigned

to missions involving the care of patients.

In this connection, The Surgeon General

also resisted demands of higher authorities to plan for the use of numbered hospitals in the zone of interior medical service. Meanwhile other units were being

activated and trained, and toward the end

of General Magee's administration measures 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 Germany, 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 counteroffensive in December 1944, Allied

forces moved inexorably toward victory in

Europe and on 7 May 1945 Nazi Germany surrendered. Meanwhile, American

troops in the Pacific pushed closer to the

main Japanese islands, completing the reconquest 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 1,895,652.1

Combat developments inevitably influenced 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 hospitals 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 illnesses grew with the widening scope and

increasing intensity of combat and the exposure of larger 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 calculating 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 employees to produce war materials reduced

the manpower pool, both military and

civilian, upon which the Medical Department 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.
170 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

available. Instead of building new hospital plants, for example, the Medical Department 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. Policies for hospitalization had to be modified

in order to hold bed requirements to the

lowest practical number. And the organization and administrative procedures of

hospitals had to be standardized and simplified to permit relatively smaller and

more heterogeneous staffs to operate them.

The task of using limited means effectively 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 continuity 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 expanded and strengthened his own office

and sought changes in the existing War

Department organization to facilitate discharge 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 created by a shift from the defensive to the offensive 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 headquarters 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 growing 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 regain 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 matters as well as the strategic direction of theater forces were confirmed and strengthened. G-1 became concerned about allocation of personnel for medical service

throughout the world, and G-4 devoted

growing attention to bed requirements

and the hospital system in general. In addition, 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. Finally, early in 1945 this trend culminated

in a War Department circular which,

while not removing him from ASF jurisdiction, 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. Millett, The Organization and Role of the Army Service Forces (Washington, 1954), Chs. IX and X; and

Ray S. Cline, Washington Command Post: The Operations 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 further interpreted as also giving The Surgeon General direct access to the Secretary 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 active 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 wording that could be interpreted as giving it

operational responsibilities for any aspect

of hospitalization. Meanwhile, Medical

Department officers who had been assigned 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 remaining 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 authority 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 discharge 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 commanders 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 command 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 position as staff officer directly under the service 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 administration 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 letters calling attention to the implications of

these studies were sent to service command surgeons monthly.7

 Also, in 1944

2

 (1) WD Cir 120, 18 Apr 45. (2) Millett, op. cit.,

pp. 298-310. 3

 Memo, SecWar for [CofSA], 6 Apr 45. HRS: G-1

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 service command.
FURTHER CHANGES 173

the Surgeon General's Office adopted the

"flying circus" method of inspection for

hospitals. Representatives of such segments of the Office as the Professional

Consultants Divisions, the Nursing Division, 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 representatives, 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 command surgeons and reduced confusion in

the field which had formerly resulted from

successive inspections by separate individuals and from the receipt of instructions 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 General'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 transfer of responsibility for convalescent hospitals (units designed for the care of shortterm 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 General Staff and the Ground Forces in establishing a general basis for the allotment of

mobile hospital units to theaters, AGF

headquarters was primarily responsible

for the more detailed preparation of mobile hospitalization for separate theaters.

Planning for fixed hospitalization in theaters for troops of all major commands—

Air, Ground, and Service Forces—continued to be, but not without opposition

by the Air Forces, a responsibility of the

Surgeon General's Office and ASF headquarters.11

Uncertainty about the extent of the Air

Forces' authority over hospitalization continued. Surgeon General Kirk believed

that all hospitals in the United States

should be combined into one system under 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 interior hospital system.13

 Attempts to establish separate AAF hospitals in theaters of

operations, though less successful, exemplified the Air Surgeon's drive for a completely 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 inspections are found in SG: 333.1 for each service command. 9

 (1) Memo for Record, by [Col] R. B. S[kinner],

26 Aug 43. Ground Med files: Transfer Binder Journal, 1943. (2) 6th ind SPMCP 322.15-17 (Cp Mackall)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 Conv 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 SvCs, 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 reorganization 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 dependent upon service forces hospitals for

the care of personnel in communications

zones. In some theaters local air and theater surgeons arranged for the attachment,

but not the assignment, of a limited number of either mobile or fixed hospitals to

theater air commands,14 but the Air Surgeon considered this arrangement unsatisfactory. He wanted theater air commands

to have complete control of their own hospitals. 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 absence from air commands, and the need of

air forces men for professional care that

was "directed from an aero-medical viewpoint."

 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 attempted 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 Surgeon General's Office and ASF headquarters.16

 To secure data for use in winning

greater support from the Air Staff and in

countering ASF arguments, the Air Surgeon 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 hospitals 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 headquarters, ASF headquarters, the Surgeon Gen14

 (1) Air Evaluation Board, SWPA, The Medical

Support of Air Warfare in the South and Southwest

Pacific, 7 December 1941-15 August 1945, pp. 431ff.

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 Overseas Hosp. HD: TAS, "Hosp for AAF Units Overseas." Also see Ltrs from Air Surg, cited below. 16

 (1) Memo, Air Surg for C of Air Staff, 29 Nov

43. (2) Comment 2, Col H. C. 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 Limits of US. (5) Memo, CG

AAF for CG ASF, 16 Feb 44, sub: Med Care of AAF

Pers, with incl. 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 commands 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 Overseas Hosp. HD: TAS, "Hosp for AAF Units Overseas."
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 installations were in reality small hospitals,

use of the term "dispensaries" kept nominally intact the War Department policy of

having service forces provide fixed hospitalization 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 situation 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-rangebomber 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 headquarters offered to furnish them. OPD

was on the verge of authorizing it to do so

when the Surgeon General's Office proposed instead the transfer of certain hospital 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 theater air forces could have separate hospitals.21

 To support his position the Air Surgeon used replies which he had received

from his March questionnaire. While they

did not show a unanimous desire among

air command surgeons for separate hospitals, they gave the Air Surgeon substantiating data for his position. The Air Staff

remained nonetheless unconvinced of the

wisdom or desirability of pressing for separate air forces hospitals generally. Instead, the Air Staff directed the Air Surgeon to prepare a study showing the need

of the XX Bomber command, at that

time located in India, for separate hospitals. 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 Surgeon had difficulty preparing a study

which the Air Staff would approve. He finally 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: Designation 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 Support 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 services."

 22

 Thus, overseas air forces never received official authority to establish

separate hospitals. In some theaters they

set up hospitals under the guise of dispensaries, while in others they operated hospitals 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 expansion and strengthening of his own Office.24

In July 1943 The Surgeon General

combined his Hospitalization and Evacuation Division with his Hospital Construction Division to form a single unit: the

Hospital Administration Division. Proposed by ASF headquarters as a means of

simplifying the organization of the Surgeon General's Office,25

 this step concentrated related functions—hospital construction, 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 August 1945 was Col. Albert H. Schwichtenberg, had four branches. The Policies

Branch, under Lt. Col. Basil C. MacLean

until he was succeeded by Lt. Col. James

T. McGibony in the fall of 1944, was responsible 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 responsible for co-ordinating the work of the

Surgeon General's Office with the Engineers in the construction and maintenance

of hospital plants. The fourth branch, the

Liaison Branch, was new and was established to meet needs that had developed

in the course of the war. It was charged

with maintaining liaison with the Transportation Corps in the movement of patients, 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.26

During the winter of 1943-44 a major

expansion and reorganization occurred.

Personnel limitations and prospective

combat-casualty loads complicated problems of planning and providing hospitalization 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, MC, 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 general reorganization, see Blanche B. Armfield, Organization and Administration (MS for companion vol.

in Medical Dept, series), HD. 25

 Memo, SG for CG ASF, 18 Jun 43, sub: Orgn of

SGO, 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. Information 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 proposed in September 1943 that this should

be considered a "new activity."

 28

 At any

rate, early the next year the Surgeon General's Office began to negotiate with ASF

headquarters for the transfer of personnel

to establish a "Facilities and Personnel

Utilization Branch" in the Hospital Administration Division. Organized by Dr.

Eli Ginzberg, an economist and statistician on loan from the ASF Control Division, this Branch was charged in February

1944 with making comprehensive hospitalization plans, including the calculation

of bed and personnel requirements, the

utilization of available buildings and personnel, and the modification of the hospital system to achieve greater efficiency

and economy in operations.29 Soon afterward, in an attempt to achieve greater

co-ordination among operational segments of his Office, The Surgeon General

reorganized his entire Operations Service.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 sections of the Liaison Branch of the Hospital Administration Division: the Prisonerof-War Liaison Unit, the Women's Medical 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 Surgeon's Office. Like the Hospital Administration 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 Schwichtenberg, 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 Hospital 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 activities was given higher status than formerly, (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 execution 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 twentythree officers and thirty-six civilians un27

 (1) Memo, Dir Control Div SGO for [Maj] Gen

[Norman T.] Kirk, 13 Jan 44, sub: Proposal for Overall Plan for Most Effective Util of Off Almt, Civ Pers,

and Space in the SGO and for Modifications in Present 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 Operations 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, reorganization, shipment, disbandment and

inactivation of such units; and maintained 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 essential technical medical data (ETMD's);

maintained records of trips of inspection

made by representatives of the Surgeon

General's Office; and interviewed and circulated reports of interviews with medical

personnel returned from overseas areas.

The Technical Division included among

its many duties the preparation and revision of tables of organization and equipment, Medical Department equipment

lists, and tables of allowances.

The Special Planning Division was responsible for plans for the demobilization

of the Medical Department and for the

medical care of civilians in occupied countries.33

A separate unit of the Operations Service, the Strategic and Logistic Planning

Unit, was responsible for determining "the

adequacy of all phases of Medical Department operations, and plans therefor, to the

extent necessary to insure timely placing

of sufficient personnel, equipment and

supplies to meet all authorized requirements,"

 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 responsibility 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.

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 Liaison 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 hospitals and the movement of patients to those

beds. In August 1944 the Women's Medical 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 responsibility, as the Resources Analysis Division, 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 centralizing operational activities and separating

administrative from advisory functions,

responsibility for the operation of the reconditioning program was transferred in

April 1945 to the Hospital Division, leaving the Reconditioning Consultants Division 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 increasing attention was given to management techniques, the Control Division

entered the hospital operations field and,

in co-operation with the Hospital Division, attempted to standardize and simplify hospital administrative procedures.40

37

 Memo for Record, by Col Tracy S. Voorhees,

Dir Control Div SGO, 3 May 44, sub: The MRO

Set-up. SG: 024.-1. 38

 An Rpt, Resources Anal Div SGO, FY 1945.

HD.

39

 (1) Morgan and Wagner, op. cit., 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 increased, changes and adjustments were

made in the hospital system. Among the

more important reasons for them were the

necessity of using limited personnel resources—particularly doctors — more effectively 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 numbers 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 Surgeon General and headed by Brig. Gen.

Albert W. Kenner to study Medical Department personnel utilization; the Hospital and Control Divisions of the Surgeon

General's Office; the ASF Control Division; and the Inspector General's Office.

These groups agreed that certain steps

were desirable: reduction in size and number of station hospitals; merger of neighboring hospitals to eliminate overlapping

and duplication; and removal of convalescent 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 personnel. 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 over1

 (1) Mins of Mtgs and Rpt of Bd of Off to Study

the Util of MC Offs, 17 Sep 43-6 Nov 43. HD: 334

"Kenner Bd." (2) Memo, Dr. Eli Ginzberg, Control

Div ASF for Chief Oprs Serv SGO thru Dir Control

Div ASF, 30 Nov 43, sub: Surv of Gen Hosps. SG:

333.1-1. (3) Memo, Lt Col Basil C. MacLean, Hosp

Admin Div SGO for Gen [Raymond W.] Bliss thru

Col [Albert H.] Schwichtenberg, 6 Nov 43, sub: Observations Based on Recent Visits ... to 9 Gen

Hosps. Off file, Gen Bliss' Off SGO, "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 SGO. SG:

333.1-1. (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 training 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 General'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 planning 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 Administration 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 recommended 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 published regulations to effect them early in

1944.5 Concurrently The Surgeon General's Facilities Utilization Branch began

to urge service command surgeons to increase 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 "constructed 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 allotted supplies and personnel. The first such

reports revealed that considerable progress 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 station hospitals did not eliminate the problem 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 SvC, 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." 3

 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 Bed's 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. 6

 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: Resources Anal Div file, "Hosp." 7

 Form SG-396, Weekly Health Report, was revised 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 caring for overseas patients, the Air Forces, it

will be recalled, had built up station hospitals to the point where many were

staffed and equipped to give general-hospital-type care, and the Air Surgeon opposed transferring Air Forces patients to

general hospitals, operated by the Service

Forces, when there were AAF station hospitals capable of treating and caring for

them. On the other hand, Surgeon General Kirk opposed separate Air Forces station hospitals.9

 If they were to continue,

he contended, their staffs should be reduced in quantity and quality to the level

required to care for only minor ills and injuries, and patients from the Air Forces as

well as from the rest of the Army who required 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 reassign 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 revised policy was published in November

1943. In addition to establishing criteria

for the selection of cases for transfer to

general hospitals, this policy clearly limited station hospitals to such operations as

appendectomies, herniotomies, and the

treatment of simple fractures of the extremities.11

 The inference was that specialists were not needed in station hospitals.

Almost immediately the Air Forces protested 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 effectively if specialists and patients requiring

specialized care were concentrated rather

than scattered,13 the Deputy Chief of Staff

of the Army directed a compromise between 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, however complicated, for which they had adequate 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 CG 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-1 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: 704.11 (10 Nov 43) (1). (2) WD Cir 304,

22 Nov 43. 12

 Memo, CG AAF for ACofS G-1 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-1 WDGS,

13 Dec 43, same sub. (3) Ltr SPMCM 322.051-1, SG

to CG ASF, 15 Dec 43, sub: MC Offs for Asgmt to

ASF T/O Units. All in AG: 704.11 (2 Dec 43). 14

 (1) Memo WDCSA 705 (24 Dec 43) DepCofSA

for ACofS G-1 WDGS, 24 Dec 43, sub: Sec 2, WD

Cir 304, 22 Nov 43. AG: 704.11 (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 patients not only from the Air Forces but

from the Service and Ground Forces as

well. The Deputy Chief of Staff accordingly directed the commanding generals

of the Air and Service Forces to prepare

a combined plan for hospitalization "on a

regional and military population basis, irrespective of command or service jurisdictional 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 applicable 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 hospitals be designated as specialized hospitals, regional hospitals, and station hospitals; 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 Surgeon 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 development 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 convales15

 (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: Proposed Plan, SGO, for the Util of MC 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, prepared 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 Fld. 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: Resources 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 requiring merely the treatment usually

given in station hospitals but also to serve

as general hospitals for zone of interior patients. General hospitals were to have the

most highly specialized staffs and to them

were to be transferred all patients evacuated from theaters of operations, except

those needing only convalescent care.

General hospitals were also to accept patients 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 hospital 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 retained the right to operate all general hospitals 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 station hospitals agreed upon between The

Surgeon General and the Air Surgeon.21

Soon afterward both The Surgeon General

and the Air Surgeon issued directives covering 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 complicated cases to regional instead of general 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 establishment of regional hospitals had eliminated much duplication.24

 During 1945,

when the patient load became heavy because 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 hospitals could take over still more of the general 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 gen20

 WD Cir 140, 11 Apr 44. 21

 Memo, CG ASF for DepCofSA, 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 different 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 Pnts in Regional Hosps

as of 25 Aug 44. SG: 632.2. 24

 Memo, Act IG for DepCofSA, 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 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. (2) Interv, MD Historian

with Lt Col James T. McGibony, MC, formerly Chief

Hosp Div SGO, 20 Feb 50. HD: 000.71.
186 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

eral and convalescent hospitals to handle

the growing influx of patients from overseas, G-4 directed the Air Forces to investigate the possibility of caring for overseas

patients in AAF regional hospitals.26 Taking the position that maximum use had to

be made of all available beds in order to

justify requests for additional beds in general and convalescent hospitals, G-4 later

directed that overseas casualties should be

placed in 4,000 beds in AAF regional hospitals which the Air Surgeon offered for

that purpose. G-4 stated that this was an

emergency measure and did not alter current policies (presumably the policy established by the Secretary of War in 1943

that all overseas patients, with minor exceptions, should be treated in general hospitals).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 hospitals, 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 investigation 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 approval of a directive making this recommendation effective. On 20 June the Secretary 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 hospital beds to take the load off the general

hospital system. The Surgeon General concurred with this statement and the original

demand was accordingly dropped.30

This development did not alter the fact

that occupancy of general hospital beds at

the end of June—despite provision of addi26

 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, CG 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 memorandums 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), CG ASF to

DepCofSA, 5 Mar 45, on Memo WDGS 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) Memo, DepCofSA 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 DepCofSA, 14 May 45,

sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632

(14 May 45). (4) Memo, Chief Planning Br G-4 for

ACofS G-4 WDGS, 2 1 Jun 45, sub: Conf with SecWar 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 disposition of patients—ran above what was normally considered the saturation point (80

percent of capacity) while the occupancy

of regional hospital beds was considerably

lower.31 Whether this situation was preferable 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 Department'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 Division 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 General had requested. It was also argued

that filling the beds of regional hospitals

with long-term patients would use up excess capacity needed to provide extra hospitalization 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 Surgeon General's argument that the administrative difficulties of adding a large

number of hospitals to those already treating overseas patients would have outweighed the gain of 12,000 beds. But it

could not be denied, of course, that "diversion of patients from the general hospital

system would prevent control of treatment

by the agency now charged with their

care."32

This last argument perhaps held the key

to the entire matter. After the establishment 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 hospitals, 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 occupied, because some of its beds were always required

for dispersion. In August 1944 the Facilities Utilization Branch, SGO, proposed reducing the "dispersion

factor" in estimating requirements from 20 to 15 percent because of a "liberal furlough policy." (Memo,

Eli Ginzberg for SG, 18 Aug 44. HD: Resources Anal

Div file, "Hosp.") In estimating requirements in January 1945 no beds for dispersion were included "on

the assumption that furloughs will provide the necessary 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), CG 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 Regional 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 participated in these transactions afterward interpreted 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 hospital system equal to that of the Service

Forces are considered. It may also derive

color from the fact that The Surgeon General, in tracing for the benefit of the Secretary 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 interpretation is the accusation by the Air Surgeon and members of his staff that The

Surgeon General was using delaying tactics. 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 authorized as types of Army hospitals in the zone

of interior in April 1944, but their origin

lay in the early war years.36 Under authority granted by the Secretary of War in July

1943, the Air Forces announced the establishment 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 operations solely because of operational fatigue.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 belonged, 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 finding suitable housing for annexes, the program was slow in getting under way and

convalescent patients accounted for approximately 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 patients should be removed from the wards

33

 Interv, MD Historian with Col John C. Fitzpatrick, MC, 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. MC] 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 ltr. 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 additional beds be provided in convalescent

"facilities," rather than in general hospitals, 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 Atterbury (Indiana), Fort Sam Houston (Texas), Fort Custer (Michigan), and Fort

Devens (Massachusetts).40

Meanwhile, a War Department circular

authorized convalescent hospitals, as distinct from convalescent centers, annexes,

and facilities. Accordingly, in June 1944

the War Department designated as convalescent 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 authorities; 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 rehabilitation of blinded war casualties, this hospital

soon afterward received personnel and

equipment for a social-adjustment training 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 movement of higher authorities to reduce the

numbers of beds in the United States, G-4

took up the matter of convalescent hospitals and in November, as a part of a compromise 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 Retraining Units. SG: 632.-1. (2) Memo, Dir Hosp Admin

Div SGO for Chief Oprs Serv SGO, 4 Dec 43, sub:

Rpt of Trip to . . . 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

 WD Cirs 140, 11 Apr 44; 228, 7 Jun 44; 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 SvCs;

An Rpt, 1944, Mitchell Conv Hosp; An Rpts, 1945,

Brooke and Wakeman Hosp Ctrs. 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 installations. 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 facilities," including "physical and psychological rehabilitation, vocational guidance,

prevocational training and resocialization."

 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 December 1944.46

During the first half of 1945, ASF convalescent hospitals were supplied with

personnel and equipment of their own;

the barracks in which they were located

were remodeled; shops, classrooms, gymnasiums and recreational facilities were

provided; and elaborate programs consisting of technical and prevocational training, general education, vocational counseling, 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 Medical Department to care for the peak load

of patients in the summer of 1945. It contributed to maximum use of specialists in

general hospitals. Furthermore, convalescent hospitals provided a better psychological environment for the care of many

patients, especially those suffering from

neuropsychiatric disorders, than did general hospitals.48

 Their value in the treatment of medical and minor surgical cases,

however, was questioned in the middle of

1945,49 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 convalescent patients from general hospitals,

groups studying the hospital system in the

fall of 1943 proposed the merger of adjacent hospitals into single installations. The

establishment of regional hospitals accomplished this in part, for in some cases nearby 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 Revised 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 Dom 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: Combination 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 general and station hospitals located on the

same Army posts, comparing personnel

required to operate them as separate installations with that needed for their

operation as consolidated hospitals. It appeared 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 supervision of the activities of two installations

by one rather than two commanding officers. Moreover, the commanders of general hospitals were subject to less control

by post commanders than were those of

station hospitals—an advantage from The

Surgeon General's viewpoint. The mergers were not expected to increase the number 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 overseas, beds formerly used for station hospital patients could be transferred to general

hospital use.53 Accordingly, five station

hospitals were consolidated with five general hospitals in the summer of 1944, as

follows: Fort Devens Station Hospital

with Lovell General Hospital, Fort Dix

Station Hospital with Tilton General Hospital, 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 general hospitals located near ports as receiving and evacuation hospitals. Throughout

the later war years Halloran, Stark, and

Letterman General Hospitals continued

to serve as debarkation hospitals, the latter 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 accepted their roles as receiving and evacuation, or debarkation hospitals reluctantly

because the processing of patients in

transit did not require the fullest use of

specialized equipment and staffs and because 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 SGO for Chief Oprs

Serv SGO, 24 Apr 44, sub: Pers Study of Five Contiguous Sets of Sta and Gen Hosps. HD: Resources

Anal Div file, "Hosp." 53

 (1) Ltr, SG to Fed Bd Hosp, 27 Jun 44, sub: Combination 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. IV, 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 Resources 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 Capacity. 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 example, thought that this practice interfered with efficient operation of the evacuation 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 receiving 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 circular 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 extent 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 headquarters to use the Camp Edwards Station

Hospital, instead of Lovell General Hospital, as a debarkation hospital for the

port of Boston. This action, he explained,

would make available more general hospital 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 elaborate 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 hospitals—those located at staging areas and

operated by the Chief of Transportation—

to free some general hospitals of debarkation work and to provide additional

debarkation beds that would be needed

for the anticipated load of casualties.62 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 Transportation agreed to convert hospitals in the

staging areas of the ports of Boston (Camp

Myles Standish), New York (Camp Kilmer and Camp Shanks), and Hampton

Roads (Camp Patrick Henry) into debarkation hospitals.64

 This action made it

57

 (1) Memo, Lt Col John C. Fitzpatrick, MRO, for

Col A. H. Schwichtenberg, Hosp Div SGO, 23 May

44. TC: 370.05. (2) Memo, Same for Chief Oprs Serv

SGO, 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 SGO thru Col A. H. Schwichtenberg, Dir Hosp Admin Div, 2 Feb 44, sub: The More

Efficient Util of Army Hosp Fac. Off file, Gen Bliss'

Off SGO, "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

 WD Cir 140, 11 Apr 44. 60

 An Rpts, 1944, Stark, Halloran, and Letterman

Gen Hosps. HD. 61

 (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 CG 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, Planning 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

a

 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: 322 Hosp. (2) Weekly Hosp Rpts, vol. II, No. 13, 30 Mar 45; No. 25, 22 Jun 45; and No. 35, 31 Aug 45.

unnecessary to devote more space in Halloran General Hospital to debarkation

work and made it possible to free all of

McGuire General Hospital and the Camp

Edwards Station Hospital, which was converted into a general hospital, for specialized medical and surgical treatment.

(Table 12) Later in 1945 the Camp Haan

Regional Hospital took over from Birmingham General Hospital the processing

of patients debarked at Los Angeles.65

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 increased during 1944 and 1945 the Air

Forces selected certain station and regional hospitals located near important landing 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, 11 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.66 Six were used for debarking 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 almost 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 installation, 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 before it was constructed, its approval represented a further development in the movement toward the use of less elaborate

facilities than general hospitals for debarkation 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 hospital 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 requirements for beds for specialized treatment. 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 together. By the time of the invasion of

Europe, the peak patient load had been

estimated and the last of the general hospitals, with the exception of four temporary 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 increasing shortage of specialists made their

concentration for maximum use more imperative 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 specialized centers and in the preparation of

a comprehensive plan to meet it.69

The general features of this plan, announced in a War Department circular in

August 1944, remained unchanged

through the remainder of the war. Related

66

 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: OCS 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, Fairfield-Suisun Army Air Fld. (2) DF WDGDS 12801,

ACofS G-4 WDGS to CofSA, 10 May 45, same sub.

(3) Ltr, SecWar to Brig Gen Frank T. Hines, Chairman Fed Bd Hosp, 15 May 45. All in HRS: OCS 632. 69

 (1) Ltr, SG to CG 4th SvC attn SvC Surg, 14 Jun

44, sub: Specialized Gen Hosp. SG: 323.7-5 (4th

SvC)AA. 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 hospital to improve the quality of professional

care. For example, neurosurgical and

neurologic centers were established together, 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 population density, to permit compliance as

far as possible with the policy of hospitalizing patients near their homes. Success

in such attempts was limited by at least

two factors: (1) there were proportionately

fewer general hospitals in densely populated 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 number of centers—in some instances as few

as two—in certain specialties such as tuberculosis, 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 centers. In the fall of 1944, for example, amputation centers were increased from 500

to 750 beds each and neurosurgical centers from 250 to 500. Subsequently, to

care for the peak patient load, capacities

were further increased, some centers having 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 numerous as to warrant the designation of

centers for the treatment of those conditions, and a shortage of internists

prompted the establishment of general

medicine as a specialty. General and

orthopedic surgery also became specialties 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 treatment, 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 specialties with a total of 132,178 beds in 65

general hospitals in the United States.70

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 internment camps in this country, the system of hospitalization formerly established

was changed only slightly during the latter half of the war. Such prisoners continued 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 Cir 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 Division, 30 June 1945. Off file, Resources Analysis Div,

SGO.
196 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

hospitals operated for U. S. Army patients. All Japanese prisoners were concentrated, 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 establishing procedures for the reception, examination, 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 general hospitals for the care of tuberculous,

insane, blind, and deaf prisoners; and, in

order to simplify the observance of security and administrative regulations, they

adopted a practice of concentrating all

prisoners who needed general-hospitaltype 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 commands. Such dispersal made difficult the

work of a commission charged with determining the eligibility of some prisoners for

repatriation as well as that of a group responsible for certifying others for "protected status" as medical personnel, under

the terms of the Geneva Convention.74

In anticipation of an influx of prisonerof-war patients after the invasion of Europe 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 generalhospital-type care, to process those eligible

for repatriation, and to hold others awaiting certification as protected personnel.75

His superior, the Deputy Chief for Hospitals and Domestic Operations, adopted

this idea and announced on 21 July 1944

that The Surgeon General was designating Glennan General Hospital as a German prisoner-of-war general hospital.76

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, 12 Jun 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 Disposition of PW Pnts in US, by Lt Col James T.

McGibony, MC. HD: 383.6. 72

 WD Cir 214, 15 Sep 43. 73

 PW Cir 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: Reception, 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: Resources 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 proposal, averring that all existing general

hospital beds—according to his estimates—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 station hospitals would violate the terms of

the Geneva Convention, and that the dispersion of prisoner-patients among many

regional and station hospitals was wasteful

of both medical and police personnel.

Early in October, therefore, ASF headquarters and G-4 approved the designation of the station hospital at Camp Forrest

(Tennessee) as Prisoner of War General

Hospital No. 2. 7 7 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 intelligence 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 prisonerof-war patients simplified administrative

and security problems and ultimately

saved American medical personnel. Prisoner-patients arriving at ports in this

country were transferred to either Glennan or Camp Forrest. There they were

sorted into three groups. Those who were

convalescent were transferred to convalescent 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 treatment were kept at one of the prisoner-ofwar general hospitals. In addition,

prisoners who were eligible for repatriation or for certification as protected personnel 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 repatriation because they were given little

opportunity to do actual medical and

surgical work. He recommended the removal 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 Pnts. 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-53129, Marshall to Eisenhower, 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 Disposition 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 recommendation.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 expansions of 1945 these hospitals grew beyond

all previous expectations. For example, by

April 1945 the Percy Jones General and

Convalescent Hospitals, with their annexes, had a strength, including both patients 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 General 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 administrative control over its own patients, requiring 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 simplify the administration of supply and

service activities and would permit the

transfer of patients between adjacent general and convalescent hospitals without

red tape. This had proved to be true when

hospital centers were established overseas.

Meanwhile, the Percy Jones General Hospital had already begun to centralize

under a single head each activity common

to both hospitals. Therefore the Operations Service sent representatives to observe its organization and operations, and

to discuss with its commander plans for

establishing hospital centers. These representatives found merit in such centralization, and the Surgeon General'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 provided for general and convalescent hospitals.85

 On 11 April 1945 the War Depart81

 (1) Memo SPMGO(4)383.6, Chief Med Liaison

Br SGO for Dep Chief Hosp and Dom Oprs SGO, 8

Jan 45, sub: Util of Enemy Protected Pers. HD:

319.1-2. (2) Rad, Lull (SGO) to CGs 4th, 7th, 8th,

and 9th SvCs, 5 Feb 45. HD: 319.1-2. (3) An Rpt, FY

1945, Hosp and Dom Oprs SGO. 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 SGO, 31 Mar and 2 Apr 45.

HD: 024.7-3. 85

 (1) WD AGO Form No 026, Request and Justification for Publication, prepared by SGO, 24 Feb

45, sub: Hosp Ctr (ZI). (2) Memo SPMCH 300.5

(WD Cir), SG 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

merit announced that nine hospital centers, each composed of a general and a

convalescent hospital, would be established at Camp Pickett, Va.; Camp Butner, N. C.; Camp Edwards, Mass.; Camp

Carson, Colo.; Camp Atterbury, Ind.;

Fort Custer, Mich.; Fort Sam Houston,

Tex.; Fort Lewis, Wash.; and Camp Forrest, Tenn.86

 Local commanders then ran

into problems in consolidating and reorganizing general and convalescent hospitals into hospital centers. Lacking authoritative 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 establishment 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 convalescent 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 adjustments 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 additional impetus from a belief that convalescent 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 hospitals, had their origins earlier and were

designed to improve the quality of hospital

care. Others, such as the merger of adjacent station and general hospitals and the

establishment of hospital centers, were expected to improve administration. Since

most of the changes were the result of wartime 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 Ctrs; and An Rpt, FY 1945,

Hosp and Dom Oprs SGO. HD.
CHAPTER XI

Bed Requirements in the Zone

of Interior

While most changes in the hospital system, discussed in the foregoing chapter,

were expected to conserve medical resources, especially physicians, they obviously 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 patients of a particular type in any available

vacant bed occasionally required the provision of more beds than otherwise needed.

Under current policies, for example, vacant 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 station hospitals could not be used for

prisoner-of-war patients requiring generalhospital-type care to avoid the establishment 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 estimated 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 numbers of combat casualties than numbers of

patients resulting from the normal incidence 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 General 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, inadequate manning of the hospitals provided. The Surgeon General's Office, ASF

headquarters, the General Staff, and other

agencies of the Government participated

in determining bed requirements, and differences of opinion that arose among them

illustrated the complexity of the process.

Despite the restrictive personnel situation in the fall of 1943, The Surgeon

General's Hospital Division continued to

consider the problem of meeting bed requirements primarily in terms of construction. Following the former practice of figuring 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 December 1945, but that the number of beds

needed in general hospitals would increase
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 Surgeon 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 construction 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 invasion 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 engaged in combat; the rate at which troops

in theaters would suffer wounds, accidental injuries, and diseases; and the proportion 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 nonbattle 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 campaign in Russia (1941). Information about

the German campaign, incidentally, was

found in a study prepared by the Office of

Strategic Services. The proportion of overseas patients who would be evacuated to

the United States was estimated on the

basis of World War I experience, "reinforced by the derived estimate of the German experience in the Russian campaign."

This estimate—30 percent of estimated

battle casualties and 3 percent of estimated

disease and nonbattle-injury cases—differed only slightly from figures for World

War I. These estimates were used to calculate 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, FY 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

for FY 1945. HD: 319.1-2. (3) Ltr, [Dr.] Eli Ginzberg

to Col Calvin H. Goddard, 2 Jan 52. HD: 314 (Correspondence on MS)V. 4

 Hosp and Evac: A Re-estimate of the Pnt Load

and Fac, Feb 44, Introduction, p. 1. HD: 705.-1.
202 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

would need beds in general hospitals, recent experience in transfers from station

hospitals (0.5 percent of the troop population) was applied to the projected strength

for 1944.

From the calculations and interpretations 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 operations and transferred from zone of interior hospitals. Such patients would normally have been provided for in general

hospitals, but on this occasion The Surgeon 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 percentage basis, would be needed by the end of

1944. Instead, in view of the limited number 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 proposed in February 1944 that an additional

40,000 beds be provided in convalescent

"facilities." Such facilities could be operated either as annexes of general hospitals

or as separate installations and would require 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 representatives of the Surgeon General's Office, the Office of the Chief of Transportation, 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 nonetheless at similar estimates of the patient load,

particularly for the first ninety days of operations 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 provide 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 facilities thus authorized but ASF headquarters 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 medical support for theaters of operations,8

demanded more attention than zone of

5

 The above two paragraphs are based on the following: (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

Calvin H. Goddard, 2 Jan 52, HD: 314 (Correspondence on MS)V. 6

 (1) Memo, Dir Plans and Oprs ASF for Dir Planning 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 agencies 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 occupancy. Statistics published by the Surgeon 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, optimism about an early end of the war made

it seem unlikely to officers in ASF headquarters and the General Staff that the

occupancy rate would increase appreciably.10

 Meanwhile various expedients

were being used to supply theaters with

their quotas of beds, among them the shipment of hospital units without full complements of professional personnel.11

 The

Deputy Chief of Staff expressed the opinion that this practice would be unnecessary if medical personnel and facilities

were properly used. He therefore directed

The Inspector General in September 1944

to investigate duplication of hospitalization 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 several days before the Deputy Chief of Staff

criticized the use of medical resources. As

early as May 1944, in the course of discussions with the General Staff about nurse

requirements, The Surgeon General's Facilities Utilization Branch had informally

proposed a reduction from 4 to 3.6 percent 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 proposed by The Surgeon General in August—was established by War Department directive.14

 The same directive,

however, authorized for the first time a

ratio for regional hospital beds: 0.5 percent of troop strength. Formerly used to

estimate the number of beds in general

hospitals needed to care for zone of interior patients transferred from station

hospitals, this figure was adopted because

such patients were eventually to be transferred to regional instead of general hospitals. Since no corresponding reduction

was made in the number of beds authorized for general hospitals it is difficult to

see that the reduction in the station hospital 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 General as only a step in the right direction.

The ASF Director of Plans and Operations 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 Comd Surgs, Off of

Air Surg, 16-20 Apr 45. SG: 337. (2) Interv, MD Historian with Lt Col James T. McGibony, MC, 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 WDCSA 632

(25 Sep 44), DepCofSA for IG, 25 Sep 44, sub: Hosp

Fac in ZI. HRS: WDCSA 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-1

and G-4, 10 Jun 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.

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 battle casualties and their evacuation from

overseas had been less than estimated, he

called upon The Surgeon General to analyze the entire hospital program with a

view to reducing the number of beds in

station and regional hospitals by 25 percent and in general hospitals to 80,000.15

To effect this reduction would have meant

closing from twelve to twenty general hospitals—a proposal made verbally by the

War Department Manpower Board during the same month.16

The Surgeon General agreed that too

many station hospital beds had been provided, but he pointed out that he had already 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 hospitalization 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 European 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 considered it unwise to order such cuts in the

face of The Surgeon General's opposition.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 authorized 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 apparently directed ASF headquarters to plan

reductions in the number of general hospital 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 Program. HRS: ASF Planning Div file, 700 "ZI Hosp." 16

 (1) Remarks by Col Schwichtenberg, MC, 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 Planning Div file, 700 "ZI Hosp." 18

 (1) Memo, Dir Plans and Oprs ASF for CG ASF,

23 Sep 44, sub: ZI Hosp Program, with incl. HRS:

ASF Planning Div file, 700 "ZI Hosp." (2) MRS,

[Gen] Somervell to [Maj Gen Wilhelm D.] 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." 20

 S/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 present 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, regional, 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 concluded that a surplus of 78,000 beds existed

in the United States.22 The Surgeon General contended that beds in convalescent

facilities should not be considered as hospital 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 interchangeable. For example, under existing policies

vacant beds in station and regional hospitals could not be used for overseas evacuees. Nor were all beds in general hospitals available for the treatment of such

patients. Some were used for prisoners of

war, non-Army patients, and Army patients 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, therefore, that the Manpower Board's conclusion about a surplus of hospital beds was

invalid.23

The final decision which the General

Staff made in the face of conflicting arguments 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 convalescent beds—10,500 of them in AAF

hospitals. This was substantially the number recommended by The Surgeon General and the Air Surgeon and already set

up in convalescent hospitals. The Manpower Board now reluctantly agreed to

provide staffs for them. Moreover, the

Staff required no cut in the existing number 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 CofSA attn G-4 Div, 7 Oct 44, same sub.

Same file. (3) T/S SPMC 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 Huncilman (ASF), 26 Dec 44, sub: Background for Staffing 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. Schwichtenberg] and E. G[inzberg]) for

ACofS G-4 WDGS, 2 Nov 44, sub: Reqmts for ASF

Conv Fac. (5) S/S WDSMB 323.3 (Hosp), Pres

WDMB to CofSA, 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 announcing the Staffs decision on 17 November 1944, G-4 directed both AAF and

ASF headquarters to study the hospital

situation further in the light of actual experience and to submit by 15 January 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 headquarters decided that "unrefined data" on

hospitalization, published by the Surgeon

General's Office in Weekly Health Reports and in ASF Monthly Progress Reports, gave erroneous impressions and

made it difficult to arrive at sound conclusions about the adequacy of hospital facilities.27

 Earlier the Surgeon General's Office 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-hospital 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 patients, civilians, veterans, and Navy personnel, and the debarkation processing of

patients arriving from theaters of operations.28

 This implied that to get a true picture of hospitalization not only the capacity 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 "debarkation beds" from the number of authorized beds. The following month he

presented similar figures for regional and

station hospitals, and at the same time

gave the percentage of effective beds occupied in each class of hospital. This percentage, 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 General showed "patients remaining," a figure 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. Gfinzberg]) 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 Planning 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 authorized, 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 already 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 hospitals, 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 compromise decision of 17 November 1944, The

Surgeon General's Resources Analysis

Division made a new study of bed requirements 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 estimates of patients to be evacuated from

theaters during 1945, the prospect that redeployment would interfere with the use

of station hospital buildings for any possible overflow from general hospitals, and

G-4's directive that further recommendations 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 recommend reducing it. In estimating requirements for beds in general and

convalescent hospitals, the Division calculated the numbers of beds that would be

needed for three groups of patients: debarkees, zone of interior and non-Army

patients, and overseas patients. The minimum number of debarkation beds needed,

it was assumed, was one half the anticipated monthly evacuee load, or approximately 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 Planning 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

H. A. Huncilman, 25 Jan 45, sub: Hosp Occupancy

Data for Monthly Progress Rpt. HRS: Hq ASF Planning 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. Fitzpatrick, MC, formerly MRO, SGO, 18 Apr 50. HD:

000.71. (2) Memo, Eli Ginzberg for the Record, 28

Nov 44. HD: 560.-2 (Hosp Ships). (3) Memo for Record 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 conflicting 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 complicated cases from station to regional, instead of general, hospitals. Beds for overseas evacuees receiving definitive treatment 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 convalescent 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 additional 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 detachment, for whom other housing would be

provided; 8,000 by placing ambulatory

patients of general hospitals in post barracks; 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 general hospitals for patients needing prolonged care. The Surgeon General suggested that about 20,500 additional beds

in convalescent hospitals could be provided by using vacant barracks located

near by. In this connection it should be

noted that he followed a policy of expanding existing hospitals rather than establishing new ones because smaller ratios of

personnel to patients were required for

large than for small installations and

scarce specialists were used more advantageously by concentrating rather than

dispersing them.35

A combination of circumstances intervened 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 interior hospitals would increase. In addition, 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 Secretary of War wrote to the Chief of Staff

early in January: "If we later prove to

34

 (1) Memo SPMCH 322 (Hosp-Cp Edwards)C,

SG for CG ASF, 21 Nov 44, sub: Use of Cp 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, MC, 20 Feb 50. HD: 000.71. (2) JCS Document 1199, 16 Dec 44. SG: 560.2. (3) Rad CMOUT-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 Surgeon General's Resources Analysis Division seems to have established better relations than formerly with the War Department Manpower Board and a new Deputy

Chief of Staff of the Army, per haps inclined to be more favorable to The Surgeon General's position than his predecessor, 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 personal 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 number 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 headquarters 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 Office had reappraised its former estimate of

requirements. Beginning in December

1944 the number of evacuees arriving in

the United States from all theaters increased 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 previously expected, and that it would be

higher by 46,000 patients than the 198,-

000 estimated in December 1944. Accordingly, 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 DepCofSA

for ACofS G-1, G-2, G-3, G-4, and OPD WDGS

and for CGs ASF, AGF, and AAF, 13 Jan 45, sub:

Med Mission Reappraised. HRS: 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 Conf with Gen Marshall, Summary, 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 CG 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 Medical 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

a

 General hospitals—only general hospitals proper. b

 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 debarkation beds and for 25,000 additional convalescent 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 headquarters 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 authorized by placing more patients on

leave and furlough, by speeding the disposition of cases being treated, and by

limiting general and convalescent hospitals more strictly to overseas patients. ASF

headquarters agreed to some additional

construction to increase the capacity of

existing debarkation facilities and justified the beds authorized in January by explaining to G-4 the upward trend in

patient evacuation.43

The peak patient load in the zone of interior 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 hospitals were needed and that even more

might have been required if many patients had not been placed on leave or

furlough. For example, the patient census

of general, convalescent, and regional hos42

 (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 "Hosp." 43

 (1) Memo, SG for CG ASF, 6 Apr 45, sub: Gen

Hosp Program, ZI, with 1st ind. SG: 322 "Hosp." (2)

1st ind, CG 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, Control Division, ASF, lists the average number of Army

patients each month and shows the peak load occurring during July.
212 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

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 furlough. 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 hospitals might have been reduced in number

or that some might have been used for

overseas patients to relieve general hospitals 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 occupancy 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)

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, developments attending the estimation of requirements for both areas were in some

respects similar. Such similarities occurred

despite the fact that co-ordination between

interested divisions of the Surgeon General's Office was incomplete.

Until the late summer of 1943 the Plans

Division of the Surgeon General's Office

continued to plan hospitalization for active overseas theaters on the 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 Medical 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 constitute a safety factor.2

 Another reason of

equal cogency was that sufficient information about various factors that affected

bed requirements during World War II

was not yet available to justify the establishment of lower ratios than those derived 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 hospitaladmission rates; (3) battle-casualty hospital-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 determined with reasonable accuracy, admission rates for battle casualties could be

estimated only roughly and were therefore uncertain at best. The average length

of time that patients stayed in hospitals

depended upon some factors that were uncontrollable, such as the severity of

wounds and the seriousness of illnesses,

and upon others, such as evacuation poli1

 For example, see Ltr, SG to CG ASF, 13 Jul 43,

sub: Trp Basis for Pacific Area. SG: 320.2. 2

 Interv, MD Historian with Col Arthur B. Welsh,

MC, 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 numbers and types of patients to be transferred 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 theater 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 conveyances 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 "reasonable" 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 normally established by the War Department

only after consultation with theater headquarters, and several months were required 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 (ChinaBurma-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 patients to the United States and to return

replacements to theaters. In addition, the

European theater favored a 180-day policy 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 theaters preferred a 120-day policy, they requested 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 reported that members of his staff, including

General Snyder, had found in a survey of

North African operations that battlecasualty rates had been lower than anticipated and that hospitalization requirements 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 mobile 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 estimated 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 equipment to permit each fixed hospital to expand 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 computation by the Surgeon General's Office

of beds needed in each theater for disease

and nonbattle-injury cases, based on experience 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. Believing that fewer beds would suffice, OPD

used The Surgeon General's rates for disease 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 proposal 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 theaters, 6.6 percent for the North African

theater, 6 percent for the Middle EastCentral-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, spe8

 (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: "Approved as amended," by order of SecWar, by Col

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 Record, 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.
218 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

cial provision had to be made for the hospitalization 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 evacuation 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 desirable 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, Asiatic, 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 theaters—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, without conversion or reorganization, as was

done in the Asiatic and North African

theaters.18

When these changes did not erase deficits of fixed beds, other methods of increasing 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 hospital units were shipped from the United

States,19 but they were insufficient to supply all theaters with authorized bed

capacities.

Another method was to enlarge hospitals 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 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." 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 ComdrIn-Chief SWPA, 18 Oct 43, sub: Reorgn and Redesignation 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 Theater (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 Central Pacific theater enlarged the table-oforganization capacities of some of its hospitals in order to provide additional fixed

beds with a minimum of additional personnel,22

 and in December 1943 The Surgeon General asked other theaters to do

likewise.23

A third method of increasing numbers

of fixed beds was to expand hospitals beyond table-of-organization capacities—

that is, to have a 1,000-bed general hospital, for example, set up beds and temporarily care for more than 1,000 patients

without any increase in personnel. Anticipated in the provision that theaters be

authorized 50-percent expansion equipment, this method was used in many instances, 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 official evacuation policies to enable them to

transfer mope patients to the United

States. The South Pacific theater, for example, operated under a 60-day evacuation 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 Division 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 anticipated 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 document showing units needed and the time

20

 See T/O 8-560, Sta Hosp, 22 Jul 42 with C 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 ACofS 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 percentage could be applied generally, unless the essential difference between functions of general and station 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. Wilson, MC for Chief Control Div [SGO], 1 Nov 43, sub:

Visit to SWPA. SG: 333.1-1 (Aust) F. (2) Rad CMIN-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 evacuation in theaters of operations. 27

 See Chart 11.


222 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

of their shipment.28 Hospital 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 example, in November 1943 the Mobilization

and Overseas Operations Branch made a

study of units required by the eighth revision 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 recommended the inactivation and reorganization of certain station hospital units in

order to supply personnel for the required

number of general and field hospitals.29

ASF headquarters approved this recommendation 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 adjustments 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 reviewed 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 authorized by the Deputy Chief of Staff in August

1943.32 Finally, and not of least importance, under a system of telegraphic reporting 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 hospitalization and at the same time, by using up

more personnel in the form of replacements, 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 hospitalization. Early in February 1944 the Surgeon

General's Office warned ASF headquar28

 An example of this document, Twentieth Revision of the Six Months Forecast, Units and Availability, 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 CG ASF, 5 Nov 43,

sub: Activations, Reorgns and Inactivations of NonDiv 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 Victory 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: G32.-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 3: G-3 file, 700-

800.

33

 Memo WDGDS 6442, Act ACofS G-4 WDGS

for CG ASF, 7 Sep 43, sub: Hosp in Overseas Theaters, 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 informed 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 station, and 11 field hospital units were activated. 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 policy of releasing from zone of interior installations men who were qualified for overseas service, additional men became available, and during the five months beginning 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 difficulty 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 headquarters that physicians to staff forty general hospital units then in training could

not be procured until June and that full

officer strength for nine of the general hospitals 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 complicated by existing policies and practices

and by the attitude of theater commanders and surgeons.39

 Following a practice

adopted early in the war—the organization of all-Negro units to provide opportunities for the use of Negro doctors and

nurses—the War Department activated a

third Negro hospital unit—the 335th Station Hospital—in August 1943. Meanwhile 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: Projection of Non-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 companion 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 Department in January 1944 requested all theaters 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 Surgeon General in May 1944 appealed to

ASF headquarters for "efforts [to] be

made to obtain an appropriate assignment" for it.41

 The same month he appealed personally to the chief surgeon of

the European theater to use Negro nurses

in at least one hospital.42 The chief surgeon 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 ChinaBurma-India theater made a trip to Washington 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 ChinaBurma-India theater, and the demands of

other theaters, the use of the 335th Station 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 allNegro 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 Hospital (a Negro unit with four white officers

in command and supervisory positions),

the 268th, 335th, and 383d Station Hospitals (all-Negro units), and the 168th Station 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 hospitalization and evacuation requirements

for full-scale combat operations. In November and December 1943 the Com41

 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. Armstrong, 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 Minister, 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 Mediterranean) during May 1944 focused attention on the European and North African theaters,47

 and twice during the winter of 1943-44 the Surgeon General's

Office made studies of their need for hospital beds. On the basis of the first, made

by the Mobilization and Overseas Operations Branch,48

 The Surgeon General

recommended to ASF headquarters that

North Africa be supplied with additional

hospital units and with additional personnel 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 disapproved. OPD was handling requests

from North Africa for additional personnel 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 raising 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 theater, 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 reconsidered. He concurred in the decision

not to raise bed ratios, but recommended

that it be considered temporary, pending

accumulation of more definite information about needs. Furthermore, he warned

that evacuation facilities (ships and

planes) would have to be adequate to remove 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 Facilities 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

46

 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 invasions actually occurred later than planned. 48

 (1) Diary, MOOB SGO, 11-17 Dec 43. HD:

024.7-5, "MOOB Diary." (2) 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." 49

 Memo, SG for Dir Planning Div ASF, 17 Jan 44,

sub: Serv Units for NA Forces. HRS: Hq ASF Planning 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 Program Br file, "Hosp and Evac, vol. 3." (2) T/S, SG to

ACofS G-4 WDGS thru CG 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 facilities. 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 hospitalization will be discussed at this point.

Decisions concerning overseas hospitalization were made at a conference on 28

March 1944. At that time General Somervell 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 requested 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 additional 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 capacities of existing hospitals with personnel available in the theater. With War

Department approval, that theater inactivated six 250-bed station hospitals and

with personnel formerly assigned to them

expanded twelve 1,000-bed general hospitals 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 general 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 Planning 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/371 NATO (31 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 attempt to balance bed requirements against

the number of hospital units already authorized.

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 European, Middle East, and American theaters should remain unchanged. G-4

rejected the proposal to raise the North

African bed ratio above 6.6 percent, stating 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 reduced 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 Pacific, where the closure of small hospitals

released enough officers to expand capacities 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 Program 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 CMOUT-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 summer 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 physicians for assignment to units earmarked

for theaters. In addition, ratios of doctors,

nurses, and enlisted men to beds were decreased in numbered hospital units as well

as in zone of interior hospitals.62 Furthermore, hospitals were "short-shipped" to

the European theater—that is, before

completion of training and without balanced or full staffs of physicians. In such

cases, the theater was expected to complete the training of units and to supply

missing specialists and other Medical

Corps officers. Such personnel was believed 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' assistants.63

 Finally, it was recognized that

authorized bed quotas of theaters in some

instances could not be met even by expedients 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 Operations 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 indications" that ratios authorized for both the

European and the Southwest Pacific theaters could be lowered,65

 but a directive of

the Deputy Chief of Staff that requirements of the European theater be reviewed 30 days after the initial landing in

France (or the mounting of OVERLORD)

61

 (1) Rad WARX 62981, Marshall to Comdr-inChief SWPA; CG USAF CPA; CG USAF SPA; CG

USAF CBI. 10 Jul 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-IN25976, CG USAF SPA to WD and CG USAF CPA,

31 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 USF 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), Marshall 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 ACofS 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, ACofS 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 admissions for the first 32 days of operations in

France and computed actual hospital admission 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—although during one week it had been as

high as 89 per 1,000. Other studies showed

that the average length of time that patients 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 Europe during World War I—27.29 days. If

admission rates in the future should approximate those of the 32-day period of

operations in France and if the average

number of days patients stayed in hospitals should be as low as in the North African 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 policies, 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 percent 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 prisoners 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 percent 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 convalescent 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 European theater and, consequently, in the

number of hospital units that would have

to be sent there. In view of these considerations, ASF headquarters recommended

on 11 August 1944 that the authorized

bed ratio for the European theater be reduced from 8 to 7 percent and that its

evacuation policy be lowered from 180 to

120 days.70 The Deputy Chief of Staff ap66

 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 Program 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 CG

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, 11 Aug 44, with

Memo for Record, on Ltr, SG to CG 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 Japanese homeland and the necessity of caring for civilians on such islands might require 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 statistical 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 increased 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 soldiers 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 percent; to this ratio were added the following: 1.00 percent for increased operational requirements, .90 percent for hospital

dispersion, .45 percent for theater dispersion, .45 percent for Allied soldiers and

prisoners of war, and .45 percent for patients from mobile hospitals.74

 The sum of

these ratios was 7.00 percent and was considered 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 September 1944 The Surgeon General recommended 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 Pacific 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 Department 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 mobile hospitals to insure mobility. This had been

pointed out by the Surgeon General's Office in August 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 recommendations, with minor modifications,

but the General Staff took no final action

upon them because a new study of hospital 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 Manpower Board to save personnel by reducing the number of hospitals in the Army—

a drive which threatened the closure of

some hospitals in the United States in the

fall of 1944—extended to overseas areas

also.77 The method which the Board used

to compute theater bed requirements

differed from The Surgeon General's. The

Board proposed that the average noneffective 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 hospitalization for all theaters, since beds

were not actually needed for all noneffectives (some being treated in quarters) and

since all hospitals could expand authorized capacities by 50 percent. If any theater 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 noneffective 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 deleting 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 recommended on 29 September 1944 that all inactive general, station, and field hospital

units (having authorized capacities totaling 44,000 beds) should be deleted from

the troop basis; that no further fixed hospital units be sent to theaters of operations; 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 restudied by 1 November 1944.79

Although OPD believed that these recommendations 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,

CG ASF for ACofS OPD WDGS, 16 Sep 44, sub:

Hosp and Evac, POA and SWPA. HRS: Hq ASF

Planning Div, "Hosp and Evac." (2) Memo WDGDS

3710, ACofS G-4 WDGS for DepCofSA, 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 ACofS 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), ACofS G-3

WDGS for CofSA, 29 Sep 44, sub: Fixed Bed Reqmts.

HRS: G-4 file, "Hosp and Evac Policy." 80

 DF, Act ACofS OPD WDGS to ACofS 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 hospitalization 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 "admission rate" method used earlier for the European 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 certain principles or assumptions which the

Mobilization and Overseas Operations

Division considered important. First, hospitals could operate with 50 percent more

patients than authorized beds for only

short emergency periods and hence expansion 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 theaters to transfer larger proportions of patients to the United States, the maintenance 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 Overseas Operations Division used actual admission rates for disease and nonbattleinjury patients for the period from July

1943 to June 1944 for most theaters. In

some instances, these rates had to be adjusted. 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 Pacific Ocean area had been 1.7, but in

anticipation of higher disease incidence in

future operations nearer Japan an admission 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 requirements by the "beds occupied" method 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-ofwar patients; and those required for dispersion. The ratio of occupied beds was

actual, based on statistical reports, but the

other ratios were estimated.

Different ratios of beds for the same theater 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 estimates 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 incl. 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 theaters except the American, China-BurmaIndia, Southwest Pacific, and Central Pacific. For the first three of these, The Surgeon General proposed reductions in

ratios from 4, 7, and 8 percent to 3, 6, and

7 percent respectively. For the last, he proposed 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 headquarters approved this study and its recommendations.82

Faced with varying estimates of bed requirements 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 General and G-3,83

 and of analyses of the different studies, G-4 arrived at a compromise which favored The Surgeon General

and on 2 November 1944 sent the following recommendations to the Deputy Chief

of Staff: (1) that the bed ratios recommended 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 Deputy Chief of Staff approved G-4's recommendations. The bed ratios thus authorized 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 percent 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 incl. (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 Overseas Theaters. Both in HRS: Hq ASF Planning div

file, "Hosp 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.
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 concurrence 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 personnel shortages and it was still necessary to

ship hospital units with less than full complements 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 hospitalization from November 1944 to May 1945

showed that enough fixed beds were supplied to meet actual requirements. During

this period only two theaters, the Southwest Pacific and the Asiatic, failed to receive 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 exception—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 theater.88

 For a short time, then, attention

was centered upon this problem. (Table

14.)

The Problem of the European Theater

in the Winter of 1944-45

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 rapidly. In addition, stoppage by the War

Department in the fall of 1944 of the

transfer (with few exceptions) of prisonerof-war patients to the United States resulted in the accumulation of 14,000

German patients in theater hospitals by

the end of December. Furthermore, failure of the European theater to follow

evacuation policies set by the War Department (because of a shortage of hospital

ships and the chief surgeon's opposition to

the use of transports for evacuation) created 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 Enlisted Technicians for Nurses in ETO Hosps. HD:

MOOD "ETO." 88

 An Rpt. SG, FY 1945, pp. 53-54. HD.

236 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

transfer to the zone of interior. Meanwhile, 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 theater'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 December 1944 the War Department informed the theater of this decision,91

 and

by February 1945 it had in operation or

in the process of organization prisoner-ofwar hospitals containing 13,000 beds.92

Failure of the theater to use vacant

evacuation space on troop transports

threatened not only to continue to contribute to a shortage of beds in Europe

and insufficient use of those in the United

States but also to create a serious evacuation problem. If patients were not evacuated as they accumulated it would be difficult 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 commanding 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.93 As a

result, the theater evacuated patients

under a 120-day policy in January, a 90-

day policy in February, and a 60-day policy in March and April.94

 By thus transferring a larger proportion of its patient

load to the zone of interior, the European

theater reduced its requirements for additional 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 December 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 expanding table-of-organization capacities

of station and general hospitals already

present.96 Later, ASF headquarters pro89

 (1) An Rpt, MOOD SGO, FY 1945. HD. (2) Interv MD Historian with [Maj] Gen [Paul R.] Hawley,

18 Apr 50. HD: 000.71. 90

 Ltr SHAEF 704-3 Med, SHAEF to CofSA thru

ACofS G-4 WDGS, 4 Dec 44. SG: 632.2. 91

 Rad, ACofS OPD WDGS to CG ComZ ETO

and CG 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

ACofS G-4 WTJGS, 4 Dec 44, sub: Evac from ETO.

HRS: G-4 file, "Hosp and Evac Policy." (2) Rad

CM-OUT-7211 3 (3 Dec 44), CofSA 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), ACofS 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 discussed, at the suggestion of the Chief of

Staff G-4 sent to Europe one of its representatives, Col. (later Brig. Gen.) Crawford F. Sams, a Medical Corps officer, to

discuss with the chief surgeon of the theater 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 hospitals scheduled earlier for shipment to

Europe.99

Meeting the needs of theaters for hospitalization in the latter part of the war was

characterized by efforts to estimate requirements as realistically as possible and

by the necessity of using a variety of expedients 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 experience; but as statistics of casualty and disease 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 capacities of some units, using the emergency expansion of others, and employing

units shipped from the zone of interior incompletely trained and staffed. Toward

the end of 1944 it was necessary to force

the European theater to observe War Department 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 expedients, such as the employment of captured enemy personnel in the the treatment 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 Fld Hosps from Auth

Fixed Beds, with Memo for Record. HRS: Hq ASF

Planning Div, "Hosp and Evac." 98

 (1) Memo, G. C. Marshall] (CofSA) for [Lt] Gen

[Thomas T.] Handy, 26 Dec 44. WDCSA: 632 A 414.

(2) Interv, MD Historian with Brig Gen Crawford F.

Sams, 18 Jan 50. HD: 000.71. 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: Diversion of Hosps. HRS: G-4 files, "Hosp, vol. III."
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 occupying 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 admitting patients to hospitals before performing 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 before their admission to wards. This practice 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 Surgeon 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 short1

 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 Commission on Organization of the Executive Branch of

the Government [Hoover Commission] by the Committee 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 C. 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 assignments, 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 hospitals repeatedly with the same complaints

and led to a tug of war between line officers and the Medical Department over

whether those who were not physically

disabled but were noneffective should be

given medical or administrative discharges.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 discharge at separation centers of all combatwounded enlisted men in the limited service 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 occupancy of beds to patients actually needing 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 process, for many factors affected it, some

tending to increase and others to shorten

it. Among them—aside from the seriousness of patients' wounds, injuries, and illnesses—were the speed with which

patients were transferred to proper types

of medical installations, the degree of recovery 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 disposing of patients after completion of treatment. 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 problem 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 Division, 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 dispositions. Over a long period of time a number 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-1 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, 20 Jul 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: 220.811-1. (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 announcements of hospitals' activity indices kept

before service command surgeons the importance 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 accelerate dispositions.9

 The following

month he established tentative monthly

quotas for the disposition of patients from

convalescent hospitals.10 Meanwhile, during the preceding year and a half, attention 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 patients promptly from station hospitals to

better staffed and better equipped hospitals, 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 hospitals involved, put an extra load on overburdened transportation facilities, and

increased the time patients stayed on hospital 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 injuries 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 authorized, a policy was established under

which patients were to be transferred

"without any more delay than is compatible with sound professional judgment" to

the "nearest adequate medical installations," regardless of their type—whether

regional, convalescent, or general hospitals—and regardless of the command

under which they operated.12 To implement this policy, both the Air Surgeon

and The Surgeon General applied to regional hospitals the bed credit system

which had been developed earlier to facilitate 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 transfer 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

 WD Cir 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 Division early in 1945 showed that forty-five

out of fifty-nine general hospitals were receiving patients who should have been

sent to other medical installations. "Beyond a doubt," a report on the study continued, "there are a large number of

overseas patients being transferred from

the debarkation hospitals to the general

hospitals who need little or no further surgical 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 involved 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 returned to duty were expected to be able to

do an effective day's work as soon as they

rejoined their outfits. To shorten the convalescent 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 transfer 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 treatment, along with the inability of Veterans Administration hospitals to accommodate large numbers of them1 8

 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 tuberculous or psychotic, until their definitive

treatment had been completed.19 As seriously wounded casualties began to fill hospital 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 hospitals until they had reached the "maximum degree of recovery."

 20

 In the following December, the President confirmed

this policy and broadened its application

to include patients whose disabilities had

not been incurred in line of duty.21 Hospital 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: Summary of Replies to the Furlough and Disposition

Study. Off file, Resources Anal Div, SGO. 16

 Richard L. Loughlin, [History of] Reconditioning [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 G. Urquhart, Veterans of Foreign Wars of US, 24 Mar 44. SG: 220.-

811-1. 19

 (1) WD AGO Form 026, prepared by Col William B. Foster, MC, 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 Surgeon 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 explained, referred to the point in a patient's

treatment when progress appeared to have

leveled off and no further substantial improvement 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 having unnecessary laboratory work performed 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 patientstay, as a reminder that unnecessary procedures should be avoided and requisite

medical treatment given promptly. Some,

and perhaps all, service commands accepted 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 personnel procedure over which the Medical

Department had no control. It was complicated by the fact that patients belonged to

different major commands (Ground, Service, 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 hospitalized 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 Clarification 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 Procedures. 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 returned 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 permanently incapacitated for full military

service should appear before Army retiring 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 forwarded recommendations of his disposition board to service command headquarters; 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 headquarters, and the Adjutant General's Office

attempted to find a way to avoid keeping

such officers in hospitals after their treatment 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 hospital and station commanders to return to

duty officers recommended for limited

service by disposition boards, without referring them, except in a few cases, to

retiring boards.30 This change in procedure reduced the length of stay in hospitals of officers in this category to such an

extent that it saved, according to the estimate of ASF headquarters, 1,000 hospital

beds annually.31

Improvements in Disability Discharge

and Retirement Procedures

Officers and men whose physical disabilities prohibited return to duty were

either retired or discharged from the service. 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 some27

 (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 CG 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-1 WDGS to SvC Comdrs, Retiring Bds, and all Named Gen Hosps, 10 Jul 43. SG:

334.6-1 Retiring Bds. 29

 Draft of WD Cir, 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 Cir). 30

 (1) Memo, CG ASF for ACofS G-1 WDGS, 25

Sep 44, sub: Physical Reclassification of Offs. AG:

210.85 (25 Sep 44)(2). (2) DF WDGAP 210.01,

ACofS G-1 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 Department it was important because any delay

in either procedure wasted beds by lengthening the stay of patients in hospitals.

Despite earlier attempts to remove

causes for delays, the disability discharge

procedure took more time than was considered necessary and in the fall of 1943

 32

both the Surgeon General's Office and

ASF headquarters began studies to simplify and standardize it. Because its Control Division was engaged in a more general study of Army administrative procedures, ASF headquarters directed The

Surgeon General to discontinue his study.

The ASF Control Division proceeded

thereafter, with assistance from the Surgeon General's Office, to develop and test

a revised procedure for disability discharges.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 discharges covered actions taken within hospitals themselves, since measures adopted

earlier had reduced administrative actions

required by headquarters other than hospitals.35

 This goal was more completely

achieved during 1944 when additional

post commanders delegated to hospital

commanders their functions relative to disability discharges, and the War Department 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 examinations 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 participated in the procedure, paper work

required for disability discharges was simplified. Separate forms and letters previ32

 (1) Memo, Dr Eli Ginzberg, Control Div ASF for

Chief Oprs Serv SGO thru Dir Control Div ASF, 30

Nov 43, sub: Surv of Gen Hosps. SG: 333.1-1. (2)

Notes on Visit to McCloskey, O'Reilly, and Percy

Jones Gen Hosps, 11 Dec 43, by Col Tracy S. Voorhees, Control Div SGO. Same file. 33

 (1) Memo, SG (Control Div) for Dir Control Div

ASF, 29 Oct 43, sub: Delays in Discharging Pnts

from Hosps. (2) Memo, SG (Control Div) for CG

Army Med Ctr, 29 Oct 43, sub: Delays in CDD Procedure. (3) Memo, CG ASF (Control Div) for SG

attn Dir Control Div, 5 Nov 43, sub: Delays in Discharging Pnts from Hosps. (4) Memo, Act Dir Control Div SGO for Brig Gen Edward S. Greenbaum,

Off of UnderSecWar, 16 Feb 44, sub: Improvements

in CDD Procedures. All in SG: 220.811-1. (5) An

Rpt, FY 1944, Control Div SGO. 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. SG: 220.811-1.

Similar letters were sent to each service command. (3)

Draft of Tentative Procedures — Discharge and Release from AD, Hq ASF, 5 Mar 44. AG: 220.8. (4)

ASF Cir 217, 13 Jul 44. (5) TM 12-235, Enl Pers—

Discharge and Release from AD (Other than at Separation Ctrs), 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 consolidated, and copies of different forms and

the number of signatures required on them

were limited. All forms were set up according to standard typewriter spacing to facilitate preparation and, in some instances,

rubber stamp entries were authorized.37

To insure speedy, well co-ordinated action

by all hospital officers concerned with discharges, 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 meeting, and the three following days. Finally,

the manual on the discharge procedure

showed graphically each step in a disability 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 procedure and with the saving in hospital beds

which it produced.39 According to an estimate of the ASF Control Division in April

1945, this saving amounted to an average

of seventeen days for each disability discharge 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 disabled 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 getting an officer before a retiring board was

complicated. After completion of treatment, his case was reviewed by a hospital

disposition board. If the board recommended retirement, its recommendation

was sent to higher headquarters, such as

that of a service command, for review. If

that headquarters approved the recommendation, 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 consider the officer's case. In the fall and winter of 1943 steps were taken to get records

37

 (1) TM 12-235, Enl Pers—Discharge and Release 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 SGO, and An

Rpt, FY 1945, Hosp and Dom Oprs SGO. HD. 40

 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." 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 Retiring 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. Schwichtenberg, 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 September, on The Surgeon General's recommendation, 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 hospitals 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 disposition boards.43

 In the latter half of 1944

another cause for delay was eliminated

when the Staff authorized hospital commanders to order officers to appear before

retiring boards without reference to higherheadquarters.44

Another method of speeding the retirement of officers was to prevent the development 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 delegated appointment authority to commanding 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 hospitalization of officers being physically reclassified 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 disability-discharge procedures, the same Division developed and published in 1945 a

technical manual on the retirement and

reclassification of officers.50 This manual,

like that on the disability-discharge procedure, gave detailed instructions in diagrammatic 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, according to ASF headquarters, the period of

hospitalization of officers awaiting disabil42

 (1) Memo SPMCH 300.3-1, Exec Off SGO 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)(1). (2) AR 605-250, C 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, SvC

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 Retiring 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 Retirement 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 occupancy 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 needing medical and surgical treatment were

less successful. Little if anything was done

to screen patients by physical examination

before admission to hospitals. The reassignment of those returning to duty continued to cause difficulty and delays in

disposition. And the policy of giving all

patients "maximum hospitalization,"

whether their disabilities had been incurred in line of duty or not, tended to

lengthen the average period of hospitalization 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 affecting 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. Although 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 "yardsticks" by which to measure their personnel 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 estimates in making personnel authorizations.

ASF headquarters then subdivided its

quota among service commands. Service

commanders in turn authorized personnel for subordinate installations which

then took similar action.3 Under this system, despite its nominally advisory capacity the Manpower Board exercised a rigid

control over the personnel which the Service Forces received, and subordinate commands 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 commands in manning hospitals, and perhaps

to influence service commanders in making authorizations, the Surgeon General's

Office developed manning tables for general, 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 gener1

 (1) Memo W600-27-43, 11 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 MC Offs, 19 Oct 43.

Off file, Gen Bliss' Off SGO, "Util of MCs 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 yardsticks and with recommendations made

by the Inspector General's Office. While

they were not compulsory they served as

guides supplied by the Medical Department 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 (military and civilian) per 100 beds in general

hospitals was 94. At that time 58.6 percent

of all beds in general hospitals were occupied. 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 number of patients on the rolls of general hospitals (those absent from hospitals on leave

or furlough as well as those occupying

beds) was 122 percent of their bed capacities, 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 general 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 resulted from a War Department policy

governing the use of personnel by the

Service Forces, reiterated by ASF headquarters in June 1943. In general, men

qualified for overseas service were to be

released as rapidly as possible from assignment 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 overseas service, hospital staffs were subject to

a continuous personnel turnover. For example, 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 DepCofSA thru CG ASF, 10

May 44, sub: Pers Strength Tables. ... (2) Memo,

WDMB 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 12 1 employees per 100 patients. See Warren P. Morrill,

"Ratio of Personnel to Patients." Hospitals (The Journal 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.
250 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

Day gave impetus to this turnover. Secondly, as hospitals replaced persons qualified for overseas service with those in other

categories, their staffs gradually became

heterogeneous mixtures of doctors, administrative 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 problems involved in the reduction, turnover,

and replacement of personnel in particular categories will now be considered.

Wider Use of Administrative Officers

Medical Corps officers available for assignment 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 hospitals 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 commanders apparently accepted the fact that

additional doctors were not available, for

they complained about shortages during

this period less than earlier. In a few instances 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 neuropsychiatrists, orthopedic surgeons, and neurosurgeons.11

 More frequently, they complained about constant changes in professional staffs and about the inferior quality 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 attention to professional activities.13

The chief method of relieving physicians of administrative work was the more

extensive use of Medical Administrative

Corps officers. It will be recalled that substitution of these for Medical Corps officers 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 Administrative Corps officers to suggest to

both the Surgeon General's Office and the

medical officer on The Inspector General's staff a wider use of administrative

officers, not only in administrative work

unconnected with medical practice but

also in jobs having semiprofessional aspects.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 battalion 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 Administrative 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 officers increased they took over all customary 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, vocational counseling, and reconditioning. In

addition, during 1944 and 1945 some hospital commanders appointed Medical Administrative Corps officers as assistants to

doctors to relieve them of duties not directly connected with the treatment of

patients. In such positions, Medical Administrative Corps officers assumed responsibility 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 supervised the work of enlisted and civilian

ward employees. Thus, by the end of the

war Medical Administrative Corps officers, 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 command 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 considers 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 Cps 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, Birmingham, and Wakeman Gen Hosps and Waltham,

Cps Barkeley, Crowder, and Shelby, and Ft McClellan 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 Conf of SvC Comdrs, 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 assigned 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 adjust 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 shorthanded and overworked, a feeling possibly heightened by the fact that nurses had

to devote attention to new activities, such

as the educational and physical reconditioning programs, that were being introduced during 1944.25

 Finally, the continuous 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 Medical Department, from the Surgeon General'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 elimination of inessential nursing records and

the concentration of patients requiring

continuous nursing care in as few wards

as possible, were administrative.27 Others,

such as the employment of civilian registered nurses and senior student nurses,

were designed to supplement the professional 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 pro22

 (1) DF WDGAP 320.21, ACofS G-1 WDGS to

CG 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 general, the authors indicate that the Medical Department's estimate of nurse requirements was unrealistically high. In an interview on 20 November 1951

General Kirk stated that the Medical Department

was "always short"' of nurses until a draft was proposed in the winter of 1944-45. (HD: 314 Correspondence on MS) V. The question of whether or not

there was a shortage of nurses in zone of interior hospitals 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, Personnel (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 personnel 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 services 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 allotment 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 installations to overseas units was made stricter

and applied more widely during 1944

than before. In January ASF headquarters 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 replacements were available.35

 Service commands interpreted these directives differently, and some pulled "key" men out of

hospitals without thought of the availability 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 published 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 General'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 Specialists. HD. (3) Quarterly Rpt, 3d Qtr 1944, Enl Pers

Br Mil Pers Div SGO. HD. (4) Mins, Conf of Post

Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44,

p. 194. HD: 337. 35

 ASF Cir 239, 29 Jul 44. 36

 (1) Ltr, Capt 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) Quarterly Rpt, 4th Qtr 1944, Enl Pers Br Mil Pers Div SGO.

HD. (3) An Rpts, Ft Bragg Regional Hosp and Beaumont 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.
254 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

commanders were satisfied with saving

technicians. Some complained loudly

about the loss of certain clerical employees, such as those occupying the position of sergeant major, whom they considered also as "key" persons.38

One reason that hospital commanders

complained about the loss of general service men was that they encountered personnel-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 hospitals 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 jobassignments had to be made with caution.

Still others had mental limitations which

made it difficult for them to absorb jobtraining. Many were physically handicapped and could not do heavy work.

These restrictions on the use of limited

service men complicated the problem of

staffing hospitals.40 Furthermore, the assignment of such men to hospitals often

created morale problems. Under the ASF

personnel-control system, each hospital

was authorized a specific number of noncommissioned officers. So long as it had

that number it could make no promotions.41

 Many limited service men assigned to hospitals held noncommissionedofficer grades which they had earned in

nonmedical units. They were usually not

qualified, either by experience or by training, 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 promotion of other men who, by reason of qualifications and jobs held, deserved to be

noncommissioned officers. Lack of opportunities 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 organization for zone of interior hospitals,

showing job specifications and corresponding grades.43

 These tables were not published in 1944. In January 1945, after the

problem of grades for enlisted men was

made more acute by the proposal to assign WAC companies to hospitals,44

 Surgeon General Kirk appealed to the Secre38

 For example, see remarks of hospital commanders 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. Unofficially men not qualified for overseas service continued to be called limited service men. 40

 An Rpts, 1944, 2d, 4th, 5th, 7th, and 9th SvC

Surgs; An Rpts, 1944, Halloran, Beaumont, Wakeman, 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-organization method of manning hospitals in

the zone of interior.45 The Secretary approved 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 attempted to have them published. For

some reason, perhaps simply red tape,

this was not done and the problem of job

qualifications and grades remained unsolved in ASF hospitals.47

Replacement of Military

by Civilian Employees

Although limited service men were authorized as replacements for men physically qualified for overseas service, chief

emphasis of War Department policy regarding nonprofessional personnel was on

the use of civilians to replace military employees, whether general service men,

limited service men, or enlisted women.

Beginning in 1943 civilians were used actually to replace enlisted men, rather than

to supplement them. Under the ASF personnel-control system established in June

of that year, hospitals had personnel ceilings 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 194050—

was approached, though not reached, during 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 military to 10 civilian employees. During

the following year civilians replaced enlisted 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 hospitals used civilian employees in greater

proportion. In March 1944 the ratio of enlisted 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 installations. About a year later, when general 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 employees, 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 opposition to staffing zone of interior hospitals according

to tables of organization. 46

 (1) DF WDGAP 321 Med, ACofS G-1 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, 31 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 civilians as apprentice dietitians, dental assistants, dental mechanics, laboratory

helpers, X-ray technicians, guards, firefighters, telephone operators, steamfitters, refrigeration and air-conditioning mechanics, 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 onefor-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, hospitals began to employ a different type of

civilian during the later war years—paid

nurses' aides—who, although not numerous, 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 WAC headquarters 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 Flds, and Fts Bragg,

Knox, and Meade, all in HD; and Ltr, Capt Luther

F. Dunlop, QMC, 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-1 WDGS, 17 Feb 45, same sub. (5) Memo

WDCSA 200.3 (3 Mar 45), Asst DepCofSA for ACofS

G-1 WDGS, 7 Mar 45, same sub. All in AG: 320.2

(18 Apr 44)(1). (6) WD Cir 87, 19 Mar 45. (7) Mins,

Conf 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 available of the employment of civilian nurses' aides in

Army hospitals is in Blanchfield and Standlee, Organized Nursing, pp. 487-89, 492-93, 568. 56

 The Women's Army Corps (WAC) was authorized by Congress to supersede the WAAC 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 ancillary personnel, The Surgeon General approved the use of Wacs and of both voluntary and paid nurses' aides. During 1944

and 1945 special recruiting campaigns

were conducted both by WAC headquarters 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 governing 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 enlisted 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 performed.60

 Aware of difficulties which hospital commanders encountered in manning installations in compliance with War

Department policies, The Surgeon General wished to give them as much flexibility as possible in the employment of military 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 attitude, along with the kind of jobs to which

some Wacs in hospitals were assigned, laid

the Medical Department open to the accusation in the fall of 1944 that it sidestepped 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-1 ruled that Wacs

should work the same hours as nurses

57

 (1) Tables on basic data and ratios of gen, regional, 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., Ch. XIX, gives from the

WAC viewpoint a full discussion of both the recruiting of Wacs for, and their use by, the Medical Department. (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 (WAC). SG:

322.5-1 (WAC) 1945. (2) Ltr, SG to CG ASF attn Dir

Mil Pers Div, 23 Jun 45, sub: Tng of Enl Pers (WAC).

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 WD WAC 720 (29 Jun 44), Dir WAC to CG

ASF, 29 Jun 44, sub: WAC Duties on KP Detail and

Hosp Orderly Asgmt. AG: 220.3 "WAC(29 Jun 44)

(2)."

61

 (1) T/S, SG to ACofS G-1 WDGS, 31 Oct 44,

sub: WAC Pers Asgd to Hosp Duties. AG: 220.3

"WAC (29 Jun 44)(2)." (2) Memo, Dir Tng Div SGO

for Chief Prof Admin Serv SGO, 22 Nov 44. HD: 353

"WAC Gen." 62

 (1) T/S SPGAM/322.5 WAC(6 Sep 44)-97, CG

ASF to ACofS G-1 WDGS, 12 Sep 44, sub: WAC

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 Medical Department, directed that WAC tableof-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 director had been followed, all of the Wacs

already serving in hospitals under the bulkallotment 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 women, 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 enlisted 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 number of enlisted women assigned to wards

and diet kitchens should not exceed 40

percent of the total enlisted staff.67

While some hospital commanders resented limitations upon their authority to

select the jobs and set the duty-hours of

Wacs, the most common problem in employing 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.68 Because of misleading recruiting

publicity, Wacs came to expect more opportunities in the nursing care of patients

than was warranted, and many were disillusioned and disappointed when they

found their actual jobs less glamorous than

had been depicted.69 Enlisted men resented the preferential treatment which

Wacs received in the matters of rank and

working conditions. Wacs in turn resented 63

 DF WDGAP 220.3 WAC, ACofS G-1 WDGS to

SG thru CG ASF, 26 Dec 44, sub: WAC Pers Asgd to

Hosp Duties. AG: 220.3 "WAC (29 Jun)(2)." 64

 T/D 8-1037, WAC Hosp Co (ZI), 17 Feb 45.

SG: 322.5-1 (WAC) 1945. 65

 (1) Mins, Mtg Held in Off of Dir WAC, 9 Mar

45. SG: 322.5-1 (WAC) 1945. (2) Memo, Act Chief

Pers Serv SGO for SG, 14 Mar 45, sub: WAC Recruiting 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) Quarterly 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-1

WDGS, 31 Jan 45, sub: Proposed WD Cir. . . . AG:

220.3 "WAC (29 Jun 44)(2)." (2) WD Cir 71, 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 general hospitals employed as many as two or

three hundred each. They continued to be

used until their repatriation in 1945. Normally, 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, laundries, post exchanges, and orthopedic

shops. Some prisoners had skilled trades

and others were skilled technicians. Hospital commanders used them, when desirable, on jobs for which they had been

trained. Generally, prisoners of war seem

to have been an industrious, easily managed 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 Department Manpower Board and ASF headquarters 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 Administrative Corps officers for doctors in

administrative positions as well as the substitution of civilians, limited service enlisted men, and Wacs for able-bodied

enlisted men; but when necessity or directives 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 substituting personnel of various kinds for

able-bodied enlisted men had no adverse

effect upon hospital operations. On the

contrary, as shown above, changes in personnel created serious problems for hospital 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: Discipline and Morale of ASF Trps. (2) Memo, Consultant Women's Health and Welfare Unit SGO for

Chief Pers Serv SGO, 28 Jul 45, sub: Use of WAC in

Army Med Instls. Both in SG: 322.5-1 (WAC). 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 "WAC Gen." 72

 (1) An Rpts, 1944, Percy Jones, Ashford, Baker,

Letterman, and Halloran Gen Hosps, and Cp Barkeley and Ft McClellan Regional Hosps; and An Rpts,

1945, Birmingham, Lovell, Baker, Baxter, and Ashford Gen Hosps and Waltham and Cp Shelby Regional 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 standards; but some, as well as certain service

command surgeons and indeed the chief

of the Surgeon General's Hospital Division, 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 nonmedical officers who investigated complaints 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 adverse effects upon professional care less if

changes eventually made in hospital staffs,

as well as measures to improve personnel

management in hospitals, had been initiated early in the war by the Medical

Department itself.

73

 (1) See above, pp. 249-59. (2) Interv, MD Historians 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 Administration 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 hospital organization and administration. It

will be recalled that the Wadhams Committee 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 experienced hospital administrator, Lt. Col.

Basil C. MacLean. In his opinion preliminary 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 standardization of organization, the elimination

of nonessential activities and records, the

simplification of work methods, and the

improvement of administrative procedures.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-discharge procedure, already discussed. By

the following January, General Somervell

informed Surgeon General Kirk that he

considered improvement of hospital administration one of the Medical Department'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 "undertake to be the lead-off man in a study of

1

 (1) Memo, Lt Col Basil C. MacLean, SGO, 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 fil

Gen Bliss' Off SGO, "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 Department paper-work."

 3

Simplification

of Administrative Procedures

A basis for the study directed by General Somervell was laid during the spring

of 1944. Work on the disability-discharge

procedure had already demonstrated the

value of simplification and standardization and about a week before the Dallas

conference the Surgeon General's Hospital Division had asked his Control Division to review hospital administrative

procedures generally. The latter Division

called for assistance upon the ASF Control Division, which had had experience

and which had personnel qualified in such

matters. In April 1944 these Divisions, assisted by service command control divisions, 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 office procedures, information office procedures, and hospital dispositions. To prevent swamping hospitals with revised but

imperfect procedures, the Hospital and

Control Divisions of the Surgeon General's Office insisted that each revised

procedure should be approved by professional consultants of that Office and tested

in selected hospitals before general adoption. To avoid unnecessary delays in their

use, procedures were to be studied separately 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 personnel because it had reduced its own staff

as an example to others, the Surgeon General'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 procedural manuals in the form desired by

ASF headquarters. Furthermore, its director was absent on special overseas missions 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 borrowed personnel from the ASF Control

Division, from Army hospitals, and from

other installations. Even so, the ASF Control 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 Control 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: Improvement 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, Control 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 before adopting them for general use, only

one chapter of the projected manual—

that on hospital admissions—was published before the peak patient load was

reached in the United States. Other revised procedures—those for linen control,

disability discharges, and disability retirements—were published in separate manuals 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 published, they were approved by the ASF

Control Division, the Air Surgeon's Office,

the Surgeon General's Control, Professional Services, Hospital, and Medical

Statistics Divisions, and the Adjutant

General's Methods Management Branch.6

The new procedure was then given a preliminary 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 revised and published in a tentative manual

of hospital procedures.8 Soon afterward,

the Surgeon General's Office called a conference 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 administration (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 admission of patients, its greatest significance

lay in changes in hospital admission records 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 addition, 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

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: 319.1-2-(Control

Div, SGO) FY 1945. The reason that Colonel MacLean took little or no part in the development of simplified administrative procedures, and left the Surgeon General's Office in the fall of 1944, is not clear

to the writer.

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 Control 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), prepared by SGO Control Div, 1 Sep 44. HD. 9

 Ltr, CO Regional Hosp Cp Swift to CG 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 Procedures. 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.
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 common 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 briefer 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 information 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 admissions 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 admission of patients, eliminated the duplication 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, considered it an improvement over the old

one.13

As in the development of the admissions

procedure which saved work for administrative officers, the Surgeon General's

Office was equally interested in procedures 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 distribution of hospital linens, was designed

for this purpose. Developed in a manner

similar to the hospital admissions procedure, 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. Additional linen-counts were made at intermediate storage points and at hospital

laundries. Under the new procedure each

hospital had a linen officer who was responsible for all linen used. All counts of

linen in wards and intermediate stations

were eliminated; and linen officers, rather

than ward officers, made periodic inventories. According to some hospitals, a disadvantage of this procedure was an

excessive loss of linens. This was compensated for, in the opinion of the Surgeon 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 SGO; and An Rpt, FY 1945, Hosp and

Dom Oprs SGO. 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: Hq ASF Control Div file, "Est Admin

Savings Resulting from Procedural Revisions." (4)

ASF Cir 395, 2 Dec 44.
INTERNAL ORGANIZATION AND ADMINISTRATION 265

the relief of doctors of administrative details. 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 stenographers in hospitals, as a result of the

civilian labor shortage and of hospital

personnel ceilings, made it necessary during 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 consultation reports, progress notes, case histories, and final summaries. Clerks organized in central pools then transcribed

the information recorded. This system of

preparing clinical records permitted doctors to keep more complete and more

legible records and to devote more attention to care of patients. It also contributed

to the more efficient use of clerical personnel. 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 administrative 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 published on the following subjects: Patients'

Funds and Valuables (1 July 1945); Hospital 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 December 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 programs of "work simplification" and "work

measurement." Work simplification was

the process of reducing the jobs of individual workers, or the operations of groups

of workers, to their simplest forms and

eliminating from them all lost motion.

Work measurement was the determination by various standards of the number

of employees required for certain jobs or

operations.18 During 1944 and 1945 hos15

 (1) An Rpt, FY 1945, Hosp and Dom Oprs SGO;

An Rpts, 1944, Lawson, Thayer, Oliver, and Ashburn Gen Hosps, and AAF Regional Hosp Keesler

Fld; 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 Birmingham 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, CG SOS for Dir Staff Divs, Cs of Sup and

Admin Servs, CGs all SvCs, 1 Mar 43, sub: Work

Simplification. SG: 024.-1.
266 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

pital control officers appointed as a result

of ASF headquarters' emphasis upon

management techniques (or administrative engineering) conducted work-measurement 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 Hospital, 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 permitted the completion in 1944 of 4,911

more work-units in 9,600 fewer workhours than in the year before. Seventeen

work-measurement and work-simplification 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 savings from local changes.21

 In this way,

hospitals adjusted their operations to

performance by reduced staffs and management 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 professional and administrative activities

were added to Army hospitals. When convalescent reconditioning was established

as an Army program, hospital commanders placed that activity in a variety of

locations in their organizational structures; but by February 1944 the Surgeon

General's Office concluded that reconditioning should be considered as a professional 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 Reconditioning 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 professional rather than an administrative service and to show neuropsychiatry as an

independent service rather than as a section 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 Birmingham Gen Hosps; An Rpts, 1945, Crile and Battey 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 designated as a Class II installation or activity (that is, general hospitals operating in 1950 under the direct control of SGO). 23

 (1) An Rpts, 1944, Baxter, Finney, Crile, Lawson, Vaughan, and Fletcher Gen Hosps. HD. (2) Ltr,

Act SG to CG ASF, 15 Mar 44, sub: Orgn Chart, Reconditioning Program, with 1st ind, CG 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

44, 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 installations. Revision of the ASF organization

manual in December 1943 caused addition of control officers to serve as staff advisers on administrative, procedural, and

management problems.25 About the same

time authority was granted all ASF installations having a strength of 2,000 or more

to appoint special services officers to conduct athletics and recreation programs

and orientation officers (later called information 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 hospitals (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, information 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 headquarters to standardize organization throughout 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 previously comprised all post activities were

replaced by seven administrative and

seven technical staff units. To make this

change, the erstwhile Administrative Division, a functional division which had included the adjutant, judge advocate, and

fiscal officer, was abolished and its officials

were listed among the seven administrative staff units. Certain technical services—

quartermaster, ordnance, chemical warfare, signal, and transportation—were

relieved from their former subordination

to the Supply Division and were established as independent technical staff units.

Medical and engineer activities, considered 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.30

General hospitals attempted to adjust

themselves to the new organizational plan

for ASF posts as they had to its predecessor. 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, Woodrow 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 organization chart, and only added to the

post organization a reconditioning division, 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 Hospital 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 reporting 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 Several hospitals on the other hand followed

that principle (and incidentally a recommendation made by the Wadhams Committee 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 desirable to make the ASF post organization

applicable to all hospitals. Officers in the

Third Service Command headquarters

and in the Surgeon General's Office, as

well as some hospital commanders, believed that technical service officers with

only minor functions in hospitals, such as

those of the Chemical Warfare Service,

Ordnance Department, and Transportation 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, personal affairs, information and education,

and classification and counseling officers)

assumed more importance in hospitals

than in other installations, some hospital

commanders and service command surgeons 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 General's Office announced that it was planning to publish a standard plan for the

organization of general hospitals, but its

development was delayed because of

shortage of personnel in the Control Divi31

 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, Gp Barkeley and Scott Fld

Regional Hosps. HD. (2) 1st ind, CO Staten Island

Area Sta Hosp to CG 2d SvC attn SvC Surg, 3 Mar

45, on Ltr, CG 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 incl. HD: 323

"Hosp Orgn." 35

 (1) Orgn Chart prepared by 3d SvC Hq, [1944].

HD: 323 "Hosp Orgn." (2) Interv, MD Historian

with Dr. H. A. Press, formerly of SGO 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."

270 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

sion and priority given to procedures for

disability discharges and hospital admissions.37

 Meanwhile, the surgeon of the

Fourth Service Command worked out a

standard plan for the organization of hospitals under his supervision.38

 Then, in

June and July 1944 the surgeon and the

control officer of the Third Service Command, 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 service commands. On the basis of their suggestions, he made minor changes in the

Third Service Command plan and

adopted it as standard for general, regional, and station hospitals.39

 It was published in July 1945 as a chapter of the

manual on hospital administration.40 The

Surgeon General's Office also worked during this period on the organization of convalescent 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 remained 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 commanders generally and service command

surgeons in some instances raised arguments against inflexible standardization.

One feared that it would crystallize hospital organization, increasing efficiency in

the operation of some installations but

prohibiting imaginative and capable commanders from making valuable innovations in others.42

 Some felt that standardization would prevent hospital commanders 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 officers assigned to them. An eye, ear, nose,

and throat specialist of intense individualism and higher rank than a chief of surgical 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 measurement of work and of personnel require37

 (1) Rad, SG to CG 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 CA)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 hospital organization by the winter of 1944.

That they did not insist on inflexibility

was demonstrated by a proviso that hospital 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 immediate staff included public relations officers,

control officers, and inspectors (called inspectors 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 detachment), the dietetics division, the veterinarian's office (for food inspection), and

the registrar's office. The plan for hospitals had no technical staff divisions as

such. Some, such as ordnance and chemical warfare, were eliminated completely;

others, such as quartermaster and transportation, were subordinated to the supply division; and another, the engineer,

was placed on the administrative staff.

The welfare services, despite the wishes of

hospital commanders, were left subordinated to the personnel division. The plan

for hospital organization naturally included professional services. There were

nine in general hospitals, including the

reconditioning service, the neuropsychiatric service, and the nursing service. In

this field hospital commanders were left

with more latitude than in the administrative 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 resembled 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 station hospitals had little appreciable effect

upon their organization.47 The chief reason, perhaps, was that the plan itself

reflected experiences of hospitals in conforming with ASF directives on organization.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 pub44

 Ltr, SG to CG 1st SvC attn SvC Surg, 16 Feb 45,

sub: Standard Orgn Charts of Gen, Regional, and Sta

Hosps, with 1st ind and incl. HD: 323 "Hosp Orgn." 45

 TM 8-262, Ch. I, Sec I, 1 Jul 45. 46

 TM 8-262, Ch. I, 1 Jul 45. 47

 Morgan and Wagner, op. cit., pp. 147-51, arrive

at this conclusion after examining the data on organization 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.

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 organizational 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 organized 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 according to the standard ASF post plan.50

Those that operated in conjunction with

general hospitals depended upon the latter 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 section and the grouping of patients into

companies, battalions, and/or regiments

for administration and supervision.52 In

the winter of 1944, when additional emphasis was placed upon the convalescent

program, the Surgeon General's Office

developed and published a guide53 which

left the organization of administrative

activities of convalescent hospitals almost

entirely to the discretion of their commanders. The result was that, as they received more patients and operating personnel, some set up administrative offices

that duplicated, or at least paralleled,

those of the general hospitals located near

by.54 The guide showed in more detail the

organization of convalescent activities.

They were to be grouped in three divisions: a receiving division, an infirmary

division, and a reconditioning division.

The infirmary division was not to be established 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 battalions (neuropsychiatric, primary reconditioning, and advanced reconditioning),

and it was to conduct the convalescent

training program. This program was to

include occupational therapy, physical reconditioning, educational reconditioning,

and classification and counseling. The

plan served as a guide to convalescent

hospitals that remained separate installations during 1945, and it was used to some

extent, particularly for the organization of

convalescent activities, by those that became 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 standard plan for their organization. It is of interest that

this plan called for fewer major units within a hospital and charged two officers, the executive officer

and the deputy commanding officer, with the co-ordination, 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

Glass 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—Revised 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.

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 convalescent hospitals and the new standard plan

for general hospitals, it showed the administrative organization of convalescent hospitals 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 essentially the same as those prescribed for general 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 separation of the reconditioning, or convalescent training, program from the administration 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 regiment (neuropsychiatric), 2d convalescent

regiment (medical), and 3d convalescent

regiment (surgical). Publication of this

plan after convalescent hospitals had

already begun to close undoubtedly limited its effect upon the organization of

such installations. (Chart 14)

The establishment of hospital centers in

the spring of 1945 was expected to eliminate duplication of administrative activities 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 because of differences among hospital centers—some being located on posts with

other activities and some constituting posts

in themselves—centers varied in organization from one to another.58

 Two extremes

were represented by the Percy Jones Hospital Center and the Wakeman Hospital

Center. (Chart 15) The former, a post itself, had operating as well as supervisory

functions, and administrative activities

common to both the general and convalescent hospitals assigned to it were performed by center headquarters.59

 Wakeman, on the other hand, was located on a

post with other Army activities that were

nonmedical in character. Post headquarters furnished some administrative services

for both the general and convalescent hospitals; 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 Functions, Cp Edwards, Mass, Embracing the Post and

the Hosp Ctr, 20 Aug 45; Orgn and Functional Manual, 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. 60

 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.


278 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

and service command surgeons.61 Following receipt of their replies, that Office by

the beginning of 1946 developed a standard plan for the organization of hospital

centers. Although never published, it was

significant because it represented The

Surgeon General's idea of what the organization 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 convalescent hospitals the administrative services

that were common to both. Hence, the

center commander's immediate staff and

the administrative staff divisions of hospital centers were to be essentially the same

as those found in both general and convalescent hospital organization charts. To

assist a center commander in supervising

and co-ordinating the professional activities 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 reported 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 similarities between the functions of posts and

those of hospitals to warrant such conformity, one may question whether it was

altogether desirable or would have been

required if standard plans emphasizing

the peculiar functions of medical installations had been issued earlier. Certainly

the Medical Department would have

benefited from having such plans available when the hospital expansion program

first began. Moreover, they would have

made easier the task of simplifying and

standardizing hospital administrative procedures. While accomplishments in this

field were substantial, it was unfortunate

that they came so late in the war. Offsetting this delay, perhaps, was the fact that

management control became an established 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 foregoing chapter, to standardize organization and simplify administrative procedures. 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 personnel and the reduction of personnel

authorized for hospitals of different types.

Trend Toward Use of Larger Units

One method of supplying greater numbers of beds to theaters without proportionately increasing the number of personnel 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 developed 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 organization, 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 hospitals—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 centers 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 theaters and none in the United States. Instead, theaters requisitioned station and

general hospital units to meet authorized

quotas of beds and established convalescent facilities with personnel available

from other sources.4

Cuts in Personnel of Hospital Units

As in zone of interior hospitals, reductions were made in the staffs of numbered

hospitals. In compliance with a G-1 directive, 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 hospital from 75 to 63.5

 Also in March, in consonance with the general policy of replacing physicians with administrative officers

wherever possible, a War Department circular directed that both the executive officers and registrars of station and general

hospitals should be Medical Administrative Corps officers. The Surgeon General

protested that executive officers, who

served as commanding officers in the absence of their superiors, needed professional training in medicine, and subsequently the General Staff amended the

announced policy to permit Medical

Corps officers to continue serving as executive officers of general hospitals.6

 Meanwhile, 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 officers and to increase the number of Medical Administrative Corps officers authorized for such units.7

 In July 1944 the number 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 hospital, 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 station 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

8-591T, Conv Ctr (3,000-bed), 12 Jun 44. (4) Interv

MD Historian with Col Arthur B. Welsh, 27 Dec 50.

HD: 000.71. (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-1 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 Hosp, 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 Operations Division stated that these cuts of Medical Corps

officers had been too great. (Ltr, Col Arthur B.

Welsh, MC. USA. 19 Apr 48, quoted in Rpt, Subcmtee 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 evacuation hospitals.9

In the spring of 1944 the General Staff

directed reductions in the number of enlisted 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 directive by reducing in the table of organization of general hospitals the number of

men who performed housekeeping functions. It overcompensated for that reduction 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 supply interior and exterior guards.12

 Subsequently, in the fall of 1944 cuts were made

also in the number of enlisted men authorized 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 reduced, it actually had that effect in many

instances because some theater commanders did not approve the use of the

teams authorized by the War Department

and desired by theater surgeons. As a result, the change was unpopular with

many Medical Department officers, especially those in theaters who wished the

personnel needed to perform station services for hospitals to be organic elements

of hospital units and not dependent upon

decisions and actions of theater staff officers. 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-organization capacities.14

Another change designed to save personnel was made in the organization of

the hospital-center unit. This unit, intended to operate a 1,000-bed convalescent camp and to perform certain administrative services common to all hospitals

in a center, was authorized 29 officers, 4

warrant officers, 1 nurse, and 255 enlisted

9

 Compare T/O&E 8-581, Evac Hosp, Semimobile, 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 SGO for Chief Oprs Serv

SGO, 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 incl. SG: 320.3-1. 12

 (1) T/O 8-550, Gen Hosp, C 4, 16 May 44. (2)

WD Cir 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 incl. SG: 320.3 "T/Os AprJun 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).
282 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

men until the early part of 1944.15 During

that year the belief developed that no saving in personnel was gained by concentrating hospitals and then providing them

with increased overhead personnel.16 Furthermore, 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 authorized.17

 This headquarters was not expected to operate a convalescent camp

and it was to borrow any additional personnel 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 European 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 available, two new hospital units were developed and a third was proposed. In

response to a request from the chief surgeon of the European theater for a hospital that would specialize in the treatment

of neuropsychiatric cases, the Surgeon

General's Office developed a table of organization in the latter half of 1943 for a

neuropsychiatric general hospital. It was

published in October.20 The second hospital 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 nontransportable 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 publication of a table of organization for a unit to

meet this need. The Surgeon General opposed this development, believing that the

reinforcement of available units—such as

platoons of field 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 published.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 Ctrs. HD. (2) An Rpts, 1945,

801st, 802d, 803d, 804th, 805th, 806th, 807th, 808th,

809th, 812th, 813th, 814th, 815th, 818th, 819th, and

820th Hosp Ctrs. 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

ACofS G-4 WDGS, 11 Aug 45, sub: Conf Rpt, Proposed 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 operations 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 operation 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 revisions of Medical Department equipment

lists between the middle of 1943 and the

end of 1945. Revision of these lists involved the selection of types and amounts

of pharmaceuticals and biologicals, of surgical 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 performance of their missions. These revisions, made by the Surgeon General's

Organization and Equipment Allowance

Branch, were based on combat experience

as revealed by reports of essential technical medical data (ETMD's), interviews

with officers who served overseas, and inspections of theater medical services; on

changes in the size and personnel of units;

and on the advice and recommendations

of the Professional and Preventive Medicine 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 mimeograph form by the Medical Department

alone. Items added to them made available to hospitals the newer drugs and

biologicals and improved items of equipment 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 housekeeping functions. The chief question was

whether such equipment would be included in tables of equipment of hospitals,

and therefore supplied automatically, or

whether it would not be included, and

supplied only when and if theater commanders requested it. Types of nonmedical 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 inadequate 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 resulted 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 considered necessary.24

 As a result, the offices

of The Quartermaster General and The

Surgeon General collaborated in changing washing formulae and laundry equipment to improve the quality of service

which laundries afforded hospitals.25

The provision of adequate amounts of

laundry equipment and of sufficient numbers of laundry operators was more complicated. On 1 July 1943 The Quartermaster General informed ASF headquarters that there was sufficient laundry

equipment in this country to meet the

needs of theaters, provided the latter requested its shipment.26

 Theater opinions

of what constituted an adequate laundry

service differed from The Surgeon General's, for theaters accepted lower standards of service than he considered desirable.27

 He wished, therefore, to find some

way to assure that sufficient laundry

equipment and personnel would be

shipped with each hospital unit. The director of the ASF Planning Division, on

the other hand, felt that theater commanders, with the advice and help of their surgeons, should determine the laundry

services needed and request the War Department to supply the necessary equipment and personnel.28

 The ASF view prevailed and in August 1943 theater commanders were reminded of the necessity of

planning in advance for the laundry service 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 technicalservice 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 attachment to hospitals when theater commanders requested them.30

 Although this served

as a reminder to theater staffs that they

had to make specific provisions for hospital laundry services, it left to theaters considerable 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 (Col Skinner). (3) Memo, SG for

CG 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, MC 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, MC for Dep

SG, 1 Jul 43, sub: Laundry for Overseas Hosps. SG:

331.5. (2) Memo, Maj John 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. Success 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 Surgeon General's Office recommended that

such equipment, including electric generators, should be specifically listed in

tables of equipment of hospital units to insure 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 included during the war in tables of equipment for general and station hospitals,

convalescent hospitals, and convalescent

camps and centers. Instead, a War Department memorandum placed upon the

Chief of Engineers responsibility for furnishing electric lighting equipment, including 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 Department authorized telephone and switchboard equipment for the 750-bed evacuation hospital only. During the early part

of the war, the tables for general and convalescent hospitals were revised to include

that equipment. Similar action was taken

for station and 400-bed evacuation hospitals during the latter part of the war.34

Other significant changes in the equipment of hospital units were additions of

tool chests of various sorts. Experience

showed that hospital personnel in many

instances had to perform much maintenance work and that the number of tool

chests previously provided was insufficient. Consequently, in successive revisions of tables of equipment of hospital

units there were added tool chests for

carpenters, refrigeration mechanics, electricians, plumbers, automobile mechanics,

and the like.35

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, MC, 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. 348. HD: 334.)

32

 An Rpt, Tec Div Oprs Serv SGO, FY 1945. HD. 33

 (1) T/O&E 8-510, Fld Hosp, C 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), 31 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 Planning Sec MOOD SGO, 5 Jun 45 (HD), stated that

switchboards and communications equipment had

been provided for 400-bed evacuation hospitals. However, 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, Fld 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.
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 expanding 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 substantially complete by the middle of 1943. At

that time forty general hospitals were in

operation and eighteen others were under

construction. Afterwards, only eight additional general hospitals were authorized,

and they were located in buildings which

the Army already had. Moreover, the closure 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 building program, there was feverish construction activity at many Medical Department installations. Mounting bed requirements in the first half of 1945 made it necessary 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 concepts 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 construction program and of the increasing availability of scarce materials to press for improvements 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 authority. He was dependent upon ASF

headquarters for approval of all major

projects and upon the Engineers for all

construction work. They, in turn, continued 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 improvements, 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 buildings. In general, that Branch tended to

rely more than before on service command

surgeons and ASF hospital commanders

1

 (1) Memo, Chief Cons Br SGO for HD SGO, 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 reasons for this development. The expansion

of existing hospital plants required individual attention and planning in order

to make maximum use of available housing 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 assistance from the War Department. Finally,

under prevailing War Department construction 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 Washington.2

 Over Air Forces hospital construction the Surgeon General's Office

exercised less supervision than it had during the early part of the war. Complying

with a request of the Air Surgeon and reflecting perhaps the growing independence 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 headquarters under policies of the General

Staff.4 When ASF approved the establishment of convalescent annexes for general hospitals in June 1943, it announced

that new construction, except for gymnasiums, 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, including schools, hotels, and National

Youth Administration buildings, with

enough space to house beds for 9,322 convalescent patients at a number of general

hospitals. Other general hospitals established annexes in vacant Army buildings

located near by.6 After approving the

establishment of convalescent centers for

25,000 patients early in 1944, ASF headquarters turned over to the Medical Department 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

2

 WD Cir 58, 19 Dec 43. 3

 (1) Memo, Dep Air Surg for Chief Hosp Admin

Div SGO, 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 Cirs 78, 18 Mar 44; 178, 13 Jun 44; 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 Disposition 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 additional construction.8

The major hospital expansion program

of the later war years came during the

first six months of 1945, after G-4 approved additional beds to meet the estimated peak load of patients. For this expansion the War Department followed

the same method—the use of existing

buildings—but permitted more improvements 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 construction, were converted into wards.

Some convalescent annexes were made

into wards and some nonhospital barracks

were converted into housing for ambulatory 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 additional barracks on posts where convalescent 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 reflooring, installing

sprinkler systems and fire escapes in converted 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-operations-type barracks, along with buildings

for detachment and company administration, recreation, supply, and messing,

were constructed to house the men displaced from hospital barracks and the

Wacs sent to hospitals to help with increased patient loads.9

Initiation and completion of this program represented co-ordinated efforts of

the Surgeon General's Hospital Construction 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 preliminary plans for hospital expansions,

determining the number of additional

beds that could be provided, and establishing general criteria for conversion

work.10 Meanwhile, the Chief of Engineers' Office called upon division engineers, by telephone, for preliminary

layout plans and cost estimates. As a result, within forty-eight hours after that

Office received a directive to proceed with

the program, it authorized division engineers to begin work.11

 To achieve speed in

the expansion, ASF headquarters per8

 (1) Tynes, Construction Branch. (2) Interv, MD

Historian with Col Achilles L. Tynes, formerly Chief

Hosp Cons Br SGO, 24 Apr 50. HD: 000.71. 9

 (1) Ltr, SG to CofEngrs, 13 Jan 45, sub: Emergency 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, Birmingham, 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: Emergency 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 Conv 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 engineers 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 instructed representatives in the field to cooperate 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 existence at hospital plants of barracks similar

in type to ward buildings made their conversion to wards relatively simple. Furthermore, establishment of convalescent

hospitals during 1944, without G-4 approval and in the face of attempts of the

Staff to reduce the number of general and

convalescent beds, meant that a considerable 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 additional 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-temperature 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 construction of such buildings could not normally 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 orthopedic consultant recommended the construction of an orthopedic clinic at Fort

George G. Meade (Maryland) Regional

Hospital in June 1944, and a few months

later an ophthalmology consultant recommended an acrylic eye laboratory and

an eye clinic for Dibble General Hospital.17

 Generally, the Medical Department

encountered little if any opposition in securing the approval of the Engineers and

ASF headquarters for the construction of

special clinical buildings. Perhaps this circumstance was due to the fact that their 12

 Memo SPMOC 632, CG ASF for CofEngrs, 22

Jan 45, sub: Prov of Add Hosp Fac for the Gen Hosp

Syst. CE: 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-Temperature 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 Regional 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 professional care of patients. In the case of other

special buildings less evidently needed for

professional care but appropriate to almost all general hospitals, the Surgeon

General's Office had to request ASF headquarters to establish a general policy permitting 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 neuropsychiatric centers were established in

many general hospitals. In October 1943

ASF headquarters approved the construction 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 relocated because some hospitals were being

closed, the Surgeon General's Office requested the construction of special buildings for centers for rheumatic fever, deaf,

paraplegic, neuropsychiatric, and plastic

surgery patients in hospitals that were expected to remain open for long periods of

time.19

Development of the convalescent reconditioning program called for additions

to hospital plants which were generally

authorized less readily than special clinical buildings. Among them were recreational facilities, such as theaters, gymnasiums, 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 educational purposes, such as libraries and radio

systems.

In the second half of 1943, with the inauguration of the reconditioning program

and the growing belief that patients recuperated more rapidly if kept occupied

physically and mentally to the maximum

extent consistent with their degree of recovery, hospital commanders began to request 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 hospitals of buildings normally erected on

Army posts, such as gymnasiums, libraries, and theaters.21

 ASF headquarters approved the construction of gymnasiums

and theaters in June and December 1943,

respectively.22

As materials became more plentiful

and the prospective load of battle casual18

 (1) Ltr, SG to CG ASF, 22 Oct 43, sub: Occupational 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] C. 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), CG ASF

to SG, 22 Jun 43, sub: Conv Ctrs, 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 program.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-reconditioning 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 February 1945 ASF headquarters approved the

installation of four-channel, program-distribution (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, automobile repairs, woodwork, photography,

electrical work, and the like; classrooms

for general academic courses, business administration, 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 theaters, libraries, clubhouses, and other

recreational buildings.26

In securing eventual approval for such

facilities, The Surgeon General encountered difficulties and delays. ASF headquarters would authorize only those

which appeared necessary for the treatment and recovery of patients, and The

Surgeon General therefore had to justify

each request by explaining the therapeutic benefits additional facilities would

afford.27 Furthermore, ASF tended to

limit programs which it approved to general hospitals that were expected to remain in operation during the postwar

years.28 The Surgeon General agreed that

extra facilities should be provided first for

general hospitals in which overseas patients were treated; but he wanted them

later for regional and station hospitals

also. He resisted attempts to limit reconditioning 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 headquarters 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 appro23

 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 Swimming 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 headquarters and the Surgeon General's Office

approved, as a rule, the use of nonappropriated funds to construct them.31

 As a result of that policy and of generous gifts by

civilians, some hospitals got such additions 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 authorized, for the war ended and their construction had to be canceled.33

Concurrently with the addition to hospitals of clinical and reconditioning facilities, the increase in administrative activities 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 maintenance, 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 intravenous medication, wound dressing,

spinal puncture, thoracentesis, catheterization, gastric lavage and gastroduodenal

suction, and oxygen administration.35 In

the last half of 1943 the Surgeon General's

Office developed standard operating procedures 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 SPMDC 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. HD:

024.7-3. (2) 1st ind, CofEngrs to CG ASF, 21 Jun 44,

on Memo SPRMC 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) Comments 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 Projects, 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 provide buildings for such services, either by

new construction or by the alteration of

existing buildings, wherever they were requested and justified by hospital commanders.39

 Thereafter, during 1944 and

1945 central service buildings were provided for all general and regional hospitals.40

In getting other administrative buildings, the Surgeon General's Office was less

successful. One fault with hospital plants

already constructed was that they lacked

rooms for clinical conferences.41 Moreover, the addition to general hospitals of

functions and activities not common in

peacetime increased the need for more

administrative space. Special services officers, reconditioning officers, personal

affairs officers, Veterans Administration

representatives, and United States Employment 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. 4 2 By

the time it was completed in February

1945 the general-convalescent hospital expansion 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 headquarters instructed the Engineers and The

Surgeon General to collaborate in planning whatever construction was needed to

bring existing hospital plants up to the

standards set by their joint study.44 Surveys 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 attempting to correct constructional defects and

to bring the Army's hurriedly erected hospital buildings up to the standards of

finish, appearance, and equipment of

civilian institutions. During 1944 the reflooring 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 Hosps. 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 personal backing of General Somervell for a

relaxation of the War Department's policy

of "Spartan simplicity" in order to permit

higher maintenance standards for hospitals.49

 About the same time, Congressional criticism of Army hospital construction and maintenance apparently spurred

ASF headquarters to more "aggressive action in increasing the maintenance program 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 improving ASF hospitals. It included covering floors in corridors and administrative

buildings, as well as in wards and clinics,

with linoleum over plywood; sealing exposed framing in corridors and nurses'

quarters; inclosing all corridors used by

patients; painting both exteriors and interiors to conform to peacetime standards,

including the use of pastel colors for interiors; 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 convalescent hospitals that would be retained

in the postwar period and to delay its extension 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 SGO 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 SGO 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 Representatives, 78th Cong, 2d sess, pursuant to H. Res. 30

(Washington, 1944). 51

 (1) Memo, SG for CG ASF, 6 Sep 44, sub: Suggested 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 SGO, 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 returning war casualties, ASF headquarters

authorized the application of the higher standards of maintenance to those

hospitals.56

Although improvement of general and

ASF convalescent hospitals was authorized in October 1944, it did not get started

until early in 1945. Causes for delay during that period and later were numerous:

the controversy over whether to limit the

program to postwar hospitals; the tardiness of service commands, which under

existing procedures had to initiate the requests 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 program and the hospital expansion program; the extension of the project to cover

barracks and other buildings newly converted to hospital use; the effort to interfere as little as possible with the normal

operation of the hospitals; and the hindrance of winter weather to the planting

of lawns and the painting of exteriors. In

view of such factors the Engineers estimated in February 1945 that the maintenance program would not be entirely

completed until the end of 1945, but that

the greater portion of it would be finished

by the end of July.57

Another aspect of the general movement to raise the standards of Army hospital plants was extension of the program

of installing air-conditioning or ventilating equipment and inauguration of a program 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 Construction Branch sought approval for the

installation of air-conditioning equipment

in the operating rooms of all general hospitals, 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 mechanicalventilating or evaporative-cooling equipment 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 mechanical-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 Debarkation Hosps. SG: 632. (2) Memo, Col L[loyd] E. Fellenz, 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: Ventilative 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 Conditioning, Ventilation, and Cooling in ZI Hosps. (4)

Memo, SG for CG ASF, 12 Feb 44, sub: Air Conditioning for Dental Clinics. All in SG: 673.-4.
296 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

equipment in patients' recreation buildings, 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-conditioning 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 installation 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 headquarters authorized the use of appropriated 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 patients would get the equipment and general 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 installed. At that time ASF headquarters

approved the Engineers' request for sufficient additional funds to complete the installation 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 attention during visits to North Africa and the

Southwest Pacific. According to plans at

the beginning of the war, hospitals in theaters 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 imported building materials according to

standard plans for theater-of-operationstype construction. None of these means of

housing had proved universally satisfactory. 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 mildewed, rotted, and disintegrated within

59

 (1) Memo, CG ASF for SG, 14 Mar 44, sub: Proposed 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 Conditioning 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: Refrigeration and Ventilation—Revision of Policy for Airconditioning 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' Signaling 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 available existing buildings. Moreover, the

Medical Department often encountered

difficulties in getting theater-of-operationstype housing constructed because of shortages of lumber in theaters and of competition for Engineer services with such highpriority projects as the construction of

harbors, docks, piers, airstrips, and essential 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 hospital 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 covered the entire inside of the tent, lowering

temperatures and promoting cleanliness.

This tent was so constructed that a complete end section could be detached from

the main body and additional center sections 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 overseas 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. During the early part of the war the Southwest

65

 (1) Memo, SG for CG ASF, 10 Aug 43, sub: Interim Progress Rpt. SG: 024.-1. (2) An Rpt, Chief

Surg SWPA, 1942. HD. (3) Ltr, Hq USASOS SWPA

to CG ASF thru CG SWPA, 16 Sep 44, sub: Rpt of

Trip to SWPA. . . . SG: 333.1-1 (Aust)F. (4

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. McDonald, MC, Chief Hosp and Evac Sec Planning Div

Oprs ASF for Gen Lutes, 21 Jul 43, sub: Improvement 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: Organization, 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) Information supplied informally by Dr. Risch on 30 November 1953.
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 concrete, 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 prefabricated 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 different things to different people, for in September 1943 the Surgeon General's Construction Division was surprised when it

discovered that the Engineers were planning precut but not prefabricated buildings.71

 The Surgeon General protested

against the adoption of precut construction, but because of the urgent need for

hospital buildings in the Pacific, ASF

headquarters, the Engineers reported, directed them to fill the theater's requisition.72

 In conferences with representatives

of the Surgeon General, the Chief of Engineers 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 buildings. The Surgeon General's Office then

prepared an urgent request to ASF headquarters for steel, and the ASF Matériel

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 hospitals requested by the Pacific.73

 Subsequently, 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 correct defects that had been revealed by

experience in using theater-of-operationstype 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 Headquarters Army Forces. Pacific, Engineers in Theater Operations, in ENGINEERS OF THE SOUTHWEST

PACIFIC 1941-45, vol. I (1947), pp. 127-28. Reference 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: Prefabricated Hosps. CE: 632 "Vol. 4." 70

 Memo, CofEngrs for SG, 19 Aug 43, sub: Proposed Plans for . . . Tropical Hosps . . . Prefabricated All Wood Bldgs, with 3 inds. SG: 632.-1 (Gen). 71

 Memo, CofEngrs for SG, 23 Sep 43, sub: Prefabricated 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 unlocated 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

C-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, hospitals planned for precut construction were

more elaborate than the theater thought

necessary. For example, floor space per

bed in wards was greater than in Australian 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 dictated austerity in hospital housing which

the Surgeon General's Office was unwilling to approve. The Southwest Pacific

agreed to accept the hospital buildings

being prepared for shipment from the

United States "on the score of expediency," but requested that they be held until

called for.75 Meanwhile, the Southwest

Pacific continued to use "Australian cowsheds" 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, unsatisfactory.77

 During the rest of 1944 and the

early part of 1945 the Offices of The Surgeon General and the Chief of Engineers

continued attempts to provide prefabricated 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

CofEngrs, 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 "Hosp 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.] MC 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 Comd 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 hospital 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 emphasis 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 redeployment after the defeat of Germany.2

In April 1945 the 60-day evacuation policy which Europe had been following on a

de facto basis for several months was made

official for both the European and Mediterranean 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 result, 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 requirements of occupation forces. Their evacuation policies were therefore set at 120

days and their fixed-bed ratios at 4 percent.6

1

 Statistics Branch, Control Division, Hq. ASF, Statistical Review, World War II: A Summary of ASF Activities (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) Cablegram CM-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. 3

 S/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. III." 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: Recommended Reduction in Fixed Beds in ETO and MTO

to 4 percent. SG: 632.2. (4) Rad CM-OUT-63182,

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

CM-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. Meanwhile, the number of beds in other areas

of the Pacific declined from 37,600 to 32,-

700.7

 The surrender of Japan 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 Department 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 Surgeon General's Office and the General

Staff turned to re-examining the needs of

all theaters.

By the end of October 1945 the number 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 236,050.11 This reduction was not

great enough to return physicians, dentists, 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-1 called a conference of representatives of other General

Staff divisions, of AAF, AGF, and ASF

headquarters, and of the Surgeon General'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 demobilization and would submit recommendations for changes in authorized ratios.12

During November and December 1945

such studies were completed and the General 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 reduced, 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 Surgeon 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 professionally staffed mobile hospitals decreased rapidly until by the end of May

1946 there were only 42,100 such beds in

all theaters.14

Contraction of the Zone 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 contraction of the general-convalescent hospital system because the reduction and

closure of station and regional hospitals,

dependent primarily upon the reduction

and closure of posts where they were located, had already begun and would continue under established procedures. After

V-E Day, G-4 called for revised estimates

of requirements and The Surgeon General projected forward to the end of 1946

his plans for shrinking the general-convalescent hospital system.16

In estimating bed requirements at this

time, there still were uncertainties to contend 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 uncertainty about the amount and rate of redeployment 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 secondary diagnoses; the number of soldiers

that would be found at separation centers

to need hospitalization, especially for tuberculosis and deafness, before their discharge from the Army; and delays that

the shortage of specialists might occasion

in the disposition of patients already

under treatment, particularly plastic surgery and amputation cases.18

In view of these uncertainties and difficulties, the Resources Analysis Division of

the Surgeon General's Office presented to

G-4 "conservative" estimates of the number of beds that could be eliminated each

quarter, in order to protect the Medical

Department against the possibility of having too few beds for any reason. For example, 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, 16 Jun 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 December, and to this number were added additional beds that would be vacant either

because of dispersion or because some patients 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 additional 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 convalescent hospital system.20

Soon after V-E Day the Resources

Analysis Division had established a procedure 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 increasing 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 decision having been made, the Division

established certain broad principles to

govern the selection of particular hospitals 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 Administration, should be transferred to these

agencies as soon as possible; hospitals in

heavily populated areas should be retained to permit the hospitalization of patients 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 designated as specialized centers for long-term

cases, such as amputation and neurosurgery cases, should be retained as long as

possible in order to keep to a minimum

the transfer of those patients to other hospitals.

In some instances, these principles conflicted with one another. For example,

Halloran and Mason General Hospitals

were located in leased buildings and McGuire 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 con19

 (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 Reduction in Hosp Fac. SG: 323.3 (Hosp). 20

 (1) Memo, SG for ACofS G-4 WDGS thru CG

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). 21

 (1) 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). (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 SvCs attn Surg, 20 Dec 45, sub: Comparative

Studies of Gen-Conv and Sta-Regional Hosp Systs.

SG: 323.3 (Hosp).










314 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

flicts complicated the selection of hospitals to be closed.22

In addition, the needs of both the Veterans Administration and the postwar

Army had not been fully determined.23

Finally, local citizens sometimes protested

the closure of hospitals, and service command surgeons, because of local conditions, 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 command of The Surgeon General. ASF headquarters 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, service commanders were required to revise

authorized bed capacities twice monthly

and to reduce personnel in accordance

with these revisions. Hospital commanders 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 headquarters. After hospital buildings were declared surplus, the Medical Department

lost all control over them and they were

disposed of by other government agencies.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 commands and called the attention of local

Army authorities to any failures in making 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 contracting 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 Convalescent Hospital for the blind, had been

closed.28 By December of that year all regional 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). 23

 (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 Retention 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, Resources 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 ACofS 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 ending 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 hospitals with 15,715 beds, only 14 general hospitals with 34,846 beds, and only 1 convalescent hospital (Old Farms) with 100

beds.30 A comparison of bed authorizations for general and convalescent hospitals 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 anticipated. 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 occupied continued to be considerably

smaller than either the number of beds

authorized or the number of patients remaining.31

 (See Table 15; also Chart 10.)

29

 (1) Weekly Hosp Rpt, vol. III, 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 hospitals were Army and Navy, William Beaumont, Fitzsimons, Letterman, Walter Reed, Brooke, Madigan,

Oliver, Percy Jones, Tilton, Valley Forge, McCornack, 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 CG

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. III, No. 13, for week

ending 29 Mar 46; vol. III, No 26, for week ending 28

Jun 46; and vol. III, 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 theaters 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 airplanes. 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 transportation facilities and care for patients

aboard them—doctors, nurses, technicians, pilots, and many others. Moreover,

equipment and supplies needed to care

for patients in transit were extensive and

sundry, ranging from aspirins to operating tables. To some degree personnel and

equipment required were governed by

transportation facilities employed, because 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 influenced 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 hospitalization 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 required a highly organized operational

system. Its development and conduct were

complicated not only by the divers means

employed but also by the distances traversed and the agencies involved. Patients

traveling by land, air, and sea from hospitals 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 embarkation and debarkation in the United

States; the Offices of the Chief of Transportation, The Surgeon General, and the

Air Surgeon; service and air commands

in the United States; and the headquarters of both the Air and Service Forces.

Involvement of so many agencies made

it important to define their respective

areas of responsibility—particularly after

1

 Interrelationships between hospitalization and the

policies and processes of evacuation have been discussed 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 commanding 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 responsible 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 evacuation of sick and wounded to be delivered

to his control.2 To assist him in this function, various responsibilities (which will

be discussed later) were assigned to the

Chief of Transportation, The Surgeon

General, and port and corps area commanders. In the early part of the war their

activities were closely supervised and coordinated 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 Surgeon General and the Chief of Transportation. 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 operations. Some of the officers of its Hospitalization 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 evacuation operations. Accordingly The Surgeon General in June 1943 assigned Colonel 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 transportation 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 increased in size and given additional authority and responsibilities. In May, it will

be recalled, The Surgeon General removed the Evacuation Branch from his

Hospital Division and merged it with the

Transportation Liaison Unit to form a

Medical Regulating Unit. This step combined the function of regulating the flow

of patients from ports to hospitals of definitive treatment with that of providing for

their transportation. Thus one office, representing 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 responsibility 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 hospitals and supervised air evacuation operations. Collaborating closely with the ASF

Medical Regulating Unit, the Air Regulating 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 complicated 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 general hospitals was also a relatively simple

procedure.

The primary means of transporting patients from overseas areas was by troop

transports. No hospital ships were available, and the movement of patients by air

was still in the experimental stage. Transports delivering troops and supplies at

overseas ports took aboard patients for return 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 dispositions. Ports receiving such information arranged with the corps area (later called

service command) in which they were located for the transportation of patients

being evacuated. Upon arrival of transports, 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 hospitals. 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. HD. (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) XI. 4

 Reports of transport surgeons, required as a part

of each voyage report by AR 30-1150, 19 September 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 General's Office, because station hospitals,

corps area surgeons, and port commanders had general hospital beds set

aside for their use by the bed-credit system.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 numbers 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 operations that made necessary such a transformation.

6

 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 ACTG

to CofAC, 15 Aug 41, sub: Air Amb, with inds. AAF:

452.-1B (Amb Planes).
CHAPTER XIX

Estimated and Actual

Requirements for Evacuation

from Theaters of Operations

Estimating future evacuation requirements was primarily a matter of calculating 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 estimates of this kind were practically unnecessary 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 simply to insuring that transports had adequate hospital space, attendant personnel,

and medical supplies, and that they were

routed on return trips to places where patients 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 November 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 circumstances estimates of the evacuation load

had to be made so that enough transportation could be assembled to handle it;

and estimates had to be made far enough

in advance so that the use of transportation facilities—which came to include airplanes and hospital ships as well as troop

transports—could be properly co-ordinated.

A study which the Surgeon General's

Office made in the winter of 1943-44 of

the patient load that would develop during 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 Surgeon General's estimate of the potential

load was questioned by ASF headquarters

and the Chief of Transportation. Subsequently, as a result of additional information supplied by the European and Medi1

 See above, pp. 201-02. The following three paragraphs are based upon "Hospitalization and Evacuation: A Re-estimate of the Patient Load and Facilities," 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

TABLE 16—PATIENTS DEBARKED IN THE UNITED STATES, 1920-45

a

 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. b

 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 

patients debarked, now located in SG: 705 "Evac Reqmts, Books I and II."
REQUIREMENTS FOR EVACUATION 325

terranean theaters, the Chief of Transportation decided to use lower figures. For

example, The Surgeon General first estimated that 44,300 patients would be evacuated to the United States during September 1944, but the Chief of Transportation

in March 1944 believed that the figure

would be nearer 27,000. Neither considered that airplanes would supply any significant 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 attention, therefore, on surface vessels.

In determining patient capacities of

transports and hospital ships expected to

be available, two factors had to be considered. The use of hospital ships for intratheater 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 according to the standards set for lifeboats and

other lifesaving equipment for patients.

Under "desirable" standards, which were

the highest in terms of lifesaving equipment, capacities would be least. If standards were lowered, capacities would be

increased. Under "adequate" standards a

transport was permitted to load more patients than it had spaces for in lifeboats,

provided the latter could accommodate

all litter and hospital ambulant patients.

For others—mental and troop class patients—only flotation equipment was necessary. 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 adequacy of planned shipping facilities differed. 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 fraction" (estimated to be about 60 percent of

the total number) of patients. They disagreed about the adequacy of transports

for the remainder of the load, including

helpless patients who could not be accommodated aboard hospital ships. On the

basis of his estimate The Surgeon General

concluded that sufficient shipping would

be available for evacuation from the Pacific but that, even under "acceptable"

conditions, there would be barely enough

space for patients from the European theater 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 decided 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, accepting recommendations of the Transportation 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 Department 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 accommodations 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 Command directed its overseas wings to prepare 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 available during 1944—a cumulative total of 9

by the end of June, 16 by the end of July,

and 22 by the end of September.4 This

number was insufficient to meet the demands 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 intra-theater evacuation; others for the

transportation of patients to the United

States.5 As troop shipping to the Mediterranean 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 European theater, generously supplied with

troop shipping because of its combat operations, received fewer hospital ships proportionately 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 hospital ship from the Pacific during 1943 and 2

 See last note above. 3

 (1) Memo, SG for CG 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

ACofS 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 CG 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 AGWAR,

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, CofT 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 proportion of patients evacuated from theaters to the United States aboard hospital

ships increased, as those authorized became 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 proportion 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 accommodations for patients aboard transports. To

raise these estimates the Chief of Transportation 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 prescribed. 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 hospital ships, even though the War Department had stated early that year that helpless 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 refused to make full use of officially announced capacities.8

 As a result, patients

accumulated in its hospitals while beds in

general hospitals in the United States remained empty. Theaters in the Pacific

complied more readily with War Department policy on the use of transports and

therefore did not develop similar backlogs,

but in the fall of 1944 a problem developed in the Southwest Pacific when the

number of mental patients to be evacuated

exceeded the capacities of returning transports for patients of that type. It was solved

by evacuating mental patients by air (a

practice formerly considered undesirable)

and by increasing and improving accommodations 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 Pnt 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 evacuating patients and the number of patients, by transportation 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 (prepared by Mvmt Div OCT) for CinC SWPA, 9 Oct

44. HD: 705 (MRO, Fitzpatrick Stayback, 1496). (2)

Memo for Record by Lt Col Lamar C. 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 inquiry: 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 incidence of trench foot, a larger number of

casualties resulting from intensified combat activity, and failure to use fully the

evacuation space available aboard transports; 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 Medical Regulating Unit, adopted by the Joint

Logistics and Joint Military Transportation 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 subtracted the numbers of patients of all

classes who could be evacuated each

month, from each theater, by troop transports and by airplanes. The remainder

represented the number of patients who

would have to be evacuated by hospital

ships. Conclusions drawn from these calculations were that a peak load of more

than 54,000 patients would require evacuation in August 1945, that hospital ships

already authorized would not be able to

transport all who could not be accommodated 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 conversion of troop transports to ambulancetype 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 shortage of space for evacuation, they anticipated 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 expected to have almost as many patients to

evacuate early in 1945 as the Pacific and

Mediterranean theaters combined. It already 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 because redeployment of transports from

Europe to the Pacific would reduce capacities 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 Regulating Officer and the Office of the Chief of

Transportation, overruled General Hawley'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 conversion. All but the last were to be converted,

manned, and operated by the Army. 12

 Following series of files (1945) deal with evacuation requirements, adequacy of hospitalization both

in theaters and zone of interior, and use of evacuation 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 discussing more extensive use of some of the

larger and faster British vessels for evacuation. Subsequently they agreed to arrangements 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 agreement was approved by the Combined

Military Transportation Committee on

16 January 1945.14 A third step was to increase 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 recommendation of the ASF Medical Regulation Officer, the Chief of Staff directed the European theater on 25 December 1944 to

arrange to use air evacuation to "the fullest practical extent". Soon afterward, the

theater Air Priorities Board agreed to allocate spaces on planes for the evacuation of

3,000 patients per month.15 A fourth step

was taken in March 1945 after a re-evaluation of the evacuation load indicated

that estimates made in December for the

Southwest Pacific and European theaters

were perhaps too low. With the concurrence of The Surgeon General, the Chief

of Transportation directed that restrictions

imposed by lifeboat standards upon patient capacities should be waived, as they

had been for the Queens, for seventeen

Army transports and three Navy transports, and that those vessels should be prepared to carry "maximum" loads of

patients.16

By these measures sufficient facilities

were provided to meet evacuation requirements 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 period 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 evacuated 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 completed 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 author13

 (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 CMT 67, 16 Jan 45, sub: Combined Mil Trans Cmtee, 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.
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 twentyfour 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 Mediterranean theater, which was considerably

smaller by the early part of 1945 than before, 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 approach 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 evacuated 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 during the first half of 1945. Of these, 19 percent 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 theaters had been so reduced that it was possible 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 airplane. Since the Pacific had no great backlog 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 transferred from the Atlantic. Just before V-J

Day space for evacuation from the Pacific was so ample that the War Department ordered a reduction in its evacuation

policy to 60 days to provide enough patients to make full use of available transportation. 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 evacuated from all theaters, 29.9 percent returned 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 remained effective with minor modifications

to its end.

Procedures for Sea Evacuation

SOS directives charged ports of embarkation, operating directly under the

Chief of Transportation, with responsibility for the evacuation of patients from

overseas areas to which they supplied war

materiel. A basic prerequisite to the discharge of this responsibility was information about the kind and number of patients to be evacuated. Accordingly, in

August 1942 SOS headquarters announced 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 physical 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 lockedward 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. Fitzpatrick) 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 COs 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. Patients 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, regardless of the degree of their disability. To

remedy this situation the War Department 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 accommodations used for troop class (Class IV)

patients.4

To furnish ports in the United States

with information about the number of patients of each type to be returned to the

zone of interior, SOS headquarters in

September 1942 devised a system of reports 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 overseas commander was required to report

monthly to the port commander serving

his area the following information: (1) the

total number of patients awaiting evacuation, (2) the number in each of the four

classes listed above who were awaiting

evacuation at each port within the theater, 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 embarked, 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 numbers 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 submit 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 erroneous report, insufficient medical personnel had been sent to Halifax to care for

the patients received and their debarka3

 Ltr AG 704.11 (3 Jun 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. 4

 (1) Ltr, Hq ComZ ETO to CofT, 10 Jul 44, sub:

Accommodations for Class 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 ACofS OPD WDGS, 3

Sep 42, sub: Essential Inf Conc 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 occurrences, as well as the arrival of patients

without prior arrangements for their reception, theaters were directed in January

1943 to exercise more care in making reports 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 evacuation, 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 sufficient 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 transportation, usually by rail, to hospitals of definitive treatment. Therefore, on 13 January

1943 the War Department directed theater commanders to report monthly, in addition to information already required,

the number of patients awaiting evacuation 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 "rotation" complicated the problem of evaluating the adequacy of patient lift because

such persons sometimes took up space on

transports which the Medical Regulating

Unit had considered available for patients. In August 1944, therefore, the War

Department directed theater commanders to add to reports of patients all other

military personnel awaiting transportation 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 information for planning purposes. As a

result, the War Department directed theaters 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 Hospitalization and Evacuation Branch prepared

a directive in October 1942 for the Chief

6

 (1) Memo, Lt Col J. 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: Reception 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 III, 1 Jan 43-15 Mar

43."

8

 Ltr, TAG to CGs Def Comds, Depts, and Base

Comds, 13 Jan 43, sub: Essential Info Conc 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) Memos, SG (Resources Anal Div) for ASF

(Plans and Oprs), 21 and 27 Feb 45, sub: Rpt for

Overseas Theaters. SG: 705. (2) Rad CM-OUT55158, 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 commanders.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 commands in which ports were located. Also,

port commanders were to compare the

number and types of patients to be evacuated during the following month with

accommodations aboard transports scheduled to call at theater ports. If it appeared

that there would be insufficient "lift" —

that is, too few ships returning from theaters or unsuitable accommodations on

available ships for different classes of patients—port commanders were to report

this fact to the Chief of Transportation in

order that additional lift might be provided. Finally, port commanders were to

use information received in embarkation

reports to plan transportation from ports

in the United States to hospitals of definitive 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 insufficient accommodations for all of them.

This situation resulted from the temporary and sudden accumulation of patients,

particularly of Class I (mental), after reports had been sent in, and from the preemption 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 Transportation was then responsible for complying

insofar as possible with desires of the theater commander. In addition, when transports 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 theater commanders in turn were required to

suballocate reported space among the

several ports under their jurisdiction.13

Later in the war, the Medical Regulating Unit used information submitted in

reports of patients being embarked and

awaiting evacuation to plan the most effective use of all available evacuation

facilities. Its Water Evacuation Section

maintained at all times current records of

patients needing transportation from different ports in the several theaters. Comparisons of such records with space for

patients aboard scheduled transports revealed whether or not anticipated lift for

a particular port or theater would be adequate. If not, the Medical Regulating

Officer recommended steps to supply the

required lift such as changes in the schedules 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 incl.

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 Daybook, Aug 42-Jun 43). (2) Memo, Chief Hosp and

Evac Sec Plans Div ASF for Col [Frank A.] Heileman, 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 transfer of patients from control of the former

to the latter. To insure co-ordination between a theater and the zone of interior,

such demarcation was necessary. Hence,

early in 1943 the SOS Hospitalization

and Evacuation Branch prepared a directive on "sea evacuation operations" which

the War Department issued on 25 January 1943.15

 This directive detailed specifically for the first time the respective

responsibilities of the Chief of Transportation, port commanders, and theater commanders.

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 commanders were charged with selecting patients 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 responsible for insuring that patients were not

placed on ships lacking suitable accommodations. For example, a theater commander 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 loading 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 theaters. 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 officially announced capacities for patients

of all classes.16

Theater commanders were also responsible for providing adequate medical

personnel for patients embarked and for

furnishing any additional medical supplies requested by transport surgeons.

Personnel whom they placed on ships normally belonged to the Chief of Transportation and were supplied to theaters

on an "attached" basis. Medical hospital

ship platoons of various sizes were attached to United States ports by the Chief

of Transportation. Port commanders then

ordered them to temporary duty in theaters of operations. Only when such platoons 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 commanders 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,

31 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 additional responsibilities in connection with

sea evacuation operations in the latter

part of the war. To reduce the medical

personnel who would be needed for assignment to regularly organized medical

hospital ship platoons, they were required

after 8 June 1944 to form Medical Department officers, nurses, and enlisted men

being returned to the United States on

"rotation," into provisional medical hospital 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 surgeons and hospital ship commanders not

only with evacuation orders but also with

lists of patients showing diagnosis, transportation classification, and type of accommodation needed for each. Similar

lists had formerly been prepared by transport surgeons and hospital ship commanders 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 suitable 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 submitted to ships' officers certified statements 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 debarkation 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 prepare 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

towards.19

The directives just discussed served as a

basis for co-ordination of activities of theaters and the zone of interior in the evacuation of patients by sea. A further step—

the co-ordination of activities of transport

surgeons with those of the ports of debarkation 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 patients, these instructions covered the

duties of transport surgeons in the transfer 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 (3 Jun 44) OB-S-E-SPMOTM, 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, CofT 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

 TC Cir 50-31, 30 May 44, sub: Use of Debarkation Tag (Manual for Trans Surg); (Revised 17 Jul

44). TC: 710. 19

 WD Cir 218, 20 Jul 45.
PROCEDURES FOR EVACUATION 337

brief diagnosis, a classification (neuropsychiatric, 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 attachment 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 Transportation Corps, assisted by the Medical

Regulating Officer, supplied transport

surgeons and hospital ship commanders

with more specific instructions than formerly. 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 covering the sailing of hospital ships were published. 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 theaters, issued a sixty-one page manual of

instructions for their commanders. It

covered such subjects as reports and

records, procedures in case of death, regulations for sanitation and hygiene, quarantine procedures, suggestions for the care

of patients at sea, supplies and equipment,

and the like.22 Instructions issued to transport surgeons and hospital ship commanders 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 medical 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 Command had asked for airplane-ambulance

service to the United States; in the first

half of 1942 it renewed its requests, pointing out then and later that evacuation by

sea was uncertain, delaying the movement 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, CofT (Mvmt Div) to CGs PEs, 9 Dec 43,

sub: Guide for Trans Surgs. HD: 705 (MRO, Fitzpatrick Stayback, 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, CG Alaska Def Comd to CG

Western Def Comd and Fourth Army, 14 Jul and 6

Oct 42, sub: Aircraft Amb for Alaska. AG: 452. The

14 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 responsibility for the development and operation

of air evacuation.24

The Air Surgeon saw in these demands

an opportunity to develop an air evacuation system,25

 but basic decisions had to be

made first as to (1) who within the Army

Air Forces would be responsible for planning and operating this system, (2)

whether or not special airplane ambulances would be provided, and (3) the extent to which air evacuation would be encouraged or permitted. On 25 August

1942 the Air Surgeon foreshadowed the

answer to the second question when he

stated that "airplanes have not been produced 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 announced its decisions. Special planes

would not be provided for the evacuation

of patients from overseas bases and theaters; but air evacuation would be carried

out in connection with the routine operation of air transports. Since the Air Transport Command operated such transports,

it would operate the air evacuation system. The Air Surgeon—not the Air Transport Command—would be responsible for

planning and establishing policies for this

system.28 To discharge this responsibility,

the Air Surgeon expanded his Office, assigning 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 evacuation. After approval by the Air and General Staffs it was announced to theaters by

the Chief of Staff of the Army on 25 September 1942. Air evacuation would be accomplished "upon call" on the Air Transport Command, but such calls would be

kept "to [a] minimum." Theater commanders 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 psychotics—who required prolonged hospitalization 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 Evacuation Branch gained this impression after conferring 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, 31 Jul 42, sub: Air Amb Evac of Pnts

from Newfoundland Base Comd. SG: 705.-1 (Newfoundland)F. 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:

SGO 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, 30 Jun 52. HD: 314 (Correspondence on MS) XI. 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, representatives of the Air Surgeon's Office, the SOS

Hospitalization and Evacuation Branch,

and the Air Transport Command collaborated in establishing operational procedures and delineating responsibilities of

various participating commands. Whereas the Air Transport Command was responsible for equipment attached to

planes, such as litter brackets, the Medical 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 arrived in the United States. Medical air

evacuation transport squadrons, consisting

of nurses and enlisted technicians, were to

be assigned to the Air Transport Command to furnish attendants for patients

aboard transport planes. Theater commanders 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 patients selected by theater commanders.

Finally, the Air Transport Command

would be responsible for the care and

treatment of patients from the time it accepted 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 patients for flight, after the first half of 1944

theater medical authorities were responsible 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 patients requiring neurosurgery, maxillofacial 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 contraindication to transportation by air.32

 On the

other hand, in the fall of 1944 the Southwest Pacific theater included mental patients 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 procedure for the air evacuation of psychiatric

patients.33

Early in 1943 the Air Priorities Division

of the Air Transport Command determined the priority of patients designated

for air transportation as against priorities

already established for passengers and

31

 (1) Rpt, Mins of Mtg, ATC, 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 11th AF, 13 Dec 42, sub:

Recommended Plan of Air Evac. AAF: 370.05. (6)

Diary, SOS Hosp and Evac Br, 17 Dec 42. HD: Wilson 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 Transport Command, 1 January 1945-31 March 1946. HD:

TAS. For a discussion of medical considerations involved in air evacuation, see Sidney Leibowitz, "Air

Evacuation of Sick and Wounded," The Military Surgeon, vol. 99, No. 1 (July 1946), pp. 7-10.
340 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

cargo in general. Three degrees of precedence 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 necessary 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 extremely urgent nature.34

 In February 1943

ATC headquarters announced that patients would normally have Class 3 priorities but could not be displaced, or

"bounced," once they were en route, except at the discretion of ATC flight surgeons 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 insure 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 determined the amount of space that would be

set aside for patients, for other personnel,

and for cargo.36 Among the obvious advantages of this system was the increased

certainty with which both theater surgeons and Medical Regulating Officers in

the United States could plan air evacuation.

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 responsible for the necessary reports. It required

a base embarking patients for another to

inform it by the fastest means of communication 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 Regulating 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 procedures for their debarkation, their movement from ships and planes to near-by

34

 Air Priorities Div, ATC, Directive No 5, Priorities 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 preparation for further transportation to hospitals of definitive treatment. Problems in

this connection were not as great for air

bases as for port commands because patients 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 general hospitals for further treatment.38

 This

responsibility conflicted with a basic principle 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 commanders 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 responsible 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 instances 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 inconvenience 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 recommendation of the latter the War Department in May directed overseas commanders 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 patients. They were responsible for removing patients from airplanes and transporting them and their baggage to such hospitals. To discharge this responsibility they

were required by ATC regulations to supply 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 patients from air debarkation hospitals to

38

 (1) AR 40-1025, 12 Oct 40; C 1, 21 Aug 42; C

4, 5 Jul 43. (2) WD Cir 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 119, 11 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 removing 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 classification of patients and to receive from the

transport surgeon his list of patients classified according to diagnosis (medical, surgical, 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 attendant. 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 transmission 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 debarkation to the Chief of Transportation,

The Surgeon General, the commander of

the New York Port of Embarkation, and

the surgeon of the Second Service Command.41

For debarking patients from ships and

transporting them to general hospitals

port commanders normally used personnel 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 battalions 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 expected, 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 Command 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 directive 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 CofT, 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 incls. SG: 705 (NYPE). (3)

Memo for Record, on 1st ind SPOPH 370.05 (11-24-

42) Hosp and Evac Br SOS to CofT, 26 Nov 42, on

unknown basic Ltr. HD: 705 (MRO, Fitzpatrick Daybook, 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 simplify 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 normally 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 nearby 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 correct. The Ninth Service Command, for

example, had to call upon the San Francisco 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 service 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 Second Service Command, for example,

transferred patients from piers located in

Brooklyn, Staten Island, New Jersey, and

the North River to service command debarkation hospitals by ambulance, government 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 Command normally used trains to move patients from ships in the Boston harbor to

Camp Edwards and Camp Myles Standish hospitals. The Fourth Service Command used motor vehicles almost exclusively 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 ambulance and in large groups by rail.47

Ports continued to be responsible for

debarking patients from ships. Normally

they used their own men, including specially 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 CofT, 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. 46

 An Rpts, 1944, Letterman Gen Hosp; NYPE;

and 1st, 2d, 4th, and 9th SvCs. HD. 47

 An Rpts from SvCs, Ports, and Gen Hosp (Halloran, Hammond, LaGarde, Letterman, Lovell,

Madigan, McGuire, Stark) and Sta Hosps (Cp Edwards, Cp Myles Standish) for 1944 and 1945 explain 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. Usually litter patients were debarked last because such preparations as transferring

them to litters could be made while other

patients were being debarked. As ports

gained experience in operations and improved 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 during 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 General directed hospitals receiving large

numbers of patients from either ships or

trains to admit them directly to wards,

without "processing" them through hospital receiving offices. The reason was to

avoid delays in giving patients needed

food, rest, and treatment. Halloran General Hospital had developed a different

system, and on request of the hospital and

the Second Service Command, The Surgeon General approved its continued use.

There, a receiving ward had been established to care for a large number of patients. 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 clothing room in which patients received fresh

hospital clothes and stored their own

clothing. There was also space for a battery of typists brought in to complete all of

the paper work required for the admission of patients. The average length of

time patients stayed in this building, before 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 seventy-two hours—so as to keep enough

beds vacant for large groups of new patients 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 carried in medical records and to determine

their ability to undertake further travel.

Primary emphasis was upon administrative 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 difficulties 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 Hospital, 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; 5 0

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 recalled, 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 Control Divisions of Stark General Hospital

and the Fourth Service Command proposed the elimination of records required

for patients admitted to hospitals for definitive 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 debarkation 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 During the winter of 1944-45 another measure toward simplifying the work of debarkation hospitals was adopted: the installation 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 seemingly small when considered individually,

the significance of such measures can be

judged more accurately if the total evacuation 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 admitted about 69,500 and Letterman about

73,000 during the entire year.53

50

 That is, partial payments of the pay and allowances due service men, made by the Army pending

full settlement of their accounts. 51

 (1) Memo, CofT (Mvmt Div by Lt Col J. C.

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 Hosps. 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: 319.1-2. (4)

Memo, NP Cons Div SGO for Hosp Div SGO, 14

May 45, sub: Procedure of Pnts Recd from Overseas

thru Stark Gen Hosp. SG: 705 (Stark GH). 53

 An Rpts, Stark, Halloran, and Letterman Gen

Hosps, 1945. HD.
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 different 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 hospitals. Meanwhile declining troop strength

in the United States, along with establishment 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 patients 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, permitting certain planes to be assigned primarily 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 planning 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 influence over the distribution of patients

among Army hospitals. His office granted

ports unlimited bed credits in general hospitals located nearest them. Port commanders 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 transferred patients to general hospitals in

which they held bed credits. General hos1

 (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 receiving 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 requested 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 Surgeon General's Office authorized the

transfer of patients in bulk and depended

upon local commanders to request individual 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 General's Office greater control over the transfer of individual patients. It involved reports to the Medical Regulating Unit of

patients received at debarkation hospitals

and of vacant beds in general and convalescent 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 locations, 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 ambulatory) of each patient received. For example, 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 classifications 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 hospitals 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, surgery, and neuropsychiatry but in terms of

the particular diseases or injuries for

which they had been designated as specialized centers. For example, hospitals

with vacant beds for male neurosurgical

patients reported them under code

"12TVKN." Early in 1945 both debarkation 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 Regulating 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 suf2

 (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 Hospitalization and Evacuation Division, SGO, was receiving

daily reports from 28 hospitals, giving number of

patients, number of medical, surgical, and neuropsychiatric 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 Hospital 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 patients 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 northeastern part of the United States, in July

1944 The Surgeon General directed that

no patients should be transferred to certain 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 hospitals 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 enabled him to authorize transfers of patients 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 hospitals 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 impossible for the Medical Regulating Officer

to send all patients to hospitals located

near their homes. Furthermore, the necessity of sending patients to specialized centers sometimes conflicted with and outweighed the desirability of sending them

to hospitals near their homes. Finally, debarkation hospitals had time for little

more than superficial examinations of patients 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 convalescent 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 telegrams, 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 transfers 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 requesting the transfer of patients to general

hospitals; the typical request covered 500

patients who had to be transferred because 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 patients 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 exclusively in Pullman cars of passenger

trains, because the necessity of transporting large groups was practically nonexistent and the Army had only six hospital

cars. For groups of patients and attendants

numbering fewer than fifty, local transportation officers arranged with railroads

for cars and routings. For larger groups,

the Office of the Chief of Transportation

made necessary arrangements, upon request of local transportation officers.8

Toward the end of the summer of 1942,

SOS headquarters, the Chief of Transportation, and The Surgeon General began to plan for the operation of hospital

trains. By that time the delivery of additional 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 complicated. Although hospital cars were procured 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 service command hospital was being constructed near each port which lacked one,

and it was anticipated that patients debarked 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 hospital 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 hospital cars most, because general hospitals

in such commands would receive large

numbers of patients for transfer to hospitals 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 commands 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. Supplemental 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 incl. HD: 705.
350 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

rail equipment were to be used to complete it.9

After the decision to attach hospital

cars to service commands was made, SOS

headquarters issued directives establishing procedures for their use. The directives

conflicted with one another and with

Army regulations governing the transportation of personnel in general. As already noted, War Department regulations

permitted local transportation officers to

arrange with railroads for the transportation of groups of persons numbering less

than fifty (after June 1943 less than forty),

but provided that the Chief of Transportation would arrange for the transportation

of all larger groups. This meant arranging

with railroads for carrier-owned equipment and for routes and schedules.10

 On

the other hand, SOS directives provided

that local transportation officers could arrange for all routings of hospital cars within the boundaries of service commands to

which they were attached. Another stated

in contradiction that except in emergencies service commands would ask the

Chief of Transportation for routing instructions to cover the movement of each

hospital car. Two SOS directives stated

that service command transportation officers would arrange with railroads for all

supplemental rail equipment, while another 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 regulations requiring the Chief of Transportation to arrange for equipment and routings for the movement of large groups.11

Such conflicting instructions caused confusion about which both the Office of the

Chief of Transportation and service commands complained.12

The feasibility of attaching cars to service 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 commanding general of the Eighth Service

Command believed that hospital cars

would be used most in the transportation

of patients arriving from theaters of operations and proposed, therefore, that they

should be controlled exclusively by the

Transportation Corps and operated by

ports.13 The Chief of Transportation considered this possibility, but agreed with

the SOS Hospitalization and Evacuation

Branch to follow plans already made.

Nevertheless, in preparation for the reception of casualties from the North African

invasion, all hospital cars were temporarily 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: Control of Hosp Tns. TC: 531.4. For a discussion of different types of Army-owned hospital cars, see below,

pp. 372-75, 381-83. 10

 (1) WD Cir 192, 16 Jun 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 SvC, 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. TC: 531.4. 13

 Rpt, Conf 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 patients began to arrive from theaters of operations, to have service commands supply personnel for hospital trains but to

place all hospital cars in pools under the

exclusive control of the Chief of Transportation. Presumably such an arrangement

would have promoted the more efficient

use of cars, but the Transportation Corps

preferred to continue the system of attaching cars to service commands in which

ports were located, and The Surgeon General's representative concurred in plans

for the allocations of 45 cars to the Second,

24 to the Third, and 27 to the Ninth Service 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 maximum 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 carrier-owned equipment to transport patients. 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 hospital 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 Evacuation 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 debarkation hospitals to transfer patients to

other hospitals, enabling the latter to anticipate 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 purpose 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 patients from debarkation to other hospitals

to consult at all times with transportation

officers as to the availability of Army hospital 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. TC: 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 SvCs, 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. 17

 (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 SGO

to Surg 9th SvC, 4 Dec 43. SG: 705.-1 (9th SvC)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 movement of patients by rail, measures were

adopted to centralize the control of hospital cars. At the end of 1943, SOS directives 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 command boundaries—was centralized in the

Office of the Chief of Transportation.

Moreover, local transportation officers

were specifically limited in the arrangements which they could make for supplemental rail equipment to instances when

fewer than forty persons were to be carried on hospital trains. When larger

groups were moved the Office of the Chief

of Transportation alone could make all arrangements. For several months this Office was indulgent, accepting generally

the recommendations of service commands as to dates of hospital train movements and the make-up (that is, the combination of Army-owned with carrierowned 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 transportation 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 Traffic Control Division determined the makeup of hospital trains and set the dates of

their departure. Upon the recommendation 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 stations for more than ten (later five) days.

This meant, for example, that a car attached 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 evacuation 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 fourteen. As long as service commands could

arrange for the movement of groups of patients that were large enough to warrant

the addition of a special tourist or sleeping car to a regularly scheduled train

(that is, any group of fifteen or more persons), 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 Tn Cars. SG: 453.-1. (2) Memo, Maj Samuel

N. Farley, TC, for Lt Col I. Sewell Morris, TC, 27

Oct 43, sub: Conf in SGO re Better Util of GovtOwned 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 Transportation—was traveling empty at approximately 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 persons 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 numbering fourteen or less. Knowing the locations 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 movements was not wholly approved by service

commands, the Surgeon General's Office

considered such control essential. One

service command surgeon 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 transportation officer in another service command believed that he could expedite the

movement of patients from the debarkation hospital which he served if he were

permitted to arrange rail movements independently. Still another service command complained of the use elsewhere of

personnel which it supplied to care for patients being transported from its own debarkation hospital. Other objections arose

from the difficulty service commands encountered in property and mess management on hospital cars attached to them

but diverted elsewhere for use. In reply to

such complaints, The Surgeon General repeatedly explained that centralized control of the movement of hospital cars and

hospital trains was necessary to insure the

maximum use of all available rail equipment, both Army- and carrier-owned, in

the orderly transportation of large numbers of patients.21

Measures other than centralization of

control were adopted to achieve better use

of hospital cars, conserve medical personnel, 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 hospital cars that had to be moved without patients 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 representatives. Though this procedure was a departure from the Army's agreement with

the railroads, the latter apparently inter20

 (1) Memo, CofT for ACofS G-4 WDGS, 16 May

45, sub: Routing Control and Carriers' Equip for

Mvmt of Pnts 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 Jun 44, with reply dated 8 Jun

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 movements 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 hospital 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 procedures involved, the ASF Control Division,

the Surgeon General's Office, and the Office of The Quartermaster General collaborated 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 maintenance. In September 1944 a circular governing accounting procedures was published by ASF headquarters, while some

months earlier the Transportation Corps

prepared technical bulletins on the maintenance of hospital cars.26

 Another problem 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 passageways. Carriers agreed to place them either

directly ahead of or directly behind other

passenger cars in the same train. Furthermore the carriers agreed, upon the request

of the Chief of Transportation and the recommendation of The Surgeon General, to

place "buffer" cars (cars in which no patients 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 transported only in air-conditioned cars. By

Army regulations and an agreement with

railroads, patients were authorized "sleeping car accommodations in tourist sleeping cars if available, otherwise standard

sleeping cars." Of the entire fleet of Pullman tourist cars, only four hundred were

air-conditioned, and it was therefore impossible for carriers always to supply airconditioned tourist cars when they were

requested. For a time during 1944 they

supplied higher-priced air-conditioned

standard sleeping cars without any increase 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 hospital 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 Connection 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 representative only, in no way intended to be

an exhaustive listing, of those encountered

by authorities on a higher level than hospital train commanders. These commanders were faced with other problems which

were perhaps even more varied and complex. Solutions for most of them had to be

found locally, for there was no War Department manual on hospital train operations. During 1945 a series of conferences

of hospital train commanders, attended

by representatives of The Surgeon General and the Chief of Transportation, were

held to discuss such common questions as

linen exchange procedures, feeding difficulties, the handling of baggage, entraining and detraining plans, personnel and

equipment requirements, means of providing recreation aboard trains, and problems of hospital car maintenance and operation.29

Some idea of the scope of hospital train

operations may be gained from the following figures. During 1944, 172 hospital

trains carrying 37,371 patients were dispatched from the Second Service Command to general and convalescent hospitals scattered throughout the United

States. During the period from 26 June

1944 to 15 October 1945, 205 hospital

trains evacuated 35,697 ambulatory patients and 17,320 litter patients from Stark

General Hospital. From January to August 1945, inclusive, the hospital train detachment of the First Service Command

made 232 trips to 1,334 destinations, covering 48,888 miles and moving 67,608 patients. 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 commands retained throughout the war the

authority to arrange with common carriers for the movement of patients as individuals or in small groups. The main

difficulty they encountered was in securing accommodations for them in sleeping

or parlor cars occupied also by civilians.

In November 1943 the ASF Control Division investigated complaints of hospitals

about delays in getting reservations for patients 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 February 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 accommodations 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: Accommodations in Air-Conditioned Sleeping Cars,

with inds. SG: 531.2. (3) WD Cir 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

Fld, 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 Cirs 229, 24 Sep 43; 316, 6 Dec 43. (3) History 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 Railroad Interterritorial Military Committee

agreed upon procedures for obtaining

reservations for individuals and for groups

of fewer than fifteen persons. For this purpose, 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 patients 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 approximately 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 delayed 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 railroad to assist hospital commanders in obtaining accommodations for patients of all

classes within the time limits established

for each. Hospital commanders were enjoined to co-operate with such representatives and, when requesting transportation

for patients in either of the first two classes,

were required to submit certificates attesting 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 agreement 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." Therefore they decided against it. In the following June, representatives of The Surgeon

General, the Chief of Transportation, and

railroad companies maintained a like

position when the Office of Defense Transportation proposed a system of priorities.

Soon afterward, however, the Interstate

Commerce Commission, on the recommendation of the Office of Defense Transportation, issued an order which provided

for the dispossession of passengers to obtain accommodations for patients. While

this action protected railroads against unwarranted 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 railroads. To avoid the latter contingency,

and particularly the unwarranted use of

priorities by general hospitals, the Army

in October 1944 revised the circular describing the voluntary agreement worked

out in May. Restating that agreement, the

revised version of the circular required

hospital commanders to submit to railroads, along with each request for reservations, certificates attesting the classifica32

 (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 Accommodations 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 provided. 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 beginning 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 arranged 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 headquarters authorized SOS installations to submit requests for the air transportation of

patients to near-by Air Forces installations, 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 Ashford General Hospital requested air evacuation to relieve congestion on railroads in

that area. A few weeks later the commandant 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 Janu33

 (1) ICC, Order 213, Title 49, Transportation and

Railroads, 27 Jun 44. HD: 531.4. (2) Memo, Col

A[lbert] H. Schwichtenberg for SG, 26 Jun 44, sub:

Rail Trans of Pnts. SG: 531.2. (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 Fld to CG AAF

(Air Surg), 17 Nov 42. AAF: 370.05 (Evac Book No

1). (2) Ltr, Surg HRPE to CO Langley Fld, 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 CO Langley Fld, 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, Richmond, Va., 16 Nov 43; AAF School of Air Evac, Bowman Fld, 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 conferred 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 commanders, the commanding general of the

Second Service Command stated that air

transportation for patients was "most

desirable," and suggested its use particularly for small groups who needed to be

moved without delay.39 In April the flight

surgeon assigned to Brooke General Hospital propounded still another reason: the

evacuation of patients by air would be

economical, saving the Government, according 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 patients by air in the United States was

made in January 1944. At that time three

troop carrier command planes, with personnel 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 required medication, such as the administration 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 patients by air in the United States (as it had

been made responsible earlier for air evacuation from theaters of operations). Soon

afterward it assigned to its Ferrying Division as a special mission the movement of

about 700 patients from coastal medical

installations to various hospitals throughout the United States. The next month

the Transport Command delegated its responsibility for domestic air evacuation to

the Ferrying Division, and began to earmark transport planes for evacuation

only.42 In June representatives of AAF and

ATC headquarters, the Ferrying Division,

the Air Surgeon, and The Surgeon General 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, requesting necessary arrangements. The latter

telephoned the Ferrying Division in Cincinnati, Ohio, to determine availability

38

 Diary, Hosp Admin Div (SGO), 8 Jan 44. SG:

314.8. 39

 Rpt. Conf CGs of SvCs. Dallas, Tex., 17-19 Feb

44. HD: 337. 40

 Ltr, Off Flt Surg Brooke Gen Hosp to CG AAF

thru Central Flying Tng Comd, 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 incl. 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 Regulating Officer informed the Ferrying Division 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 patients 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 transported about 100,000 patients from debarkation hospitals to general and convalescent 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 otherwise possible the policy of transferring patients promptly and directly from debarkation 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 Division, June 20, 1942 to August 1, 1944. ATC: Hist Div.

(2) 1st ind, CG Ferrying Div ATC (Surg) to CG ATC

attn Surg, 24 Sep 44, on Ltr, CG 2d SvC to CG 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. 11 (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 encountered in this process, as well as in

manning and equipping hospital trains.

Motor Ambulances

Of all conveyances the motor ambulance was the most widely used and transported 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 theaters of operations, it was called at different times the field ambulance, the station

ambulance, and the cross-country ambulance. Others of more specialized—and

therefore more limited—use were the metropolitan and multipatient ambulances.

General-Service Ambulances

Because general-service ambulances

were basic conveyances for patients in

both peace and war, experiments to improve them were made between World

Wars I and II. In 1932 a field ambulance

on a (4 x 2)1 chassis of 11⁄2-ton capacity

was developed by the Medical Department Equipment Laboratory and by 1939

it had replaced ambulances of World War

I type. Although this ambulance was designed for use at Army posts and camps in

the United States as well as for field service 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 civilian 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 oper1

 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 Wartime Ambs. HRS: G-4/29094. (2) Ltr, QMG to

TAG, 15 Apr 35, sub: Mil Characteristics for Ambs,

Light Fld Type. QMG: 451.8. For letters on motor

vehicular requirements and assignment of ambulances see files HRS: G-4/29714 and QMG: 451.8;

for changes in specifications and rear spring improvements 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 Department 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 vehicles and to simplify the procurement and

distribution of spare parts as well as the

maintenance and repair of vehicles. It announced in August 1939 that all tactical

vehicles (that is, those used by table-oforganization units) would be all-wheeldrive types, and that only five chassis

would be considered standard for the

Army: 1⁄2-ton, 11⁄2-ton, 21⁄2-ton, 4-ton, and

71⁄2-ton.4 The Medical Department Equipment Laboratory and Holabird Quartermaster Depot then concentrated on experiments with a 1⁄2-ton (4 x 4) chassis, and

in June 1940 The Surgeon General announced that the ambulance built on it

would be "accepted as the new crosscountry 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 patients. When the first of this type was delivered 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 hospitals in the zone of interior as well.6

 In

short, the new cross-country ambulance

was a better general-service ambulance

than the 11⁄2-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—1⁄4-ton (4

x 4) and 3⁄4-ton (4 x 4)—were introduced,

and the 1⁄2-ton (4 x 4) was dropped from

the Army's standard list. As early as February 1942 the Quartermaster Corps was

anticipating issuing 3⁄4-ton ambulances in

place of 1⁄2-ton vehicles.7 About four

months later plans for the change had

been completed, and 3⁄4-ton ambulances

were ordered along with other 3⁄4-ton vehicles. Although similar in appearance to

the 1⁄2-ton ambulance, the new 3⁄4-ton ambulance 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 operations, it was used widely in the zone of

interior as well. The stoppage of passenger-car production early in the war curtailed the procurement and use of

metropolitan ambulances built on pas3

 2d ind, SG to TAG, 3 Jan 40, on Ltr, SG to TAG,

25 Nov 39, sub: Fld 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 G[arfield] L. McKinney (Planning

Subdiv) for SG, 14 Jan 41, sub: New Cross-Country

Amb; Insp at Carlisle Bks, 13 Jan 41. Off file, Research and Dev Bd SGO, "Cross-Country Amb." 7

 (1) Ltr QM 451 M-ES, QMG to SG, 14 Feb 42,

sub: Reclassification of Amb, Fld, 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 Motor Vehicles.
362 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

PLACING THE FOURTH LITTER PATIENT IN A FIELD AMBULANCE

senger-car frames.9 The Medical Department 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 (11⁄2-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, ambulances of the new types were issued to zone

of interior installations. In addition, 356

chassis for 11⁄2-ton (4 x 4) trucks were

taken from a civilian pool of motor vehicles in 1943 and were used to build modified field ambulances for service in lieu of

unavailable metropolitan ambulances.11

Thus, in addition to the metropolitan ambulances 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 11⁄2-ton (4 x

2) field ambulance; the 11⁄2-ton (4 x 4)

modified field ambulance; the 1⁄2-ton (4 x

9

 For letters on efforts to secure additional metropolitan ambulances and their procurement and distribution see file SG: 451.8-1 (1939-43). Also see History 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 hospitals 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 Fld 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 3⁄4-

ton (4 x 4) ambulance.

By the winter of 1942-43 it appeared

that the 3⁄4-ton ambulance was not entirely satisfactory for overseas use. SOS headquarters thought it took up too much

shipping space, and some theaters expressed dissatisfaction with its performance. 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 transported, while reports from North Africa

indicated that the 3⁄4-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 January 1943 proposed several methods of

overcoming these difficulties: shipment of

the standard ambulance in a two-unit

pack for reassembly in theaters of operations, replacement of its metal body with

bows and a tarpaulin top, and provision

of "litter kits" for use in adapting stand12

 (1) Diary, SOS Hosp and Evac Br, 13, 16, 22,

and 28 Jan 43. HD: Wilson files, "Diary." (2) Ltr,

CinC SWPA to CG SOS, 21 Nov 42, sub: Improvement 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 (Correspondence on MS) XI.
364 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

MOTOR AMBULANCES. Left to right, 1⁄2-ton (4x4), 3⁄4-ton (4x4), and 3⁄4-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 countered with a different proposal. The Medical Department Equipment Laboratory

had already begun to evaluate experiments of medical units in replacing litter

bearers with motor vehicles—particularly

1⁄4-ton (4 x 4) trucks, or jeeps—to transport 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 uncovered jeep—were so small that litters

protruded over their sides or ends. Consequently the Medical Department Technical Committee and the Surgeon General's Office had proposed in August 1942

the development of a light forward-area

ambulance on a nonstandard chassis—a

1⁄4-ton (4 x 4) chassis to which an extra

axle and two wheels were added, making

it a 3⁄4-ton (6 x 6) chassis. SOS headquarters had disapproved this proposal because it conflicted with the War Department's policy of using only standard

chassis.14 The Surgeon General's Office

still believed that this vehicle was a practical solution to the dual problem of saving 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: Arabs.

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 ltr.

(3) Memo, Chief Dev Br Research and Dev Div SGO

for Chief Fld Equip Br Research and Dev Div SGO,

3 Sep 42, sub: Forward Area Amb. All in Off file, Research 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 recommendation to the Army Ground

Forces, principal user of front-line ambulances. Rather than introduce a new type

of chassis, AGF headquarters recommended the modification of the 3⁄4-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 Laboratory collaborated in the development of

an ambulance on a 3⁄4-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 General's Office recommended that one with

plywood and steel paneling be adopted as

standard.16 As the 1944 ambulance procurement program was nearing completion (April 1944), the new "knock down"

ambulance was standardized, and the

older 3⁄4-ton vehicle, which had been issued widely to units in all areas, was reclassified as a limited standard item.17

Metropolitan Ambulances

The possibility of procuring metropolitan 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 Committee that "The Army may not have

considered the need for street ambulances

to be used in connection with [Army] hospitals 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" ambulances. When The Surgeon General took

this opportunity to insist upon the procurement of 200 metropolitan ambulances, 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 requirements for metropolitan ambulances could

continue to be met by using field (or general-service) ambulances.19

 The Surgeon

General's Office then surveyed service

command needs and in January 1945 reported 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. Accordingly 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 CG 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,

"Cross-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, 3⁄4-ton, 4x4 , Amb KD-Standardization 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, 9 Jun 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, 24-ton,

4x2 , with 2 inds. Both in SG: 451.8-1.
366 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

ASF headquarters to authorize the development of "substitute standard" metropolitan 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 multipatient 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 General'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 21⁄2-ton (4 x 2) frontwheel-drive bus-type vehicles, van-type

semitrailers pulled by 13⁄4-ton and 21⁄2-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 required. For example, the front-wheeldrive bus was a nonstandard vehicle and

lacked sufficient traction for cross-country

use, while the semitrailer lacked maneuverability in combat areas and was too

rough for patients. The 21⁄2-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 developed a standard multipatient ambulance.

Meanwhile its Equipment Laboratory

converted eight experimental, nonstandard, 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 Letterman and Halloran General Hospitals in

place of the passenger buses requested by

Letterman, and instead of the additional

standard general-service ambulances requested for Halloran by the second Service

Command.23 The next month the Laboratory recommended that the project for

the development of a multipatient ambulance be continued, but Surgeon General

20

 (1) Ltr, SG to all SvCs, 26 Sep 44, sub: Amb,

Metropolitan, 3⁄4-ton, 4x2 , Reqmts, with replies. SG:

451.8-1. (2) Ltr, SG to CG 7th SvC, 15 Sep 44, sub:

Trans of PW Pnts in Carry-alls, with 7 inds. Ord:

451.8-39. (3) Ord Tec Cmtee, Item 27294, 20 Mar

45, sub: Amb, 3⁄4-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),

451.8-1, 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:

451.8-1 (9th SvC). (2) Memo, 2d SvC Ord Br for

DepCofOrd Tank-Auto Ctr (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 development of such special purpose vehicles as

mobile medical and dental laboratories,

optical repair units, and dental and surgical 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 headquarters added four more for other debarkation hospitals on the west coast (two

for Birmingham General Hospital and

two for Fort Lewis). By October the number requested for the Ninth Service Command 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 multipatient 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 sixteen litter patients. This limitation was

expected to eliminate difficulties encountered earlier in attempts to develop multipatient ambulances that could carry

either litter or ambulatory patients in

both the zone of interior and combat

zones. At first ASF headquarters was reluctant to approve a developmental project for a vehicle in small demand. It proposed, 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 decided that front-wheel-drive bus-type vehicles of the kind procured for experimental purposes in 1940 and 1941 should

be used. An important factor in this decision was the statement by the company

making such vehicles that it had "open

production facilities" and could therefore

"offer favorable delivery," if standard engines, transmissions, and axles were made

available to them.27 In addition, The Surgeon 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 Department 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 Fld Equip Dev Br SGO for Chief Research

Coord Br SGO, 27 Jul 43, sub: Experimental 3⁄4-ton

Amb. Off file, Research and Dev Bd SGO, "BusType 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 Letterman 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 immediately 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, 11⁄2-ton, (4 x 4) Ord Maintenance, for

Mitchel Fld, 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 ambulances began almost immediately after the

contract was awarded late in December

1944. Preliminary work on blueprints and

specifications had already been completed, and on 8 January 1945 construction 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 patients arrived from theaters of operations—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 development 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 multipatient 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 procuring 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 governmentowned cars; (2) "semipermanent" trains

composed of one government-owned administrative car, called a unit car, and an

appropriate number of commercial baggage 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, 11⁄2-ton,

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 administration. There were doubts that those of

the first type could be constructed in sufficient 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 deteriorating international situation. As a part

of a more general project to furnish lightweight trains for use on damaged or poorly 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, according to the Engineers, to transport patients

"from the front line to any point in the

Communications Zone or Zone of Interior." The Surgeon General's Office and

the Medical Department Board agreed to

adopt this train "for planning purposes,"

believing that they were not thereby eliminating 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 kitchen large enough to feed 250 people,

space for transporting 28 litter patients,

and quarters for 1 officer, 2 noncommissioned officers, and 2 cooks. Among its advantages had been its flexibility, its economy 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 special 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 construction 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, 30 Jul 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 MFSS

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. Furthermore, the unit car's kitchen facilities

had helped to solve one of the major problems of World War I—the feeding of patients. Because of these advantages, and

since the Engineers were already working

on plans for cars for completely government-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 addition to the kitchen, an operating or

dressing room and more space for attendants, 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 eliminate all spaces for patients, in order to increase 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 medical 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 (dressing, kitchen, and personnel) of the proposed 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 Department Board and the Surgeon General's

Office studied "in a new light" the Engineers' 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 necessary facilities for the care of the sick and

wounded" and could be used with commercial cars to make a complete hospital

train either in the zone of interior or in

theaters of operations. The Surgeon General 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 impractical.35

 Thereafter, the Surgeon General's Office and the Medical Department

Board collaborated with the Quartermaster 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, 

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; 11th ind, SG to MFSS, 8

Jun 40, on 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. 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 establishment of Army bases in the Atlantic and

the prospective passage of selective service legislation created a potential need for

hospital trains, the Surgeon General's Office 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

Need for 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 another 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 sleepers. 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. TC: 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-andthrough aisles, and that patients on litters

could therefore not be carried from sleepers 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, following recommendations of the Medical

Department, prepared plans for converting 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 Pullman berths with sixteen two-tiered stationary beds made by the Simmons Company. 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 contracts were let with the Pullman Company in September. It was then anticipated 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 December 1941.39

 (Table 17)

When the Japanese attacked Pearl

Harbor, the Army had two unit cars and

four ward cars—enough governmentowned 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 equipment 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 additional 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 decision. The unit car developed in 1940

had no space for patients. Capable of feeding up to 500 persons, its kitchen could be

used to capacity only with trains consisting 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, Capt 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 Goto 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 Maneuvers, 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

Sources: Hosp. Cars in Interchange Service—All 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 Company 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 facilities. It differed from the ward car only in

the replacement of a toilet and berths for

two patients with an operating or dressing 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 patient's berth, or stored at the side of the

car. Food would come from commercial

dining cars. Thus the Medical Depart41

 (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 H[oward] 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

DRESSING ROOM IN HOSPITAL

WARD DRESSING CAR, 1942

ment 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 patients. 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 governmentowned 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 Francisco, 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 Office initiated action to get them air-conditioned. 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 General's Office on the one hand and the Engineers 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 install and because it was commonly used

on Pullman cars at the time. The Surgeon

General's Office preferred a type of mechanical air-conditioning equipment

which was thought to insure more even

temperatures and was not dependent

upon batteries for operation when hospital cars were standing.43

 A mechanical

system of this type, produced by Mountain Aire Products, Incorporated, was installed 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

Feb 42, with blueprints, Plan 4103-A, 4103-B. SG:

453.-1. (2) Specifications for Remodeling 18 Pullman

Parlor Cars to Hosp Ward Cars for WD, from Pullman 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: AirConditioning for Hosp Tn No 1, with 5 inds. SG:

453.-1. (2) Memo SPOPM 673, ACofS for Oprs SOS

for CofEngrs, 18 Jun 42, sub: Mechanical Air Conditioning for Unit Cars. Same file.

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 Transportation Corps in December 1942 recommended installation of ice-activated systems and "declined to accept responsibility" 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 performance standards, the former in the

spring of 1943 had ice-activated air-conditioning equipment installed in the ward

and ward dressing cars which had been

delivered during 1941 and 1942. The installation of such equipment in hospital

cars ordered after the fall of 1942 raised

no problem, because they were procured

with the air-conditioning systems normally used by companies supplying the

cars—some mechanical and some ice-activated.45

 Later, during 1945, the Mountain 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 Transportation Corps as well as the Surgeon General'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 hospital 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 experience 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 interior were not yet fully envisioned. Nor

was the strain which the war was to put

on commercial transportation entirely

comprehended. Nevertheless, officers concerned with secret planning for the North

African invasion were anticipating the

reception of casualties from that operation, 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

SGO (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

SGO, "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 Conditioning 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

Cars). 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. TC: 531.4. 47

 Memo, Sup Div OCT to Rail Div OCT, 19 Jan

45. TC: 531.4.
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, Lt. Col. William C.

Keller, had recently been assigned for the

purpose of advising on rail evacuation,

issued a directive on 23 July 1942 that provoked a re-examination of the hospital

train program. It called upon the Engineers to develop a new type of hospital

car, called a rail ambulance car, and suggested 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 Pullmans, sleepers, diners, and baggage cars,

and second, that available railway facilities 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 twoor three-tiered; quarters for medical attendants, including one officer, one nurse,

and four enlisted men; kitchen facilities

capable of feeding both patients and attendants; and a dressing room and pharmacy. 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 service of some of its load. From seven to

eighteen cars of this type could make up

complete hospital trains; or single cars, attached 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 suggestion that additional hospital cars were

needed. He pointed out that small numbers of patients could still be moved in

Pullman cars of regularly scheduled trains.

For the mass movement of patients he preferred a complete train made up of government-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 contended, 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 General 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 Pullman 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 commercial cars for its use. Furthermore, the

Surgeon General's Office opposed the use

of three-tiered berths because it was difficult 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 hospital trains which his Office had planned

would be sufficient, The Surgeon General

reviewed requirements about a month

and a half later and concluded in October 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 estimated 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 estimated that thirty-two additional hospital

trains would be needed. He recommended, therefore, that instead of rail

ambulance cars thirty-two ward dressing

cars and sixty-four ward cars be procured.50

 This recommendation, as well as

types of hospital cars in general, was discussed 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 General 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 Transportation 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 Transportation Corps proposed that one rail ambulance 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 regular troop movements.53

 It seems that the

Transportation Corps believed that commercial dining cars would not be available

in sufficient numbers but that Pullman

and tourist sleepers would. SOS headquarters therefore decided not to approve

The Surgeon General's recommendation,

but directed the Engineers instead to procure thirty-two self-contained rail ambulance cars.54

The Surgeon General's Office, which

"considered the controversial matter [of

the types and numbers of hospital cars required] 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 complete and final decision."

 55

 During that

meeting The Surgeon General's representative stated that he preferred ward 50

 4th ind SPOPH 322.15, ACofS for Oprs SOS to

SG, 25 Sep 42; 5th ind SPMCP 322.2-5, SG to CG

SOS, 10 Oct 42, on Memo SPOPM 370.05, ACofS

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

C[harles] 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 patients from kitchens improvised in railway

baggage cars, if diners should not be available, rather than to agree to the procurement 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 operations.57

 Following Medical Department

recommendations, the Engineers completed preliminary drawings and specifications for a combat-zone hospital train of

twenty-one 40-ton cars (operating, personnel, kitchen, and ward cars) by the end

of November 1942. The Surgeon General's

Office then suggested changes in the proposed specifications and in January 1943

recommended to the Chief of Transportation 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 program included forty overseas hospital

trains of twenty-one cars each for procurement in 1943 and 1944, but none had

been ordered and SOS headquarters

doubted that these figures actually represented requirements. The SOS Hospitalization and Evacuation Branch therefore conferred on 18 February 1943 with

representatives of the SOS Requirements

Division, the Surgeon General's Office,

and the Transportation Corps. The Surgeon General's representative informed

SOS headquarters that only fifteen overseas 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 experimental and training purposes. Soon afterward the War Department learned that

the European theater was procuring

twenty-three hospital trains in the United

Kingdom and on 8 April 1943 the Surgeon General's Office requested the Transportation Corps to have only the experimental 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 drawings 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 Cars, 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, returned 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 (sixteen in each car), and uncomfortably

rough even at speeds of less than thirtyfive miles per hour.60

 Finding no further

need for this train in the United States, the

Technical Division of the Surgeon General'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, experience 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 installation of storage lockers, floor lights, bulletin boards, and bedside holders for patients' 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 attendants from commercial diners. Hospital

train commanders found that in transporting 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 collaborated 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 designed to fit inside the windows of standard tourist and Pullman cars. It was re60

 (1) Memo, Col I. Sewell Morris, OCT for Mvmt

Div OCT, 4 Nov 43, sub: Hosp Tn for Calif-Ariz Maneuver 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 S

Apr 44, sub: Hosp Tn, Contract W-2789-tc-1201.

TC: 531.4. 61

 (1) Draft rad prepared by Tec Div SGO for dispatch 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

Car 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 Monmouth, 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 hurting themselves on car windows and from

attempting to escape.64

The feeding problem was more complicated. Train commanders were almost

unanimous in complaints about difficulties 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 midmorning or midafternoon nourishment for patients 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 problem was discussed in February 1943 in a

series of conferences on railway rates between railroad officials and representatives of the Surgeon General's Office, the

Transportation Corps, and the SOS Hospitalization 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 afterward 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 headquarters 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 headquarters 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, Interterritorial Mil Cmtee Rail Carriers to SG, 6 Apr

43. with incl. 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 SvC, 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 General'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 distribution of patients among general hospitals.

Establishment of a policy of caring for

patients from theaters of operations in hospitals 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 different general hospitals. For a time the practice of sending a complete trainload of

patients (from 200 to 300) to one general

hospital continued, and it was often necessary to retransfer patients to other hospitals. During the latter half of 1943, however, 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 receive treatment. This was done by making

up trains in sections which could be cut off

at intermediate points for routing to different general hospitals. Each section consisted of a combination of ward cars, ward

dressing cars, and commercial sleeping

cars. The chief difficulty encountered in

this practice was in feeding patients. Until kitchen cars were delivered, the entire

train had to depend upon uncertain commercial dining car service. Even if kitchen

cars had been available, each section separated 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 ambulance car designed by the Engineers in

the fall of 1942.69 They were to be used as

parts of complete hospital trains; for secondary movements from the main, or primary 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 preliminary step to further action on The Surgeon General's request, an evaluation of

the passenger traffic problem with particular reference to the transportation of

patients. The next month this headquarters 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.70

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 completed 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 SCSU 2d SvC to SG, 2 Oct 43,

sub: Cons of Hosp Unit Cars. TC: 531.4. (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.

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 available 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 desired 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 headquarters, 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 ambulance 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 hospital 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 patients. 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 medical 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 ambulatory 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 lighting fixtures, and air-conditioned.74

 Although 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, TC: 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 Department 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 dressing 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, regardless 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) separate 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 additional 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 hospital 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

Fld, SI, N.Y.; 10-13 Jul 45, Presidio of San Francisco.

HD: 531.4 (Conf). (2) Records of hospital train movements, 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 transport small groups of patients on commercial 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 estimated 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, because 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 numbers 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 Surgeon General requested the Transportation 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 significant 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 delivered. 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 required the use of 1,200 Pullman cars to

supplement government-owned cars.79

Thereafter, the number of patients declined rapidly and by late August 1945,

when the last of the cars ordered in January had been delivered, the Medical Department declared surplus thirty-six modified 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 patients. 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 organized between June 1942 and June

1943, and for a short time there was confusion about their purpose both in SOS

headquarters and among service commands. In September 1942, on recommendation 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 transported by train in the United States. After

the North African invasion, casualties began to arrive in increasing numbers. Furthermore, hospital cars which the Army

had ordered early in 1942 were delivered 77

 (1) History . . . Medical Regulating Serv

. . . , Tab 5, Hospital Trains. (2) Memo, SG fo

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 Program 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 SGO, 1943. HD. (2) 2d

ind, CG SOS to CG 4th SvC, 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 twentyfour were assigned to service commands.83

In discharging responsibility for manning

them, service commands encountered

difficulty in determining how many doctors, 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 supplemented with such common-carrier

equipment as Pullmans, diners, and baggage cars. They carried varying numbers

of patients and depended upon the railroads in the early part of the war for mess

service. To supply service command surgeons with a more appropriate guide, SOS

headquarters on 24 December 1942 directed 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 doctors, 1 nurse, and 21 enlisted men for 400

patients. Soon afterward SOS headquarters directed the Second Service Command—and presumably others—to use

this guide in requisitioning personnel for

use aboard hospital trains.84

As experience accumulated in transporting increasingly large numbers of patients,

ASF headquarters in August 1943 issued a

new guide—Table of Distribution 8-

1520—which differed from the one prepared 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 officer, 3 nurses, and 11 to 16 enlisted men for

190.85 Despite a moderate increase in personnel in the new guide, it proved inadequate, 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 carried 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 commands 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 CGs and COs

of SvCs and PEs, and to SG, 15 Sep 42, sub: Mil Hosp

and Evac Oprs, with incl. 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 organization 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 General Hospital. This hospital assigned them

to ward duties, maintained their records,

paid them, and considered them administratively 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 commanding officer of the hospital medical detachment who, in turn, had to request permission 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 payday a month later. The hospital considered 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 hospital service. Nevertheless this system kept

all personnel fully occupied in the intervals between train movements, and perhaps some of the problems connected with

it could have been solved by minor administrative changes. The Second Service

Command however adopted a different

solution by requisitioning additional personnel for train operations and assigning

it, along with that already available, to a

separate unit, the 1247th Service Command Service Unit.87

During 1944 other service commands

followed this example. The organization

of train units that were separate from hospital detachments was discussed at a service commanders' conference in February

1944 and was indorsed by the commanding general of the Service Forces. Afterward, in July 1944, the First, Third, and

Ninth Service Commands organized separate 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 evacuation detachment, consisting of litter

bearers and clerks as well as train personnel, was organized at Stark General Hospital.88

 The organization of separate units,

if their members were kept fully occupied,

was superior to the use of hospital personnel 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 estimate 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: 531.4. (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, McGuire 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 actually needed for train operations. For example, 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 difference, 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 dentist, 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 balancing 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 construction. Builders of hospital cars normally

procured and installed such items, but in

some instances the Medical Department

procured certain special ones, such as instrument 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 Medical Department equipment lists. The latter were the more important, because

hospital cars carried few items supplied by

services other than the Medical Department. By the fall of 1940, when procurement of the first two unit cars was approved, 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 bandages, 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 incl. HRS: ASF P

ning Div Program Br file, "Hosp and Evac, vol. 3."

(2) Memo, Dep Dir Plans and Oprs ASF for DepCofS

for SvCs ASF, 8 May 44, sub: Est of Numbers of Sick

and Wounded Arriving from Overseas, with incl.

Same file. 90

 (1) History, Office of the Surgeon, Second Corps

Area and Second Service Command From 9 September 1940 to 2 September 1945. HD. (2) Notes for Gen

Kirk on Conf 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 Fld

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 Car No 2. Off file, Research 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 SCSU 1247, 27 Jun 45, sub: Sterilizers for Hosp Ward Cars. SG: 453 (2d SvC)AA. 92

 (1) Memo, [Col] A[lbert] G. L[ove] for Lt Col

[Francis C.] Tyng, 10 Oct 40, sub: Hosp Unit Car.

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 prepared for them also, and when their delivery was expected in the spring of that

year the Surgeon General's Office requested SOS headquarters to approve the

inclusion of assemblages, packed according to these lists, as authorized items in

tables of allowances for hospital cars.

Approval was given, and these lists became the official basis for the issuance of

equipment and supplies to ward and ward

dressing cars when they were first delivered to the Army in the late summer of

1942.93

These early equipment lists were necessarily theoretical in nature, because the

Medical Department had had no experience, when they were prepared, in operating hospital cars of the types developed

during World War II. In 1943 they were

revised. Subsequently, as experience accumulated, hospital train commanders

proposed further revisions. Their recommendations were at variance with one another, and the Surgeon General's Office

had difficulty in deciding which to

accept.94 Hence, at a hospital train commanders' conference in February 1945, a

representative of the Surgeon General's

Technical Division distributed a tentative

equipment list, based upon recommendations 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 published in March 1945.96

 Several months

later it appeared that train commanders

were dissatisfied with the supplies and

equipment agreed upon and at a conference 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 developed 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 developed 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, CG 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 SCSU 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 Cars, 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, Research and Dev Bd SGO, "Unit Car, 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.99 Another example of new

equipment was the bath tray. Fitting on

the sides of hospital berths, this tray simplified the work of nurses in bathing patients in bed. It was first put in use by the

Second Service Command in the latter

part of 1944. The Surgeon General's Office adopted the idea and began a development 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, hospital car commanders were authorized to

draw equipment and supplies, to replace

those used, from any medical supply officer in the United States. Normally, however, home stations made replacements.101

To avoid bookkeeping, linen was exchanged on an item-for-item basis. Regulations 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 commanders' 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 hospitals at the ends of trips.102

99

 (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 incl.

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 Program Br file, 370.05 "Hosp and Evac." (2) Transcript

of Proceedings, Hosp Tn Conf, 15-16 Feb 45. HD.
CHAPTER XXIII

Providing the Means for

Evacuation by Sea

Most of the patients evacuated from

theaters of operations to the zone of interior 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 existing 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 enlarge and improve their hospital facilities.

These efforts were only partially successful, because funds for such work were

limited. Furthermore, the ships themselves

were too old to warrant extensive alterations, 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 subsequent months, the New York Port of Embarkation proposed in the fall of 1940 that

the U.S. Army Transport Chateau Thierry

should be converted into a part-time hospital 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 Subdivision, The Surgeon General disapproved, stating that the proposed transport 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 expansion needs were the Irwin, Kent, Munargo, Orizaba, and

President Roosevelt (Joseph T. Dickman.) For their histories, 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: 571, 573.27; TC: 571.4; and in surgeons' reports

attached to voyage reports filed in TC: 721.1. Also see

Chester Wardlow, The Transportation Corps: Responsibilities, 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 CO

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

(11-26-40). (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 recommended instead that "the idea of developing a hospital ship be given further study,"

and that the Army continue to use transports 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 remained 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 (Mobilization 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. Disturbed by this loss to the Navy of evacuation space and fearing a repetition of

World War I experiences, when the Navy

failed to evacuate patients to the satisfaction 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 Surgeon General's Office were favorably impressed; but the chief of the Surgeon General'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 action 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 longrange 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 prewar plans to the contrary partially solved

this problem,8 for the Army could continue 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 Conventions 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, Germany, Italy, and Japan. In 1942 the Medical Department published an article on the Conventions, along

with copies of their texts. Albert G. Love, "The

Geneva Red Cross Movement: European and American Influence on its Development," Army Medical

Bulletin, No. 62 (1942). 4

 (1) Memo, Lt Col John R. Hall, SGO, for Planning and Tng Div SGO, 10 Dec 40, sub: Conv of

USAT Chateau Thierry into a Hosp Trans Ship. (2)

2d ind, SG 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-4/29717-51. 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-4/29717-100. 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 during the first half of 1942. General Headquarters approved the use of both transports and hospital ships for evacuation,

but believing that the enemy would not

respect the terms of the Hague Convention 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 position that transports could be used for

evacuation from areas with ample shipping, 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 contingent 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 responsibility. 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 Quartermaster General recommended the conversion 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 operated 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 headquarters 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. Furthermore, 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 depending 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 supplemental estimates for funds for six hospital 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 ACofS 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 Department . . . in the World War (1923), vol. I, pp. 3

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 hospital 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 Commission 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 Secretary of War, it urged the Maritime Commission to procure six hospital ships for

the Army, whether to be operated by the

Army or Navy, and called upon the Secretary of the Navy to settle with the Army

this question of jurisdiction. The administrator 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 requirements." Because of its close relation

to other shipping problems, the Secretary

of the Navy proposed that the whole question 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 shipping situation but also other matters: the

probability of enemy respect for the

Geneva and Hague Conventions, the British practice of evacuating patients by sea,

and the estimated evacuation requirements 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 medical records. If hospital ships should be

used, he disapproved painting and marking them as international conventions

stipulated. Rather he proposed that they

be painted like transports for travel in

convoy and reveal their identity as hospital ships only under "desirable" circumstances. In view of agreement between the

two medical services on the use of transports 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 transportation service" would be by returning

troop transports. Since the Army and

Navy disagreed on the question of hospital

ships, the Joint Chiefs announced a compromise decision in June 1942. Three vessels would be procured and operated as

hospital ships under the Hague Convention. 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 middle of 1942, the first of these ships was not

placed in service until June 1944.

In the course of these protracted negotiations, the Army—believing that the

general problem of evacuating patients

from ground operations in overseas theaters 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 ambulance transports was revived by the

Transportation Corps. The Surgeon General reversed his prewar position in opposition 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 authorized, 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 inbound. Making its first trip as an ambulance 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, uncertainty 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 hospital with beds equal in number to 1 percent of its passenger capacity for cases of

sickness en route.18 Before the war the

number of hospital beds on most transports had been increased to provide additional space for patients being evacuated

from overseas areas. In March 1942 the

Office of the Chief of Transportation proposed that the larger bed capacities be

officially authorized for all transports—

those to be procured as well as those already in service. Both the Surgeon General'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 proportion of beds for different types of patients, 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 accommodations for them SOS headquarters 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. TC: 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 portion of general ward beds of each ship's

hospital into beds for mental patients.19

Thus during 1942 ratios (expressed in percentages) of hospital beds to troop berths

were authorized for various types of transports as follows:

Meeting standards set for ships' hospitals on vessels converted into troop transports depended upon the time available to

ports for modifications and improvements.

Throughout 1942 transports were hastened 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 Division 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 standards 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 headquarters. Preferably, the hospital was to

be located slightly aft of midship, not more

than one deck below the uppermost "continuous 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

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 incl. 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 Capacities. TC: 541.1. 21

 (1) Ltr, SG (Hosp Cons Div) for CofT, 26 Nov

42, sub: Gen Specifications for Hosp Areas on Converted Trans. SG: 632.-1 (BB). (2) Memo, Maj John

C. Fitzpatrick for Chief Hosp and Evac Br Plans Div

SOS, 17 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 coordination among the Surgeon General's

Office, the Office of the Chief of Transportation, 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 conferences early in 1943 the Maritime Commission agreed to submit its plans thereafter 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 patients on transports. Until that time some

berths had been enclosed with wire cages,

making spaces approximately 6x3x 3

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 "unnecessary and inhumane" accommodations.

The neuropsychiatry section of the Surgeon General's Office supported this proposal. It pointed out that advances in

medical practice, such as the use of sedation, hydrotherapy, and diversional activity, with minimum mechanical restraint,

made it possible to care for mental patients in specially constructed wards. The

Chief of Transportation therefore requested the Maritime Commission to

eliminate metal cages from future transports and directed port commanders to remove existing ones and provide suitable

security-ward space instead on other

transports. Although surgeons of several

ports argued that they would then be unable to care for mental patients, especially

on long voyages in tropical areas, the

Transportation Corps and The Surgeon

General remained firm.24 To guide transport and port surgeons in caring for seriously 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 Elizabeth, which since early 1942 had been carrying 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 arrangements 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 incl. TC: 632. 23

 Correspondence on ships' hospitals of troop ships

and reports of conferences with Maritime Commission representatives are found in SG: 632.-1 (BB) and

TC: 632. 24

 (1) Ltr, Surg NYPE to SG (Col Tynes), 19 Jan

43, sub: Psychotic Pnts on Army Trans. TC: 632. (2)

Memo, SG for CofT 15 Feb 43, sub: Elimination of

Cages for Care of Mental Cases on US Army Trans.

SG: 632.1 (BB). (3) Ltr, CofT to US Mar Comm, 27

Feb 43. TC: 632. (4) TC Cir 35, 1 Mar 43, Elimination of Cages for Mental Pnts. (5) Letters from port

surgeons at San Francisco and New Orleans containing objections to removal of cages are filed in SG:

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 hospitals aboard, but changed their attitude

after American officials explained that

shortages of shipping and lack of hospital

ships made it imperative to evacuate patients 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 transports. When completed, each hospital

would be operated by American Army

personnel. The construction of new hospital areas began early in November when

the Queen Mary came into port. Several

months later work was begun on the Queen

Elizabeth.

27

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 Colonel), Chief Surgeon of the U. S. Army

Forces in the British Isles (later the European 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. Repeatedly thereafter the European theater

requested hospital ships of the War Department, 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 evacuation. The most logical seemed to be the

use of hospital ships on a "pick-up" service. In response to these needs, the Surgeon 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 patients from scattered island bases, to evacuate casualties from large-scale landing

operations, or to supplement transports in

evacuating patients from the more distant

and larger theaters.30 The Chief of Transportation referred this recommendation to

the Joint Staff Planners. Earlier, in

August, a request for three Conventionprotected 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 HMT

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. Hawley) to SG, 25 Apr 42. SG: 560.2 (Gr Brit). (2) Rads

CM-IN-4037 (11 Aug 42), CM-IN-6044 (17 Aug

42), CM-IN-7813 (21 Aug 42), USASOS (London)

to AGWAR; CM-OUT-5084 (16 Aug 42), CMOUT-7479 (24 Aug 42), AGWAR to USASOS

(London). OPD: In and Out Messages. 29

 (1) Diary, Misc Br SOS (Col [William L.] Wilson), 20 Jul 42, HD: 705 (MRO, Extracts from Hosp

and Evac Br SOS Diaries). (2) Ltr, CG CPE to CofT,

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, 16 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 referred 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 November 1942 the Joint Chiefs of Staff disapproved requests for additional hospital

ships.31

Early in 1943 events caused a change in

existing policy. To demands of the European 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 Department 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 Concurrently, 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 Governments, 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 theaters for hospital ships and growing evidence 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 conversion of freighters. Moreover, British hospital 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, Fitzpatrick 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, US AT 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 315/2)

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 Powers) in State Dept file 740.00117 Eur War 1-1648. By

May 1943 Japan had 20 hospital ships, while Germany 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 December 1941. It was designated as a Convention-protected ship on 31 October 1942. The Navy ship Relief

was likewise designated as a hospital ship on 5 February 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 hospital ships, whether British or American,

might be used for the transportation of

medical personnel and equipment without

violating the provisions of the Hague Convention.35

 This meant that space on hospital ships could be used for medical transport 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 authorized 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 misunderstandings 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 hospital 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 hospital 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 submission 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. 36

 (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). Reports 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 CofSA, 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 outbound 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 transportation of troops. After both the Combined and Joint Chiefs of Staff had considered the theater's acceptance of this offer,

North Africa was notified on 22 April that

the Acadia would be converted into a hospital 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 belligerent 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 departure 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 earlier 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 outbound voyages. To permit observance of

the amended policy, the Joint Chiefs authorized the conversion of slow-speed passenger 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 authorized 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 ad38

 (1) Ltr, CG ASF for ACofS 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 incl. OPD:

573.27. 39

 (1) Rads CM-IN-14498 (27 Mar 43); CM-IN6760 (12 Apr 43); CM-IN-12911 (21 Apr 43),

NATOUSA to WD. (2) Rads CM-OUT-SSSS (8

Apr 43); CM-OUT-5910 (14 Apr 43); CM-OUT9291 (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 hospital ships and 6 hospital carriers, and the United

States would provide 2 hospital ships as soon as available. 40

 (1) Memo, ACofS 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 conversion 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 Surgeon General because their basic characteristics 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 located above the water line in areas that

had natural ventilation and from which

patients might be removed easily if it became necessary to abandon ship. The

cruising range of a vessel determined

whether it was suitable for transoceanic

service, and its speed determined the number of trips per month and thus the number of patients it might evacuate. In June

1943, therefore, The Surgeon General arranged with the Chief of Transportation

for joint inspection of vessels before selection for conversion.42

The ships chosen represented a compromise. In several instances, vessels were

rejected by the Surgeon General's representatives, 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 General's Office had to agree to the conversion of six EC-2 cargo ships. The remaining 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 converted into hospital ships according to plans

approved by the Surgeon General's Hospital 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 General'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 patients, and quarters for the ship's crew and

41

 (1) JCS 315, 13 May 1943; JCS 315/1, 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 acceptance or rejection of certain transports (e.g., Robin

Adair, Manuel Arnos, Utahan, William L. Thompson),

revision and changes in plans for hospital areas, problems of construction, and Medical Department inspections during conversion, see TC: 564, SG: 632.1

(BB), SG: 560.2, and HD: 560.2 (Hosp Ships, Hosp

Cons Br). 44

 Tynes, Construction Branch, pp. 94, 113.

PROVIDING THE MEANS FOR EVACUATION BY SEA 407

medical complement. Experience in planning ships' hospitals for transports and in

converting the Acadia and Seminole served

as a guide at first. More satisfactory standards evolved as additional experience accumulated with later conversions. Normally the Surgeon General's Office preferred to have the following located on

decks above the water line: quarters for

officers, nurses, and medical attendants;

the surgical suite; clinical and administrative areas; and wards for litter patients,

for patients who had communicable diseases, and for those who were seriously

disturbed mentally. Decks at the water

line, or just below it, were considered suitable 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, including 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 nonsterile supplies, and an X-ray and darkroom—was preferably placed on the main

deck slightly aft of center. To insure freedom from unnecessary traffic, isolation

and mental wards were considered best

located when they were aft. Clinical and

administrative areas, including the dressing room, pharmacy, laboratory, surgeon's office, medical records office, chaplain's office, Red Cross office, transportation 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 patients requiring evacuation, the Movements Division of the Transportation

Corps proposed in the fall of 1943 to devote approximately half the capacity of

each hospital ship to accommodations for

them. Wards for such patients were

equipped for safety with concealed radiators 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 neuropsychiatric disorders, large wards with

minimum security devices were used. Isolation wards for patients with communicable 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 constructed on the decks of some hospital

ships to provide areas where mental patients 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 hospital 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 bulkheads 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, cleaning gear rooms, utility rooms, diet kitchens, 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 bulkheads were needed as protection against

dust in operating rooms, sterilizing rooms,

dressing rooms, and smaller wards, and,

in addition, as a safety measure—for covering 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 organization for hospital ship complements at

the beginning of the program, the Medical Department had to estimate the number 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 organization, some of the conversion plans

48

 (1) Tynes, Construction Branch, pp. 101, 106.

(2) Memo, SG for CofT, 26 May 43, sub: Steel Bulkheading 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 merchant marine crews, along with friction

between maritime unions on the one hand

and the Transportation Corps and Surgeon 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 Surgeon 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 importance 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 committed 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. 95-116. (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, 17 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 Convs. TC: 564.
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 service from February through May 1944,

and one of the three ships being constructed by the Navy was commissioned

the next month. Thus by the end of June

1944 there were nine hospital ships serving the Army, instead of the nineteen anticipated. The next month seven more

were completed and in August and September 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) Meanwhile the Southwest Pacific had converted 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 Government.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 designated 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: 740.00117 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 converted 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 retain names that were not "entirely inconsistent" 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 carrying the same names. As a result, at the

suggestion of the Surgeon General's Office

most hospital ships commissioned thereafter 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 directives 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 accommodations as utility rooms and dressing stations. Unless construction of ships was too

far advanced, the Commission generally

made the revisions requested by the Surgeon General's Office.54

Less success was achieved in negotiations with the British to improve hospitals

on their transports. Normally they followed a policy of making few if any structural changes in ex-passenger vessels. In

December 1943 this problem was referred

to the Combined Military Transportation

Committee and, as a result, the Transportation Corps and the Medical Department had to approve specifications for

hospital areas aboard British transports

that were considerably lower than those

for American transports. For example, according 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 patients to be evacuated and in the proportion 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 increased by 3 percent of the troop capacity

of each Army-owned and chartered transport. He also requested the War Shipping

Administration to make similar changes

on ships it operated for the Army. This

meant an increase in authorized accommodations for mental patients from 2 to 5

percent of the troop capacity of Armyowned transports and from 11⁄2 to 41⁄2 percent 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 noncommissioned 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, G-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)BB. (2) Memo, SG for CofT, 17 Feb 44,

sub: Comments on Proposed Agreement Conc Minimum 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: Minimum 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 October 1944, the Operations Division, War

Department General Staff, in a meeting

with representatives of the Chief of Transportation, 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 individual cells would be provided on transports 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 remaining accommodations for mental patients were to be in small locked wards

holding twelve or fewer patients.57

A study in the winter of 1944 of the anticipated 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 representatives 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 evacuation of patients. To increase their patientcarrying 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 providing food carts for serving hot meals to

patients unable to attend mess formations.58

To permit the "maximum loading" of

seventeen Army and three Navy transports—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 vessels. In March 1945 the Chief of Transportation established the following standards for such changes: additional diet kitchens, 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 patients; additional mattresses and pillows

should be provided; lee rails should be attached alongside the berths of all litter patients 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: Increase in Mental Pnt Capacity on Trans. TC: 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 CM-OUT-72113 (3 Dec 44); CMOUT-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 assistance; and additional dispensaries and

surgical dressing rooms should be constructed for the routine dressings and

emergency care patients might need en

route.59 These changes increased the capacities of seven transports to an average

of more than 1,300 patients each, including 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 minimum necessary to fit them as "ambulance-type hospital ships." Recognizing

the necessity of this policy, The Surgeon

General agreed that existing deck structures 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 suitable 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 collaborated with the New York Port of Embarkation 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 return 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 conditioned 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 airconditioning 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: Increase of Litter Capacity of Trp Ships. All in TC: 569. 60

 Total patient capacities of the vessels varied from

404 on the Borinquen to 2,618 on the George Washington. 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

A[chilles] 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 recommendations about the source and use

of personnel for ships. In response The

Surgeon General proposed the establishment of Medical Department pools at

ports in the zone of interior and in theaters of operations. From such pools port

commanders in the zone of interior could

assign appropriate medical staffs to ships'

hospitals on outbound transports and theater commanders could assign additional

attendants to care for patients on return

trips. After completing voyage assignments, the attendants could return to theater pools by the first available ship.

When not on transport duty, they could

be used to supplement the staffs of hospitals located near ports either in the zone of

interior or in theaters of operations.64

SOS headquarters at first partially approved The Surgeon General's plan. On

18 June 1942 it authorized port commanders to establish pools of Medical Department personnel, under control of port

surgeons, from which to furnish complements 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 surgeon and twelve enlisted men. Before departure 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 commanders could supply additional attendants.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 patients in theaters, it was impractical to

estimate the number of evacuees to be returned. Finally, port pools were difficult

to keep in operation because ships sometimes were diverted and did not return

directly to home ports.

The SOS Hospitalization and Evacuation Branch therefore suggested a different 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 appropriate 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 technical 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 adoption. Because table-of-organization units

were inflexible, he contended, they were

wasteful of personnel when used in operations characterized by variable factors,

such as ships' destinations, length of voy64

 (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 activation often platoons in September. The

next month, the table of organization for

"Medical Hospital Ship Platoons, Separate," was published. It provided for a

permanent complement of medical personnel 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 different numbers of patients.66

Publication of this table did not settle

the question entirely. In November 1942,

when SOS headquarters was about to activate thirty additional platoons, The Surgeon General again objected to their use.

Whether because of this objection or for

other reasons, SOS headquarters seems to

have compromised. Supplementary platoons were organized to serve aboard

transports carrying patients, but table-oforganization units to serve as the permanent medical complements were never

activated. Instead, SOS headquarters

continued to supply personnel for this

purpose in allotments to port commanders.67

Measures to Conserve Personnel

Steady and large increases in evacuation 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 providing attendants for patients aboard transports. In the fall of 1943 the use of inflexible table-of-organization units was questioned 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 constituted the surest way, he insisted, for

ASF to discharge its responsibility for the

care of patients after they left theater control. In October 1943 representatives of

The Surgeon General, the Chief of Transportation, 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 returning casual medical personnel to supplement 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 importance, the Office of the Chief of Transportation in November 1943 developed a

guide for theaters to use in placing platoons aboard transports. This guide took

account of the fact that variations in types

66

 (1) Memo, ACofS for Oprs SOS for SG, 28 Aug

42, sub: T/O for Med Pers on Amb Ships and Trp

Trans, with ind. (2) Memo, ACofS for Oprs SOS for

Dir Mil Pers SOS, 1 Oct 42, same sub. (3) Memo, SG

for CG 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 CofT, 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 number of attendants provided. For example,

while two 100-bed platoons would be required to care for 100 mental or litter patients, 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 November 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 authorized 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 increased their table-of-organization capacity 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 platoons 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 return 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 disapproved, suggesting instead that theaters be

directed to form more provisional platoons.72

Other measures were also necessary to

70

 (1) Ltr, CofT to CG ETOUSA 13 Nov 43, sub:

Util of Med Hosp Ship Plat, Sep. HD: 705 (MRO,

Fitzpatrick Stayback, 498). (2) Rad CM-OUT-7672,

WD (Mvmt Div OCT) to CG NATOUSA, 18 Mar

44. SG: 322.8-1. (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, with incl 4. AG: 704.11 (3 Jun 44). 71

 (1) Ltr, CofT to CG ASF thru SG, 1 Apr 44, sub:

Reorgn of Med Hosp Ship Plat (Sep). HD: 705

(MRO, Fitzpatrick Stayback, 1077). (2) Memo, CofT

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 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). (2) Ltr, CofT to CG

ASF thru SG, 25 Oct 44, sub: Request for Prov Med

Hosp Ship Plats, Sep. HRS: ASF Planning Div Program Br file, "Hosp and Evac." (3) Memo, CofT 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 organized platoons by reducing the time

they spent in the United States and in returning to theaters. Although such units

were assigned to the Chief of Transportation, 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 Movements 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 theaters more quickly than could ports. Later,

the War Department suggested that theaters might establish air priorities for

them, in order to reduce the time normally 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 Transportation and were attached to ports. In

December 1942 The Surgeon General

asked where and how they were to be

placed aboard transports carrying patients. Representatives of his Office, of the

Office of the Chief of Transportation, and

of SOS headquarters subsequently decided that platoons should be attached to

overseas theaters on a temporary duty

basis and that theater commanders should

be responsible for placing them on transports as needed.74

 After attachment to

theaters platoons came under the administrative control of theater commanders.

This step gave rise to complaints that theaters 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 followed a policy of not interfering with theater commanders in the control of platoons

attached to their commands and intervened 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 Serv

. . . , sec 3. (2) Rad CM-OUT-69352, WD 

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 Stayback, 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: Constitution 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 (11-21-42).

(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, CofT for

CGs PEs, 17 Jun 43, sub: Mvmt Orders, Med Hosp

Ship Plats, Sep. TC: 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 Col J[ames] T. McGibony, 15 May

45. sub: Misuse of Med Pers. HD: 705 (MRO, Newman 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 "repeated reports" that it both overloaded

transports and supplied insufficient medical 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 General's Office that nursing care on transports returning from the Pacific was below

"desirable standards." Believing the cause

of this situation to be an inclusion in provisional 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 justified its existence. On V-E Day 176 regularly organized platoons were being used

to attend patients returning from the

European theater, and several months

later there were 116 in the Pacific. Altogether there were 332 platoons in service in August 1945.78

 Officers familiar with

their work agreed generally that they performed 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 dentists, pharmacists, and laboratory technicians 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 Regulating Officer proposed only one change—

the second officer in each platoon might

be of any branch of the Medical Department 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 hospital ship company early in 1942. Published 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 Pnts from Milne Bay.

HD: 705 (MRO, Fitzpatrick Stayback, 1495). 77

 Draft Rad, WD (Mvmt Div OCT) to CinC

AFPAC, CGs SFPE, SPE, LAPE, 20 Jul 45. HD: 705

(MRO, Newman Stayback, 195). 78

 Reports of locations, assignments, and movements 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, weekly Status Rpts, beginning in Mar 44. 79

 (1) History . . . Medical Regulating S

. . . , secs 3.7 and 3.8. (2) Memo for Record

sources Anal Div SGO, 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 SGO, 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 December 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 transports for conversion under the 24-hospital-ship program, the table of organization for hospital ship companies had to be

revised. It was designed to supply personnel for ships with 500 or more beds, but

those to be converted were to have varying 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 hospital ships were to be manned by both

civilians and soldiers—the former to operate vessels and the latter to care for patients. 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 borderline 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 devoted much space considered desirable for

litter patients—almost an entire deck located 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 provided with more commodious quarters

than the Army allowed enlisted men. As a

result, The Surgeon General and the

Chief of Transportation agreed to use enlisted 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 Organization and Equipment 8-537T, Hospital

Ship Complement.85

While the new table provided for complements to serve on ships ranging in capacity, 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 Current Trp Basis, with Memo for Record. AG: 320.2

(10-10-42). (2) Diary, SOS Hosp and Evac Br (Fitzpatrick), 31 Dec 42. HD: Wilson files, "Diary." (3)

See pp. 398, 403-04. 83

 (1) Ltr, CO 204th Hosp Ship Co to CG 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 A[chilles] 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 dentists 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 increased from twelve to seventeen. Greatest

changes affected enlisted men in the nonmedical services and were governed by the

division of duties between civilian and

military crews announced by the Transportation Corps in December 1943.86

 Because the civilian crew was to prepare

food for all persons aboard, with the exception of special diets for patients, the

seventeen military cooks formerly authorized were reduced to one. Since the military 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 patients), operate the laundry, and supply

dining room service for assigned enlisted

men, patients, and both civilian and military personnel authorized to eat in the

saloon mess. It was also to provide room

service for all patients and military personnel. For these purposes forty-seven enlisted men were added. To permit them to

serve in wards when not engaged in nonmedical 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 involved in using both civilians and enlisted

men on hospital ships. In February 1944

the crews of two threatened to strike unless 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 transports into hospital ships, for the drawings

already made had to be modified to provide quarters for the additional civilians.

Thereafter, the Chief of Transportation

supplied the Surgeon General's Office

with manning tables for each of the hospital ships being provided, so that accom86

 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 SGO for Chief

Hosp Cons Br Hosp Div SGO, ca. Feb 44, sub: Qtrs

for Civ Crews, Hosp Ships. HD: 560.2 (Hosp Ships,

Hosp Cons Br). (2) Memo, SG (Fitzpatrick) for CofT

(Water Div), 22 Feb 44, sub: Full Civ Crews Aboard

Army-Opr Hosp Ships. HD: 705 (MRO, Fitzpatrick

Stayback, 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 patients. 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 anticipated for Army hospital ships—hospitalization 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 installations and needed only a minimum of

medical and surgical care en route. After

some had been used in support of amphibious operations, the suggestion was made

that the tables of organization of complements 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 hospital ships. From the time the first four were

activated in the latter part of 1942 until

the end of January 1945, twenty-five additional 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 completion 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 depended 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 incl.
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 number 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 issues after each voyage, required individual

consideration by port surgeons and medical supply officers. Before the war they

collaborated locally with transport surgeons in determining the needs of each

transport and in supplying initial and replacement 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 headquarters 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, distributed 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 carrying 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 supplies and equipment, laboratory supplies

and equipment, X-ray supplies and equipment, operating room equipment, and the

like.94 In the fall of 1942 the Surgeon General's Office revised these lists and in December issued them in a new form.95

The problem of equipping and supplying 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 Transportation Corps was informed of fixed equipment 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 developed standard equipment lists for hospital 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 COs of CAs,

PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: Oprs

Plans for Mil Hosp and Evac, with incl. AG: 704. 93

 Ltr, Surg NYPE to SG thru CG 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 1945.99

In addition to medical items ships

needed other supplies and equipment.

Medical Department units serving on

ships needed certain organizational equipment. To meet this need, tables of equipment were issued early in 1943 for medical

ambulance ship companies and for medical hospital ship companies.100

 Certain

housekeeping items, such as mess equipment, 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 division 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 encountered difficulty in dividing items for

which each was responsible. The Army

understood that the Navy and its contractors were to supply all medical equipment

that was fixed, or attached, to these ships

and that the Army was to furnish all portable 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 messing equipment, linens, and blankets, and

its contractors were to furnish all mattresses 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 General's Office believed that adjustable berths

similar to beds used in hospitals were

needed for seriously ill patients. As a result, a particular type of adjustable berth,

known as a "gatch bed," was developed

for use on Army hospital ships.104 Alternating 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. 100

 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. 103

 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 I.C. Sys. TC: 632 (Hosp Ships). (2) Memo,

CG SOS (Lutes) for CofT, 8 Oct 42, sub: Electrotherapeutic 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. Laundries aboard ships were necessary if the

quantities of linens carried were not to be

inordinate. Yet laundry operations consumed a tremendous volume of fresh water, 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 problem the Surgeon General's Office developed a salt-water washing process. In the

summer of 1944 successful tests at the Naval Receiving Station and the Army

Medical Center (both in Washington,

D.C.) demonstrated that salt-water washing was both safe and efficient. The process 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, ultimately used on all Army hospital ships,

reduced by about 80 percent the amount

of fresh water ordinarily needed for laundry operations.106

106

 (1) Historical Record, Laundry Section, Hospital 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.
CHAPTER XXIV

Providing the Means

for Evacuation by Air

Experiences of World War II firmly

established air transportation as an acceptable if not preferable method of evacuation, 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 surface vessels, had to be fitted in with the

transportation of troops and cargo. In theaters this problem was often solved by

informal arrangements between local surgeons 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 transportation 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 interior. 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 Medical 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 procurement 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 transportation 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 experiments upon which plans for their use in

wartime could be based. In each instance,

because of difficulty encountered in securing sufficient funds for the procurement of

requisite planes for training and for defense of the United States, the General

1

 David N. W. Grant, "Airplane Ambulance Evacuation," The Military Surgeon, vol. 88, No. 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 transport planes were fitted with litter-holding

brackets to enable them to move patients

from one hospital to another. In exceptional cases only, training centers were

permitted to convert small planes into airplane 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 ambulances in wartime crystallized. Experience

of the Germans in air evacuation during

the Polish campaign, an account of which

appeared in the Army Medical Bulletin,

4

perhaps contributed to this development.

The chief of the Medical Division of the

Office of the Chief of the Air Corps, the

surgeon of GHQ Air Force, and The Surgeon 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 headquarters.5

 The Chief of the Air Corps and the

General Staff implied approval of these

propositions, and the latter on 5 September 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 converted by the installation of litter racks,

the procurement of small airplane ambulances 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 available or anticipated for procurement. The

General Staff then verbally modified its

directive, relieving the Air Corps of responsibility for maintaining plans for the

wartime conversion of single-engine airplanes.7

 Soon afterward, when the Gulf

2

 (1) Memo, ACofS G-4 WDGS for CofSA, 8 Jun

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, CofAC to Chief Mat Div AC Wright

Fld, 5 Dec 31, on Ltr, Maj Robert [E. M.] Goolrick,

AC to CofAC thru Chief Mat Div Wright Fld, 23 Oct

31, sub: Amb Airplanes. AAF: 452.1 (Amb Planes).

(2) Memo, Chief Med Sec OCofAC for SG, 25 Jan 38.

SG: 451.8-1. 4

 (1) Ltr, SG to CofAC, 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

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: Air Corps Med Trans

Group. AG: 320.2 Med (7-11-40). 6

 (1) 2d ind, CofAC 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 CofAC, 5 Sep

40, same sub. All in AG: 320.2 Med (7-11-40). 7

 (1) R&R Sheet Comment 1, Exec OCofAC to Tng

and Oprs, Plans and Mat Divs OCofAC, in turn, 9

Sep 40, sub: Air Amb Serv. AAF: 452.1-B (Amb

Planes). (2) R&R Sheet Comment 3, Plans Div

OCofAC to Mat Div OCofAC thru Exec, 17 Sep 40,

same sub. Same file.
428 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

Coast Air Corps Training Center requested procurement of single-engine airplane ambulances for peacetime crashrescue work, the Chief of the Air Corps

disapproved the purchase of airplanes exclusively 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 conversion. 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 ambulances of three small planes of a new

type just being procured—0-49s—provided 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 attendant, in addition to the pilot, and had

been assigned to training centers.11

Meanwhile the Surgeon General's Office and the Medical Division of the Office

of the Chief of the Air Corps had been

making plans for the use of airplane ambulances 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 evacuate patients in airplane ambulances and

requested the publication of information

about such units in a Medical Department field manual. They also devoted attention 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 witnessed a demonstration of an Autogiro

and discussed with company officials the

characteristics desired in a front-line airplane ambulance.12

 By the latter part of

November the company producing Autogiros submitted drawings for an ambulance. The Air Corps Materiel Division

agreed that this type of plane, if successfully developed, would be useful in forward areas, but believed that the one proposed would be unsuccessful because of its

weight. It recommended, therefore, that

further action on the question of an ambulance Autogiro be suspended until after

completion and testing of others being

developed for Air Corps tactical missions.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 CofAC. All in AAF: 452.1-B (Amb

Planes). 9

 Memo, Fld Serv Sec Mat Div Wright Fld for Tec

Exec Mat Div Wright Fld, 17 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 Comment 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 Fld 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 SGO, "Amb Airplane." 13

 (1) Memo, Mat Div OCofAC for Mat Div Wright

Fld, 28 Nov 41, sub: Amb Autogiro. AAF: 452.1-B

(Amb Planes). (2) Memo, Mat Div Wright Fld 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 3⁄4 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 second occurred in Burma in April 1942. In

both instances regular transport planes

(C-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 ambulances. In July 1942 the Alaska Defense

Command asked for a large airplane ambulance, and was supported in its request

by the Western Defense Command. The

next month The Surgeon General requested an airplane ambulance for use in

transporting patients from the Newfoundland Base Command to the United States.

These requests produced a confirmation—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 considered 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 Materiel Command to review its transport

procurement program to assure the installation of litter supports in planes during

their manufacture and to provide for their

installation in all C-53s purchased without 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 Fld 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 Fld 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 prevented 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 training 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

C-46 Airplanes. AAF: 370.05 (Evac).
432 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

Southeast Air Corps Training Center requested 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 willing 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 adapted, with least modification, to carry

litters.18

The Materiel Command reported in

August 1942 that small planes most suitable for adaptation to ambulance service

were the AT-7 and the C-64. The Air

Forces had 127 of the former on hand, and

300 C-54s were being procured. Either

could be modified to carry at least two litters and a medical attendant, in addition

to the pilot. They would be more suitable

than the O-49s (L-1s) 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 therefore requested authority to have a local

subdepot modify one AT-7 and to have a

manufacturer modify one C-64 in production, in order to determine which

would be preferable as an ambulance.19

This recommendation was considered

by AAF headquarters, along with a request 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 communications work, pilot dispersal, and

light cargo movement. Consequently it

was decided not to modify AT-7s, but to

have manufacturers equip all C-64s, beginning 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 November 1942 that it would have to meet its requirement 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 January 1943 when the Air Surgeon proposed

the assignment of L-1Bs—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 Fld, 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, Capt John 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 addition to the pilot—to meet a need expressed by the Second Air Force. Soon

afterward the Flying Training Command

renewed its attempt to get airplane ambulances. By this time—the spring of 1943—

training programs, such as the glider towing program, were being curtailed and

small liaison planes (L-1s) formerly used

were no longer needed. As a result, some

of them were assigned for ambulance service to the Second Air Force, and the Flying Training Command was permitted to

modify about 100 liaison-type planes to

meet its needs.23 Soon afterward the AAF

Requirements Division announced officially a policy which it had formerly observed without publicity. When a training

station needed a special airplane to be

held always in readiness purely as an ambulance airplane, its requirement would

be treated as a special one and would be

met by the conversion of a suitable available 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 Zones

After the war began, the Air Surgeon

and The Surgeon General continued to

plan for the use of small airplane ambulances 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 evacuation 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 submitted 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 accommodate only a pilot and one patient,26

but after consultation with the AAF Directorate of Military Requirements the

Materiel Command informed the company that the Army had no use for such a

plane. It stated that litter bearers were the

most effective means for removing casualties from battlefields with rough terrain;

that even if the terrain were suitable for

landing, a plane was too vulnerable a target 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 manufacturer 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 M[ervin] 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. McCloy, Asst SecWar, 20 Apr 42, with incl. 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 Col 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 General a small plane which he had converted

into an ambulance. It was likewise considered 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 training centers might adapt to ambulance use.

Apparently the Air Surgeon believed that

this might result in discovery of an existing plane that could be used in combat

zones as well as in the zone of interior.29

Despite uncertainty about the availability of a suitable plane for use in forward areas, the Air Surgeon continued to

plan in those terms. One method of getting approval for his plans was to have

airplane ambulances considered as organic 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, therefore, that squadrons equipped with small

planes, or "puddle jumpers," were not required 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, MC,

SGO, 7 Nov 42, sub: Air Evac of Pnts. HD: 370.05. 29

 Memo by Lt Col Thomas N. Page, MC, 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 incl. 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. Coleman, Organization and Administration, AAF Medical Services in the Zone of the Interior (1948), p. 689. 32

 (1) R&R Sheet Comment 4, Dir Mil Reqmts

AAF to AG 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 Airplanes—Provisions for Evac Wounded by Cargo Airplanes. 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 Fld 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 solution to the problem of evacuating patients 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 helicopters for a period of eight months. Although 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 preliminary consideration to the use of helicopters for evacuation and was requiring

that they be fitted for the external attachment of "capsules" suitable for carrying

litter patients. It was anticipated that this

would enable each XR-5 and R-5 helicopter to carry four litter patients and

each XR-6 to carry two. In collaboration

with the Aero Medical Research Laboratory, the Materiel Command was studying 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 attached 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 ambulances had been approved, in from ten

to eighteen months.37

Progress in the general helicopter program 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 patients and an attendant within its fuselage.

In conformity with established policy, the

AAF Requirements Division directed that

any helicopter developed to meet this requirement should be suitable for basic use

as a cargo plane and should be equipped

for carrying litters only if this did not interfere with such use.39

 The Air Surgeon

also apparently requested the procurement of 150 helicopters for use by his proposed 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 transport 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. Clair to Maj Gen W[ilhelm] D. Styer, CofS SOS, 23 Nov 42. Off file, Research 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 SecWar to Col W[ood] S. Woolford, Air

Surg Off, 31 Dec 42. Same file. 36

 (1) Ltr, SG to Chief Engr Div Wright Fld, 21 Dec

42, sub: Helicopter Dev. AAF: 452.1 (Helicopters).

(2) Memo, Air Surg for Mat Comd Wright Fld, [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: Helicopter 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 CG 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 Fld,

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 ordinarily 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 patients singly or in small numbers.41

 Meanwhile, 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 assignment 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, assignment of additional transport planes to

supply enough "lift" for evacuation in addition to normal operations became an

accepted practice in the zone of interior

40

 R&R Sheet Comment 1, Air Surg to Oprs, Commitments, and Reqmts Div AAF. 4 Mar 44, and Comment 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-IAFRTH, TAG to CG ETO, 5 May 45, sub: AAF

Helicopter Program. Both in AAF: 452.1 (Helicopters).
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 patients from Stark General Hospital to

other hospitals in the zone of interior. Several months later the Air Transport Command temporarily assigned twelve C-47s

to its Ferrying Division for a similar "special 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 operations grew until it reached forty-nine by

September 1944.43

As patients continued to be evacuated

from theaters to the zone of interior in regular transport planes, efforts were made

during 1944 and 1945 to increase the

number of patients they carried. The increase was accomplished in two ways. One

was the installation of newly developed

webbing-strap litter supports. More patients 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 installation 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 patients theaters would evacuate by air. In

the spring of 1944, it will be recalled, the

Air Transport Command authorized theaters to ignore the old system of priorities

for air transportation and determine locally 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 collaborated in the development of an organization—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 organization, the number of subordinate units it

should have, and the amount of personnel

43

 (1) Organizational History of the Ferrying Division, June 20, 1942 to August 1, 1944, pp. 271-78.

ATC: Hist Div. (2) Initial Medical History (11 February 1943 to 30 June 1944), Headquarters Ferrying Division, Air Transport Command. HD: TAS. (3) Quarterly Medical History, Headquarters Ferrying Division, Air Transport Command, 1 July-30 September

1944. HD: TAS. (4) Memo, Air Surg for SG, 27 Jul

44. SG: 580. (5) Memo, Comdt 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, CG ATC to ACofS 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 ambulance organization should be composed of

both Air Corps and medical personnel, the

former to maintain and operate ambulance 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 patients during flights but would also operate 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 ambulances 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 disapproved by the General Staff because airplane ambulances were included as organic elements of medical rather than Air

Corps units of the evacuation organization.47

 Another, submitted by The Surgeon General in October 1940, apparently

remained in the G-3 Division of the General 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 ambulance squadron. This squadron was to

be a companion unit for an Air Corps

transport group composed of a headquarters squadron, a flight squadron, light,

equipped with eighteen single-engine liaison planes for front-line evacuation, and

two flight squadrons, heavy, each

equipped with twelve two-engine transport 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 responsibility 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, 11 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 MFSS to SG thru Comdt

MFSS, 31 Jan 41, sub: FM 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 Surgeon, 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-1. (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 commands, the light squadron was to have

twenty small planes and twenty pilots assigned 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 officers, 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, theaters, defense commands, task forces, or

field armies.50 The Air Staff having approved the plan for this organization, the

I Troop Carrier Command activated such

a unit in October 1942, using initially officers and men transferred from the 38th

Medical Air Ambulance Squadron. This

unit—the 349th Air Evacuation Group—

at first consisted of a headquarters squadron and one heavy squadron. In November, when a light squadron and two additional 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 destroyed the basic concept underlying their

formation.

With the decision to consider air evacuation 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 February 1943. This unit had no personnel for

the movement of patients in motor ambulances or the operation of medical stations

at loading points. It consisted of a headquarters and four evacuation flights, each

made up of six flight teams. A commanding officer, a chief nurse, an administrative 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 surgical 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 squadron 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

Sheet Comment 1, Air Surg to Dir War Orgn and

Mvmt AAF, 15 Sep 42, with incl. AAF: 370.03. (3)

Rpt, Mins of Mtg, ATC, 13 Oct 42, Air Evac of

Wounded. AAF: 3 70.05. 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 Soboroff, op. cit. 52

 (1) An Rpt, FY 1943, Oprs Div Air Surg Off.

DAF: SGO 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 personnel for air evacuation operations indicated 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 originally anticipated, the 349th continued in

existence as a training school until June

1943. At that time the Air Forces established a School of Air Evacuation at Bowman Field, Kentucky. This school operated 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 continued in use throughout the war. As air

evacuation operations within the United

States began to assume significant proportions early in 1944, ATC headquarters

announced in April that additional nurses

trained in air evacuation would be assigned to ATC hospitals and would be

used, along with enlisted technicians qualified to assist them, to form flight teams for

planes transporting patients between hospitals 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. Personnel 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 patients 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 Division, June 20, 1942 to August 1, 1944. ATC: Hist Div.

(2) Quarterly Medical History, Headquarters Ferrying 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 permitted 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 located 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 enabling 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 Washington 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 General's Office and ASF headquarters asked

for an increase in air evacuation from theaters 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 required the care of only nurses and enlisted

technicians. Moreover, for such short periods, 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 patients treatment at hospitals en route. In

such a case, the transportation of 500 patients by hospital ship required eight doctors, eight other officers, thirty-four nurses,

and 135 enlisted men. To transport a similar number of patients by air in one continuous flight required seventeen planes

(assuming that each carried thirty patients) 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 transportation of 500 patients across the Atlantic by

hospital ship normally required approximately seven days and therefore used

about 1,295 man-days of medical attendance, 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 Newfoundland, 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 operational 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. Schwichtenberg on a first draft of this chapter. Also see Journal of

the American Medical Association, Vol. 141, No. 8 (1949),

pp. 540-41.
442 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

evacuation of patients. Early in 1942 the

Air Forces began to use Douglas removable metal-type litter racks, which had already 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 replacements had to be stocked at various fields.

Furthermore, it was discovered in the fall

of 1942 that standard racks did not accommodate all types of American litters

currently in use in combat theaters. The

Materiel Center at Wright Field (Ohio)

therefore undertook a series of experiments, and by the early part of 1944 it developed 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 evacuation mission and stowed in floor compartments while two sets of webbing straps

could be spaced and anchored permanently 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 twentyfour. Preparation of planes for evacuation

with webbing-strap supports could be accomplished in six to eight minutes, a fraction 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 position, 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 potential steel shortage in turn brought about

the development early in 1943 of both

straight and double-folding laminatedwood-pole litters. The latter could be collapsed 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 became available in the summer of 1943, the

61

 David N. W. Grant, "A Review of Air Evacuation 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 Fld, Ohio, 9 Sep 42, sub:

Correction of Standard Type Litter Support Now Being 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. 65

 John 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 aluminumpole litters. Those issued were unpopular—the former because of its weight and

the latter because it did not fold up well

in field use.67 The folding laminatedwood-pole litter continued to be preferred

until February 1944. At that time the Air

Forces recommended that straight aluminum-pole litters be procured for the remainder 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 evacuation. Thus the litter which had been designed 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 laminated-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 developed for the Air Corps as Medical Department items. A flight service chest,

standardized before and improved during

the war, was furnished each air evacuation

transport squadron. An airplane ambulance 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 supplies and equipment to care for the immediate 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 unassisted. For longer ones, medical evacuation personnel considered the chest too

small for efficient use.70 Variation in distances between theaters and the zone of

interior and in the types of patients evacuated was so great that standardization of

a chest for universal use was impractical.

Therefore, improvisations of cabinet-type

containers for long trips and the development 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-oxygen 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, Flt Serv, Empty), and

400.114/3023 (Chest, Amb, Airplane, Empty). (2)

T/E 8-447, 30 Nov 42. (3) Ltr, SG to CG 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 Pacific 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 problem in feeding patients developed when

flights extended over long periods of time.

Cargo and transport planes had no facilities for cleaning or washing dishes, trays,

or silverware; and their crews lacked experience in preparing suitable meals for

patients from a limited variety of available

foods. By January 1944 this problem became serious and the Air Forces started a

survey to find a solution. Nevertheless,

provisions for feeding patients being evacuated from theaters continued to be little

more elaborate than sandwiches, hot coffee, 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 November 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, patients because of lying on litters for several hours and medical attendants because

of lifting and changing the position of patients 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 conditioners to cool planes' interiors at stopover 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 Transport 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 unloading litters in high-door planes were

accomplished manually. When air evacuation 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 unloading of patients proved to be rapid,

safe, and comfortable and was adopted at

most Air Transport Command installations throughout the world by the end of

the year.78

The exchange of property used in air

evacuation constituted a difficult problem. 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 installations, 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 General 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. According 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 return 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 squadrons reflected both the development of

special equipment for air evacuation operations 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), CG 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 unsatisfactory operation of the property-exchange

system.83 Medical supplies were to be

requisitioned from medical depots operated by the Air Service Command according to requirements determined by the

Supply Division of the Air Surgeon's Office.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 substitution of the Air Forces' newly developed therapeutic-oxygen kit for the portable 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 squadron. 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; C 1, 11 Dec 44; C 2,

25 Jan 45.
CHAPTER XXV

Evacuation Units for Theaters

of Operations

The evacuation units discussed in preceding 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. Mention 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 transported patients from front-line areas rearward through combat zones to mobile

hospitals. Certain aspects of these units—

such as changes in their organization, personnel, 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 transportation of patients in combat zones, as

already pointed out,2 either were organic

elements of larger nonmedical organizations such as infantry regiments and divisions, 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 belonged, their functions remained the same.

Aid men of the medical detachment accompanied 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 technicians 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, depending upon the type of division concerned—collected casualties from aid

stations and transported them first to collecting stations and then to clearing stations farther to the rear, sorting them at

each station for additional treatment and

return to duty or for preparation for further evacuation. Units that were assigned

directly to corps and armies, such as medical 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 reinforcements 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 primarily 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 regiment which consisted of a regimental

headquarters and band, a headquarters

and service company, a collecting battalion of three companies, an ambulance

battalion of three companies, and a clearing 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 warrant officers, and 14,615 enlisted men,

contained 34 officers and 476 enlisted

men. It consisted of a headquarters and

headquarters detachment, a clearing company, and three collecting companies.5

Containing litter bearers, collecting-station personnel, and ambulances, each collecting 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 medical regiment continued in existence, serving 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 specifically 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 evacuation system, though not in the actual

transportation of patients, was the medical

gas treatment battalion. While other medical units had some means of treating at

least small numbers of gas casualties, none

was adequately equipped to treat the influx of casualties which might result from

the use of gas on a large scale. The Surgeon 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 sterilization and bath battalion. The medical

gas treatment battalion was made up of a

headquarters and three clearing companies. 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 Fld Manual, Mobile Units of the

Med Dept, 12 Jan 42. 8

 (1) Ltr, SG to TAG, 11 Jun 41, sub: T/Os, with

2 inds. AG: 320.2 (6-11-41). (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 organization of existing combat zone evacuation

units were revised and new units were

developed for use with new combat organizations. 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 organization were developed for appropriate medical 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 revisions in the tables of organization of

three of the more common types: the medical detachment of the infantry regiment,

the medical battalion of the infantry division, and the medical regiment serving the

field army.

Unlike the infantry regiment which it

supported, the medical detachment's enlisted strength increased appreciably—

from 96 to 126—when its table of organization was revised in April 1942. The inclusion 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 detachment. Seven 1⁄4-ton trucks (jeeps),

seven 1⁄4-ton trailers, and one 21⁄2-ton truck

replaced one motorcycle, fourteen 1⁄2-ton

trucks, and two 11⁄2-ton trucks.11

The infantry division's medical battalion, according to early plans, was to receive 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 Administrative 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, exclusive of trailers, rose from 87 to 93. The

addition of trucks accounted for this increase, 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 organization 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, submitted for publication in July15

 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 required fewer drivers and mechanics, and

hence the new table provided for fourteen

fewer enlisted men than formerly. In addition, one Medical Corps officer was eliminated, 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 AGF,

AAF, and SOS, 31 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 officers (two) remained unchanged.16

The revision of the table of organization

of medical regiments early in 1942 provided for an entirely new type of organization. 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 collecting companies and one clearing company. The collecting companies of battalions 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 platoons in order to provide increased treatment facilities in army areas. This revision

of the medical regiment was based on two

of its functions as an army unit: the evacuation of divisional clearing stations and

the reinforcement of divisional medical

services. Having battalions and companies

similar to those of divisional medical battalions, the new medical regiment would

simplify the problem of supplying reinforcing units to divisions in combat and,

it was anticipated, would permit better

ambulance evacuation of divisional clearing stations. This change in the organization 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 rising from sixty to seventy-two.17

 To provide

even more ambulances for field armies, if

they should be needed, and for communications zones as well, The Surgeon General developed about the same time a table

of organization for separate motor ambulance 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 response to a War Department directive to

reduce personnel and equipment, especially vehicles, in all Army organizations,20

AGF headquarters established a Reduction 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 vehicles of both the regimental medical detachment and the divisional medical battalion. 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 vehicles of the detachment was the replacement of its 21⁄2-ton truck with a 11⁄2-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 become 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 explanation 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)(1) 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 battalion 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 company the number of litter bearers was reduced from thirty-six to thirty-one. The

Reduction Board believed that the use of

jeeps to evacuate casualties from the battlefield warranted this action, but supported 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 unless 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, organized under existing tables, were not entirely 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 evacuation units. The chief cause of dissatisfaction 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 economy 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 battalion, and the substitution of small administratively self-sufficient units, such as

companies, which could be grouped for

training and tactical use under separate

battalion and group headquarters detachments.24

 This proposal reflected a general

trend in the Army Ground Forces "away

from the organic assignment of resources

to large commands according to readymade patterns, and toward variable or

ad hoc assignment to commands tailormade for specific missions"25

—a trend

that was to end during 1943 in the disappearance 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, 15 Jul 43, 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 8-17, Collecting Co, Med Bn, 1 Mar 43; and T/O 8-18, Clearing Co, Med Bn, 1 Mar 43. (2) M/S GNRQT/24549,

sub: T/O 8-16, 8-17, and 8-18, with following comments: CG AGF to Reqmts AGF, 5 Dec 42; Reduction 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, 17 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 headquarters 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 1943.26 Thereafter,

instead of being rigid table-of-organization

battalions and regiments, evacuation units

of corps and armies were flexible battalions 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 development 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 Department 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 medical 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 Administrative Corps officers wherever possible

affected the make-up of evacuation units

also.29 In battalion and group headquarters, for example, administrative officers

replaced physicians as operations officers

(S-3s). Of perhaps more significance was

the substitution in the medical detachments 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 proposal to make this substitution in the medical detachments of coast artillery, antiaircraft artillery, engineer, signal, and

ordnance battalions, but he disapproved

at first the recommendation that it be extended 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 impair the efficiency of their medical services.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 detach26

 (1) M/S GNRQT/31566, sub: Med T/Os, Comment 5, Ground Med Sec to Reqmts AGF thru Reduction 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, 12 Mar 43; Comment 8, Ground Med Sec to Sec Gen Staff AGF, 16

Mar 43; Comment 10, Sec Gen Staff AGF to Reduction Bd, 18 Mar 43. AGF: 320.3. (2) Memo for Record, 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 8-317, 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: Conservation of MC 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

ment of the infantry regiment, for example, there were five Medical Corps, two

Dental Corps, and three Medical Administrative Corps officers instead of seven

Medical Corps and two Dental Corps officers. One Medical Corps and one Medical

Administrative Corps officer, instead of

two Medical Corps officers, served with

each of the three battalion medical sections. In the detachment's headquarters

there were two Medical Corps officers, instead of one as formerly, to insure a replacement if needed for one of the battalion surgeons.31

Further changes were made in existing

evacuation units, and new units were proposed 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 privates were soldiers in excess of the complement of personnel needed to perform the

functions for which units were designed

and were provided to serve as replacements for losses occurring in the first

phases of combat or, when in garrison, for

men who would normally be absent because of furloughs, sickness, and the like.

Until May 1944 basic privates represented

an addition of about 10 percent to the normal 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 evacuation units of both divisions and armies. It

had been recognized for some time, he

stated, that the clearing companies of divisional 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, according to the Ground Surgeon, emphasized 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 separate collecting companies were not required in army areas because separate

ambulance companies were authorized as

army units. The Ground Surgeon therefore proposed to eliminate collecting companies as army evacuation units, and to

substitute for them additional separate

ambulance companies and separate litter

bearer companies. For the latter he prepared a tentative table of organization. He

further proposed that the men and officers

formerly assigned to collecting-station platoons 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 Cir 99 (1944). AG: 320.3 (10-30-41)

(2). (2) WD Cir 122, 28 Mar 44. 32

 WD Cir 201, 22 May 44. 33

 T/O&E 8-15, Med Bn, 15 Jul 43, with C 2, 3

Jul 44. 34

 WD Cir 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 commissioned 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 because oxygen and drugs could be administered to gas casualties by gas treatment

teams and other medical units, the decontamination of equipment and clothing was

not a proper function of the Medical Department, and the ability of gas treatment

battalions to locate and decontaminate

personnel as soon after exposure as necessary was doubtful.37

 The Ground Surgeon

also questioned the utility of such battalions and considered them wasteful of personnel.38

 Moreover, since gas warfare had

not been used, medical gas treatment battalions 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 Service. In October 1944, therefore, The Surgeon General requested and received permission 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 evacuation 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 representatives, the Assistant Chief of Staff, G-4,

directed The Surgeon General to prepare

a table of organization for a medical holding unit.41

 The resulting unit, a medical

holding battalion authorized in May 1945,

consisted of a headquarters and three

holding companies, each capable of han35

 (1) Memo for Record, on M/S, Comment 4,

Ground Med Sec to ACofS G-1 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) proposed 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) XL 39

 (1) Diary, Tec Div SGO, 7 and 14 Oct 44. HD:

024.7 Oprs Serv. (2) T/O&E 8-125, Med Gas Treatment 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 unlocated 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 replaced 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 equipment of evacuation units in order to improve the standard of emergency medical

service under combat conditions.45

Changes were also made in the equipment of evacuation units to increase their

mobility. For example, early in the war

the Medical Department developed a

pack carrier for battalion medical equipment. This carrier—a canvas container

mounted on a wooden frame—permitted

the supplies and equipment used in battalion aid stations to be packed in loads

(averaging about forty pounds each) that

could be carried by individuals of battalion medical sections.46

 Later in the war,

after aluminum became available for the

purpose, aluminum-pole litters were substituted, it will be recalled, for heavier

ones made of steel.47 Another change contributing to greater mobility in evacuation

was the development of litter racks for

jeeps, permitting in many instances the

substitution of motor for pedestrian evacuation 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

42

 (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 AGF 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 Co, Med Bn, 15 Jul 43, with

C 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: Addition to T/Es of Certain Med Units. Ground Med files:

Chronological file, Folder 2. (2) T/O&E 8-138, Clearing 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 comparing 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] A[lfred] P. T[hom]

for Col Shambora, 2 Mar 43, sub: Comments on Lessons Derived from Oprs at 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 similar reductions were made in the equipment of those units. After the reductions

made in the winter of 1942-43, the cubage

of equipment of evacuation units underwent 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 infantry division's medical battalion increased

in cubage from about 1,475 to about 1,600

ship tons in February 1945. Similar increases occurred early in 1945 in the

equipment of other evacuation units.51

Another measure to increase the mobility and improve the standard of combat

zone medical service was the development

by the Medical Department of certain vehicles for special purposes. The organization 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 Laboratory 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 vehicle consisted of a van body mounted on

a standard 21⁄2-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 clearing 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 delivered 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 operations. 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 ACofS 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' Fld ManualOrgn, Tec, and Logistical Data, 10 Oct 43 and 21

Dec 44. 51

 FM 101-10, Staff Offs' Fld Manual—Orgn, Tec,

and Logistical Data, 21 Dec 44 and 1 Aug 45. 52

 Johnson and Wilson, op. cit., 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 Department. In addition to surgical trucks,

the Medical Department developed other

special vehicles for use in theaters of operations. They were a mobile dental laboratory truck, mobile optical repair truck, a

mobile dental operating truck, and ah

army medical laboratory truck. Development 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, training, and using in the United States the

evacuation units that would operate in

combat zones of theaters of operations belonged almost exclusively to the Ground

Forces. Before the reorganization of the

War Department in March 1942,54 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 combat zones and gained in addition the

responsibility for preparing their tables of

organization and equipment, recommending 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 combat 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 example, for emergency medical care and

evacuation each corps generally had a

medical battalion; each army, three medical 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 evacuation of casualties from divisional clearing stations.57

 Soon afterward, the standard army and corps were abandoned as

yardsticks for determining the number of

service units needed.58 In addition, early

in 1943, as mentioned above, nondivisional medical units organized under inflexible tables of organization, such as medical

regiments, were replaced by flexible battalions and groups made up of variable

combinations of separate ambulance, collecting, and clearing companies. While

these changes did not affect the automatic

inclusion in the troop basis of medical

units that were organic elements of com53

 Johnson and Wilson, op. cit., 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, 352-54.

(2) Orgn of Major Units, incl to Ltr, TAG to CGs

AGF, AAF, and SOS, 31 Mar 42, sub: Policies Governing 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. 354-71.
458 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

bat forces still organized under tables of

organization, they did require the establishment 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 collecting 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 clearing, and 105 ambulance companies.60

 The

troop bases subsequently approved did

not follow this recommendation. For example, in April 1944, when planning was

in terms of 89 divisions, the troop basis included 162 collecting, 104 clearing, and

75 ambulance companies.61 The discrepancy between the ratio recommended by

the Ground Surgeon and that in which

separate medical companies were authorized 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 Washington.62

 In May 1945, just before the war

in Europe ended, there were in the troop

basis for the support of 89 divisions the following 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 company, had already been deployed to theaters of operations.63

The activation and training of medical

evacuation units were so closely intertwined with the activation and training of

other Ground Forces units that any account of them would reflect generally a

larger picture already described in considerable 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 recommendations of the Ground Surgeon.

During most of 1942 they were trained

under the supervision of division commanders. In the latter part of that year

and the early part of 1943, however, AGF

headquarters established special local

headquarters (Headquarters and Headquarters 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 inspections and reports, kept AGF headquarters

59

 (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 Department units will be included in a volume 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 shortage 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 authorized 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 possible 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 equipment 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 supply 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 medical units engaged in maneuvers in Louisiana 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: Chronological 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 dependent upon the issuance of their own

organizational equipment for use in medical service, because The Surgeon General

had established a policy before the war—

and it was continued—of supplying dispensary buildings erected in training

areas of Army camps with medical supplies and equipment from station stocks.73

Medical units of infantry divisions normally 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 dispensary for all persons in the infantry regiment 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 examination at sick call to need hospital

care were usually transported to station or

regional hospitals in ambulances of divisional 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 personnel 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 supply 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 various 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 training purposes or for later use in theaters of

operations. It was the Ground Surgeon's

opinion that such experience was invaluable 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 divisional clearing stations. For example,

during maneuvers in 1942 the 68th Med73

 The Annual Report, Surgeon First Army, 1941,

spoke of the establishment of this policy. Its continuance 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. 76

 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 installations: 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 established aid and prophylactic stations in

towns within the area of operations, maintained clearing stations for army troops,

evacuated casualties from division and

army clearing stations to evacuation hospitals 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 assigned, Ground Forces medical units on

maneuvers gained valuable practical experience 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 hospitalization 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 hospitals. (Table 16) Meanwhile, evacuation

units that were organized and trained in

the United States transported many thousands 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 Department prepared for and discharged this

unprecedented task of hospitalization and

evacuation has been the subject of this

volume. From the details already presented, 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 partial 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 requirements. 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. Hospitalization and evacuation units had been organized and were being trained, but they

were few in number. Also, there was uncertainty as to the role of these particular

units—whether they would remain in the

1

 These figures are "preliminary pending publication of final tabulations based on the individual medical records." Memo, Eugene L. Hamilton, Chief

Med Statistics Div SGO for Clarence Smith, Historical 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 depending upon existing buildings and had revealed many unsatisfactory features in

plans for cantonment-type hospitals. Blueprints were drawn, therefore, for hospitals

of a new type, to be of two-story semipermanent construction. An improved

general-service ambulance had been developed 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 improved, it was uncertain whether the

Army or Navy would operate transports,

and therefore evacuate patients from overseas 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. Evacuation from theaters and transportation of

patients from ports to general hospitals in

the United States proceeded according to

peacetime procedures, with little indication of changes that would be required for

a wartime load. Plans for air evacuation

were in the hopeful more than the practical stage. And plans for the internal administration of hospitals and the global

operation of a system of hospitalization

and evacuation were in terms of expanding 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. Planning 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 preparedness 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 Department—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 emergency 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, emphasis gradually shifted to evaluating experience as it accumulated and to planning 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 economy, 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 existing plans, with attendant alterations,

additions, and repairs. Eventually, availability of materials and general dissatisfaction 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 construction. Toward the completion of the

construction program, efforts were made

to co-ordinate plans of the Army for hospital construction with those of other agencies and with postwar needs. Concurrently

with the establishment of additional hospitals 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 hospital units—remained in training in this

country for long periods after their activation, 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 Surgeon 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 procedures that were to endure throughout the

conflict. An early decision of importance

was that the Army would operate transports and evacuate patients aboard them.

A corollary decision toward the middle of

1943 was that the Army would also operate hospital ships to supplement the space

available for evacuation on transports.

Procedures that required only minor adjustments later in the war were established

to co-ordinate the activities of theaters,

ships' surgeons, ports of embarkation, and

corps areas (later called service commands) 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 scheduled transport airplanes was also established, but it was policy during this period

to keep air evacuation to a minimum. Despite 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 evacuation were thereby shelved. Procedures

were also developed—albeit directives announcing them were unclear and in some

instances contradictory—for the movement of patients by hospital train in the

United States. While hospitals and the

hospital system in the zone of interior continued for the most part to operate under

peacetime procedures, the designation of

general hospitals as centers for specialized

treatment and the establishment of a policy of hospitalizing patients near their

homes occurred early in 1943. These actions came too late to influence the location of general hospitals, and had not had

time by the middle of 1943 to affect appreciably procedures for evacuation in the

zone of interior. The desirability of shortening the length of time patients stayed in
466 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

hospitals was recognized and efforts toward that end were begun. They pertained primarily to procedures in administrative 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 desirability of convalescent-reconditioning programs, caused the establishment early in

1943 of convalescent centers and annexes—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 situation. The mobility of war on land masses

and the character of operations in island

areas highlighted the necessity of modifying 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 installations of all types and sizes. In this connection, 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 opposed 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 Surgeon General's recommendation for the

development of a forward-area ambulance

was disapproved by higher authority, but

the general-service ambulance was modified to facilitate its shipment to and use in

theaters of operations. Experiments with

multipatient ambulances were unsuccessful, 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 reorganization in the War Department was taking

place. The creation of three major commands — Ground, Air, and Service

Forces—required delineations of responsibility for hospitalization and evacuation,

and raised questions concerning the extent

of The Surgeon General's authority. Responsibility 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 responsibility and authority, and his relationship

with The Surgeon General, were not sufficiently delineated to prevent recurring

instances of friction between them; particularly when the Air Surgeon attempted

to set up a completely separate hospital

system for the Air Forces. The establishment within ASF headquarters of a group

concerned with hospitalization and evacuation and headed by a Medical Corps officer had a variety of effects. This group

assumed the lead in planning and in coordinating the activities of the many agencies involved in evacuation operations,

with the full concurrence, apparently, of
SUMMARY AND CONCLUSIONS 467

the Surgeon General's Office. When it entered the field of hospital operations it

encountered opposition. Whether the good

it accomplished in this field counterbalanced the ill-feeling and friction which it

engendered is difficult to determine accurately even now. Progress had been made

by the middle of 1943 in composing differences and solving problems arising from

the reorganization, but further adjustments 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 allout war with more limited resources than

had been anticipated. The problem of

estimating requirements therefore demanded continual and increasing attention. 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 attempt 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 evacuation from theaters and in determining

hospitalization for both theaters and the

zone of interior. Facilities provided on the

basis of this estimate seemed excessive during 1944 and, as the personnel situation

became more restrictive, various agencies

of the War Department urged retrenchment. Reductions followed in the ratio of

beds (to troops) authorized for station hospitals in the United States and for fixed

hospitals in most theaters of operations.

Early in 1945, when requirements increased, general and convalescent hospitals in the United States had to be expanded rapidly, more hospital train cars

had to be procured, and additional hospital ships had to be rushed to completion.

Experience in estimating requirements

during 1944 and 1945 pointed up the importance of collecting casualty and disease

data early in the war for planning purposes. It also highlighted the necessity and

difficulty of correlating far in advance

estimates of requirements with estimates

of the time when they would occur. Furthermore, 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 uneconomical use of limited resources.

Limited resources affected hospitalization and evacuation in more ways than in

demanding repeated estimates of requirements. Shortages of personnel led to widespread 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 officers were used more extensively to replace

Medical Corps officers in administrative

and semiprofessional positions; and limited service enlisted men, civilians, and

enlisted women replaced the major portion 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 hospitalization and evacuation organizations

were overgenerous in their use of personnel 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 Administrative Corps officers, limited service enlisted 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 protectedpersonnel in the medical service of theaters

and the zone of interior, and the substitution of small units that could be used in

flexible combinations for larger rigid tableof-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 barracks for detachments, and post barracks

for convalescent patients. While several

station hospital plants were converted into

general hospitals, earlier plans and proposals to meet in the same manner a growing 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 hospital improvement to correct some of the

deficiencies in cantonment-type buildings

erected earlier. Although hospital construction was curtailed about the middle

of 1943, the major portion of the program

of constructing hospital cars and ships occurred 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 latter part of the war—partly because of limitations upon available resources but also

for other reasons, such as competition

between the Air Surgeon and The Surgeon General for the control of segments

of hospitalization, the desirability of providing a helpful psychological atmosphere

for convalescent patients, and the emergence of new needs. The existing program

of specialization in general hospitals was

extended to promote the effective use of

scarce specialists. The development of regional hospitals represented an attempt to

eliminate duplication inherent in the

operation of dual sets of hospitals (Air and

Service Forces) by providing hospitalization 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 security problems and contributed eventually to personnel economy. Although there

were no significant changes in the system

of hospitalization and evacuation in overseas areas, efforts were made to provide

theaters with additional types of units,

such as medical holding battalions, mobile army surgical hospitals, and convalescent 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 established, the most important modification was the creation of a Medical Regulating 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 governmentowned 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 hospitals in relation to population density

rather than troop concentrations.

In connection with changes in the hospitalization 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 management engineering. Attempts to standardize hospital organization—a prerequisite to the simplification of administrative

procedures—amounted to conformance

with the standard organization of ASF

posts more than improvements and innovations in hospital organization as such.

The introduction of management engineering led to work-load studies, worksimplification measures, and the streamlining of certain administrative procedures, especially those affecting the length

of time patients remained in hospitals and,

consequently, the number of beds required. Another factor affecting bed requirements—the performance of adequate

diagnostic procedures to permit the admission 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 facilities for evacuation. Despite its earlier objection 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 promoted 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 Surgeon General proposed, and higher authority approved, the development of a

multipatient ambulance. A front-line ambulance 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 evacuation units. While airplane ambulances

were never authorized or developed, improvements in litter supports permitted

increases in the capacities of transport

planes for evacuation. Eventually, an increase in the availability of planes led to a

modification of existing policy and the as3

 Comment by Dr. Eli Ginzberg, formerly Dir, Resources Anal Div SGO, incl to Ltr to Col Calvin H.

Goddard, 5 Nov 51. HD: 314 (Correspondence on

MS) V.
470 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

signment to several commands of planes

for use primarily in the movement of

patients.

Further adjustments to the new organization 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 headquarters 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 position 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 jurisdictions of the Air Surgeon and The Surgeon General gradually evolved. The

Surgeon General was never in a position,

though, to exercise a controlling influence

over the entire hospitalization and evacuation system of the Army. Perhaps an important 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 interior as possible. This required him to act

in a disinterested manner on matters involving him as an interested party. Nevertheless, despite difficulties caused by its

organizational structure, the War Department and its agencies, including the Surgeon General's Office, managed successfully with limited resources to provide

adequate hospitalization and evacuation

for an Army of over 8,000,000 men

engaged in a global war.
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

AGWAR 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

Fld 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, Matériel

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
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

PMG 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

SecWar 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 Medical 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 official correspondence, memoranda, and reports 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 classifications of documents used in the preparation of this volume, or even those used

most often, is both undesirable and unnecessary 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 commanding officers of hospitalization and

evacuation units and installations that

ranged from 3,000-bed hospitals to separate ambulance companies. Although

these annual reports obviously must be

used with caution, because surgeons and

commanders in some instances undoubtedly attempted to present the most favorable view possible of their activities, they

contain a wealth of information not otherwise 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 Overseas Operations Division, the Medical

Regulating Unit, and the Resources Analysis Division. To supplement these papers,

the Unit periodically borrowed wartime

documents from current office files of the

Medical Facilities Planning Branch (formerly Hospital Construction Branch), Medical 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 General's Office covering the period from the

fall of 1943 to the end of the war. In addition, 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 information on relations between the Surgeon General's Office and the SOS Hospitalization 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 General's unit cards (large cards giving in

abbreviated form the chronology and history of individual military units) of Medical Department organizations, including

hospitalization and evacuation units. (The

original cards are filed in the Organization and Directory Section, Operations

Branch, Administrative Services Division,

Adjutant General's Office.) Other documents 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 Historical Unit had in its custody, on indefinite loan, three blocks of files of considerable 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 Section, Departmental Records Branch, Adjutant 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 Hospitalization 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 Historical 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 medical 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 Historical Unit for this study were certain files of

ASF headquarters and the War Department General Staff, which are in the custody 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 General Staff files, those of G-4 were naturally

most rewarding, but those of G-1, G-3,

and OPD were also consulted with success
BIBLIOGRAPHICAL NOTE 479

in many instances. Conclusive information, particularly about controversies or

disputes that reached high levels of authority for decision or solution, could be found

often only in the files of the Chief of Staff,

U. S. Army, the Assistant Secretary of

War for Air, and the Secretary of War.

Other files 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 operations; among them were the Quartermaster Corps, the Corps of Engineers, and the

Transportation Corps. While the wartime

files of AAF and AGF headquarters were

available and useful, it was particularly

disturbing to be unable to find among

them anything resembling central files of

the offices of the Air and Ground Surgeons. Finally, and certainly not of least

importance, were the files maintained by

The Adjutant General during the war.

Because his Office was the War Department's office of record, all official communications to and from the General Staff

found their way into the AG files.

Printed primary sources were also used

in the preparation of this volume, but because of the wide circulation they enjoyed

it is unnecessary to indicate the depositories in which they are located. Obviously Army regulations, War Department

circulars, field manuals, technical manuals, tables of organization and equipment,

and the like, are basic sources for any military history. Of interest because they

helped the writer fit the history of hospitalization 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 Congressional committee reports, a few were

used when they appeared to have a direct

bearing on the subject under consideration.

As noted at greater length in the preface, the writer also derived much information from interviews and correspondence

with persons active in Medical Department affairs during the war.

Secondary Sources

While there are no published monographs or special studies on Army hospitalization and evacuation during World

War II, there are a number of unpublished preliminary histories and historical

monographs on Medical Department activities that have been helpful to the writer

of this volume. Among them are a group

of studies prepared by the Historical Division, Office of The Surgeon General, immediately after the end of the war. They

are the following: [Samuel M. Goodman],

A Summary of the Training of Army Service Forces Medical Department Personnel,

1 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. Morgan and Donald O. Wagner, The Organization 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. Blanchfield 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 particularly 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 volumes which they are preparing on Medical Department organization and personnel, 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 Planning and Control Divisions of ASF headquarters supplied information that undoubtedly existed in documents which

could not be located in ASF files. Histories

of Medical Department activities of the

Air Transport Command, its Ferrying Division, I Troop Carrier Command, and the

Fourth Air Force were used to supplement information found in the files of AAF

headquarters. Wartime histories of Medical Department activities in overseas commands, on file in the Historical Unit, supplied 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 histories, all of them are in fact final reports

of the offices concerned. On file in the Historical 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, Hospital 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 Prisoners of War, World War II; and Achilles

L. Tynes, Data for Preparation of Historical Record of Construction Branch of the

Surgeon General's Office during the Expansion 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, Washington 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 Organization 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 Procurement 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: Organization, Supply and Services, Vol. I (Washington, 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. Ashburn, A History of the Medical Department of

the United States Army (Boston, 1929); Roland W. Charles, Troopships of World War II

(Washington, 1947); Engineer, Office of

the Chief, General Headquarters Army

Forces, Pacific, Engineers in Theater Operations in ENGINEERS OF THE SOUTHWEST PACIFIC, 1941-45, Vol. I. (1947);

Logistical History of NATOUSA-MTOUSA

(Naples, Italy, 1945); The Medical Department of the United States Army in the World

War, Vol. I (Washington, 1923), Vol. V

(Washington, 1923), Vol. VIII (Washington, 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 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

Strategic Planning for Coalition Warfare: 1943-1944

Global Logistics and Strategy: 1940-1943

Global Logistics and Strategy: 1943-1945

The Army and Economic Mobilization

The Army and Industrial Manpower

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 Western Hemisphere

The Framework of Hemisphere Defense

Guarding the United States and Its Outposts

The War in the Pacific

The Fall of the Philippines

Guadalcanal: The First Offensive

Victory in Papua

CARTWHEEL: The Reduction of Rabaul

Seizure of the Gilberts and Marshalls

Campaign in the Marianas

The Approach to the Philippines

Leyte: The Return to the Philippines

Triumph in the Philippines

Okinawa: The Last Battle

Strategy and Command: The First Two Years

The Mediterranean Theater of Operations

Northwest Africa: Seizing the Initiative in the West

Sicily and the Surrender of Italy

Salerno to Cassino

Cassino to the Alps

The European Theater of Operations

Cross-Channel Attack

Breakout and Pursuit

The Lorraine Campaign

The Siegfried Line Campaign

The Ardennes: Battle of the Bulge

The Last Offensive
The Supreme Command

Logistical Support of the Armies, Volume I

Logistical Support of the Armies, Volume II

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

Time Runs Out in CBI

The Technical Services

The Chemical Warfare Service: Organizing for War

The Chemical Warfare Service: From Laboratory to Field

The Chemical Warfare Service: Chemicals in Combat

The Corps of Engineers: Troops and Equipment

The Corps of Engineers: The War Against Japan

The Corps of Engineers: The War Against Germany

The Corps of Engineers: Military Construction in the United States

The Medical Department: Hospitalization and Evacuation; Zone of Interior

The Medical Department: Medical Service in the Mediterranean and Minor

Theaters

The Ordnance Department: Planning Munitions for War

The Ordnance Department: Procurement and Supply

The Ordnance Department: On Beachhead and Battlefront

The Quartermaster Corps: Organization, Supply, and Services, Volume I

The Quartermaster Corps: Organization, Supply, and Services, Volume II

The Quartermaster Corps: Operations in the War Against Japan

The Quartermaster Corps: Operations in the War Against Germany

The Signal Corps: The Emergency

The Signal Corps: The Test

The Signal Corps: The Outcome

The Transportation Corps: Responsibilities, Organization, and Operations

The Transportation Corps: Movements, Training, and Supply

The Transportation Corps: Operations Overseas

Special Studies

Chronology: 1941-1945

Military Relations Between the United States and Canada: 1939-1945

Rearming the French

Three Battles: Arnaville, Altuzzo, and Schmidt

The Women's Army Corps

Civil Affairs: Soldiers Become Governors

Buying Aircraft: Materiel Procurement for the Army Air Forces

The Employment of Negro Troops

Manhattan: The U.S. Army and the Atomic Bomb

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 hospitals, 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 subordinate 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 Evacuation 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 convalescent 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 convalescent 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 evacuation, 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 combat 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 Division; Hospitalization and Evacuation Branch;

Medical Regulating Unit; Mobilization Division; Plans and Operations, Director of; Provost 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 operations, 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 procedures, 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 SGO, 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 SGO 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 construction, 18

decides publication date for hospital manning

guide, 31

directs ETO to use transports for evacuating patients, 209, 328-29

directs full use of air evacuation by ETO, 329

grants increased hospital train personnel to service commands, 391

notes delay in retirement procedure for officers, 36

orders organization of WAC companies for hospitals, 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 hospital 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 ChinaBurma-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 hospitals, 99

effect of recommendations on policies and procedures of Medical Department, 61

Committee to Study the Medical Department—Con.

gives causes for shortcomings of hospital construction, 93-94

proposal of separate convalescent accommodations opposed by SG, 118

proposes changes in hospital administration, 122,

123, 127, 268

recommends maximum hospitalization for patients, 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 concerning 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, convalescent.

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 general 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 demobilization.

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 SG'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 maintenance 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 proportions 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 medical requirements for ZI, 202

authorized to expand general and station hospitals, 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 evacuation.

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 evacuation, 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 Reports; 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, convalescent, evacuation, field, general, portable surgical, 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
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-1 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 facilities, 119

G-3 Division, War Department, 9, 219

approves agreement as to responsibility for hospitalization 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 hospitals, 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 evacuation, 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 patients from overseas, 186

questions propriety of allotting funds for modernization 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, 9, 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-1 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 MC 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 MC 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, 81, 82

Helicopters for evacuation, 434-36. See also Autogiros for evacuation.

Hines, Frank T., Administrator of Veterans Affairs,

and Chairman, Federal Board of Hospitalization, 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 constructionplanning 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
492 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR

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 modified), 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; Transports, 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. Robert 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 SGO, 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 requirements; 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, surgical. 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, 141

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-BurmaIndia 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 patients 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 Houston), 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

Camp 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

McCaw 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 Atterbury), 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 hospitalization for AAF in UK, 175

opposes separate AAF station hospitals, 183

orders program for establishing convalescent annexes, 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 Evacuation Branch, SOS, 56

conservative tendencies, 53

criticizes suggestions for changes in hospital administration, 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 convalescents, 118

and project for emergency hospitalization, 81, 82-

83

recommendation on hospital construction approved 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 MC 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 General, Office of the.

Mediterranean theater. See also North African

theater.

authorized to expand general and station hospitals, 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 T/O 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; Installations 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 organization 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; Southwest Pacific Area.

Panama Canal Zone, hospitals in, 4, 142

Patients. See also Neuropsychiatric patients, accommodations 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, 243-47, 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; Medical Administrative Corps, Medical Corps;

Negroes; Prisoners of war; Tables of organization 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 21⁄2-ton truck chassis unsuitable for

ambulance body, 366

develops new-type hospital tent, 297

helps develop air conditioning for evacuation airplanes, 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 Reconditioning 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 requirements, 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 general 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 MG 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. LeRoy 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 Wadhams Committee, 122

disapproves light ambulance, 364

establishes procedure for movement of patients

by rail, 350

favors delaying establishment of separate convalescent 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 evacuation, 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 Expeditionary 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, hospitals 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 medical units; Tables of Organization and Equipment.

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. Norman T.; Magee, Maj. Gen. James C.; Reynolds, Maj. Gen. Charles R.

Surgeon General, Office of the

attitude toward expanding the medical service, 6

attitude toward use and equipment of T/O hospitals in ZI, 151-60

comes under jurisdiction of SOS, 55

controversy over planning hospitalization, 63-67

opposes general-hospital-type care in AAF hospitals, 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 Subdivision, 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 Division, 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 transports, 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 debarkation 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 evacuation, 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 hospital or ambulance transports, 398

raises standards for ships' hospitals, 413-14
INDEX 503

Transportation Corps—Continued

responsibility for equipping ships' medical personnel, 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; Installations and units, medical.

Veterans Administration

confers on change in patients' discharge procedure, 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 hospitals 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 staffs, 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 programs, 265-66

U.S. GOVERNMENT PRINTING OFFICE: 1989 242-456/00014