The Medical Corps Hospitalization and Evacuation, Zone of Interior

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 protectingthe health of the troops and binding up the wounds of those who have bornethe battle. As in the matter of feeding and clothing, the general public has well-established civilian standards against which it can measure the efficiency ofthose responsible for the Army's medical service. When conducted with speedand professional competence this service is a source of comfort to both the manin uniform and his family and friends; when it fails to equal or excel the systemof medical care to which American society is accustomed it is subject to imme-diate and strong protest from a people able and willing to criticize. The success-ful conduct of a military medical service therefore requires not only a knowl-edge of contemporary civilian medical practice but also administrative talentcapable of adjusting the demands of the public and the medical profession tothe Army's needs in time of war with the minimum of friction.

This is the first volume of a series which relates the hospitalization andevacuation experience of the Army in World War II. It should prove enlighten-ing both to military men directly or indirectly concerned with the Army'smedical service and to that large group of doctors and hospital administratorswho daily face policy and management problems similar to those recountedhere.

A. C. SMITHMajor General, USAChief, Military History

Washington, D. C.25 June 1954

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Introductory Note

The medical histories of the Civil War and the First World War which werepublished under the auspices of earlier Surgeons General contain lengthydescriptions of hospitalization and evacuation in rear areas. The present volumetherefore continues the Army Medical Service's tradition of presenting a detailedaccount of these operations during a great war.

The contrasts between World War II and earlier wars in matters of hospitali-zation and evacuation are of course striking. The Army provided—at a maxi-mum—more than twice as many hospital beds in the United States inWorld War II as it did in World War I, although curiously enough the numberof beds in the zone of interior hospitals of World War I was very little largerthan that in the Federal rear-area ("general") hospitals of the Civil War. Theprocess of transporting and regulating the flow of patients to these hospitals inWorld War II differed in important respects from the methods used earlier. Yetdespite these—and many other—changes, real elements of continuity existed.The convalescent hospitals and specialty centers, which became outstandingfeatures of the World War II hospital system, existed on a smaller scale in WorldWar I. The horse-drawn ambulance of the Civil War gave way to the motorambulance of the two world wars, but hospital trains carried large numbers ofpatients in 1864 as in 1918 and 1945. Even the use of airplanes for transportingArmy patients in the United States, an important factor in evacuation duringWorld War II, had its small beginnings in World War I.

These observations are not meant to imply that the recent changes inhospitalization and evacuation outside the combat areas were less numerous orimportant than the features which remained essentially the same. They aremerely a reminder that the full meaning of this volume can only be grasped ifit is read with some knowledge of earlier events. Even without this background,however, readers who now or in the future are engaged in the work of hospitali-zation and evacuation should find much in the account to help them build onthe achievements and avoid the pitfalls of the past. If the book serves that pur-pose, the work of the author and his assistants will be amply justified, as will theinterest of the many officers and civilians who responded so freely when calledupon 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. degreefrom Harvard, and except for a dissertation, has completed the requirementsfor a Ph.D. degree at Duke University. He taught history at Newberry College

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from 1940 until he entered the Army in World War II. During the war heserved as an officer in the Medical Administrative Corps of the Army. From1946 to 1954, he was a member of the Historical Division of the Office of TheSurgeon General.

GEORGE E. ARMSTRONGMajor General, U.S. ArmyThe Surgeon General

Washington, D. C.11 January 1955

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Preface

This volume is one of several planned for a series on the history of the Med-ical Department of the United States Army during World War II. It dealsprimarily 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 andwounded soldiersl in the attempt to restore them to physical fitness; and theterm "evacuation" includes all of the means necessary to move patients fromone place to another, whether from the battlefield to a hospital in the rear ofcombat zones, or from one hospital to another in the United States. The pro-fessional care of patients is not discussed in this volume; this subject will betreated fully in other studies being prepared by specialists in the various fieldsof medicine and surgery. Nor are details of the internal administration andoperation of hospitals and evacuation units described here except to the extentnecessary to explain the evolution of general policies and practices affectingthe system of hospitalization and evacuation as a whole. Also, this volumeconfines itself almost entirely to events in the zone of interior (that is, theUnited States). This approach excludes any account of overseas hospitaliza-tion and evacuation operations, but not a discussion of the plans and prepara-tions for them in the United States. Hospitalization and evacuation in theatersof operations will be covered elsewhere in this series. Treatment in this volumeof the evacuation of patients from theaters to the United States might seemillogical unless the reader understands that the Army considered this operationa function of the zone of interior.

While hospitalization and evacuation are closely related, each is a compli-cated operation within itself. For simplicity and clarity they are treated in thisvolume as separate subjects, the first three parts dealing with hospitalizationand the fourth with evacuation. Any account of hospitalization and evacuationinvolves some consideration of such elements as supplies and personnel. Thisvolume therefore necessarily overlaps to some extent the subject matter of othervolumes planned for this series. An effort has been made to keep such duplica-tion to a minimum, with the result that some subjects may seem to have beenslighted and others—such as the services of the Red Cross in hospitals—over-looked. Fuller information on these topics will be found in other volumes beingwritten by the Army and by other agencies.

1 A system of hospitalization and evacuation for army animals was also maintained by the Med-ical Department, but was of small dimensions and is not dealt with in this volume.

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Though many agencies of the War Department were involved in the actionsrequired to provide the Army with hospitalization and evacuation services—the War Department General Staff, especially its G-4 Division; the offices ofThe Surgeon General, the Air Surgeon, and the Ground Surgeon in Washing-ton, and of surgeons of local commands elsewhere; the headquarters of theArmy Ground, Air, and Service Forces; and the offices of chiefs of various tech-nical services—emphasis has been placed in this volume on the work of TheSurgeon General and his Office. While the history is not written with any con-scious partiality for the viewpoint of The Surgeon General, it is written fromhis vantage point. There are several reasons for this approach. Most importantis that The Surgeon General by tradition and directive is the chief health officerof the Army, and it is to him that the public looks when matters of health andmedical care are concerned. A more practical reason is that the records of theSurgeon General's Office were more readily available than those of the officesof other surgeons. Finally, concentrating upon activities of the Surgeon Gen-eral's Office is a very useful means of limiting the scope of this work and of giv-ing it focus, without excluding consideration of actions affecting hospitalizationand evacuation by agencies on higher, parallel, and lower levels of authority.

This volume is based almost entirely on records filed in various collectionsunder the jurisdiction of the Department of the Army. With minor exceptionsthe author had free and unlimited access to them. Because of The SurgeonGeneral's decision not to request "top secret" clearance for historians, thewriter was not permitted to use the few files retaining that classification. Thislimitation is believed to have been of little consequence, because most of theonce top-secret documents either had been given lower classifications or hadbeen declassified altogether by the time they were needed. The author was alsodenied access to files of The Inspector General containing confidential com-plaints made to his representative during inspections of individual installations,but reports of more general inspections and investigations of hospitalization andevacuation by the chief medical officer on the staff of The Inspector Generalwere made available. Compared with the records actually used, those to whichaccess was denied are probably insignificant in quality as well as quantity.Publicity already given to the "tons of documents" through which one mustsearch in the preparation of a volume of this kind makes it unnecessary to com-ment further on that subject.

Because of the nature of the source material for this volume, the form of itsfootnotes may appear unconventional to some readers. The following generalobservations will help in understanding them. Normally, a document is firstidentified by its type, file number (in some instances), sender, addressee, date,and subject. Its location is then given by indicating the collection of files andthe specific folder in that collection in which it is found. The security classifica-tion of documents is not given.

Numerous technical terms have been used in this work, despite an earnesteffort to avoid employing words and phrases in a manner understood by mem-bers of the military establishment but not by general readers. As a rule, tech-nical terms and general terms given a special meaning by the Army are ex-

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plained when they are first introduced in the text. Abbreviations have beenused freely, especially in the footnotes. In most instances they are those author-ized by the Army. Reference to a list of abbreviations at the end of the volumewill help the reader interpret many of them.

The problem of how to designate Army officers whose ranks changed fromtime to time has been settled by giving the rank an officer held at the time ofthe action discussed. An effort also has been made to mention at some point inthe 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. Theywere compiled from documents used in wartime operations, and further investi-gation by statisticians may eventually result in figures that are somewhat dif-ferent. Nevertheless, it is believed that any variations will be inconsequentialand will not diminish the historical significance of the data used here.

It is impossible to acknowledge in detail all of the help which the authorreceived in the preparation of this work. Many acknowledgements will befound in footnotes throughout the volume. As for others, the author is especiallyindebted to Miss Zelma E. McIlvain and Mr. Hubert E. Potter for theirassistance. Miss McIlvain did the major portion of research for Part Four andprepared preliminary drafts for much of Chapters XXII, XXIII andXXIV. Mr. Potter assisted in research for parts of Chapters XXII,XXIII, XXIV and XXV, and prepared preliminary drafts for certain portionsof them. In addition, he assisted the writer immeasurably in obtaining impor-tant, hard-to-find documents.

The author is also indebted to the entire staff of the Historical Unit. Mrs.Josephine P. Kyle, Chief of its Archives and Research Branch, and her staffwere indefatigable in searching for and locating not only large blocks of filesbut also individual documents requested by the writer. Typists of the Admin-istrative Branch spent many weary hours making extracts from documents andtyping drafts and final copies of chapters. Editorial clerks of this Branch pre-pared the tables in this volume and carefully checked and rechecked themanuscript before it was finally submitted for publication. My colleagues inthe Historians Branch, and especially its chief, Dr. Donald O. Wagner, whosupervised the preparation of this study, reviewed the manuscript and mademany helpful suggestions for its improvement. The Armed Forces Institute ofPathology prepared the organization charts, under the supervision of MissSylvia Gottwerth, formerly of the Historical Unit. Finally, Col. Joseph H.McNinch, MC, Col. Roger G. Prentiss, Jr., MC, and Col. Calvin H. Goddard,MC—successive chiefs of the Historical Unit—gave the author and his assist-ants unflinching support, especially by their scholarly attitude toward thepreparation of this volume.

A word of appreciation is also due to many persons outside the present Sur-geon General's Office. Many officers who participated in events discussed inthis volume—now retired or serving in other assignments—gave the authorvaluable help. Those interviewed usually spoke freely and frankly of their ex-periences. Others made excellent critical comments on drafts of chapterssubmitted to them for review. The information which they thus furnished was

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especially helpful in filling in the background of important documents andevents. The names of many appear in footnotes throughout the volume, buttwo deserve special mention here—the wartime Surgeons General, Maj. Gen.James C. Magee and Maj. Gen. Norman T. Kirk. The author is also gratefulfor criticisms and editorial assistance from Col. Leo J. Meyer, Deputy ChiefHistorian, Office of the Chief of Military History, and from members of theEditorial Branch of the same Office.

CLARENCE McK. SMITHWashington, D. C.10 March 1953

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ContentsPART ONE

Hospitalization during the Emergency Period, 8 September

1939—7 December 1941Page

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . 3The State o f Army Hospitalization, 1939 . . . . . . . . . . . . 3Effect o f the War in Europe . . . . . . . . . . . . . . . . 6

Chapter

I. ORGANIZATION AND RESPONSIBILITIES FOR HOSPI-TALIZATION . . . . . . . . . . . . . . . . . . . . . . 8

The Surgeon General's Position in the War Department . . . . . . 8T h e Surgeon General's Office. . . . . . . . . . . . . . . . . 9The Surgeon General's Control Over Hospitals and Hospital Units . . 10

II. PLANNING FOR AND EXPANDING HOSPITALS IN THEUNITED STATES . . . . . . . . . . . . . . . . . . . . 1 3

Hospital Construction . . . . . . . . . . . . . . . . . . . 1 3Hospital Administration . . . . . . . . . . . . . . . . . . 2 6

III. PLANS AND PREPARATIONS FOR HOSPITALIZATION INOVERSEAS AREAS . . . . . . . . . . . . . . . . . . . 3 8

Mobilization Planning . . . . . . . . . . . . . . . . . . . 3 8Preparing Hospitalization for Overseas Areas During a Peacetime Mo-

bilization . . . . . . . . . . . . . . . . . . . . . . . 4 3

PART TWO

Hospitalization in the Early War Years,

7 December 1941—Mid-1943

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . 5 3IV. CHANGES IN ORGANIZATION AND RESPONSIBILITIES

F O R HOSPITALIZATION . . . . . . . . . . . . . . . . 5 4Reorganization o f the War Department . . . . . . . . . . . . . 54The Surgeon General's New Position . . . . . . . . . . . . . . 55T h e Wadhams Committee . . . . . . . . . . . . . . . . . . 6 1Changes in the Surgeon General's Office . . . . . . . . . . . . . 61A Dispute About General Planning for Hospitalization and Evacuation. . 63

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Chapter Page

V. HOSPITAL PLANTS IN THE UNITED STATES . . . . . . 68Types o f C o n s t r u c t i o n . . . . . . . . . . . . . . . . . . . . 6 8Estimates o f Hospital Capacity Needed . . . . . . . . . . . . . 78Location, Siting, and Internal Arrangement of Hospital Plants . . . . 88Maintenance o f Hospital P l a n t s . . . . . . . . . . . . . . . . 9 4Conformity of Hospital Construction to Needs. . . . . . . . . . . 100

VI. EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR HOS-PITAL SYSTEM . . . . . . . . . . . . . . . . . . . . . 1 0 3

Command Relationships o f Hospitals . . . . . . . . . . . . . . 103Special Types of ASF Station H o s p i t a l s . . . . . . . . . . . . . 109Port a n d Debarkation Hospitals . . . . . . . . . . . . . . . . 1 1 3Designation of General Hospitals for Specialized Treatment . . . . . 116The Question of Establishing Convalescent Hospitals . . . . . . . . 117

VII. MINOR CHANGES IN HOSPITAL ADMINISTRATION . . 121Question of Simplified Organization and Internal Administrative Pro-

cedures. . . . . . . . . . . . . . . . . . . . . . . . . 1 2 1Efforts To Shorten the Average Period of Hospitalization . . . . . . 124Early Changes in the Size and Composition of Hospital Staffs. . . . . 131Problem of Furnishing Supplies and Equipment for Hospitals . . . . . 137

VIII. PROVIDING HOSPITALIZATION FOR THEATERS OF OP-ERATIONS . . . . . . . . . . . . . . . . . . . . . . . 1 4 0

Meeting Early Emergency Needs . . . . . . . . . . . . . . . 1 4 0Modification of Hospitals for Overseas Areas . . . . . . . . . . . 143Hospital Units in the Troop Basis. . . . . . . . . . . . . . . 149The Question of Equipping and Using Numbered Hospitals in the Zone

o f Interior . . . . . . . . . . . . . . . . . . . . . . . 1 5 1Preparing for the Support of Offensive Warfare . . . . . . . . . . 160

PART THREE

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

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . 1 6 9IX. FURTHER CHANGES IN ORGANIZATION AND RESPON-

SIBILITIES F O R HOSPITALIZATION . . . . . . . . . . 1 7 1Relationship of The Surgeon General With Other War Department Agen-

cies . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7 1Expanding and Strengthening the Surgeon General's Office . . . . . . 176

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Chapter Page

X. ADJUSTMENTS AND CHANGES IN THE ZONE OF INTE-RIOR HOSPITAL SYSTEM . . . . . . . . . . . . . . . 1 8 1

Closure of Surplus Station Hospital Facilities. . . . . . . . . . . 181Establishment o f Regional Hospitals . . . . . . . . . . . . . . 1 8 2Development o f Convalescent Hospitals . . . . . . . . . . . . . 1 8 8Merger o f Adjacent Hospitals. . . . . . . . . . . . . . . . . 1 9 0Attempts To Limit the Use of General Hospitals as Debarkation Hos-

pitals . . . . . . . . . . . . . . . . . . . . . . . . . 1 9 1Extension of the Practice of Establishing Specialized Centers . . . . . 194General Hospitals for Prisoners o f War . . . . . . . . . . . . . 195Establishment o f Hospital Centers . . . . . . . . . . . . . . . 1 9 8

XI. BED REQUIREMENTS IN THE ZONE OF INTERIOR. . . 200First Attempts To Base Requirements on an Estimate of the Patient Load . 201Movement To Reduce the Number of Hospital Beds in the United States . 202Changes in the Manner of Reporting Beds . . . . . . . . . . . . 207Meeting Increased Requirements for the Peak Patient Load. . . . . . 208

XII. ESTIMATING AND MEETING REQUIREMENTS OF THE-ATERS F O R HOSPITAL BEDS. . . . . . . . . . . . . . 2 1 4

Factors Influencing B e d Requirements . . . . . . . . . . . . . . 2 1 4Establishment of Bed Ratios for Theaters of Operations . . . . . . 216Efforts To Provide Theaters With Authorized Quotas of Beds . . . . 218Estimating Requirements for Major Combat Operations. . . . . . . 224Movement To Reduce Authorized Bed Ratios . . . . . . . . . . . 227The Problem of the European Theater in the Winter of 1944-45. ... 234

XIII. CHANGES IN POLICIES AND PROCEDURES AFFECTINGTHE OCCUPANCY OF HOSPITAL BEDS IN THE ZONEO F INTERIOR . . . . . . . . . . . . . . . . . . . . . 2 3 8

Problem o f Limiting Hospital Admissions . . . . . . . . . . . . 238Measures To Shorten the Length of Patient-Stay . . . . . . . . . 239

XIV. CHANGES IN SIZE AND MAKE-UP OF THE STAFFS OFZONE O F INTERIOR HOSPITALS . . . . . . . . . . . 2 4 8

General Nature o f Changes. . . . . . . . . . . . . . . . . . 2 4 9Wider Use o f Administrative Officers . . . . . . . . . . . . . . 250Alleviation of the "Shortage" of Army Nurses. . . . . . . . . . . 251Greater Use o f Limited Service Men . . . . . . . . . . . . . . 253Replacement of Military by Civilian Employees . . . . . . . . . . 255Use o f Wacs in Army Hospitals. . . . . . . . . . . . . . . . 256Use of Prisoners of War in Army Hospitals . . . . . . . . . . . 259

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Chapter Page

XV. IMPROVEMENTS IN THE INTERNAL ORGANIZATIONAND ADMINISTRATION OF HOSPITALS IN THE UNITEDSTATES . . . . . . . . . . . . . . . . . . . . . . . . . 2 6 1

Simplification o f Administrative Procedures. . . . . . . . . . . . 2 6 2Work-Measurement and Work-Simplification Programs . . . . . . . 265Additional Activities and Their Place in The Organizational Structure of

Hospitals . . . . . . . . . . . . . . . . . . . . . . . 2 6 6Effect on Hospitals of the ASF Standard Plan for Post Organization . . 267Emergence o f Standard Plans for Hospitals . . . . . . . . . . . 268Details of the Medical Department's Standard Plans . . . . . . . . 271

XVI. CHANGES IN THE ORGANIZATION AND EQUIPMENT OFHOSPITAL UNITS PREPARED FOR OVERSEAS SERVICE. 279

Trend Toward Use o f Larger Units . . . . . . . . . . . . . . 279Cuts in Personnel o f Hospital Units . . . . . . . . . . . . . . 280N e w Hospital Units . . . . . . . . . . . . . . . . . . . . 2 8 2Changes i n Supplies a n d Equipment . . . . . . . . . . . . . . 2 8 3

XVII. HOSPITAL CONSTRUCTION AND MAINTENANCE. . . . 286Providing Housing for Additional Beds in General and Convalescent Hos-

pitals i n t h e United States . . . . . . . . . . . . . . . . . 2 8 7Construction of Additional Facilities at Existing Hospital Plants . . . 289Improvements i n Existing Hospital Plants . . . . . . . . . . . . 293Housing for Hospitals in Theaters of Operations . . . . . . . . . 296

XVIII. RETURN TO A PEACETIME BASIS. . . . . . . . . . . . 300Redeployment and Demobilization of Numbered Hospital Units . . . . 300Contraction of the Zone of Interior Hospital System . . . . . . . . 302

PART FOUR

Evacuation to and in the Zone of Interior

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . 3 1 9XIX. ESTIMATED AND ACTUAL REQUIREMENTS FOR EVAC-

UATION FROM THEATERS OF OPERATIONS . . . . 323

XX. DEVELOPMENT OF PROCEDURES FOR EVACUATIONFROM THEATERS TO THE ZONE OF INTERIOR ... 331

Procedures f o r S e a Evacuation. . . . . . . . . . . . . . . . . 3 3 1Procedures f o r A i r Evacuation. . . . . . . . . . . . . . . . . 3 3 7Procedures f o r D e b a r k a t i o n . . . . . . . . . . . . . . . . . . 340

XXI. MOVEMENT OF PATIENTS IN THE UNITED STATES . . 346Regulating the Flow of Patients . . . . . . . . . . . . . . . 346Procedures f o r Rail Evacuation . . . . . . . . . . . . . . . . 349Procedures f o r A i r Evacuation. . . . . . . . . . . . . . . . . 3 5 7

Chapter Page

XXII. PROVIDING THE MEANS FOR EVACUATION BY LAND. . 360Motor Ambulances . . . . . . . . . . . . . . . . . . . . . 3 6 0Hospital Trains. . . . . . . . . . . . . . . . . . . . . . 3 6 9Problems in Manning Hospital Trains . . . . . . . . . . . . . 388Supplies and Equipment for Hospital Trains. . . . . . . . . . . 391

XXIII. PROVIDING THE MEANS FOR EVACUATION BY SEA. . . 394Ships' Hospitals and Hospital Ships . . . . . . . . . . . . . . 394Medical Attendants for Service on Transports. . . . . . . . . . . 414Hospital Ship Complements . . . . . . . . . . . . . . . . . 4 1 9Problems in Providing Supplies and Equipment for Hospital Ships and

Transports . . . . . . . . . . . . . . . . . . . . . . . 4 2 2

XXIV. PROVIDING THE MEANS FOR EVACUATION BY AIR. . . 426Aircraft . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 6Medical Flight Attendants . . . . . . . . . . . . . . . . . . 4 3 7Efforts To Supply Appropriate Equipment for Air Evacuation. . . . . 441

XXV. EVACUATION UNITS FOR THEATERS OF OPERATIONS. 447Organization, Personnel, and E q u i p m e n t . . . . . . . . . . . . . 447Activation, Training, and Use in the United States. . . . . . . . . 457

SUMMARY A N D CONCLUSIONS . . . . . . . . . . . . . 4 6 3LIST O F ABBREVIATIONS . . . . . . . . . . . . . . . . 4 7 1BIBLIOGRAPHICAL NOTE . . . . . . . . . . . . . . . . 4 7 7INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . 4 8 5

TablesNo. Page

1. Comparison of the War Department's Plan and The Surgeon General'sRecommendation for Fixed Beds for Theaters of Operations . . . . . 40

2. Army Hospitals Established in Converted Civilian Buildings by End of1943. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3

3. Building Schedule for Type-A Hospital, General Hospital Plan. . . . . . 774. Positions and Ranks in Zone of Interior Hospitals Permitted but not

Required To Be Filled by Medical Administrative Corps Officers,9 April 1941 . . . . . . . . . . . . . . . . . . . . . . . . . 1 3 2

5. Hospital Units Shipped Overseas, 7 December 1941 to 1 July 1942 ... 1446. Affiliated General Hospital Units . . . . . . . . . . . . . . . . . 1577 . Affiliated Evacuation Hospital Units . . . . . . . . . . . . . . . . 1 5 88. Use of Nonaffiliated General Hospital Units Activated during 1 9 4 1 . . . 1619. Use of Nonaffiliated Station Hospital Units Activated during 1941 . . . . 162

10. Use of Nonaffiliated Evacuation Hospital Units Activated during 1940a n d 1941 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6 3

11. Use of Nonaffiliated Surgical Hospital Units Activated during 1940 and1941 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6 4

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No. Page

12 . ASF Debarkation Hospitals . . . . . . . . . . . . . . . . . . . . 19313. Hospitalization Data as of 29 June 1945 . . . . . . . . . . . . . . . 21114. Evacuation Policies and Authorized Bed Ratios, Major Theaters of

Operations . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 515. U. S. Army General Hospitals in the United States during World War II. 304-1316. Patients Debarked in the United States, 1920-45 . . . . . . . . . . . 32417 . Hospital Car Procurement Program, 1940-45 . . . . . . . . . . . 37418. United States Army Hospital Ships in World War II . . . . . . . . . 406

ChartsNo. 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 . . . . . 273. Organization of Lawson General Hospital, 1941 . . . . . . . . . . . 294. The Surgeon General's Estimates in 1941-42 of Bed Requirements in

General Hospitals in Continental United States and Actual BedsReported January 1942-July 1944 . . . . . . . . . . . . . . . . 8 5

5. Status of Station and General Hospital Beds in Continental United States:December 1941-June 1943 . . . . . . . . . . . . . . . . . . . 1 0 2

6. Organization of Baxter General Hospital Compared With Standard Planfor SOS Post Organization, 1942-43 . . . . . . . . . . . . . . . 125

7. Organization of the SGO for Hospitalization and Evacuation, 1943-45 . 1798. Hospital Beds Authorized and Occupied by Type of Hospital in Con-

tinental United States: 1943 and 1944 . . . . . . . . . . . . . . 2049. Hospital Beds Authorized and Occupied, and Patients Reported in all

Hospitals in the Continental United States: June 1944-December 1946. 21210. Hospital Beds Authorized and Occupied, and Patients Reported by

Convalescent, Regional, General, and Station Hospitals in ContinentalUnited States: June 1944-December 1946. . . . . . . . . . . . . 2 1 3

11. Fixed Hospital Bed Capacity and Occupancy in Overseas Theaters:March 1943-December 1945 . . . . . . . . . . . . . . . . . 220, 2 2 1

12. Organization of Mayo General Hospital, 1944. . . . . . . . . . . . 26913. Comparison of Standard Plans for Organization of ASF Posts and ASF

General Hospitals, 1945 . . . . . . . . . . . . . . . . . . . . 2 7 214. Standard Plan for Organization of ASF Convalescent Hospitals, 1945. . 27415. Organization of Percy Jones Hospital Center, 1945. . . . . . . . . . 27616. Standard Plan for Organization of a Hospital Center (ZI), 1945 . ... 277

xxii

IllustrationsPage

Plan f o r Cantonment-type Hospital . . . . . . . . . . . . . . . . . . 1 6Lawson General, a Cantonment-type Hospital . . . . . . . . . . . . . 1 7Valley Forge General, a Semipermanent-type Hospital . . . . . . . . . . 24Plan f o r Theater-of-Operations-Type Hospital. . . . . . . . . . . . . . 7 1Oliver General Hospital . . . . . . . . . . . . . . . . . . . . . . . 7 2Plan f o r Type A Hospital . . . . . . . . . . . . . . . . . . . . . . 7 4Birmingham General, a Type A Hospital. . . . . . . . . . . . . . . . 75McGuire General, a VA-Type Hospital . . . . . . . . . . . . . . . . 7 9Location of General, Convalescent, and Regional Hospitals During World

W a r I I . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9Placing the Fourth Litter Patient in a Field Ambulance . . . . . . . . . 362Field and Metropolitan Ambulances Used in 1942. . . . . . . . . . . . 363Motor Ambulances . . . . . . . . . . . . . . . . . . . . . . . . . 3 6 4Exterior View of Multipatient Metropolitan Ambulance, 1945. . . . . . . 368Interior o f the Multipatient Metropolitan Ambulance . . . . . . . . . . 369Stationary Beds in Hospital Ward Car, 1941 . . . . . . . . . . . . . . 372Dressing Room in Hospital Ward Dressing Car, 1942 . . . . . . . . . . 375Plans fo r Hospital Cars, 1941-42 . . . . . . . . . . . . . . . . . . . 376Plans for Rail Ambulance Car and New Hospital Unit Car . . . . . . . . 384Ward in New Hospital Unit Car, 1944. . . . . . . . . . . . . . . . . 386Receiving Room in New Hospital Unit Car, 1944 . . . . . . . . . . . . 387Surgical Ward on USAHS Shamrock . . . . . . . . . . . . . . . . . . 408Surgical Ward on USAHS Louis A. Milne . . . . . . . . . . . . . . . 409Dressing Station on USAHS Louis A. Milne . . . . . . . . . . . . . . 410T h e USAHS Larkspur . . . . . . . . . . . . . . . . . . . . . . . . 4 1 1C-46 Transport Plane Ready To Unload Patients . . . . . . . . . . . . 429Interior of C-46 Transport Plane . . . . . . . . . . . . . . . . . . . 430Interior of C-54 Transport Plane . . . . . . . . . . . . . . . . . . . . 431Loading a Patient on an L-5 P l a n e . . . . . . . . . . . . . . . . . . 436

All illustrations are from the files of the Department of Defense except those onpp. 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 proclaimeda "limited national emergency" on 8 Sep-tember 1939, just one week after Germanyinvaded Poland, the Medical Departmentof the United States Army was operating7 general hospitals and 119 station hospi-tals. Five of the general hospitals were lo-cated in the United States—Walter Reedat Washington, D. C.; Army and Navy atHot Springs, Ark.; Fitzsimons at Denver,Colo.; Letterman at San Francisco, Calif;and William Beaumont at El Paso, Tex.The other two were in overseas posses-sions—Tripler in the Hawaiian Islandsand Sternberg in the Philippines. Of thestation hospitals 104 were on Army postsin the United States and Alaska, while theremainder were divided among the Philip-pine Islands, the Hawaiian Islands, andthe Panama Canal Zone. Each station hos-pital was designated by the name of thepost on which it was located and eachgeneral hospital, except one, was namedfor a deceased medical officer. Hence, sta-tion and general hospitals in the UnitedStates in both peace and war, as well asthose in overseas possessions in peacetime,were called "named hospitals."

Station hospitals and general hospitalshad different functions. The former servedlocal and ordinary needs, usually receiv-ing patients from stations where locatedand treating those with minor ills and in-juries only. General hospitals, on the otherhand, were designed to serve general andspecial needs. By transfer from station

hospitals they received patients who suf-fered from severe or obscure diseases aswell as those who needed complicatedsurgery.

Capacities of named hospitals depend-ed largely upon troop populations served.Other factors also influenced their capac-ities, such as climate, prevalence of dis-ease, general physical condition of troops,and types of activities in which the latterwere engaged. Hospital capacities andhospital requirements were expressed interms of beds, which in the Army meantnot only beds themselves but also shelter,equipment, utilities, and personnel thatwent with them. For an Army strength of135,749 in the United States and Alaskain June 1939 there were 4,136 generalhospital beds and 8,234 station hospitalbeds. This represented a bed ratio tostrength of approximately 3 percent forgeneral hospitals and 6 percent for stationhospitals. For a strength of 10,993 in thePhilippines there were 317 general hospi-tal beds and 360 station hospital beds. Inthe Hawaiian Islands, the most healthfulof overseas possessions, there were 350general hospital beds and 360 station hos-pital beds for a strength of 20,601. ThePanama Canal Zone, with next to thehighest sick rate in the Army, had only269 station hospital beds for a strength of13,533, a ratio of 1.98 percent. This un-usual situation resulted from the fact thatcivilian Canal Zone hospitals—Gorgas,Colon, and Corozal—staffed with ArmyMedical Corps officers but under the con-trol of the Governor of the Canal Zone,

4 HOSPITALIZATION AND EVACUATION, ZONE OF INTERIOR

cared for a considerable portion of theArmy's patients in that area.1

The Surgeon General believed that theArmy's hospitals were inadequate, evenfor peacetime needs. He had begun a long-range program in 1934 to improve and ex-pand them but funds appropriated byCongress for Medical Department con-struction had been sufficient for little morethan essential maintenance of existingbuildings. As a result, the Army's hospitalsin 1939 were poorly suited to any increasein its strength. In Panama only fifty bedswere located in a hospital building. Theremainder were crowded into buildingserected for other purposes. Hospital plantsin the Hawaiian and Philippine Islandsneeded repairs and alterations. In theUnited States hospital buildings weresmall and widely scattered among a num-ber of permanent Army posts. Erectedtwenty-five to thirty years before, manylacked facilities for the separation of pa-tients according to grade, sex, and disease,and for such modern diagnostic and treat-ment procedures as basal metabolism,X-ray, and oxygen and physical therapy.Of the entire number, The Surgeon Gen-eral considered only twenty-five as mod-ern, fire-resistant buildings and only fiftyof the remainder as worth modernization.The others, he believed, should be re-placed with new buildings.2

For the care of patients in theaters ofoperations in wartime the Medical De-partment had a doctrine of hospitalizationand evacuation that dated from the CivilWar and had been successfully appliedduring both the Spanish-American Warand World War I. Casualties were givenemergency treatment at a series of medicalstations established in the forward areas ofcombat zones. To provide such treatmentas well as the transportation of patients,when necessary, from one station to

another farther to the rear, every regimentand separate battalion of all arms andservices, except medical, had a medicaldetachment, and every division had amedical regiment, medical battalion, ormedical squadron. To furnish as near thefront as possible a higher type of treatmentthan first aid or emergency medical care,hospitals designed for easy movement andhence called "mobile hospitals" were as-signed to field armies. They were of threetypes: surgical hospitals, evacuation hospi-tals, and convalescent hospitals. Surgicalhospitals were planned for use in either di-vision or army areas of combat zones. Indivision areas they were to carry outemergency procedures, such as treatmentof shock, control of stubborn hemorrhage,reconstitution of blood following hemor-rhage, and fixation of complex fractures,in order to prepare men with serious in-juries for further removal to the rear. Inarmy areas they performed much thesame function as evacuation hospitals.Evacuation hospitals normally served onlyin the rear areas of combat zones. Theyprovided definitive treatment for evacueesfrom forward areas and for the sick and

1 Annual Report of The Surgeon General, U.S. Army,1939 (Washington, 1940), pp. 170, 250; 1940 (Wash-ington, 1941), p. 1 (cited hereafter as Annual Report. . . Surgeon General). Only Puerto Rico, with a meanannual strength of 1,312, had a slightly higher admis-sion rate than Panama. Puerto Rico had no Armyhospital 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 onAppropriations, House of Representatives, 76th Cong, 1stsession [H. R. 6791] Supplemental Military AppropriationBill 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 HouseCmtee on Mil Approps (1939). HD: 321.6-1. (4) Pre-liminary Estimates, QMC, FY 1941 (25 May 39). Offfile, Hosp Cons Div, SGO. (5) An Rpts, CA Surgs.SG: 319.1-2. (6) C. M. Walson, "Observations atArmy Hospitals," Army Medical Bulletin, No. 42(1937), pp. 65-72.

INTRODUCTION 5

injured of surrounding areas. They re-turned some patients to duty after shortperiods of treatment, transferred otherswith prospect of early recovery to conva-lescent hospitals, and prepared still othersfor transportation to general hospitals forcontinuation of treatment. Convalescenthospitals were not staffed and equipped toperform major surgery. Their chief func-tion was to restore to physical fitness pa-tients received from evacuation hospitals,to treat cases of venereal disease, and tocare for patients from units located near by.

For service in communications zonesthere were station and general hospitals.The latter received patients not only fromstation hospitals but mainly from evacua-tion and surgical hospitals. They returnedsome to duty in theaters of operations andtransferred others for further treatment togeneral hospitals in the zone of interior.Since it was expected that hospitals incommunications zones would rarely needto be moved, station and general hospitalswere called "fixed hospitals." When sev-eral were grouped in one location theymight be combined into a hospital centerwith a 1,000-bed convalescent camp. Allhospitals in theaters of operations, whetherfixed or mobile, were designated by num-bers rather than by names and locations,and hence were called "numbered hos-pitals."3

Unlike named hospitals in the UnitedStates, numbered hospitals had standardcapacities, staffs, and equipment that wereestablished by tables of organization,tables of basic allowances, and equipmentlists. Tables of organization for hospitalsshowed the capacities of installationswhich different units were designed tooperate. While tables of basic allowanceslisted equipment authorized for units andtheir members, they did not itemize sucharticles as drugs and biologicals, surgical

gauzes, surgical instruments, dental sup-plies and equipment, laboratory suppliesand equipment, X-ray supplies and equip-ment, and operating-room equipment.These were included under one heading asan "assemblage." Items for hospital as-semblages were listed individually and byamounts in Medical Department equip-ment lists.

For use in theaters of operations in June1939 the Medical Department had littlemore than doctrine. Only five MedicalDepartment field units were in existence—four medical regiments (two of which wereoverseas) and one medical squadron. Ac-cording to The Surgeon General, failureto have other units in training resultedfrom a shortage of Medical Departmentenlisted men. Congress limited their num-ber to 5 percent of the strength of theArmy, and use of more than 4 percent innamed hospitals and other peacetime in-stallations left few for field units. Early in1939 The Surgeon General had sought anincrease in the Medical Department'sallowance of enlisted men, but withoutsuccess.4

To provide officers for wartime hospi-tals—physicians, dentists, and nurses—The Surgeon General had proposed inMarch 1939 the revival of "affiliatedunits." These were reserve units sponsoredby civilian hospitals and medical schools.Such units had been organized by theAmerican Red Cross during World War Iand had contributed substantially toArmy hospital service in France. "I amconvinced," wrote Surgeon GeneralCharles R. Reynolds, "that the MedicalDepartment can have reserve hospital

3 AR 40-580, MD, Hosps—Gen Provisions, 29Jun 29.

4 (1) Cmtee to Study the MD, 1942, Testimony ofCol Albert G. Love, p. 2. HD. (2) Annual Report . . .Surgeon General, 1939 (1940), pp. 179-82.


units ready to function as required . . .only by civil institutions sponsoring theseunits, especially those needed within theearly periods of mobilization. . . ."5 InAugust 1939 the Secretary of War ap-proved in principle The Surgeon Gen-eral's plan to organize affiliated units tostaff 32 general, 17 evacuation, and 13surgical hospitals. Full approval was givenseveral months later.6

The only reserve equipment which theMedical Department had on hand wasthat stored after World War I. It was "of1918 vintage, incomplete in modern oper-ating-room equipment, wholly deficient inessential laboratory equipment, totallylacking in X-ray, physical therapy andhydrotherapy equipment, and stockedwith scientific items now obsolete andrapidly becoming obsolescent."7 More-over, with few exceptions, tables of or-ganization and tables of basic allowancesfor field medical units, including hospitals,had not been changed since 1929, and thepreparation of new equipment lists forthem had just been begun in January1939.8 To prepare for war the Medical De-partment had to start almost from scratch.

Effect of the War in Europe

The period of the emergency in theUnited States was for the Medical De-partment a time of partial preparation forwar through the provision of the hospitali-zation actually required for an expandingArmy. Its steps in this direction weresometimes painful and often halting. Sev-eral factors accounted for this. Formalmobilization planning of the Medical De-partment, like that of the rest of the Army,was based upon a belief that the antici-pated force of 1,000,000 to 1,200,000 menwould be called up only if the United

States or its possessions were attacked. Itwas therefore essentially defensive in na-ture. Moreover, there was uncertaintyabout the nature of increases of theArmy—whether rises in the authorizedstrength of the Regular Army were tem-porary or permanent and whether or notthe mobilization that finally occurred wasfor a year of training only, as it purportedto be. Furthermore, funds which the Gen-eral Staff could secure for the entire Army,let alone the Medical Department, werelimited by the caution of the Presidentand the sentiment of Congress. Finally,The Surgeon General and his associates,like many others in the Army and theGovernment at large, found it difficult tobreak peacetime habits of thought andaction in order to plan imaginatively for asecond World War.9

5 (1) Ltr, SG to TAG, 17 Mar 39, sub: Affiliation ofMD Units with Civ Insts. HD: 326.01-1 (AffiliatedUnits). (2) The Medical Department of the United StatesArmy in the World War (Washington, 1923), vol. I,p. 102 (cited hereafter as The Medical Department . . .in the World War).

6 (1) Cmtee to Study the MD, 1942, Testimony, pp.8-10. HD. (2) Annual Report . . . Surgeon General, 1940(1941). pp. 177-78. (3) For a full discussion of the re-vival of affiliated units see John H. McMinn and MaxLevin, Personnel (manuscript for a companion vol-ume in this series). HD.

7 Ltr, SG to TAG, 6 Apr 40, sub: Status of MD forWar. AG: 381 (4-6-40) (1).

8 (1) Tables of organization and tables of basicallowances that were available in June 1939 are onfile in HD. (2) Incl 2, Ltr, Brig Gen Harry D. Offuttto 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 andPreparations (Washington, 1950), pp. 15-56, 126-71,in UNITED STATES ARMY IN WORLD WARII, discusses plans and preparations of the GeneralStaff, along with limiting factors and influences, inconsiderable detail. Robert E. Sherwood, Roosevelt andHopkins: An Intimate History (New York, 1950), pp.157-62, discusses the difficulty Government Depart-ments displayed in adjusting to planning for a globalwar.

INTRODUCTION 7

The war in Europe had almost immedi-ate effects upon the Army and the MedicalDepartment. In September 1939 the au-thorized enlisted strength of the RegularArmy was increased from 210,000 to227,000. The next spring, as the Nazi warmachine rolled toward the English Chan-nel, it was again raised—to 280,000 inMay and to 375,000 in June. Then, in thelatter part of 1940, after the fall of France,Congress approved a peacetime mobiliza-tion. From September of that year untilDecember 1941, the Army's strength grewfrom 438,254 officers and enlisted men to1,686,403. The Medical Department hadto expand its operations accordingly. Thisinvolved mainly building up facilities inthe United States, where 85 to 90 percentof the troops were stationed, but hospitalsin overseas possessions also had to be ex-panded and additional ones provided fornew Atlantic defense bases. While a regu-lar system of field hospitalization andevacuation was as yet unnecessary, medi-cal units had to be organized and preparedfor such service.10

The expansion of hospital facilities inthe United States involved many consider-ations. Decisions had to be made as to thetypes of housing to be used and the num-ber of beds that would be needed. Meanshad to be found for providing suitable hos-pital plants in as short a time as possible.New hospitals had to be manned and the

staffs of old ones augmented. "Green" offi-cers had to organize hospitals and establishprocedures for their administration. Sup-plies and equipment had to be placed inhospital plants at appropriate times.Finally, it was necessary to develop proce-dures for the operation of the greatlyexpanded hospital system.

The preparation of hospital units forfield service sometimes conflicted withthese activities, for such units also de-manded personnel and equipment. Theamount they should be given while intraining was a moot question. The numberof such units to be activated had to be de-termined. After they were organized theyneeded to be trained. Before most of thesesteps could be taken, tables and lists gov-erning their organization, manning, andequipment had to be revised and modern-ized.

The challenge of an expanding RegularArmy and a peacetime mobilizationaffected only slightly the organizationalstructure of the Army for hospitalization.Yet this structure and its changes must beunderstood before the actions of variousagencies in providing hospitalization arediscussed.

10 Biennial Report of the Chief of Staff of the UnitedStates Army, July 1, 1939 to June 30, 1941, to the Secretaryof War (Washington, 1941) (cited hereafter as BiennialReport . . . Chief of Staff, 1939-41). Figures on strengthof the Army were supplied by the Strength Account-ing Branch, AGO.

CHAPTER I

Organization andResponsibilities

for HospitalizationHospitalization, like other activities of

the Medical Department, was plannedand supervised by medical officers calledsurgeons. The commander of every non-medical military organization, from head-quarters of the Army in Washington (WarDepartment) to battalions in the field, hadon his staff a surgeon whose duties wereboth advisory and administrative. As astaff officer he advised on matters affectingthe health of all members of a commandand exercised technical control (that is,professional and medical as opposed toadministrative and military) over all med-ical activities under the jurisdiction of hiscommander. As an administrative officerhe also exercised command control overhis own office and in some instances overcertain medical units and organizationssuch as hospitals.1

The Surgeon General's Positionin the War Department

The chief medical officer of the Armywas The Surgeon General.2 He served asmedical adviser to the Chief of Staff and

was directly responsible to him for theplanning and technical supervision of allArmy hospitals. In his capacity as head ofa service he commanded, beside the per-sonnel in his own Office, medical "fieldinstallations" of the War Department. Likethe chiefs of other arms and services, suchas the Chief of Infantry, the Chief of theAir Corps, and The Quartermaster Gen-eral, The Surgeon General was subject tosupervision by the War Department Gen-eral Staff.

The General Staff, while it had noauthority to command, in actual practicedid so, issuing directives and orders andapproving or disapproving recommenda-tions of The Surgeon General. In such in-stances it acted in the name of the Chief ofStaff or the Secretary of War. The Staffhad five divisions, each of which repre-

1 (1) AR 40-10, MD, The MC—Gen Provisions,6 Jun 24. (2) Blanche B. Armfield, Organization andAdministration (manuscript for a companion volumein this series), has a full discussion of the organizationof the Medical Department.

2 The War Department capitalized the definitearticle in the formal designations of certain generalofficers, presumably to distinguish them from otherswith similar titles.

ORGANIZATION AND RESPONSIBILITIES FOR HOSPITALIZATION 9

sented a functional grouping of duties ofthe Chief of Staff. They were the Person-nel (G-1), Military Intelligence (G-2),Organization and Training (G-3), Supply(G-4), and War Plans (WPD) Divisions.The Supply Division was charged byArmy regulations with the preparation ofplans and policies for hospitalization andevacuation and the supervision of suchactivities. In peacetime it limited itself inthis field primarily to matters of construc-tion and supply. The Personnel Divisionhandled matters pertaining to personnelthat were Army-wide in scope; the Organ-ization and Training Division, those relat-ing to the organization, training, and useof field units. Direct communication be-tween divisions of the General Staff andany chief of service (such as The SurgeonGeneral) was authorized by Army regula-tions, but formal requests and decisionswere normally channeled through theOffice of The Adjutant General, the WarDepartment's office of record.3

In the latter part of 1940, after mobiliza-tion began, medical officers were assignedto several War Department agencies hav-ing a direct interest in hospitalization andevacuation. In October 1940 Brig. Gen.(later Maj. Gen.) Howard McC. Snyderwas assigned to the Office of The InspectorGeneral and remained in that positionuntil the end of the war. Shortly afterwarda medical officer was transferred from theSurgeon General's Office to GeneralHeadquarters (GHQ), an organizationestablished in July 1940 to supervise thetraining of field forces, including medicalunits. About the same time Lt. Col. (laterBrig. Gen.) Frederick A. Blesse was placedin the G-4 division of the General Staff.During 1941 he was transferred to GHQand was succeeded in G-4 by Maj. (laterCol.) William L. Wilson.4

The Surgeon General's Office

When President Roosevelt proclaimedthe emergency, The Surgeon General wasMaj. Gen. James C. Magee. He had suc-ceeded Maj. Gen. Charles R. Reynoldsthe preceding June. Most divisions of hisOffice had something to do with hospitali-zation and evacuation. Particularly con-cerned was the Planning and TrainingDivision, headed by Col. (later Brig. Gen.)Albert G. Love. It had three subdivisions:Planning, Training, and Hospital Con-struction and Repair. The last of theseoperated almost independently, its chief,Lt. Col. (later Col.) John R. Hall, havingdirect access to General Magee.5 This sub-division handled all of The Surgeon Gen-eral's construction problems, estimatingbed requirements and planning hospitals.In this work it collaborated with the WarDepartment's constructing agencies—theQuartermaster Corps and the Corps ofEngineers. This subdivision grew from 2officers, 3 civilian architects, and 4 clerksin September 1940 to 4 officers, 4 archi-tects, and 7 clerks by the end of 1941.6 Theremainder of the Planning and TrainingDivision dealt with medical field units. It

3 (1) Mark S. Watson, Chief of Staff: Prewar Plansand Preparations (Washington, 1950), pp. 57-84, inUNITED STATES ARMY IN WORLD WAR II,has an excellent discussion of the origin and powers ofthe General Staff. (2) AR 10-15, Gen Staff, Orgn andGen Duties, 18 Aug 36. (3) FM 101-5, Staff Officers'Field Manual, 19 Aug 40.

4 (1) Armfield, op. cit. (2) Kent R. Greenfield, Rob-ert R. Palmer and Bell I. Wiley, The Organization ofGround Combat Troops (Washington, 1947), pp. 1-32,in UNITED STATES ARMY IN WORLD WARII, have a discussion of the development of GHQ.

5 Interv, MD Historian with Col Love, 27 Aug 47.HD: 000.71.

6 Achilles L. Tynes, Data for Preparation of Histori-cal Record of Construction Branch of The SurgeonGeneral's Office during the Expansion Period of theArmy and World War II (1945) (cited hereafter asTynes, Construction Branch). HD.


estimated the number that would be re-quired and prepared or revised their tablesof organization and equipment. UntilGHQ was established in July 1940, thisDivision also supervised the training anduse in the United States of hospital andother medical units. The Finance andSupply Division furnished hospitals withsupplies and equipment and allotted themfunds for the employment of civilians. TheMilitary Personnel, Dental, Veterinary,and Nursing Divisions handled militarypersonnel and certain professional matters.The Professional Service Division estab-lished policies for medical care and treat-ment and issued technical directives tomaintain professional standards.7

In recognition of the growing impor-tance of problems of hospitalization duringmobilization, a Hospitalization Subdivi-sion was set up in the Professional ServiceDivision in February 1941. Two monthslater it was separated and became theHospitalization Division. Lt. Col. (laterCol.) Harry D. Offutt was made its chiefand continued in that capacity throughoutGeneral Magee's administration. Estab-lished with one officer and one clerk, thisdivision expanded to three officers andthree clerks by the end of June 1941. Al-though it was charged with the develop-ment of plans and policies for hospitaliza-tion and evacuation through liaison withother divisions of the Surgeon General'sOffice, it had neither the authority nor thestaff to make comprehensive plans and co-ordinate the actions of others in makingsuch plans effective.8

The Surgeon General's ControlOver Hospitals and Hospital Units

While all hospitals were under the tech-nical supervision of The Surgeon General,

not all were subject to the same control byhis Office. The degree varied according tothe command structure of the War De-partment. For administrative purposes theUnited States was divided into nine corpsareas, each in charge of a corps area com-mander under the jurisdiction of the Chiefof Staff. Overseas possessions were organ-ized into three departments that corre-sponded administratively to corps areas inthe United States. All stations in depart-ments and most in corps areas were underthe command-control of department andcorps area commanders respectively. Lo-cated within corps areas but beyond thejurisdiction of their commanders werefield installations of the War Department.They operated directly under the chiefs ofvarious arms and services in Washingtonand were therefore called "exempted sta-tions."

Hospitals classified as War Departmentfield installations were subject to the great-est amount of control by The SurgeonGeneral because they were under his com-mand. All general hospitals in the UnitedStates were in this category. In only oneinstance was an intermediate commanderbetween The Surgeon General and a gen-eral hospital commander. Walter ReedGeneral Hospital was under the jurisdic-tion of the commandant of the Army Med-ical Center (Washington, D. C.), who wasin turn under the command of The Sur-

7 Armfield, op. cit.8 SG OOs 32, 13 Feb 41; 87, 18 Apr 41. In an inter-

view on 15 November 1949 Brig Gen H. D. Offuttstated that he never felt handicapped by a lack of per-sonnel in his division. HD: 000.71. In an interview on10 November 1950 Maj Gen James C. Magee (Ret)stated that no one division could have exercisedauthority over all factors involved in hospitalizationand that vesting such authority in one division wouldhave subordinated other divisions of the SurgeonGeneral's Office to a sort of overlordship. HD: 314(Correspondence on MS) III.

ORGANIZATION AND RESPONSIBILITIES FOR HOSPITALIZATION 11

geon General. Despite this intermediatestep, Walter Reed actually received closersupervision from the Surgeon General'sOffice than did other general hospitals,largely because of its proximity. Next inline in degree of control were hospitals ofexempted stations of all other services andof all arms except the Air Corps. For ex-ample Fort Benning (Georgia), includingits station hospital, was under the Chief ofInfantry and Fort Belvoir (Virginia) wasunder the Chief of Engineers. The chiefs ofarms and services normally had no sur-geons on their staffs and were thereforeprone to refer problems connected withhospitalization to The Surgeon General.He employed corps area surgeons as hisown field representatives to supervise hos-pitals of exempted stations. Corps areahospitals, under the command-control ofcorps area commanders, were supervisedby corps area surgeons in their dual capac-ities as local staff officers and technicalrepresentatives of The Surgeon General.Hospitals furthest removed from the lat-ter's influence were those in overseas de-partments, not only because of their dis-tance from Washington but also becausedepartment surgeons did not serve as fieldrepresentatives of The Surgeon General.9

Although hospitals of the Air Corpswere theoretically in the same class asthose of exempted stations of other armsand services, they were actually in a some-what different category. The Chief of theAir Corps had in his Office a MedicalDivision, whose head was analogous to astaff surgeon and therefore assumed con-siderable authority over Air Corps stationhospitals. During 1940 and 1941, as theAir Corps expanded, the number of suchhospitals increased. Soon after a reorgani-zation of the air forces in June 1941, whichestablished the Army Air Forces and gave

it control over the Air Corps, the Secretaryof War directed a blanket exemption of allAir Corps stations—new as well as old—from corps area control. The followingOctober the head of the Air Corps Medi-cal Division, Col. (later Maj. Gen.) DavidN. W. Grant, was assigned to AAF head-quarters and designated "Air Surgeon."This series of events tended to separate AirCorps hospitals from other Army hospitalsand to place them more under control ofAAF headquarters at the expense of theSurgeon General's Office.10

A shift of responsibility which affectedThe Surgeon General's control over medi-cal units, including those for numberedhospitals, had meanwhile occurred. Untillate 1940 certain corps area commandersand surgeons acted also as commandersand surgeons of the four field armies in theUnited States. Corps area surgeons weretherefore responsible, under their com-manders and The Surgeon General, forsupervising the training of field medicalunits. In October 1940, the command offield armies was taken away from corpsarea commanders and placed in the handsof separate army commanders responsibleto GHQ in Washington. GHQ and armyheadquarters were charged with the train-ing and use on maneuvers of all field units.Actually, this transfer of training functionswas not so complete as anticipated,11 eventhough in November 1940 all table-of-

9 (1) AR 170-10, CAs and Depts, Admin, 10 Oct39. (2) AR 350-105, Mil Educ, Gen and Spec ServSchs—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, 12Sep 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, AAFMedical Services in the Zone of Interior (1948), pp.45-76. HD.

11 See below, pp. 43-48.


organization units in the United States,including those of the Medical Depart-ment, were either assigned or attached toarmies or corps.12

In the changes just enumerated wereseeds that were eventually to grow intobitter weeds for The Surgeon General.Among them were the trend of the ArmyAir Forces toward separatism and its de-velopment of a separate set of hospitals,the establishment of medical officers inheadquarters on a higher level of author-ity than The Surgeon General, and the

latter's partial loss of authority over medi-cal field units. Understanding somethingof these changes and of responsibilities andrelationships of various War Departmentagencies, one may now turn to a consider-ation of the manner in which the Armyprovided hospitalization during the emer-gency period.

12 (1) Greenfield et al., op. cit., pp. 3-4, 6-9. (2)Armfield, op. cit. (3) Ltr, TAG to 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 ExpandingHospitals in the United States

Hospital Construction

Early Basic Decisions

Any large-scale expansion of "hospitalfacilities"—that is, wards, offices, andclinics normally found in civilian hospi-tals, plus housing for commissioned andenlisted personnel, storage for medicaland military supplies and equipment, andadministrative space for nonmedical mili-tary activities—demanded a simplemethod of estimating requirements andauthorizing beds. Such expansion also de-manded that additional housing be pro-vided as rapidly and inexpensively aspossible.

The method prescribed by mobilizationregulations for estimating bed require-ments was one that Colonel Love had de-vised from World War I experience. Itinvolved computation of the number ofbeds needed for successive 15-day periodsof mobilization on the basis of averagedaily admission rates, the rate of accumu-lation of patients in hospitals by 15-dayperiods, and increases and decreases introop strengths during these periods.When hospitals were expanded for the Sep-tember 1939 increase in the Army, thismethod proved too complicated for gen-

eral use and The Surgeon General in-cluded in his Protective Mobilization Planof December 1939 a simpler one, also de-vised by Colonel Love—the multiplicationof troop strength by a predetermined per-centage of beds. In August 1940 G-4adopted the latter, and its simplicity madeits ready acceptance by all agencies of theWar Department a foregone conclusion.1

Opinion differed on the proper percent-age to use in estimating and authorizingstation hospital beds. The Surgeon Gen-eral used 4 percent in calculating require-ments in the fall of 1939, and G-4 beganto use this figure in planning for mobiliza-tion in August 1940. Experience of theprevious winter made some surgeons be-lieve it provided insufficient beds for"green troops,"2 and on 6 September1940 General Magee asked the GeneralStaff to consider 5 percent as the probable

1 (1) Albert G. Love, "War Casualties," Army Med-ical Bulletin, No. 24 (1931), pp. 18, 37, 38, 68. (2) MR4-3, 2 Apr 34; MR 4-2, 13 Feb 40; and SG PMP,1939, Annex No 29. (3) Ltr AG 600.12 (8-6-40) M-D-M, TAG to C of Arms and Servs, CGs of CAs, andCOs of Exempted Stas, 7 Aug 40, sub: Supp No 2 toWD Cons Policy. SG: 600.12-1.

2 (1) Synopsis Ltr, Surg 4th CA to Surg Ft McClel-lan. 13 Aug 40, sub: Expansion of Hosp Fac, and 8inds. SG: 632.-1 (Ft McClellan) N. (2) Ltr, Surg 7thCA to SG, 10 Sep 40, sub: Hosp . . . NG. SG: 632.-1(7th CA) AA.


requirement for station hospital beds.3

G-4's Construction Branch verbally ap-proved this ratio, but the Assistant Chiefof Staff, G-4, Brig. Gen. Richard C.Moore, later reversed this action, author-izing station hospital beds for only 4 per-cent of the strength served but permittingprovisions for expansion to 5 percent ifnecessary.4 This meant in the case of newhospitals that wards would be constructedwith space for beds for 4 percent of a com-mand but that utilities, administrativebuildings, and clinical facilities would beconstructed to serve a hospital with bedsfor 5 percent. Thus additional wards couldbe erected later without overloading the"chassis" of a hospital. The ratio of bedsin general hospitals to the total strength ofthe Army—1 percent—received officialsanction at the same time. General Mageedid not protest the decision as to stationhospitals but observed a policy during thefollowing year of supporting local requestsor initiating action for increases in bedratios in specific instances.5

The manner of providing additionalhousing was a subject on which TheSurgeon General and the General Staffeventually came to marked disagreement.Based on a belief that unnecessary con-struction should be avoided and a fearthat sudden attack would require mobi-lization before requisite construction couldbe completed, War Department policy in1939 was to use existing housing to themaximum extent possible.6 Mobilizationregulations therefore called for the use ofexisting Army hospitals, with emergencyexpansions, for the initial beds required.To house additional beds other buildingswould be used in the following order: (1)Federal hospitals, (2) civilian hospitals,(3) vacated Army posts, and (4) publicand private buildings such as schools andhotels. Finally, as a last resort, new station

and general hospitals would be con-structed.7

For all new buildings the War Depart-ment planned to use one-story frame con-struction, called "cantonment-type." Itrequired The Quartermaster General tokeep on file standard plans for such build-ings.8 Those for hospitals had been pre-pared in 1935 in collaboration with TheSurgeon General's Hospital Constructionand Repair Subdivision. They consisted offorty-nine drawings: forty-five for admin-istrative offices, clinics, wards, messes,quarters for personnel, and service build-ings, and four for twenty different com-binations of these buildings to make hospi-tals ranging in size from 25 to 2,000 beds.Most of the buildings were of a standardsize. To reduce the danger of fire, all wereseparated by a minimum of fifty feet. Foreach group of not more than five, thisspace was increased to 100 feet. Each hos-pital therefore covered a large area, a 500-bed installation spreading over twentyacres. Advantages of this hospital were itsrelatively low cost, the rapidity with whichit could be erected, and the small number

3 Ltr, SG (Magee) to TAG, 6 Sep 40, sub: MD inMob. 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-4WDGS 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 Dec40, sub: Cons Sta Hosp, and 4 inds. SG: 632.-1 (FtJackson) N. (2) 5th ind, Surg Ft Sill to CG 8th CA, 12Mar 41, on cy Ltr, CG Ft Sill to TAG, 10 Dec 40,sub: Add Hosp. Ft Sill. SG: 632.-1 (Ft Sill) N. (3) LtrSG 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, speechby Lt Col Harry L. Twaddle, GSC, Chief Mob BrG-3 Div WDGS, 30 Sep 39. G-3 Course No 13 and13A, AWC, 1939-40.

7 MR 4-3. 2 Apr 34; MR 4-3, G-1, 31 Dec 34; andMR 4-2, 13 Feb 40.

8 MR 4-1, Sup; Cons; Trans, 5 Jan 40.

PLANNING AND EXPANDING HOSPITALS 15

of highly skilled workmen needed to con-struct it. Its most obvious disadvantageswere the danger of fire and the adminis-trative difficulties caused by the wide areacovered.9

The hospital construction policy enun-ciated in mobilization regulations was notmade the official guide for the provisionof hospitals for Regular Army expansionsin 1939 and 1940, but certain aspects ofit were followed. Thus, although appar-ently no attempt was made to use non-Army buildings, existing Army hospitalswere expanded and new construction wasauthorized only at stations not served bysuch. For example, essential units of a350-bed cantonment-type hospital—amess hall, a clinical building, and severalwards—were constructed at Camp Jack-son (South Carolina), a National Guardencampment. Regular Army posts whichalready possessed hospitals, such as FortMcClellan (Alabama) and Fort Benning(Georgia), expanded them by convertinghospital porches, barracks, and otheravailable buildings into hospital wards.10

In such instances results were unsatisfac-tory. At Fort Benning, for example, thesurgeon had to enlarge a 230-bed hospi-tal, built for a garrison of 4,000, to servea strength of 19,000 in January 1940. Hedid this by adding 334 beds in porches,barracks, and a portable wooden building.The operating rooms, clinics, laboratory,and mess halls of the permanent hospitalwere then too small for the greater bedcapacity. Thus there was created, he ex-plained, "a relative giant with inadequateheart and internal viscera." 11

Despite this experience, in the spring of1940 G-4 planned to establish the practiceof expanding existing hospitals as officialpolicy for subsequent increases in the Reg-ular Army. Both The Surgeon Generaland The Quartermaster General opposed

this move. Among the many objectionsthey raised, probably the most importantfrom the medical viewpoint was the onejust noted—limits upon expansion of bedcapacity imposed by the size of operatingrooms and clinical facilities. Of equal im-portance, from the construction viewpoint,was the unsuitability of many barracks forhospital use because of their location orstructural characteristics. Moreover, itwas improbable that their conversion andeventual reconversion would be cheaperin the long run than the erection of can-tonment-type hospitals. On 24 May 1940,therefore, Colonel Love, Acting The Sur-geon General, recommended that all ad-ditional beds should be housed in newcantonment-type hospitals. G-4 disap-proved this recommendation, perhaps be-cause of shortages of funds and uncer-tainty about the nature of increases in theRegular Army, and on 7 June 1940 issuedan official "Policy for Hospitalizationduring the Emergency." It authorizedcantonment-type hospitals for new stationsbut required the expansion of existinghospitals on all Regular Army posts.12

9 (1) Floyd Kramer, "Mobilization Type Hospi-tals," Army Medical Bulletin, No. 31 (1935), pp. 1-19.(2) Tynes, Construction Branch, HD.

10 See correspondence in SG: 632.-1 (Cp Jack-son) D. 632.-1 (Ft McClellan) N, and 632.-1 (Ft Ben-ning) N.

11 Ltr, Surg Ft Benning to SG, 19 Jan 40, sub: AnRpt of Sta Hosp. SG: 632.-1 (Ft Benning) N.

12 (1) Memo, Exec Off G-4 for Cons Br G-4WDGS. 22 May 40, sub: Hosp. (2) Memo QM 600.1C-C, QMG for ACofS G-4 WDGS, 28 May 40, sub:Util of Bks for Temp Hosp Accommodations. (3)Memo, Act SG for ACofS G-4 WDGS, 24 May 40,sub: Hosp for Increase in the Army above 227,000.(4) Memo, Chief Cons Br G-4 for ACofS G-4 WDGS,3 Jun 40, sub: Util of Bks for Temp Hosp Accommo-dations. (5) Memo, Chief Cons Br G-4 for ACofS G-4WDGS, 5 Jun 40, sub: Hosp for Increases of Army.(6) Ltr AG 705 (6-5-40) M-DM, TAG to CGs of allCAs, COs of Exempted Stas, and CofArms and Servs,7 Jun 40, sub: Policy for Hosp during Emergency. Allin HRS: G-4/31757.


PLAN FOR CANTONMENT-TYPE HOSPITAL

The inapplicability of this policy soonbecame apparent. For example, despite arecommendation by The Surgeon Generalthat a 550-bed cantonment-type hospitalbe constructed for Camp Ord, G-4 di-rected on 6 June 1940 that the camp con-tinue to use an expanded hospital at thePresidio of Monterey. The Surgeon, theQuartermaster, and G-4 of the NinthCorps Area opposed this decision. Theypointed out that the hospital and barracksat Monterey did not have enough totalspace to accommodate all the beds neededand that some cantonment-type construc-tion would be necessary. In addition, boththe barracks and the hospital were old

and in need of repairs, were potential fire-traps, were separated by a public road,and were located six miles from the troopsat Ord. In view of these arguments, theGeneral Staff reversed its decision andauthorized the construction of a canton-ment-type hospital at Camp Ord.13

As plans were made to receive drafteesin the fall of 1940, dissatisfaction with theexisting policy increased and The SurgeonGeneral attempted to get it changed. His

13 (1) Ltr. SG to Surg 9th CA, 6 Jun 40, sub: Hospfor 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.


LAWSON GENERAL, A CANTONMENT-TYPE HOSPITAL

Office supported requests of local sur-geons for exemption from its provisions.14

On 5 September 1940 General Mageeconferred with General Moore and thenext day sent him a personal note. Refer-ring to the impossibility of providing anadequate hospital at Fort Benning underthe established policy, he stated: "Thereis so much dynamite in this that I thinkyou should know about it." 15 Nevertheless,the War Department did not immediatelyrevise the policy, and G-4 permitted fewexceptions to it.16 As a result the situationbecame so serious by mid-September thatthe Chief of Staff asked The InspectorGeneral to investigate the rights and

wrongs of interchanges between G-4 andThe Surgeon General as well as delays indeciding the type of construction to beused.17 Apparently The Inspector Gen-

14 For example, see: Memo, SG for ACofS G-4WDGS, 11 Sep 40, sub: Hosp, Ft McClellan. SG:632.-1 (Ft McClellan) N.

15 Memo, Maj Gen J[ames] C. Magee for Brig GenR[ichard] C. Moore. 6 Sep 40. SG: 632.-1 (Ft Ben-ning) N.

16 (1) Rad AG 600.12 (9-5-40), TAG to CG 9thCA, 10 Sep 40. SG 632.-1 (Ft Lewis) N. (2) Ltr, SurgFt Benning to SG, 21 Aug 40, sub: Cons of MedFac, and 3 inds. SG: 632.-1 (Ft Benning) N. (3) Syn-opsis Ltr, CG Ft Bragg to CG 4th CA, 6 Sep 40, and5 inds. SG: 632.-1 (Ft Bragg) N.

17 Memo, CofSA for IG, 14 Sep 40. HRS: OCS17749-225. The reply to this memorandum has notbeen located in War Department files.


eral's report favored The Surgeon Gen-eral's position, for soon afterward theChief of Staff personally approved Gen-eral Magee's recommendation "that theerection of cantonment hospitals be an-nounced as the normal procedure" for alllarge posts, whether Regular Army ornot.18

The revised policy on hospital construc-tion, issued by the War Department on 26September 1940, discarded the long-established plan to construct additionalbuildings for hospitals as a last resort only.Thereafter peacetime hospitals were to beexpanded only on small posts where clin-ical facilities were generally sufficient foradditional patients. Cantonment-typehospitals were to be constructed else-where.19 Without this change hospitals onRegular Army posts would have consistedof a hodgepodge of small permanent hos-pitals, permanent barracks, and tempo-rary buildings required to supplementthem. Delay in making the revision wasresponsible for much confusion and somedelay in the erection of suitable hospitalbuildings on Regular Army posts,20 butit had no effect on hospitals for new postsbecause cantonment-type constructionhad been authorized for them since June1940.

Planning for Constructionand Selecting Sites of Hospitals

Planning for station hospitals was doneon a day-to-day rather than a long-termbasis, because their size, number, and lo-cation depended almost entirely upon aconstantly changing troop distribution. Inthe fall of 1940 the Surgeon General's Of-fice prepared two studies showing the ad-ditional beds that would be required byJune 1941 at each post in the United

States,21 but lack of information aboutultimate troop distribution and changesin station strengths limited their value. Insome instances three or more increases inauthorized strengths required the samenumber of revisions of hospital construc-tion plans for a single post.22 As informa-tion about stations and their strengths be-came available, the Construction and Re-pair Subdivision prepared plans forhospital construction for each. Consistingof the number of beds needed, the typesand numbers of buildings required, andthe layout or arrangement of buildings,these plans amounted only to recommen-dations. Final decisions on hospital con-struction were made by G-4 for groundforce stations and by the Chief of the AirCorps for air stations. Because of the day-to-day type of planning and the lack ofinformation about action on his recom-mendations, The Surgeon General foundit difficult to keep track of station hospitalsauthorized for construction.23

Planning for general hospitals was on amore comprehensive basis. Although it

18 (1) Memo, SG for ACofS G-4 WDGS, 20 Sep40, and note thereon signed G. C. M[arshall]. (2)D/S, ACofS G-4 WDGS to TAG, sub: RevisedPolicy for Hosp during Emergency. Both in HRS:G-4/31757.

19 Ltr AG 600.12 (9-25-40) MD, TAG to CofArmsand Servs, CGs of CAs, and COs of exempted Stas,26 Sep 40, sub: Revised Policy for Hosp during Emer-gency. HRS: G-4/31757.

20 SG: 632.-1 (Ft McClellan) N; 632.-1 (Ft Ben-ning) N; 632-1 (Ft Bragg) N.

21 SG Ltrs, 1 Oct and 7 Nov 40, sub: Bed ReqmtStudy. SG: 632.-2.

22 SG: 632.-1 (Ft Jackson) N, 1940; SG: 632.-1 (FtOrd)C, 1940; SG: 632.-1 (Ft Bragg) N, 1940.

23 (1) Ltr, CofAC to SG, 17 Apr 41, sub: Increasesin Str for Pilot Tng Sch, and 9 inds. AAF: 632B Hospand Infirmaries. (2) Ltr AG 600.12 (9-28-40) M-D,TAG to QMG, 3 Oct 40, sub: Temp Cons ... 5thCA. SG: 632.-1 (5th CA) AA. (3) Memo, SG forQMG, 7 Oct 40, sub: Ft Knox. SG: 632.-1 (FtKnox) N. (4) Ltr, SG to Fed Bd of Hosp, 5 May 41.SG: 632.-1.


depended to some extent upon troop dis-tribution, the fact that general hospitalswould serve more than one post andwould operate directly under The Sur-geon General gave him considerable lati-tude in determining their size, number,and location. On 10 August 1940 G-4sought information on increases in generalhospitals that passage of the SelectiveService Act would require.24 In responseThe Surgeon General proposed the con-struction often new general hospitals witha total capacity of 9,500 beds—one eachin the First, Second, Fifth, Sixth, andSeventh Corps Areas; three in the Fourth,where the troop concentration would beheaviest; and two in the Ninth, wheretroops would be spread from Canada toMexico. In the Eighth Corps Area, heproposed redesignation of the 1,700-bedFort Sam Houston (Texas) Station Hospi-tal as a general hospital, since it wasalready performing the functions of bothtypes.25 Plans had already been made toincrease the capacity of Walter Reed Gen-eral Hospital, in the Third Corps Area, byrelieving it of station-hospital cases whichit had previously received from near-byposts.26 With the general hospitals alreadyin operation, this plan would have pro-vided a total of over 15,000 general hos-pital beds in the United States for an ex-pected Army strength of 1,400,000.

The expansion of general hospitals dur-ing 1941 followed basically The SurgeonGeneral's plan. On 25 September 1940G-4 approved the construction often gen-eral hospitals, with a total capacity of10,000 beds, in locations substantially thesame as those recommended by The Sur-geon General.27 Objections of the com-mander of the Eighth Corps Area to re-designation of the Fort Sam HoustonStation Hospital caused The Surgeon

General to withdraw that proposal.28

During 1941, therefore, the following gen-eral hospitals were added to the five theArmy already had: Lovell at Fort Devens,Mass.; Tilton at Fort Dix, N. J.; Stark atCharleston, S. C.; Lawson at Atlanta,Ga.; LaGarde at New Orleans, La.; Bil-lings at Fort Benjamin Harrison, Ind.;O'Reilly at Springfield, Mo.; Hoff atSanta Barbara, Calif.; and Barnes at Van-couver Barracks, Wash.29 No additionalones were required until September 1941,when an increase in the size of the Armywas anticipated. At that time The SurgeonGeneral submitted a proposal for a pro-portionate increase in the number of gen-eral hospital beds,30 but it was latermerged with a larger plan to meet theneeds of a wartime Army.

Selection of proper sites was an essentialfactor in planning for hospital construc-tion. It was important, for instance, forboth station and general hospitals to havesufficient space for future expansion; to befree from objectionable neighbors such asfactories, 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 GenHosp (8-10-40)(1).

26 4th ind SGO 701.-1, SG to TAG, 5 Aug 40, and7th 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 toTAG, 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.


to be located on terrain that was moder-ately level and properly drained. The ac-cessibility of good highway and railroadnets was especially important for generalhospitals, whose function was to receivepatients from other hospitals. The avail-ability of good water supplies and of ade-quate utilities connections had also to beconsidered. The Quartermaster General'schief interest in hospital sites lay in theirsuitability from an engineering and con-struction standpoint.

During the emergency period TheQuartermaster General selected construc-tion sites in collaboration with other in-terested War Department agencies. Forhospitals, this meant both The SurgeonGeneral and corps area commanders.31 Inthe early phases of mobilization the selec-tion of sites for station hospitals was left inmany instances to local authorities, forThe Surgeon General's Hospital Con-struction and Repair Subdivision hadlittle personnel to spare for such activities.Sites so selected were generally satisfac-tory but sometimes had undesirable fea-tures, such as promixity to training areas,poor drainage, or inadequate space forexpansion. As the press of work abatedduring 1941, The Surgeon General beganto exercise more direct supervision oversite selection through visits of his repre-sentatives to stations where hospital con-struction was anticipated.32 The selectionof sites for general hospitals was morecomplicated and time consuming, eventhough the general areas in which theywere to be located were first approved bythe General Staff. As a rule, the War De-partment directed corps area commandersto appoint boards, with medical repre-sentatives, to make investigations andrecommendations. Their surveys requiredconsiderable time and their recommenda-

tions in some instances were deemed un-satisfactory. In such cases, the Secretaryof War appointed other boards represent-ing The Surgeon General, The Quarter-master General, the General Staff, andcorps area surgeons to make furthersurveys and recommendations.33

Difficulties in ProvidingSatisfactory Hospital Plants

The Surgeon General and The Quar-termaster General disagreed about themanner in which the Medical Depart-ment as the using agency should exerciseadvisory supervision over hospital con-struction. The Surgeon General insistedthat his office should review each buildingschedule which was sent out and eachchange in plans proposed by the field. Hebelieved that this procedure was necessaryto maintain the proper division of spaceamong various hospital services, an ap-propriate relationship among differentbuildings of a hospital plant, and thepossibility of future expansion. In hisopinion experience justified this position.For example, hospital construction at FortFrancis E. Warren (Wyoming) was de-layed from early November 1940 until

31 Memo QM 322.2 C-OT (Gen Hosps), QMGfor ACofS G-4 WDGS, 11 Jan 41, sub: Gen Hosps,and D/S G-4/32445, ACofS G-4 WDGS to TAG, 15Jan 41. sub: Control of Cons Projects. AG: 322.2 GenHosp (7-15-40)(1) Sec 1.

32 (1) Tynes, Construction Branch, p. 32. (2)Memos from offs of Hosp Cons and Repair Subdivdated 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, 14Nov 40, sub: Gen Hosps. HRS: G-4/29135-11. (2)Ltr, TAG to CG 4th CA, 29 Sep 40, sub: Cons ofCantonment Hosps 4th CA (Atlanta, Charleston, NewOrleans). 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 GenHosps (7-15-40) (1) Sec 4.


January 1941 because The QuartermasterGeneral sent out plans which The SurgeonGeneral had not approved and againstwhich local authorities protested. At FortRosecrans (California) local quarter-master and medical officers erected a two-story wooden hospital which The SurgeonGeneral considered unsafe. In otherplaces, such as Camp Wallace (Texas),Camp Custer (Michigan), Camp Roberts(California), and Camp Leonard Wood(Missouri), local changes in approvedplans produced hospitals considered un-satisfactory by The Surgeon General.34

Hoping to speed construction, TheQuartermaster General proposed stand-ardization and decentralization—the useof standard building schedules (that is,lists of buildings for hospitals ranging insize from 25 to 2,000 beds) approvedinitially by the Surgeon General's Officeand subject to no further changes by it,and the delegation of authority to makechanges in hospital layouts and buildingplans to medical and quartermaster offi-cers in the field.35 Nevertheless, because ofThe Surgeon General's insistence, boththe Quartermaster Corps and the Corpsof Engineers followed the practice of re-ferring hospital building schedules andlayouts to his Office for approval andtwice during 1941 The QuartermasterGeneral instructed his field agents not tochange hospital construction plans with-out prior approval of the Surgeon Gen-eral's Office.36

Centralization of the Medical Depart-ment's advisory supervision over hospitalconstruction did not necessarily assureerection of satisfactory hospital buildings.That depended considerably upon theplans used. Drawn in 1935, they weresimply pulled "off the shelf when needed.The medical officer (Col. Floyd Kramer)

who had helped prepare them warned theSurgeon General's Office that they wouldnot be entirely satisfactory, and in Octo-ber 1940 Colonel Hall, of the HospitalConstruction and Repair Subdivision, in-dicated that he was "by no means certain"that they would "suit our 1940 ideas."37 Itsoon appeared that they did not. Hospi-tals built on such plans had insufficientspace for some activities and none at allfor others. X-ray clinics and laboratorieswere too small for use in modern medi-cine. Administration buildings had insuf-ficient space for extensive records requiredfor patients and civilian employees andwere cut up into too many small rooms forefficient use. Post dental work requiredmore room than originally expected. Gen-eral hospitals needed more space for quar-termaster activities. Inadequate kitchensand mess storerooms became the source offrequent complaints. Offices for the medi-cal supply officer and the medical detach-ment commander, recreation buildings forpatients and for nurses, post exchange

34 (1) Ltr, SG to QMG, 5 Jan 41, sub: UnauthChanges in Cantonment Hosps. . . , with 2d ind, SGto QMG, 14 Feb 41. SG: 632.-1. (2) 1st ind, SG toQMG, 17 Jul 41, on Synopsis Ltr, QMG to SG, 17Jul 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: UnauthChanges in Cantonment Hosps. . . . (2) Synopsis Ltr,QMG to SG, 17 Jul 41. Both in SG: 632.-1.

36 (1) Ltr QM 632 C-EP Hosp Fac, QMG to SG,9 Aug 41, sub: Add Hosp Fac. SG: 632.-1. (2) 2d ind,CofAC to CofEngrs, 11 Aug 41, on Ltr, SG to Cof-Engrs, 31 Jul 41, sub: Hosp Insp, AC Sta, 8th CA.Same file. (3) Ltr, QMG to Cons QMs, 8 Feb 41, sub:Hosp Layouts. Same file. (4) Ltr QM 632 C-EP(Zone VII), QMG to Zone Cons QM, Zone VII, 12Sep 41, sub: Revisions in Hosp Plans and Layouts. Offfile, Hosp Cons Div SGO, "Policy File."

3 7 (1) Lessons Learned from Planning and Con-structing Army Hospitals, Speech by Col John R.Hall, 16 Sep 43. HD: 632.-1. (2) Ltr, Col J. R. Hallto Col H. C. Coburn, Jr, MC, Sta Hosp Ft Bragg, 16Oct 40. SG: 632.-1 (Ft Bragg) N.


buildings, ambulance garages, and strongrooms for safeguarding narcotics as re-quired by Federal law were not includedin existing plans. Of equal importance,neuropsychiatric wards for which planswere provided lacked sufficient strengthand safety features to prevent patientsfrom attempting escape or suicide.38

The question of whether to revise exist-ing plans completely or to make piece-meal changes arose in the fall of 1940.General Love, Chief of the Planning andTraining Division, advocated their com-plete revision, but Colonel Hall demurredon the ground that he would encounterdelays and difficulties in securing ap-proval of G-4 and co-operation of TheQuartermaster General.39 That his posi-tion had some basis in fact is indicated bya controversy from August through Octo-ber over proposed changes for separatebuildings. After The Quartermaster Gen-eral complained that requests of The Sur-geon General for piecemeal changes weredelaying construction, their offices hurledcharges and countercharges against eachother until G-4 forbade further changes instandard designs without Staff approval,and the chief of the G-4 ConstructionBranch, concluding that further argumentwas useless, closed the controversy byrecommending on 18 October 1940 thatall papers pertaining to it be filed.40 Twomonths later The Quartermaster Generalproposed a complete revision of canton-ment-type hospital plans, but ColonelHall maintained his former position, thistime for a different reason. "It is theopinion of this office," he wrote, "thatsufficient experience with the plants to beerected according to the present plans hasnot yet been had to make a complete andsatisfactory revision possible at thistime."41

As soon as hospitals built on the 1935plans were received from contractors, stepshad to be taken to correct their defectsand overcome their deficiencies. Severalmethods were adopted. One was to rear-range the use of space. For example, localcommanders converted wards into X-rayclinics and laboratories and used the spacevacated in clinical buildings to increasesurgical facilities. To replace the bed capacity thus lost, The Surgeon General ob-tained additional wards.42 Another meth-od was to modify the buildings erected.Changes in neuropsychiatric wards, suchas the removal of exposed pipes, weremade to increase the safety of mentallydisturbed patients; and kitchens and messhalls were enlarged by adjacent construc-tion.43 A third method was to constructadditional buildings, such as storehouses,

38 (1) An Rpts, 1941, Sta Hosps at Fts Knox andBragg, Cps Lee, Roberts, Claiborne, and Bowie, andO'Reilly Gen Hosp. HD. (2) Memo, IG for ACofSG-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 Mar41. 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, 17Aug 40, sub: Changes in Standard Design, with 3dind, 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 forACofS 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 andGp Roberts and O'Reilly Gen Hosp. HD. (2) Ltr, SGto TAG, 7 May 41, sub: Request for Urgent Emer-gency Cons, and 2d ind AG 600.12 (5-7-41), TAGto 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, SGto Hq AAF, 9 May 42, on Ltr, Surg Southeast ACTng Ctr to SG, 5 May 42, sub: Hosp Messes. SG:632.-1. (3) Ltr QM 300.5 C-ED(Gen), QMG to allCons QMs, 21 May 41, sub: Piping—DetentionWards. SG: 632.-1.


ambulance garages, post exchanges, andstrong rooms.44 Finally, existing plans fora few buildings, such as neuropsychiatricwards, kitchens, and messes, were revisedduring 1941 for subsequent use, in orderto prevent perpetuation of the process ofbuilding and changing.45

Development of a New Typeof Hospital Plant

In the spring of 1941 complaints weremade in both military and civilian circlesthat the hospitals constructed not onlylacked space for certain activities but alsowere unsatisfactory from an administrativeand safety viewpoint.46 Wide dispersal ofbuildings intensified administrative prob-lems without assuring adequate fire pro-tection. As early as January 1941 theoffices of The Quartermaster General andThe Surgeon General had agreed upon aprogram of installing draft-stops in closedcorridors that connected different build-ings of hospital plants, as a fire-protectionmeasure.47 In May the Chief of the AirCorps secured appropriations for the in-stallation of automatic fire-sprinkler sys-tems in fifty-eight Air Corps hospitals andThe Quartermaster General made plansfor their installation in all other hospitalswith 400 or more beds. By December 1941the installation of such systems in all thewards, except detention wards, and in thepatients' kitchens of cantonment-type hos-pitals became War Department policy.48

Meanwhile work had begun on thedevelopment of a new type of hospital.When complaints about existing plantswere first made, Colonel Hall expressedThe Surgeon General's preference formore compact hospitals built of fire-resist-ant materials.49 Soon afterward his Officebegan to collaborate with the Quarter-

master General's in designing such a plant.It consisted of buildings that were gener-ally two stories high with exterior walls ofmasonry and interiors of slow-burningmaterials. Such construction permitted amore compact arrangement of structuresthan had previously been possible. Wardbuildings were placed opposite each otheron a central connecting corridor permit-ting one diet kitchen and one ward officeand examining room to serve two wards.Two-story corridors connected the build-ings of a hospital group, and ramps wereplaced at suitable intervals to give accessfrom 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) LtrAG 600.12 (8-4-41)MO-D-M, TAG to CGs of allDepts 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, 7Aug 41, sub: Modification of M-16 Mess, with 1st indQM 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 AsstOCE for Engr Div OCE, 3 May 41, and Memo, HeadEngr for Exec Asst OCE, 6 May 41, sub: Hosp Lay-outs. CE: 632 Pt I.

47 Memo, SG (Hall) for QMG, 29 Jan 41. SG:632.-1.

48 (1) Synopsis Ltr, CofAC to CofEngrs, 9 May 41,sub: Fire Prevention in Hosps, with 1st ind, CofEngrsto CofAC, 17 May 41, and three subsequent inds. SG:671.2. (2) Memo QM 632 C-ED (Gen), Design SecOQMG for Chief Design Sec OQMG, 13 May 41,sub: Sprinkler and Alarm Systs — Hosps. CE: 671.3Pt 1. (3) 3d ind AG 671.7 (10-2 1-41) MO-D, TAGto CofEngrs, 26 Dec 41, on Ltr QM 671 C-RU (Gen),QMG to TAG, 21 Oct 41, sub: Fire Protection. Samefile.

49 2d ind SGO 600.12-1, SG (Hall) for TAG, 16Apr 41, on Ltr, Nathaniel O. Gould to SecWar, 27Mar 41. AG: 600.12 (3-27-41) (1).


VALLEY FORGE GENERAL, A SEMIPERMANENT-TYPE HOSPITAL

space for medical care, the width of allwards, clinics, and other key buildings wasincreased from twenty-five to thirty-twofeet, and facilities that were either lack-ing or inadequate in cantonment-typehospitals were introduced or redesigned inplans for the new type.50 On 6 August1941 the Staff authorized the constructionof two-story, semipermanent, fire-resistantplants for all future hospitals.51 Finaldrawings were not completed for severalmonths, and before they could be put intogeneral use the United States was at war.

Evaluation of HospitalConstruction Program

Although hospitals constructed duringthe period of peacetime mobilization didnot "even approach the ideal," in ColonelHall's opinion the wonder was "not thatso many mistakes were made but ratherthat we have been able in a somewhatsatisfactory manner to meet our obligation

to the sick and wounded." 52 Hospital bedshad to be provided on a scale unknown inordinary times. Between September 1940and December 1941 the number of nor-mal beds (that is, those for which 100square feet of space each was provided inward buildings) in station hospitals in-creased from 7,391 to 58,736 and in gen-eral hospitals, from 4,925 to 15,533.(Chart 1) Only in the fall and winter of1940-41 was there a shortage of normalbeds. At that time the Medical Depart-ment used emergency and expansion beds(that is, those set up on the basis of sev-enty-two square feet each not only in

50 (1) Tynes, Construction Branch, pp. 39-40. (2)Ltr, SG to CofEngrs, 7 Feb 42, sub: Fire-ResistantType of Hosp. SG: 632.-1.

51 2d ind AG 632 (7-7-41) MO-D, TAG to QMGand SG in turn, 6 Aug 41, on Ltr, SG to TAG, 7 Jul41, sub: Fire-Resistant Type of Cons for Hosp. SG:632.-1.

52 Lessons Learned from Planning and Construct-ing Army Hospitals, speech by Col Hall, 16 Sep 43.HD: 632.-1.


wards but also in porches, halls, barracks,and tents) and sent some patients to near-by civilian and Veterans Administrationhospitals.53 It also continued a policy, be-gun early in 1940, of reducing the numberof Civilian Conservation Corps and Vet-erans Administration patients in Armyhospitals and in December secured WarDepartment approval of a policy of limit-ing sharply the hospitalization of depend-ents of military personnel.54 In the springof 1941 construction began to catch upwith needs and after March the number ofpatients in hospitals at no time exceededthe total number of normal beds. (SeeChart 1.)

Hospital Administration

Internal Organizationand Administrative Procedures

When mobilization began, the onlyguide to the organization and administra-tion of Army hospitals was an Army regu-lation published in the mid-1930's. It gavehospital commanders much discretion inboth fields and lacked detailed instructionsfor inexperienced officers to follow.55 Amore specific guide was therefore neces-sary. In October 1940 the Medical De-partment devoted an entire issue of theArmy Medical Bulletin to an article preparedby Col. Charles M. Walson, then surgeonof the Second Corps Area, entitled "Sta-tion Hospital Organization Chart, Regu-lations, and Medical Department Ques-tionnaire." During the first half of 1941the Training Subdivision of the SurgeonGeneral's Office revised this article andthe War Department issued it in July as atechnical manual.56

The manual described hospital organi-zation in considerable detail, advocatingthe separation of activities into two major

categories, administrative and profes-sional, and the grouping of professionalactivities into services composed of sub-units called sections. For example, thesurgical service of a station hospital mightcontain sections devoted to general sur-gery, orthopedics, obstetrics and gynecol-ogy, urology, eye-ear-nose-and-throat dis-orders, anesthesia, roentgenology, andphysiotherapy; the medical service, sec-tions for general medicine, contagious dis-eases, dermatology, neuropsychiatry, anddetention. The manual also provided for aheadquarters, or commanding officer'sstaff, separate from other administrativeunits of general hospitals. In addition, itdescribed the duties and responsibilities ofstaff officers, as well as important admin-istrative procedures, and contained check-lists for chiefs of services to use in measur-ing the efficiency of operations. While itwas somewhat more specific than theArmy regulation governing hospital ad-ministration, this manual also gave localcommanders considerable autonomy.(Chart 2)

53 (1) An Rpts, 1941, Sta Hosps at Cps Beauregard,Shelby. Blanding, Custer, and Roberts, and Fts Leon-ard Wood. Sill, and Bragg. HD. (2) AR 40-1080, par2 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 StaHosp Ft Snelling to Surg 7th CA, 9 Sep 40, sub: Authto Reduce Floor Space. . . , and 3 inds. SG:632.-1 (Ft Snelling) N.

54 (1) Rpt, Conf of SG with CA Surgs, 14-16 Oct40, and 10-12 Mar 41. HD: 337. (2) Memo, ACofSG-4 WDGS for CofSA, 5 Dec 40, sub: Reply ofSecWar to VA. HRS: G-4/28901-17. (3) Ltr, SG toTAG, 28 Nov 40, sub: Med Care for Dependents. . . and cy Ltr AG 702 (11-28-40) M-A-M, TAGto 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) TM8-260, 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: TM8-260. AG: 300.7 TM 8-260 (4-15-41)(1).


Lack of a specific directive requiringstandard hospital organization resulted inmany local variations.57 The one generalpoint of similarity was the separation ofadministrative from professional activities.In most hospitals the latter were organizedas sections that were grouped in services:medical, surgical, dental, and laboratory.Some hospitals looked upon nursing as aseparate professional service, although themanual recommended that the nursingunit be considered an administrative one.Others gave activities that might havebeen included as sections of either themedical or surgical service a higher status.For example, the station hospitals at FortLewis (Washington) and Fort Knox(Kentucky) possessed orthopedic services;that at Fort Ord (California) had sepa-rate genitourinary and eye-ear-nose-and-throat services; and that at Fort Bragg(North Carolina), a separate neuropsychi-atric service. On the other hand therewere but three professional services at the1,200-bed station hospital at Camp Bowie(Texas): medical, surgical, and nursing.

Administrative units were usually notgrouped in services, and their numbervaried from one hospital to another. Forexample at Stark General Hospital therewere 29, including staff offices; at La-Garde, 14; while the number proposed inthe manual was 12. Station hospitals like-wise varied. On some posts they wereunder the supervision of station surgeons,who supplied certain administrative serv-ices. In one such instance the station sur-geon handled all hospital personnel andsupply activities. On other posts, a singleofficer served both as station surgeon andas hospital commander. The Fort BraggStation Hospital, which was divided intothree sections located from one quarter ofa mile to a mile apart, had separate com-

manders for each unit, but possessed acentral registrar's office, medical supplysection, nursing section, mess and hospitalfund, military and civilian personnel divi-sions, and medical detachment. Generalhospitals not located on Army posts usu-ally had administrative sections not foundin station hospitals, such as the financeand provost marshal's offices.

Neither Army regulations nor the man-ual on organization limited the number ofofficers a hospital commander could super-vise directly. Thus the number of individ-uals reporting to him varied as did theorganization of administrative and pro-fessional activities. As a rule, only chiefs ofprofessional services, not of sections underthem, reported to the commanding officer,but in most hospitals the chief of eachadministrative section reported directly tothe commander or his executive officer.Thus the officers supervised directly by ahospital commander sometimes reachedlarge numbers. For example, at StarkGeneral Hospital the chiefs of four profes-sional services and twenty-nine differentadministrative sections reported directlyto the commander. In some instances thenumber of officers actually reporting wassmaller than it seemed, because one officerfrequently held several positions. (Chart 3)

Administrative procedures likewise var-ied from hospital to hospital. Since therewas no manual covering hospital opera-tions in detail, hospital commanders werefree to supplement general proceduresoutlined in Army regulations as they saw

57 (1) The following three paragraphs are based on:An Rpts, 1941, Sta Hosps at Fts Knox, LeonardWood, Lewis, Bragg, Sill, Ord, and G. G. Meade, andGp Bowie, and Stark, Billings, Hoff, LaGarde, andLawson Gen Hosps. HD. (2) See also: Edward J.Morgan and Donald O. Wagner, The Organizationof the Medical Department in the Zone of the Interior(1946), pp. 102-06. HD.


fit. Hospital regulations published in theArmy Medical Bulletin in October 1940 andin Technical Manual 8-260 in July 1941were probably of value to some, but offi-cers opening new hospitals often borrowedcopies of regulations and administrativeforms of other hospitals to use as guidesin establishing their own administrativeprocedures.58

The Surgeon General supervised anddirected the professional work of hospitalsthrough inspections by members of hisOffice and the issuance of technical in-structions, but he exercised little directcontrol during this period over their ad-ministrative activities. Rather he de-pended on The Inspector General andcorps area authorities to keep hospitals inline with Army procedures and to reportadministrative problems that arose.59

The question of whether the autonomygiven hospital commanders resulted in lessefficient operations than might have other-wise been the case was not discussed dur-ing the period under consideration. Argu-ments might have been raised in favor offlexibility which permitted accommoda-tion to local situations. Later on, lack ofuniformity in organization and adminis-tration became a subject of much discus-sion and efforts were made to developstandardized organizations and simplifiedadministrative procedures.60

Manning of Hospitals: ManningGuides and Personnel Problems

In September 1940 there was no up-to-date guide for manning named hospitals.Since they were then small, few in num-ber, and widely different in constructionnone was needed, for personnel require-ments of each installation could be deter-mined best on an individual basis. With

the opening of large hospitals built onstandard plans, corps area surgeons beganto need a guide to use in computing re-quirements and distributing personnel.The only available one was a 1929 tableof organization for wartime station hospi-tals in the zone of interior.61 Althoughnamed hospitals were not being organizedunder it the General Staff early in 1940had given the Third Corps Area permis-sion to use this table as a guide, pendingthe publication of a "table for convertingbed requirements into personnel require-ments." Preparation of the latter in theSurgeon General's Office was delayeduntil December 1940, because the revisionof tables of organization for field forceunits had priority.62

As submitted to the General Staff, thenew guide called for more personnel, espe-cially officers and enlisted men, than didthe old one. For example, a 500-bed sta-tion hospital under the old table was tohave 25 officers, 60 nurses, and 200 en-listed men; under the new guide, 37 offi-cers, 60 nurses, and 275 enlisted men. TheSurgeon General thought that the oldtable did not provide sufficient personnelfor "a present day hospital." AlthoughG-1 agreed that the amount called for by

58 (1) Interv, MD Historian with Maj Gen HowardMcC. Snyder, 25 May 48. HD: 000.71. (2) See also:An Rpt, 1941, Lovell Gen Hosp. HD.

59 (1) Interv, MD Historian with Col Albert G.Love, 27 Aug 47. HD: 000.71. (2) Interv, MD His-torian with Gen Snyder, 25 May 48. HD: 000.71.

60 See below, pp. 121-24, 268-78.61 T/O 786 W, Sta Hosp, ZI, 1 Jul 29.62

(1) 2d ind, TAG to CG 3d CA, 28 Mar 40, onLtr, Surg 3d CA to SG, 22 Jan 40, sub: Civ Employeesin Sta Hosps. AG: 381 (1-1-40) Sec 1. (2) 1st indSGO 370.01-1, SG to TAG, 9 Apr 40, on Ltr, TAGto CGs of CAs. COs of Exempted Stas, C of Arms andServs, 28 Mar 40, same sub. Same file. (3) Ltr SGO370.01-1, SG to TAG, 19 Dec 40, sub: Guide for De-termining Pers Reqmts, Sta Hosps, ZI. AG: 381 (11-3-37) Sec 1-12.


the new guide was reasonable,63 the Staffdelayed its publication because it ex-pressed requirements in terms of militarypersonnel only and called for more en-listed men than the number already al-lotted to hospitals. The first objection wasapparently removed in January 1941when Maj. (later Col.) Arthur B. Welsh,of The Surgeon General's Planning andTraining Division, stated that civilianscould be substituted for enlisted men onan approximate man-for-man basis.64 Twomonths later, incidentally, his superiorofficer, General Love, informed corps areasurgeons that civilians should replace en-listed men on a three-for-two basis.65 Inview of continued disagreement amongmembers of the General Staff over thetotal number of enlisted men involved, thequestion of publication was submitted inMarch 1941 to the Chief of Staff. As aresult a "Guide for Determination of Med-ical Department Personnel" was pub-lished on 9 April 1941 with the under-standing that it represented requirements,not availabilities.66

Publication of the guide did not meanthat hospitals were to have the strengthprescribed. The Surgeon General appar-ently had no trouble in getting the Gen-eral Staff to authorize the number of phy-sicians, dentists, and nurses whom he de-sired, but he encountered difficulty in pro-curing the number authorized.67 Duringthe fall and winter of 1940-41 hospitalsconsidered the shortage of physicians andnurses acute. To alleviate it they employedcivilian nurses on a temporary basis andused Medical Corps officers from fieldforce units located near by. Medical Ad-ministrative Corps officers filled a fewadministrative positions, but the Armyhad few such officers and their substitu-tion for Medical Corps officers in admin-

istrative work gained little headway priorto the war years. By the spring of 1941 theprocurement situation had apparently im-proved and many hospital commandersreported that the number of officers andnurses assigned to them was adequate.68

The question of the number of enlistedmen to be assigned to named hospitalswas bound up with the use of civilian em-ployees and the training of medical per-sonnel. The Surgeon General contendedthat the Medical Department needed pro-portionately as many enlisted men innamed hospitals during mobilization as inpeacetime in order to train enlisted menin technical duties for use later as cadresand fillers for new units and installations.He insisted, therefore, that hospital staffsshould have no higher proportion of civil-ians than 20 percent of the total enlisted

63 (1) Memo, Act SG for ACofS G-1 WDGS, 1 Apr41, sub: Approval of T/O for Sta Hosps in the ZI.HD: 322.052-1. (2) Memo G-1/13308-291, ACofSG-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, ACofSG-1 WDGS for ACofS G-4 WDGS, 8 Jan 41, samesub. 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 WDGSfor ACofS G-4 WDGS, 14 Feb 41, sub: Guide for De-termining Pers Reqmts, Sta Hosp, ZI. (2) MemoG-3/42107, ACofS G-3 WDGS for ACofS G-4WDGS. 28 Feb 41, same sub. (3) Memo G-4/31697,ACofS G-4 WDGS for ACofS G-1 WDGS, 11 Mar41, same sub. (4) Memo G-4/31697, ACofS G-4WDGS for CofSA, 22 Mar 41, same sub. All in AG:381(11-3-37) Sec 1-12. The Chief of Staffs stamp ofapproval 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 GenHosps and Sta Hosps at Cps Livingston and Forrest,Fts Knox and Jackson, and Indiantown Gap Mil Res.HD.


and civilian staff.69 On the other hand,faced with the problem of dividing a givennumber of enlisted men among field forceunits (including numbered hospital units)and zone of interior installations of thevarious arms and services, the GeneralStaff believed that civilians should consti-tute as much as 50 percent of the staffs ofnamed hospitals. In this connection G-3suggested that the Medical Departmentmight affiliate (not explaining what itmeant by this term) numbered hospitalunits with named hospitals to provideadditional enlisted men for service in thenamed hospitals and at the same time togive the numbered hospital units the bestpossible training.70 The Surgeon Generalplanned to train numbered units in namedhospitals, but he apparently expected themembers of such units to be used not asregular operating personnel but as under-studies of their opposite numbers. Repeat-edly, therefore, he asked for greater allot-ments of enlisted men for fixed installa-tions of the Medical Department, butwithout success.71 Hence, the enlisted menauthorized for assignment to general andstation hospitals were fewer than TheSurgeon General desired, and those re-ceived by hospitals were fewer than thenumber authorized. To supplement themhospitals used civilians and men fromnear-by field medical units, the formersometimes constituting more than half ofthe total enlisted and civilian staffs.72

In addition to having less military per-sonnel than they considered desirable,hospitals received officers and enlistedmen who needed further training. Nursesand Medical Corps Reserve officers wereof course qualified by training and experi-ence to care for the sick and injured, butmost who entered the Army after Septem-ber 1940 knew little about the administra-

tion of Army hospitals. In some instancesthis resulted in devotion of more time andenergy to paper work than was ordinarilythought proper. Recognizing the need fortraining Reserve officers in administrativeprocedures before assigning them to hos-pitals, The Surgeon General authorized aprogram in November 1940 to train fiftyReserve and National Guard officers eachmonth for such positions as registrar, de-tachment commander, receiving and dis-position officer, adjutant, executive officer,medical supply officer, and mess officer.In general, though, the burden of trainingofficers and nurses in administrative workfell upon the commanding officers of thehospitals to which they were assigned.73

A majority of enlisted men available forservice in hospitals during 1941 lacked aknowledge of both military and technicalmatters. The number of Medical Depart-ment men in the enlisted Reserves was

69 (1) Ltr, SG to TAG, 3 Sep 40, sub: Employmentof 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. Samefile. (3) Memo, Act SG (Brig Gen A[lbert] G. Love)to ACofS G-1 WDGS, 1 Apr 41, sub: Increase inAuth for MD EM for . . . Overhead. HD:322.052-1.

70 Memo G-1 /15081 Med, ACofS G-1 WDGS forACofS G-3 WDGS. 13 Sep 40, sub: Allocation of MDPers, and Memo G-3/6541 Med 68, ACofS G-3WDGS for ACofS G-1 WDGS, same sub. AG: 381(1-1-40) Sec 3.

71 (1) For example, see: Memo, Act SG for ACofSG-1 WDGS, 1 Apr 41, sub: Increase in Auth for MDEM 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 atCps Blanding, Bowie, and Forrest, Fts Bragg andKnox, Indiantown Gap Mil Res, and Hoff Gen Hosp.HD.

73 (1) Interv, MD Historian with Gen Snyder, 25May 48. HD: 000.71. (2) An Rpts, 1940, Sta Hospsat Cps Livingston, Blanding, Edwards, Shelby, For-rest, J. T. Robinson, and Claiborne, Fts Jackson,Bragg, and Knox, and O'Reilly, Lawson, Hoff, Bil-lings, and Tilton Gen Hosps. HD. (3) SG Ltrs 79,7 Nov 40; 14. 26 Feb 41; and 32, 5 Apr 41.


negligible, and the Medical Department'sreplacement training centers and enlistedtechnicians' schools did not begin to turnout trained men in large numbers untilthe summer of 1941.74 Regular Army en-listed men from hospitals already in oper-ation formed the cadres of enlisted detach-ments of new hospitals. The remainderwere usually men assigned direct fromreception centers. The necessity of givingthem basic military training interferedwith their performance of technical duties,and hospital commanders generally pre-ferred men from replacement trainingcenters after they became available. Tomake up for the lack of technical training,hospitals instituted on-the-job trainingprograms which varied in content andvalue from one installation to another.75

Civilians in Army hospitals were nor-mally used in jobs traditionally held bysuch enlisted men as medical technicians,ward orderlies, clerks, cooks and cooks'helpers, repair and maintenance men,and janitors. In some instances civiliannurses were employed, and until the endof the first year of the war all female dieti-tians and physical therapy aides were incivilian status. The chief problem in theuse of civilians was procurement. To re-duce difficulties in that connection TheSurgeon General in September 1940 de-centralized to corps areas the employmentof civilians for station hospitals, includingthose on exempted stations. He retainedin his Office for a time the employmentof civilians for named general hospitals.76

Among local conditions that continued tohamper the procurement of sufficientnumbers of qualified civilians, the mostimportant were lack of housing near hos-pitals in isolated areas, inadequate trans-portation to such hospitals, absence oflabor markets in some places, and com-

petition of other government agencies foravailable civilians.77

Shortages of Supplies and Equipment

Another difficulty encountered in open-ing new hospitals was a shortage of suit-able supplies and equipment, and com-plaints of hospital commanders on thisscore were frequent.78 Depots met earliestneeds by issuing reserves stored afterWorld War I. As a result, much that hos-pitals received, such as surgical instru-ments, plaster of paris bandages, andward furniture, was of 1918 vintage.When reserves proved insufficient, depotssupplemented them with local emergency

74 (1) Annual Report of The Secretary of War, 1941(Washington, 1941), pp. 95, 134. (2) McMinn andLevin, op. cit. (3) [Samuel M. Goodman], A Summaryof the Training of Army Service Forces Medical De-partment Personnel, 1 July 1939-31 December 1944([1946]), pp. 38,46-48.

75 (1) An Rpts, 1941, Sta Hosps at Cps Livingston,Blanding, Edwards, Shelby, Forrest, J. T. Robinson,Bowie, and Claiborne, Fts Jackson, Bragg, and Knox,and O'Reilly, Lawson, Hoff, Billings, and Tilton GenHosps. HD.

76 Ltr, SG (Fin and Sup Div) to Surgs CAs andDepts, 12 Sep 40, sub: Use of Civ Pers in Army Hosps,and Ltr, TAG to C of Arms and Servs, CGs ofExempted Stas, 31 Oct 40, sub: Provision for Civ Em-ployees in Hosps of Exempted Stas. AG 381 (1-1-40)Sec 3.

77 An Rpts, 1941, Sta Hosps at Cps Livingston,Blanding, Edwards, Shelby, Forrest, J. T. Robinson,Bowie, and Claiborne, Fts Jackson, Bragg, and Knox,and O'Reilly, Lawson, Hoff, Billings, and Tilton GenHosps. HD.

78 Unless otherwise indicated, the following para-graphs are based upon annual reports of Barnes, Hoff,Lawson, and O'Reilly General Hospitals, and CampsBeauregard, Blanding, Claiborne, Croft, Forrest,Shelby, and Forts Bragg, Jackson, Lewis, and LeonardWood Station Hospitals. In a conference on 10 No-vember 1950, General Magee disagreed with the in-terpretation given here, stating that he personallyfound a high state of satisfaction with supplies whenhe inspected hospitals. (Notes filed in HD: 314 [Cor-respondence on MS] I.) For a statement about thegeneral shortage of Army supplies in 1940, see MarkS. Watson, Chief of Staff: Prewar Plans and Preparations(Washington, 1950), p. 209, in UNITED STATESARMY IN WORLD WAR II.


purchases but even so had to ship many as-semblages 50- to 60-percent complete.79

Hospitals thus failed initially to receivemany critical items. Most frequently lack-ing were sterilizers, X-ray equipment,orthopedic equipment, dental operatingunits, cystoscopic instruments, and cath-eters.

To make up for shortages hospitals re-sorted to a variety of expedients. In someinstances medical and dental officers senthome for their own instruments. At CampClaiborne (Louisiana) they personallypurchased medical supplies which theyconsidered requisite. The station hospitalat Camp Blanding (Florida) made up forits lack of laboratory supplies and equip-ment by borrowing from the University ofFlorida and the Florida State Board ofHealth, while the Camp Claiborne Sta-tion Hospital borrowed an X-ray devel-oping tank from a dealer in Shreveport,Louisiana. In other instances Army au-thorities arranged locally to use the facil-ities of neighboring hospitals. For exam-ple, the Camp Beauregard (Louisiana)Station Hospital sent cases requiringX-ray and electrocardiographic work tothe Veterans Administration Facility atPineville, La.; used the diagnostic andclinical facilities of the Central LouisianaState Mental Hospital for neuropsychia-tric patients; and sent fractures requiringreductions or large casts to the BaptistHospital in Alexandria, La. Where officeand ward furniture was lacking, hospitalsimprovised desks, chairs, and tables fromboxes and lumber salvaged from the hos-pital's construction. Thus the improvisa-tion and ingenuity of local personnel com-pensated to a great extent for shortages ofsupplies and equipment.

The above situation resulted initiallyfrom the inadequacy and obsolescence ofthe war reserve. It continued because con-

siderable time was required both for in-dustry to convert to the production ofgoods on the scale demanded and for theMedical Department to modify its peace-time methods of requirements-computa-tion, purchasing, stock-control, storage,and distribution. Although the quantityof supplies became more adequate by thefall of 1941, the situation was by no meanssatisfactory at the end of the year andmany items were still on "back order." 80

Development of Procedures AffectingOperation of the Hospital System

As new station and general hospitalsopened, broad policies and procedures togovern the hospital system in general be-came necessary and The Surgeon Gen-eral's Hospitalization Division concen-trated its efforts in those fields.81 The needfor a new policy to govern the selection ofpatients for transfer to general hospitalsdeveloped in the spring of 1941. Until thattime hospital commanders and corps areasurgeons decided which cases were suffi-ciently "serious, complicated, or obscure"to require treatment in the five generalhospitals then in operation. Few restric-tions were placed upon them: cases ofresection and amputation requiring thefitting of prostheses were to be transferredto Walter Reed, Letterman, or Army andNavy General Hospitals; patients withtuberculosis, to Fitzsimons; and "cases ofsuch diseases as the waters of the hotsprings of Arkansas have an establishedreputation for benefiting," to Army and

79 (1) Memo, Lt Col R. L. Black, Dir Storage andMaintenance Div SGO for HD SGO, 16 Nov 44, sub:Sup [Depot] Hist Highlights. HD: 400.24 (Storageand Distr). (2) Hist and Procedure Manual of theToledo Med Depot, 1941-45. HD.

80 Richard E. Yates, The Procurement and Distri-bution of Medical Supplies in the Zone of the Interiorduring World War II (1946), pp. 22-46. HD.

81 Cmtee to Study the MD, 1942, Testimony of ColHarry D. Offutt, pp. 196-98. HD.


Navy.82 To provide a more exact guidethe Hospitalization Division developed apolicy that was published on 26 March1941.83 While it did not relieve local sur-geons of responsibility for selecting pa-tients to be transferred, it provided gen-erally that all requiring more than sixtydays of hospitalization as well as thoseneeding specialized treatment not avail-able at station hospitals should be sent togeneral hospitals. Major elective 84 oper-ations were to be performed at generalhospitals only. Station hospitals were todispose of enlisted neuropsychiatric orpsychotic patients locally, but were tosend officers, nurses, and warrant officerswho were similarly affected or who hadother disabilities which made them unfitfor further military service to general hos-pitals for observation and disposition.Hospitals previously designated for thecare and treatment of special cases wereto continue to receive them as in the past.

Soon after this policy was establishedthe Hospitalization Division developed aprocedure to implement it. Under currentArmy regulations hospital commandersneeded corps area approval for eachtransfer of a patient from a station to ageneral hospital.85 As new hospitalsopened, this requirement resulted in muchpaper work for corps area surgeons and indelayed treatment for patients. On 19May 1941, therefore, The Surgeon Gen-eral requested authority to set aside spe-cific numbers of general hospital beds towhich station hospitals might transferpatients without reference to corps areaheadquarters. The General Staff ap-proved this request and on 21 June 1941authorized the establishment of a systemof bed credits. This permitted the Hospi-talization Division to allot a certain num-ber of beds in general hospitals to eachlarge station hospital and, through corps

area surgeons, to small ones. Thereafterpost commanders normally transferredpatients to general hospitals without refer-ence to higher authority. When stationsneeded changes in allotments, they ordi-narily requested them through corps areasurgeons. In emergencies, they were au-thorized to communicate directly withThe Surgeon General.86

The procedure for transferring patientsfrom station to general hospitals was fur-ther simplified in the late summer of 1941.Until then Army regulations requiredeach hospital to make extracts or copies ofthe clinical records, including case his-tories, of patients being transferred, to besent along with them. As the number ofpatients increased, this time-consumingprocess began to delay their transfer andhence their treatment. The Surgeon Gen-eral then secured approval of a changewhich permitted station hospital author-ities to transfer to general hospitals, alongwith patients, the original clinical recordsof their cases. The transferring hospitalkept only clinical-record briefs and crossreferences indicating the disposition oforiginal records.87

Another problem for the Hospitaliza-tion Division was the disposition of pa-tients. It concerned the Hospital Con-struction and Repair Subdivision also, forprompt disposition of patients reducestotal bed requirements by making avail-able for patient care more of the beds al-

82 (1) AR 40-600, Gen Hosp, Gen Provisions, 31Dec 34. (2) Mins, SGO Conf with CA Surgs, 10-12Mar 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 necessaryto 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.


ready set up. During 1941 there was con-siderable local dissatisfaction with diffi-culties and delays encountered in grantingpatients disability discharges from theArmy. Believing that lack of experienceon the part of many medical officers wasresponsible, one corps area surgeon issueda directive in 1940 to clarify proceduresfor handling such cases.88 In general, thecentralization in corps area headquartersof authority to discharge men on certifi-cates of disability, rather than inefficienthospital procedures, seems to have beenconsidered the most important reason fordelays.89 Apparently sharing this view,The Surgeon General secured authorityin September 1941 for the commanders ofgeneral hospitals to grant disability dis-charges. At the same time, it should benoted, the War Department was furtherdecentralizing such authority to otherlocal commanders, including those ofdivisions, reception centers, replacementtraining centers, and exempted stations.The Surgeon General also secured author-ity for general hospital commanders toissue travel orders for men returning toduty or being discharged from the Army.90

In the fall of 1941 the Chief of Staff be-came concerned about delays in the re-tirement of disabled officer-patients.When General Marshall called a case ofthis kind to his attention, The SurgeonGeneral replied that such delays were"chronic" but that they occurred in largepart in Army administrative channelsafter general hospitals had completedtheir work and made their recommenda-tions. Soon afterward he directed generalhospital commanders to "personally as-sure themselves that the disposition ofofficer patients is expedited insofar as thiscan be done without prejudice to the in-terest of the individual or of the Govern-ment." 91 Further steps to speed the dis-

position of officer-patients were not takenat this time.

Partial simplification of the procedurefor granting disability discharges wentsome distance, though not as far as pos-sible, toward relieving Army hospitals ofpatients who were unnecessarily occupy-ing beds. Action was also taken to relievehospitals of certain other patients—that is,some of those suffering from tuberculosis,psychosis, and other chronic diseases. Atthe beginning of mobilization the Presi-dent approved a recommendation of theFederal Board of Hospitalization thatmembers of the armed forces who were in-jured or incurred disabilities "in line ofduty" and whose physical rehabilitationby the Army or Navy was not feasibleshould be cared for by the Veterans Ad-ministration. Accordingly the SurgeonGeneral's Office secured approval inMarch 1941 for the transfer to the Veter-ans Administration of most enlisted menwho were permanently disabled by thedevelopment of pulmonary tuberculosis.Two months later this provision was ex-tended to all classes of chronic disabilitycases. Three classes of tuberculous pa-tients—those nearing retirement afterthirty years of service, those in the firstthree noncommissioned grades whose re-covery was probable within a year, andthose whose cases were considered not tohave been incurred in line of duty—wereto be kept in the Army and transferred toFitzsimons 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 Sep41; 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 COsGen Hosps, n d, sub: Disposition of Off Pnts. (4)Memo, Act SG to CofSA, 6 Oct 41, same sub. All inSG: 705.-1. (5) WD Cir 217, 15 Oct 41.


patients in the last group were able, theywere to be discharged to their own care orthat of relatives.92

The removal of psychotic patients fromArmy hospitals was more complicated.Many could not be transferred to the Vet-erans Administration because their dis-abilities had existed before induction.State institutions were often reluctant toaccept those who required care in lockedwards. As a result psychotic patients be-gan to accumulate in Army hospitals.Early in the mobilization period a largethree-story section of Walter Reed Gen-eral Hospital was converted into closedwards and the Medical Department ar-ranged to use, as an annex to that section,100 beds in St. Elizabeth's Hospital inWashington. One or two closed wardsmore than had been planned were con-structed at each new general hospitalerected during 1941. In the summer ofthat year, after Walter Reed General Hos-pital had demonstrated the rather ele-mentary fact that transfer of psychotic pa-tients to state institutions was expeditedby addressing requests to proper stateagencies or authorities, The Surgeon Gen-eral issued a circular letter naming thosein each state. About the same time hisOffice arranged to establish a special neu-ropsychiatric center in the just-completedand unused State Hospital at Danville,Ky. Called Darnall General Hospital, itwas ready to receive patients a few monthsafter the Japanese attacked Pearl Har-bor.93

Starting almost from scratch in Septem-ber 1939, the Medical Departmentreached a state of partial preparation forwar by December 1941. To provide hospi-tals for a rapidly expanding Army in theUnited States, a simple method of com-puting requirements was adopted and

ratios of beds to troop strength—smallerthan The Surgeon General considered de-sirable—were officially established. Ex-perience in expanding hospital facilitiesshowed that it was impracticable to relyupon the use of existing Army hospitalsand available non-Army buildings. It alsorevealed imperfections and shortcomingsin cantonment-type hospitals planned inthe thirties, with the result that a new typeof hospital more compact and fire resist-ant was developed. As new hospitalsopened, the Surgeon General's Officeevolved general guides for their organiza-tion and administration but left hospitalcommanders with much autonomy in thisfield. Attention was focused not upon in-ternal hospital administration but uponsimplifying procedures affecting the hospi-tal system in general. In this connectionattempts were made to reduce unneces-sary occupancy of beds by patients nolonger needing treatment or of no furtheruse to the Army. There were shortages ofpersonnel, though authorized allotmentsfor hospitals were generous, and it wasnecessary in many instances to substitutecivilians for enlisted men. Shortages ofsupplies and equipment were alleviated bythe ingenuity of hospital commanders andtheir staffs. Meanwhile, the Surgeon Gen-eral's Office was also concerned with plansand preparations for overseas hospitaliza-tion, the subject to which the discussionnow turns.

92 (1) Annual Report . . . Surgeon General, 1941(1941), p. 253. (2) Ltr SGO 300.3-1, SG to TAG, 7Apr 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 toQMG, 17 Dec 40, sub: Add Fac for the Care of In-sane, and 1st ind QM 632 C-EP (Gen Hosp), QMGto SG, 31 Jan 41. SG: 632.-1. (3) SG Ltr 64, 24 Jun41, sub: Disposition of NP Pnts. (4) Annual Report . . .Surgeon General, 1941 (1941), p. 165.

CHAPTER III

Plans and Preparationsfor Hospitalizationin Overseas Areas

Mobilization Planning

Planning for field hospitalization in theevent of mobilization involved determina-tion of the numbers and types of medicalunits that would be needed for the forceanticipated, provision of up-to-date guidesfor their organization and equipment, andarrangements for furnishing them withpersonnel and supplies. Until the fall of1940 the defensive nature of all War De-partment mobilization planning com-bined with limitations upon availablefunds to hold Medical Department activ-ities in this sphere largely within the realmof paper work.

Determining the Numberof Medical Units Needed

Determination of the number of mobilemedical units that would be needed wasgoverned primarily by the number ofcombat units authorized. Each combatorganization such as a regiment or divi-sion had a standard structure consistingof a specific number of units of the severalarms and services, including medical, that

were "organic" parts of the larger unit.Thus units designed to provide emergencymedical care and transportation for pa-tients in divisional areas of combat zoneswere automatically required along withthe regiments and divisions of which theywere a part. The organization of corpsand armies, though not strictly governedby tables of organization, was also stand-ardized. On recommendation of The Sur-geon General in the winter of 1939 a"type army" (that is, a standard army)was authorized 3 medical regiments, 10evacuation hospitals, 8 surgical hospitals,1 convalescent hospital, 1 medical labora-tory, and 1 medical supply depot. A corpswas authorized either a medical regimentor a medical battalion. Other medicalunits varying in kind and number mightbe authorized as a General Headquarters(GHQ) reserve force. In July 1940 theWar Department Protective MobilizationPlan listed as mobile medical units, foran anticipated force of approximately1,150,000 men, 8 medical regiments, 5"reinforcing" medical battalions, 1 horse-drawn ambulance company, 1 medicaltroop, 17 evacuation hospitals, 13 surgicalhospitals, 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 fixedmedical units such as station and generalhospitals for given combat forces. To esti-mate the number needed the SurgeonGeneral's Office again turned to ColonelLove's analysis of World War I battlecasualty experience. From this study somemembers of the Planning and TrainingDivision believed that beds in fixed hospi-tals should equal 15 percent of a theater'sstrength. Others believed a lower ratiowould suffice.2 The Surgeon General in-dicated in his Protective MobilizationPlan of 1939 that 126,000 fixed bedswould be needed by the end of the firstyear of mobilization.3 The War Depart-ment Plan provided for only 35,000—in32 general hospitals, 4 station hospitals,and 2 hospital centers. The Surgeon Gen-eral considered this provision "alarminglyinadequate" and attempted during 1940to secure an increase both in the numberof beds authorized and in their scheduledrate of availability. In February he sub-mitted a study showing that a minimumof 115,000 fixed beds would be required,but because G-3 believed that the major-ity of troops to be mobilized should be al-lotted to combat arms, The SurgeonGeneral's recommendations received onlypartial approval. On 6 August 1940 theGeneral Staff authorized an increase inthe number of 1,000-bed general hospi-tals from 32 to 102. The number of stationhospitals and hospital centers remainedas originally planned.4 (Table 1)

Revision of Tables of Organizationand Equipment Lists

As a part of its mobilization planningthe Surgeon General's Office undertook a

general revision of tables of organizationof all medical units and the preparationof up-to-date equipment lists for them. Al-though these projects had been startedearlier, only the equipment list for med-ical regiments and the tables of organiza-tion for medical regiments and squadronshad been completed by the fall of 1939.After the President declared an emer-gency this work was pushed to completionby the end of 1940.

Changes in the tables of organizationof medical units that supplied emergencymedical care and transportation for pa-tients in combat zones reflected changesin combat units to increase their mobilityand flexibility. When the infantry divisionwas "streamlined" and converted from a"square" to a "triangular" organization,its organic medical unit was reduced froma regiment to a battalion and appropriatetables for the latter were prepared. Like-wise, the medical battalion eventually be-

1 (1) Kent R. Greenfield, Robert R. Palmer, andBell I. Wiley, The Organization of Ground Combat Troops(Washington, 1947), pp. 263-68, 275-80, in UNITEDSTATES ARMY IN WORLD WAR II. (2) 1st ind,SG to TAG, 11 Oct 39, on Ltr, TAG to C of Armsand 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-3WDGS, 13 Jul 40, sub: Corps Med Units and AtchdMed, and Army Med Regts. HD: McKinney files.(4) War Department Protective Mobilization Plan,1940, Annex No. 7, Pt. I. AG: Budget Div, WDGSfiles, A-45-7.

2 Memo, GLM [Col Garfield L. McKinney] forCol [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 WDPMP, 1939, with 1st ind AG 381 (7-8-40)M-C,TAG to SG, 6 Aug 40. HD: 370.01-1. (3) MemoG-3/6541-Med-64, ACofS G-3 WDGS for Sec GenStaff, 14 Apr 40, sub: Status of MD for War. AG: 381(4-6-40) (1). (4) The War Department MobilizationPlan, speech by Lt Col Harry L. Twaddle, GSC,Chief Mob Br G-3 Div WDGS, 30 Sep 39. G-3Course No 13 and 13A, AWC, 1939-40.


TABLE 1—COMPARISON OF THE WAR DEPARTMENT'S PLAN AND THE SURGEON GENERAL'SRECOMMENDATION 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. Plansfor the organization of armored divisionsrequired the preparation of tables of or-ganization for medical units of that typeof combat organization. In 1940 the tablesof medical regiments and squadrons wereagain revised. Generally there was a tend-ency to increase the personnel in medicalunits of all sizes and to replace animal-drawn with motor vehicles. Basically,none of the changes made altered theMedical Department's long-establisheddoctrine of hospitalization and evacuationin combat zones.5

Changes in tables of organization ofhospital units reflected a growth in spe-cialized medicine. New tables publishedduring 1940 listed for the first time thespecialists required as ward officers andchiefs of sections of professional services.They also allotted to hospitals more en-listed men having specialists' ratings and

correspondingly fewer having only basicmilitary training. For the first time, theyprovided for civilian dietitians, physical-therapy aides, and dental hygienists. Inmany cases the total number of officersand enlisted men was increased. For ex-ample, in a 1,000-bed general hospital thenumber of officers rose from 42, of whom30 were physicians, to 73, of whom 55were physicians, and of enlisted men from400 to 500. These changes, the SurgeonGeneral's Office believed, would enablemilitary hospital units "to perform thenecessary additional specialized medical

5 (1) Documents on the revisions are in SG: 320.3-1,1939 and 1940. (2) History of Organization andEquipment Allowance Branch [SGO], 1939-44. HD.(3) Ltr, Surg 4th CA to Corps and Div Surgs, 26 Mar40, sub: Third Army Maneuvers. HD: McKinneyfiles. (4) Memo, Capt Thomas N. Page for [Brig.] Gen[Albert G.] Love, 28 Dec 40, sub: Activities of thePlanning Subdiv [SGO]. HD: McKinney files.


and surgical work required, in order toapproach the standards of medicine andsurgery as practiced in first class civilianhospitals. . . ."6

Although no new hospital unit was de-veloped during the emergency period, achange in the surgical hospital indicatedthe Medical Department's awareness ofthe problem of developing a highly mobileunit to care for seriously wounded casual-ties near the front lines. The single-unit250-bed surgical hospital developed afterWorld War I was replaced by a new 400-bed surgical hospital to be organizedunder a table of organization issued on1 December 1940.7 Similar in some re-spects to the "mobile hospital" adaptedfrom the French auto-chir during WorldWar I,8 the new hospital comprised aheadquarters and three subordinate ele-ments: a mobile surgical unit and two200-bed hospitalization units. Each of thelatter had its own headquarters. Sinceeach subordinate unit was capable of in-dependent operation, the surgical unitwould be free to move forward, as soon asone hospitalization unit was immobilizedwith patients, to operate for the other hos-pitalization unit or to supplement the fa-cilities of other medical stations. Some ofthe surgical units, the Surgeon General'sOffice anticipated, would have completeoperating, sterilizing, X-ray, and medicalsupply rooms permanently installed onbus-type or van-type motor vehicles.9

Along with revised tables of organiza-tion, new equipment lists were prepared.At the beginning of 1939 the only onesavailable were shipping lists used duringWorld War I. Like the medical supplycatalog, they contained many articles thatwere obsolete and lacked others that hadbeen developed in intervening years. To

enable medical units to give modern med-ical and surgical treatment, it was neces-sary to find out from manufacturers whatarticles were available and to analyze thefunctions and activities of each unit, fromreveille to taps, to determine which wereneeded. Another factor, the transporta-tion of units to theaters of operations, hadto be considered. To conserve shippingtonnage an attempt was made to includeonly indispensable articles in equipmentlists. This work was done by Colonel Off-utt, assigned to the Army Medical Centerin January 1939 and later transferred tothe Surgeon General's Office. He collab-orated with the Medical Field ServiceSchool (Carlisle Barracks, Pennsylvania),Walter Reed General Hospital, and TheSurgeon General's Supply Division andPlanning and Training Division. The firstlist completed (in June 1939) was for themedical regiment. Others—includingthose for hospitals—followed during theremainder of 1939 and the first ten monthsof 1940. As rapidly as they were approvedby the Surgeon General's Office they weremimeographed and sent to the variousmedical supply depots. Concurrently, thetable of basic allowances for the MedicalDepartment was revised by The Surgeon

6 (1) The above paragraph is based largely on acomparison of the following T/Os: Gen Hosps, T/O683W (6 Jun 32) with T/O 8-507 (25 Jul 40); StaHosp, T/O 684W (1 Jul 29) with T/O 8-508 (25 Jul40) and Evac Hosp, T/O 283W (1 Jul 29) with T/O8-232 (1 Oct 40). (2) See also Ltr, SG to TAG, 11 Jul40, 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 ColGuy B. Denit, MC, C&GS Sch, Ft Leavenworth, 11Feb 41. SG: 322.3-1. (2) For documents on the experi-mental development of these vehicles see SG: 322.15-17.


General's Planning and Training Divisionand was published on 1 November 1940.10

Efforts to Assure Availability of Equipmentand Personnel for Units Planned

Revision of equipment lists emphasizedthe importance of modernizing WorldWar I unit assemblages in storage. Afterthe war in Europe began, Surgeon Gen-eral Magee requested funds for this pur-pose. In April and again in May 1940 heinformed the General Staff of the MedicalDepartment's unpreparedness for war,stating: "I have not at the War Depart-ment's disposal for any emergency onecomplete, modern 1,000-bed general hos-pital for instant dispatch."11 Funds whichthe General Staff could secure werelimited.12 Moreover, believing that TheSurgeon General failed to recognize thatincreases in industrial capacity sinceWorld War I would make procurementeasier and faster, G-4 opposed "piecemealaction" which favored the Medical De-partment alone. Hence the Staff onlypromised "consideration" of Medical De-partment requirements along with thoseof other services, and it was not until themonth before the passage of the SelectiveService Act that substantial funds forMedical Department equipment were in-cluded in the War Department's budgetrequests.13

To provide professional staffs for hospi-tals included in the Protective Mobiliza-tion Plan, The Surgeon General early in1940 began to arrange with civilian medi-cal institutions for the organization ofauthorized affiliated units. By June 1940he requested an increase in their number,stating that the response of sponsoring in-stitutions was more enthusiastic than hehad expected. The next month the Gen-

eral Staff raised the numbers authorized to68 general, 30 evacuation, and 23 surgicalhospital units. About a year later the Sur-geon General's Office reported success inthe organization of affiliated units for 41general, 11 evacuation, and 4 surgical hos-pitals—approximately the number origi-nally authorized in 1939.14

Attempts to secure enlisted men fortraining in hospital units were only par-tially successful. Although draftees couldbe used to fill units scheduled for activa-tion during mobilization, trained cadreswould be required for each one and someunits would have to be ready for action onM Day. Therefore some men needed to betrained in units before mobilization. In-creases in the authorized enlisted strengthof the Army during 1939 and 1940 andin the authorized strength of the MedicalDepartment in May 1940 from 5 to 7 per-cent of Army's strength afforded someadditional men. Since most of them wereneeded for organic medical units of divi-sions or for expanding named hospitals,

10 (1) Hist of Basic Equip Lists for Med T/O Orgns,incl 2, to Ltr, Brig Gen Harry D. Offutt to Col H. W.Doan, 10 Jun 48. HD: 322. (2) .Memo, Capt ThomasN. Page for Gen Love, 28 Dec 40, sub: Activities ofthe 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 andPreparations (Washington, 1950), pp. 156-66, inUNITED STATES ARMY IN WORLD WAR II.

13 (1) Memo G-4/20052-134, ACofS G-4 WDGSfor 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, ActACofS 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 AG381(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.


the General Staff at first allotted none atall to nonorganic medical units and num-bered hospitals. Insisting upon the neces-sity of training men in such units, TheSurgeon General secured authority inJune 1940 for the organization, along withone medical laboratory and one medicalsupply depot, of two evacuation and twosurgical hospital units at half their table-of-organization enlisted strength, but itwas not until 1 August 1940 that the firstof these was activated.15

Preparing Hospitalization for Overseas AreasDuring a Peacetime Mobilization

Mobilization of the Army for a year ofpeacetime training reversed the situationwhich had been anticipated in mobiliza-tion plans. Instead of field medical unitssuch as regimental medical detachments,medical battalions, medical regiments,and numbered hospitals to support combatforces engaged in defensive operations, thegreatest need was for named hospitals inthe United States. Hence, they had firstcall upon medical personnel and equip-ment. Moreover, since the United Stateswas not at war, additional hospitalizationrequired in bases and possessions outsideits continental limits was provided on apeacetime basis—that is, in named hospi-tals. Nevertheless, medical units had to beorganized and trained along with thecombat forces they were designed to sup-port.

Activation of Field Medical Units

When mobilization began in September1940 the Army had, aside from the medi-cal units that were organic parts of exist-ing divisions, only the following field med-ical units: 2 surgical hospitals, 2 evacua-

tion hospitals, 2 medical regiments, 1 med-ical supply depot, and 1 medical labora-tory.16 Additional organic medical unitswould be activated and trained along withtheir parent units, such as infantry divi-sions. Their number depended upon thenumber of parent units that would becalled into being by the General Staff. Thenumber of nonorganic units—those serv-ing with armies, corps, and General Head-quarters—that would be activated fortraining might differ from the numberneeded for combat operations. In anticipa-tion of the passage of the Selective ServiceAct, The Surgeon General had recom-mended in July 1940 the activation at halfstrength of all such units in the ProtectiveMobilization Plan except hospital centers,hospital trains, the auxiliary surgicalgroup, and the general dispensary.17 TheGeneral Staff partially adopted this rec-ommendation in preparing the 1941 troopbasis. In December 1940, it authorized thefollowing corps, army, and GHQ medicalunits: 8 medical battalions, 8 medicalregiments, 1 medical supply depot, 1medical laboratory, 1 general dispensary,15 evacuation hospitals, 6 surgical hospi-tals, 22 general hospitals, and 22 stationhospitals.18 Approximately half of these

15 (1) Memo, ACofS G-1 WDGS for TAG, 6 Nov39, sub: Enl Pers, MD. G-1: 15081-Med. (2) Ltr AG320.2 (5-13-40)M-D, TAG to SG, 14 May 40, sub:Adequacy of Serv Units as Contained in Proposed TrpBasis, with 1st ind, SG to TAG, 20 May 40. SG:320.2-1. (3) Memo, SG for ACofS G-3 WDGS, 26Jun 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 cardsof 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 CGsof all Armies et al., 16 Dec 40, sub: Constitution andActivation of Units. AG: 320.2(11-15-40)(1) Sec 1.


units were to be activated in February1941 and the rest in June. Early in 1941the Staff revised the troop basis, andauthorized an additional medical bat-talion and two additional medical regi-ments. By the end of June 1941 all of theunits authorized had been activated. Thenext month two additional station hospi-tal units were provided when two provi-sional hospitals, organized but not neededfor a task force, were redesignated asnumbered hospitals. Although plans weremade later in the year for additional units,no more were authorized until after warcame.19

Role of Hospital Units;Their Personnel and Equipment

Confusion existed about the purpose ofthe hospital units activated during thisperiod. The character of the mobilizationand the nature of the international situa-tion were perhaps responsible for this.Under the Selective Service Act, Reserv-ists and draftees could not legally be madeto serve outside the United States exceptin its territories and possessions. Neverthe-less, the Army being mobilized had to beprepared for action anywhere in the eventof a threat to the security of the country.

The Surgeon General seems to have re-garded authorized hospital units as pri-marily if not exclusively schools for tacticaltraining that would furnish cadres forother similar units or would providetrained enlisted men as fillers for the hos-pitals that would be called up in case ofwar—that is, the affiliated units. Alongwith shortages of personnel and equip-ment and demands of named hospitals forboth, this view undoubtedly influenced hisrecommendations and plans for supply-ing hospital units with these elements. As

tactical training units, numbered hospitalswould need—in The Surgeon General'sopinion—officers and equipment for unitadministration and field training only.Their enlisted members would be giventechnical training in named hospitals orin enlisted technicians' schools. Moreover,full assemblages of equipment and com-plete officer staffs were not available fornumbered hospitals. Therefore, The Sur-geon General planned to issue only fieldtraining equipment to numbered hospitalunits and he recommended that fewofficers, from two to five, should be as-signed to each.20

The General Staff considered the 1941hospital units not as training schools butas true hospitals which could operate inthe United States (presumably on maneu-vers) or in theaters of operations "in theevent of an emergency." On 3 January1941 it issued a letter to that effect.21

Despite this view, the Staff adopted TheSurgeon General's recommendation thathospital units be given only part of theirpersonnel—perhaps because of the short-age of men and officers to meet variousneeds and demands.22 Those formed dur-

19 (1) Annual Report . . . Surgeon General, 1941(1941), pp. 153-54. (2) An Rpt, 1941, Surg GHQ.HD. (3) Ltr AG 320.2(5-14-41) MC-C-M, TAG toCofS GHQ; CGs of all Armies, CAs, and Depts; C ofArms and Servs, etc, 22 Nov 41, sub: Revision of TrpUnit 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 . . . SurgeonGeneral, 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 CofSGHQ CGs of Armies, et al., 3 Jan 41, sub: Purposeand Tng of Certain MC Units to be Activated withSel Serv Men. SG: 322.3-1.

22 Ltr AG 111 (12-23-40) M-C-M, TAG to CofSGHQ; CGs Armies, CAs, and Depts, 31 Dec 40, sub:Trp Basis, PMP, 1941. AWC: 160-93.


ing 1941 received initially, in addition tocadres of Regular Army enlisted men,from two to five officers each and onlyenough selectees—either from receptioncenters or from replacement trainingcenters—to provide them with about halfof their table-of-organization enlistedstrength.23

The position of the Staff on equipmentdiffered from The Surgeon General's. InDecember 1940 it announced a supplypolicy for all Army units—they would ob-tain complete issues of authorized equip-ment, except controlled items (that is,those in short supply and issued only onspecial instructions by the War Depart-ment), by submitting requisitions to corpsarea headquarters. Two weeks later itissued another directive making this policyapplicable specifically to Medical Depart-ment units,24 but a shortage of suppliesand equipment made compliance withthis directive impossible when hospitalunits were first activated in 1941.25

Toward the middle of 1941 the views ofThe Surgeon General on the purpose ofhospital units began to coincide with thoseof the General Staff. By that time he hadbeen required to provide medical com-plements for hospitals being established innew overseas commands and to preparemedical support for task forces beingformed to occupy the French West Indieswhen it was feared that area might fallinto German hands.26 For these purposeshe drew personnel from named hospitalsin the United States. In May 1941 he in-formed G-3 that he was having consider-able difficulty in providing hospitals for"task forces destined for early dispatch."Explaining that he had to collect medicalpersonnel from many scattered sources forthis purpose, he pointed out that this wasnot only a disorderly process but also a

threat to the medical service of the hospi-tals from which personnel was drawn. Hetherefore asked G-3 to authorize full com-plements of officers, nurses, and enlistedmen for seventeen of the hospitals acti-vated earlier in 1941. This would simplifythe problem, he thought, of convertingtraining units into functional units. At thesame time he requested authority to with-hold from such units all supplies andequipment, except training equipment,individual equipment, motor transporta-tion, and controlled items, until their as-signment to missions involving medicalcare.27 Early in July the Staff approvedsufficient increases in the personnel ofeleven—but not seventeen—units to bringtheir number of enlisted men up to almostfull table-of-organization strength and ofofficers and nurses up to 50 and 75 percentrespectively. The Staff also approved TheSurgeon General's proposal to withhold theissuance 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, and214th Gen Hosps. HD.

24 (1) Ltr, TAG to CofS GHQ; CGs Armies, CAs,et al., 30 Dec 40, sub: Current Sup Policies and Pro-cedure. AG: 475 (8-12-40) (1) Sec 1. (2) Ltr AG320.2 (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 wasavailable in medical supply depots in June 1941.Memo for Record on Memo, Act ACofS G-4 WDGSfor TAG, 13 Oct 41, sub: Equip for Med Units. . . .HRS: G-4/33344. (2) See An Rpts of numberedhosps cited above. HD.

26 (1) See below, pp. 48 and 49. (2) An Rpts, 1943,167th and 168th Sta Hosps. HD. These hospitals wereoriginally organized as provisional hospitals, StationHospitals A and B, for service with a task force beingorganized for the occupation of the French WestIndies.

27 Memo, SG for ACofS G-3 WDGS, 27 May 41,sub: Med Units, Task Forces. . . . AG: 320.2 (5-27-41) (6).


eleven units, thus sanctioning, at least forthis group, the practice already followed.The next month, G-4 refused to grant TheSurgeon General's request to approve thispractice as policy for all other numberedhospital units. Accordingly, when a "WarDepartment Pool of Task Force Units"was formed in August 1941, raising thetotal number of hospital units earmarkedfor actual operations from eleven to thirty-one, different supply procedures prevailedfor the two groups.28

In the fall of 1941 the difference ofopinion about issuing hospital assemblagesreached a crucial point when G-4 notedthat only four assemblages had been com-pleted by October, that demands of thePhilippine Army and lend-lease aid mightseriously interfere with the completion ofothers, and that, according to its observers,hospital units participating in maneuversneeded full issues of equipment. Accord-ingly G-4 asked The Surgeon General forrecommendations on speeding up theequipment of units in the task force pool.29

In reply The Surgeon General pointed toprogress, stating on 5 November 1941 thatfive 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 bymanufacturers and again requested per-mission to hold assemblages in depots un-til hospital units were assigned to missionsinvolving the actual care of patients. Insupport of this request he argued thatunits in training did not need full equip-ment, storage for it in the field was inade-quate, careless handling by unit memberswould cause breakage and deterioration,and units would be unable to repackassemblages for shipment.30 Maintainingits position but recognizing the possibilityof warehousing shortages, G-4 began a

survey of corps area storage facilities on6 December 1941 and directed The Sur-geon General to earmark and hold allavailable equipment for specific unitsuntil further notified.31

Training and Use of Hospital Units

In accord with The Surgeon General'splan—that members of hospital unitswould receive tactical training in units buttechnical training in named hospitals—numbered hospital units were generallystationed near named hospitals, but con-fusion existed about the command thatwas 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 Jul41, 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 ExpeditionaryForces. SG: 322.3-1.

29 (1) Memo, Act ACofS G-4 WDGS for TAG, 13Oct 41, sub: Equip of Med Units for WD Pool of TaskForces, with Memo for Record. HRS: G-4/33344. (2)1st ind, SG to TAG, 16 Oct 41, and 2d ind, TAG toSG, 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 ColClarence 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 Poolof Task Forces. HD: Wilson files, "Vol. I, 15 May 41-20 Jan 42." (4) D/S, Act ACofS G-4 WDGS forTAG, 25 Oct 41, sub: Equip for Med Units for WDPool of Task Forces, with Memo for Record. HRS:G-4/33344.

30 (1) Ltr, SG to TAG, 5 Nov 41, sub: Equip forMed 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 andProcedures for Classification, Storage, and Issue ofSup." Same file.

31 (1) Memo, Act ACofS G-4 WDGS for TAG,27 Nov 41, sub: Equip forMed Units for WD Pool ofTask Forces, with Memo for Record. HRS: G-4/33344. (2) 1st ind, TAG to SG, 6 Dec 41, on Ltr, SGto 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.


corps areas late in 1940, the General Staff,it will be recalled, either assigned or at-tached to the four field armies all num-bered medical units, including station andgeneral hospitals that did not normallyserve under the jurisdiction of field armies.At the same time, the Staff directed corpsarea commanders to make their medicalfacilities available for the training of hos-pital units, and it forbade army com-manders to assume control over such unitswithout the approval of corps area com-manders. Furthermore, while one direc-tive stated that the personnel and units offield forces on duty with corps areas wouldbe controlled entirely by corps area com-manders, another forbade the same com-manders to assume jurisdiction over fieldforce units undergoing training in corpsarea installations.32 As a result, neitherGHQ nor the Surgeon General's Officeexercised any very direct control overnumbered hospital units, and the unitsthemselves were sometimes confused as towhether they were subject to army or corpsarea command.33

Without close supervision from higherauthorities the training which hospitalunits received depended primarily uponthe attitudes of local surgeons and unitcommanders. In some instances, well-planned on-the-job training programswere established in named hospitals andwere co-ordinated with unit field training.In others, the commanders of named hos-pitals assigned men from numbered unitsto vacant jobs regardless of their trainingvalue. In such cases technical training suf-fered because many men did only menialwork, and controversies developed be-tween hospital commanders responsiblefor post medical care and unit com-manders responsible for the technical aswell as the field training of their men.34

Confusion about the control of hospitalunits also affected their use on maneuvers.Explaining his lack of authority over hos-pital units, The Surgeon General sug-gested that the personnel of some shouldbe used to augment the staffs of namedhospitals and to assist medical detach-ments, battalions, and regiments engagedin maneuvers. He proposed that otherunits should be employed in giving medi-cal care as they would in theaters of oper-ations.35 Their use in this manner was lim-ited by incomplete staffs and lack ofequipment. In some instances evacuationhospitals borrowed enough personnel andequipment from other medical units andfrom corps areas to enable them to providelimited hospitalization for troops in thefield. After they were set up, such hospitalstended to become stationary. Army com-manders then had to improvise mobilehospitals by using personnel and equip-ment of medical regiments. Generallyarmies had to rely upon corps areas for

32 (1) Ltr AG 320.2(9-27-40) M-C, TAG to C ofArms and Servs, CGs of Armies, Army Corps, Divs,CAs and Depts, etc., 3 Oct 40, sub: Orgn, Tng, andAdmin 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, 14Jan 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, 2 2 2 d , 2 1 3 t h , 215th , and 183d GenHosps. HD.

34 (1) Memo, Lt Col T. E. Huber for Historian, TngDiv SGO, 4 Jun 45, sub: Unit Tng, ASF, World WarII. HD: 353. (2) Memo 2, incl to Ltr, Col Daniel J.Sheehan, MC, to Col Roger G. Prentiss, Jr, MC, 10May 51. HD: 314 (Correspondence on MS) III.

35 Rpt, Conf of SG with CA Surgs, 10-12 Mar 41.HD: 337.


hospitalization of troops on maneuvers.To assist corps area hospitals and at thesame time to give members of numberedunits some experience in the actual opera-tion of hospitals, station, general, evacua-tion, and surgical hospital units were at-tached to named hospitals in maneuverareas. Because their members were usuallyintegrated with the staffs of corps areahospitals, such units not only tended tolose their identities but also failed toacquire experience as functioning organi-zations.36

Furnishing Hospitalizationfor Overseas Areas

Even before war actually began, addi-tional hospitalization had to be suppliedfor troops in garrisons in territorial posses-sions of the United States and on islandbases leased from the British in September1940. In the Hawaiian and PhilippineIslands, the Panama Canal Zone, PuertoRico, and Alaska, hospitals were ex-panded as in the United States and addi-tional increments of supplies and person-nel were sent to care for the expansion.37

According to War Department plans, theAtlantic bases were to be garrisoned andoperated on a peacetime basis. The Sur-geon General's Office therefore plannedhospitalization for them in the same wayas for posts in the United States. Aftercomputing bed requirements on a 5 per-cent ratio, the Hospital Construction andRepair Subdivision collaborated with theChief of Engineers (who was charged withthe construction of those bases) in drawingplans for permanent or semipermanenthospital buildings of appropriate sizes.Meanwhile, other groups in the Officeplanned shipments of supplies and equip-

ment and earmarked personnel to bedrawn from existing installations for newhospitals.38

Implementation of the plans to garrisonthe Atlantic bases got under way early in1941 before construction was completed.In January a few medical officers and asmall detachment of enlisted men sailedwith troops being sent to St. John's, New-foundland. They operated a 40-bed hospi-tal aboard the transport Edmund B. Alexan-der until it was ready to return to theUnited States about the middle of June.Then they moved into a rented estate atNorthbank.39 In April, a second group ofmedical personnel, consisting of 21 medi-cal officers and 164 enlisted men, accom-panied the garrisons bound for Trinidadand Bermuda. The detachment whichaccompanied the Trinidad base force es-tablished a hospital in a temporary, single-building structure. The one which went toBermuda set itself up, along with baseheadquarters and other activities, in ahotel building. In other bases medical offi-cers with small staffs operated dispensariesand arranged for the hospitalization ofpatients needing further treatment either

36 An Rpts, 1941, Surg GHQ, First Army, SecondArmy, Third Army, Fourth Army, and 1st, 4th, 6th,10th, 11 th , 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, Welshfile.

38 (1) Memo, Lt Col H. D. Offutt for Maj Welsh,8 Feb 41. HD: Atlantic Bases file folder. (2) Ltr, SGto CofEngrs, 25 Feb 41, sub: Floor Plans for MD Facat Antigua, Bahama, British Guiana, and SaintLucia. SG: 632.-1. (3) Memo, SG for Maj [Henry I.]Hodes, G-3, 28 Nov 40, sub: MD Pers for AtlanticBases. HD: Atlantic Bases file folder. (4) Ltr, SG toCofEngrs, 10 Mar 41, sub: Med Sups and Equip. . . , and 1st ind, CofEngrs to SG, 31 Mar 41. Samefile.

39 An Rpt, 1941. Sta Hosp. Newfoundland BaseComd. HD.


in hospitals established by the Engineersfor civilians working on Army construc-tion or in hospitals operated by theBritish.40

In the fall of 1941 the first numberedhospital units were sent overseas. Underan agreement with the Icelandic Govern-ment, the United States established a forcein Iceland as an outpost of defense. On5 September 1941 the second echelon ofthis force, "the first United States expedi-tion to depart with a complete plan andall means necessary to implement it,"41

sailed from New York. The 11th, 167th,and 168th Station Hospitals accompaniedit. The last two were composed of RegularArmy men drawn from named hospitalsin the United States and organized inmid-1941 as provisional Station HospitalsA and B for service with an expedition(later canceled) to the French West Indies.The other was made up primarily ofdrafted men who converted themselvesinto Regular Army soldiers by volunteer-ing for three-year enlistments before sail-ing. Upon arriving in Iceland only one ofthese units actually operated a hospital in1941. On 24 September the 168th openedin a permanent three-story frame buildingat Camp Laugarnes. The 11th and 167thwere attached to the 168th and served asmaintenance and construction forces onroads, utilities, and buildings.42

Plans and preparations for hospitaliza-tion in overseas areas were limited duringthe emergency period by meager fundsand the uncertain nature of the peacetimemobilization. For this reason the MedicalDepartment encountered difficulty—as itwould later for other causes—in securingauthority from the War Department Gen-eral Staff to plan for and activate as manyhospital units as it considered desirable.

For estimating requirements the SurgeonGeneral's Office had only World War Iexperience to rely upon, and there weredifferences of opinion as to how manyfixed beds would be really needed. Inorder to enable units to give modern med-ical care, the tables governing their organ-ization and equipment were revised. Al-though personnel authorized by such re-visions was often increased, the GeneralStaff began a practice—to be carried togreater lengths later—of requiring reduc-tions in both personnel and equipment fortable-of-organization units. Affiliated unitswere organized and some regular unitswere activated. The role of the latter wasuncertain, but The Surgeon Generalgradually tended to agree with the Gen-eral Staff that some of them at least wouldbe used to give actual medical care. Therest would continue to train fillers foraffiliated units. While The Surgeon Gen-eral and the General Staff agreed uponthe policy of providing hospital units withless than full quotas of officers and enlistedmen, they disagreed upon the question ofwhether or not units in training shouldreceive full issues of supplies and equip-ment. This dispute was to continue un-abated during the first half of the war.

40 (1) Memo, Maj A. B. Welsh for Brig Gen A. G.Love, 7 Apr 41, and Ltr AG 320.2(4-8-41)M-D-M,TAG to C of Arms and Servs, 8 Apr 41, sub: Immedgarrison for Bermuda and Trinidad. . . . HD: At-lantic Base file folder. (2) A History of Medical De-partment Activities in the Caribbean Defense Com-mand in World War II, vol I, pp. 245-46, 281-82,311, 314, and 320. HD. (3) An Rpt, 1941, Surg Ber-muda Base Comd. HD.

41 Greenfield et al., op. cit., pp. 22-23. For a fulldiscussion of the agreement with Iceland and theforce sent for its defense, see Stetson Conn and ByronFairchild, Defense of the Americas, Vol. II, a forth-coming volume in the series UNITED STATESARMY 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 mobiliza-tion the United States was not preparedfor the offensive when war came on 7 De-cember 1941. An immediate necessity wasthe deployment of troops to protect thecountry and its overseas bases. At the sametime the Nation's power had to be mo-bilized and co-ordinated with that of itsAllies. The Army's total strength increasedfrom 1,686,403 in December 1941 to6,993,102 in June 1943. Although mosttroops were of necessity in training in theUnited States, enough were overseas bythe latter part of 1942 to permit a transi-tion from the defensive to the offensivewith assaults upon the Japanese in theSolomons and the invasion of NorthAfrica. By June 1943 the peak of the prep-aration phase was reached. The nextmonth saw the beginning of a steadydecline in the strength of the Army athome as more and more troops movedoverseas. In the latter half of 1943 theinvasion of Sicily and Italy occurredand the Pacific island-hopping, whichwas to culminate in the defeat of Japan,began.

The Medical Department, like the restof the country, was unprepared to supportoffensive operations at the outbreak of thewar. This lack of preparation is most evi-dent in the field of hospitalization. Fewhospital units were in training and equip-ment in the war reserve was inadequateand in part obsolete. Although hospitals inthe United States were sufficient for theArmy that had thus far been mobilized,

additional beds had to be provided rap-idly as the Army's numerical strength shotupward. The first year and a half of thewar was therefore a period of "growingpains" for the Medical Department, dur-ing which it adjusted itself to the demandsof global warfare and with some difficultydiscarded or modified peacetime practicesand procedures in favor of those requiredby far-flung offensives. It was a time offinding out what was wrong with prewarplanning and of correcting errors; of meet-ing immediate needs in the quickest possi-ble fashion and of preparing at the sametime for future operations. Under GeneralMagee's leadership, the Department ex-hibited certain conservative tendencies inhospital expansion and administrationwhich sometimes irked those in higherpositions of authority. Nevertheless manydevelopments considered progressive inthe later war years had their origins duringthis period.

At this time also a reorganization of theWar Department shifted The SurgeonGeneral to a new position in the officialhierarchy. Affecting his responsibility andauthority for hospitalization, it requiredmajor adjustments in the relationships ofhis Office with other War Departmentagencies. The main features of that reor-ganization and its effects, along withchanges in units in the Surgeon General'sOffice concerned with hospitalization,need to be discussed before details of theexpansion and administration of hospitalsare considered.

CHAPTER IV

Changes in Organizationand Responsibilitiesfor Hospitalization

Since most changes occurring early inthe war in the responsibilities of variousagencies for hospitalization resulted fromthe reorganization of the War Departmentin March 1942, major outlines of the neworganization must be described brieflyhere.1 In this connection one should un-derstand that difficulties in hospitalizationand evacuation resulting from the reor-ganization were aspects of a larger prob-lem involving activities of the MedicalDepartment in general and that similarproblems were often encountered by othertechnical and supply services.

Reorganization of the War Department

Under the new setup the General Staffwas relieved of some of its administrativeand operative functions in the zone of in-terior by the creation of three major com-mands—Army Air Forces, Army GroundForces, and Services of Supply (calledArmy Service Forces after March 1943).The divisions of the General Staff were todevote themselves to planning, to the gen-eral supervision of matters for which theywere traditionally responsible, and to thestrategic direction offerees in theaters ofoperations. The three major commands

were all subject to the supervision andcontrol of the General Staff, under theChief of Staff, General George C. Mar-shall. War Department charts placedthem all on the same level, but differencesof opinion subsequently developed overwhether or not they were actually coequalin authority.

The Army Air Forces, which had beenestablished in June 1941 and had attaineda great deal of practical autonomy, hadtaken the lead and supplied the drive forthe reorganization as a means of protect-ing and regularizing its current position.Colonel Grant continued as the Air Sur-geon. The Army Ground Forces com-prised the arms (such as Infantry, Caval-ry, and Artillery) and was responsible for

1 Fuller discussions may be found in other volumes:(1) John D. Millett, The Organization and Role of theArmy Service Forces (Washington, 1954), pp. 23-42,93-97, 132-37, 148, 298-309, Ray S. Cline, Washing-ton Command Post: The Operations Division (Washing-ton, 1951), pp. 61-74, 90-95, 111-19, and Kent R.Greenfield, Robert R. Palmer, and Bell I. Wiley, TheOrganization of Ground Combat Troops (Washington,1947), pp. 142-45, 268-71, all in UNITED STATESARMY IN WORLD WAR II. (2) Wesley FrankCraven and James Lea Cate, eds., The Army Air Forcesin World War II (Chicago, 1948), Vol. I, pp. 257-67.(3) Blanche B. Armfield, Organization and Adminis-tration (MS for companion vol. in Medical Dept.series). HD.

CHANGES IN ORGANIZATION AND RESPONSIBILITIES 55

preparing the ground army for combat.General Headquarters was now liqui-dated and much of its personnel wastransferred to AGF headquarters. ColonelBlesse then became Chief Surgeon of theArmy Ground Forces (or the Ground Sur-geon). He remained in that position untilDecember 1942, when he was succeededby Col. William E. Shambora, and re-turned to it again in May 1944 for the restof the war.

To the Services of Supply were assignedthe corps areas, the technical and supplyservices such as the Medical Departmentand the Quartermaster Corps, certainWar Department administrative services,and some of the functions and personnelof G-4. Lt. Gen. (later General) Brehon B.Somervell, Assistant Chief of Staff, G-4,of the War Department General Staffsince 25 November 1941, became Com-manding General, Services of Supply.Under his jurisdiction was The SurgeonGeneral, the head of the Medical Depart-ment.

The Surgeon General's New Position

Uncertainty developed about the effectthe reorganization had or should have onresponsibilities and authority for hospital-ization and other medical activities. WhileGeneral Magee recognized that therewere "changes in the flow of control fromthe Secretary of War to the Medical De-partment," he did not believe that the re-organization had altered the responsibilityof The Surgeon General for the healthand medical care of the entire Army.2 Ap-parently he did not comprehend at theoutset the full impact on his office of theinterposition of an intermediate head-quarters between himself and the GeneralStaff. According to SOS doctrine General

Somervell was responsible for all activities,including hospitalization, within the Serv-ices of Supply and was at the same timestaff adviser to—and in some instancesspokesman for—the Chief of Staff on sup-plies and services, including medical, forthe entire Army.3 In his new position, TheSurgeon General was an adviser to Gen-eral Somervell. In this capacity the extentto which General Magee could dischargewhat he considered to be his responsibil-ities depended primarily upon the degreeto which General Somervell accepted hisrecommendations (1) regarding SOSmedical matters as the basis of commanddecisions and (2) regarding Army-widemedical matters as a basis for action oradvice to the Chief of Staff. So far as hos-pitalization and evacuation in particularwere concerned, it depended—partially,at least—upon the role of a medical sec-tion in SOS headquarters.

When SOS headquarters was estab-lished in March 1942 a medical officer,Lt. Col. William L. Wilson,4 was trans-ferred from G-4 along with GeneralSomervell, Brig. Gen. (later Lt. Gen.)LeRoy Lutes, and others. For severalmonths he served in the MiscellaneousBranch of the SOS Operations Divisionunder General Lutes. In July 1942, whenSOS headquarters was reorganized, a

2 (1) Ltr, SG to CG SOS, 25 Mar 42, sub: Med Servof 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. Samefile. (3) The SOS viewpoint is explained in Millett,op. cit., pp. 143-47.

4 Colonel Wilson received his promotion frommajor to lieutenant colonel on 18 April 1942 but itwas retroactive to 1 February 1942. This accounts forthe fact that documents signed by him and cited inthe footnotes show him as a major until the middle ofApril.


Hospitalization and Evacuation Branchwas established in General Lutes' officeand Colonel Wilson was made its chief.This Branch gained additional medicalofficers and by October 1942 it had, inaddition to its chief, one Medical Admin-istrative Corps and three Medical Corpsofficers. Lt. Col. William C. Keller, aphysician formerly with the PennsylvaniaRailroad, was in charge of a railwayevacuation section. Maj. (later Col.) JohnC. Fitzpatrick, who had had experience asa transport surgeon, was in charge of a seaevacuation section. Maj. (later Lt. Col.)Henry McC. Greenleaf devoted his atten-tion to hospitalization. The administrativeofficer, Maj. (later Col.) Harry J. Nelson,was in charge of office administration.5

The SOS statement of the functions ofthis Branch—to review plans for, co-ordi-nate activities related to, and insure themeans for hospitalization and evacua-tion—was subject to different interpreta-tions. General Magee believed that hisOffice was best equipped to decide uponmedical matters and that his adviceshould be given preponderant weight. Ac-cordingly, in his opinion any medical of-ficer in a staff position of a higher head-quarters should be a representative of TheSurgeon General and should receive hisinstructions and advice from the SurgeonGeneral's Office. He interpreted estab-lishment of the Hospitalization and Evac-uation Branch as representing a desire inSOS headquarters for a section to co-ordinate activities of various Army agen-cies in the transportation (or evacuation)of patients.6

The SOS viewpoint was different. InJuly 1942 General Lutes informed corpsarea commanders that the "Hospitaliza-tion and Evacuation Branch lays downthe policies to the Surgeon General on

Hospitalization and Evacuation," andthat it then visited their areas to see if"policies and plans as laid down to theSurgeon General" were satisfactory andwere being followed.7 Colonel Wilson tookthe position that hospitalization and evac-uation required supervision by a higherheadquarters than the Surgeon General'sOffice. In explaining his position as chiefof the SOS Hospitalization and Evac-uation Branch, he emphasized that hehad no authority as a staff officer to makedecisions or to issue orders concerninghospitalization and evacuation (that couldbe done only by General Somervell orGeneral Lutes) but that it was his respon-sibility to gather and evaluate informationon such matters and to present it, alongwith recommendations for action, to Gen-erals Lutes and Somervell. If his advicediffered from The Surgeon General's, hestated, he gave the latter's opinion as wellas his own.8 In view of different concep-tions of their respective responsibilities, itwas perhaps inevitable that conflictswould develop between the SOS Hospi-talization and Evacuation Branch and theSurgeon General's Office.9

5 (1) WD Cir 59, Orgn Chart, SOS Orgn, 2 Mar42. (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 notesemployed by Maj Gen James C. Magee in conf in HDAML, 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, 18Apr 42, sub: Hosp and Evac Oprs, SOS. HD: Wilsonfiles, "No 472, Hosp and Evac, 1941-42." (2) Cmteeto 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.


The extent to which The Surgeon Gen-eral could discharge his responsibility forthe health and medical care of the Armydepended also upon willingness of com-manders of the Ground and Air Forces toadmit that the Commanding General,Services of Supply, or one of his subordi-nates, had any authority—even technicaland professional—over matters for whichthey were responsible and upon whichtheir own surgeons could advise them.

So far as hospitalization in the UnitedStates was concerned, this involved mainlythe Air Forces. Since the Ground Forceswere to occupy and use stations operatedby the Services of Supply, AGF headquar-ters readily accepted the dictum that the"Medical Department under the com-mand of the Commanding General, Serv-ices of Supply," would furnish all of itshospitalization and evacuation in theUnited States except that provided byfield medical units operating under tac-tical control. On the other hand, it will berecalled that the Air Forces already had aseparate set of hospitals and the reorgan-ization placed them, along with stationsthey served, under command of the Com-manding General, Army Air Forces.

Several documents issued after the re-organization purported to clarify the re-spective responsibilities of the commandersof the Air and Service Forces and the re-lationships of the Air Surgeon and TheSurgeon General. A General Staff direc-tive charged all commanders with "com-mand responsibility for the operation ofall medical facilities under their controland for future planning in connectiontherewith." It also charged the Com-manding General, Army Air Forces,"with development and operation of airevacuation," and the Commanding Gen-eral, Services of Supply, with providing

"for the evacuation of sick and woundeddelivered to his control," and with "ad-ministrative responsibility for the coordi-nation of the plans of all commands forevacuation of the sick and wounded to bedelivered to his control, and for coordina-tion of plans for hospitalization within thecontinental United States." An SOS direc-tive on 18 June 1942 charged The SurgeonGeneral with "the initial preparation andthe maintenance of basic plans for mili-tary hospitalization and evacuation oper-ations, and the coordination of the planstherefor of all commands concerned." Anannouncement of an agreement betweenthe Air Surgeon and The Surgeon Gen-eral, approved by G-3, had stated earlierthat the "routine conduct of medicalactivities with the Army Air Forces" was a"responsibility of each local surgeon actingunder the Air Surgeon, who is responsibleto The Surgeon General for the efficientoperation of Medical Department tech-nical activities with the Air Forces." Ithad also stated that the Air Surgeonwould not duplicate activities of the Sur-geon General's Office, "with the exceptionof those procedures necessary for theproper control of Medical Departmentpersonnel and activities under the juris-diction of the Army Air Forces." 10

None of these documents specificallystated that the Services of Supply was to

10 (1) Ltr, SG to CG SOS, 25 Mar 42, sub: MedServ of Army. HD: 321.6-1. (2) Memo, CG SOS forACofS G-3 WDGS, 26 Mar 42, sub: Med Activitiesunder 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 toCGs AGF, AAF, SOS, All Def Comds, All Depts, AllTheaters, and All Sep Bases, 18 Jun 42, sub: WDHosp and Evac Policy. HD: 705.-1. (5) Ltr SPOPM322.15, CG SOS to CGs and COs of CAs, PEs, andGen Hosps, and to SG, 18 Jun 42, sub: Opr Plans forMil Hosp and Evac, with incl. SG: 705.-1.


exercise authority over AAF hospitaliza-tion and all of them were sufficientlyvague to permit a variety of interpreta-tions. Difficulties that arose from AirForces' resistance to SOS claims of au-thority and from the Air Surgeon's striv-ings for completely separate AAF hospi-talization will be discussed later.11

The division of responsibility for hospi-tal units being prepared in the UnitedStates for overseas service was clearer.This problem involved mainly the ArmyGround Forces, for the Air Forces at thattime had no such units and made no bidfor them.12 Moreover, in February 1942General Magee had secured Staff ap-proval of a policy of "providing over-allhospitalization for task forces, instead ofattempting to provide separate hospital-ization for the air and ground componentsthereof. . . ." 13 While it was clear thatthe reorganization placed medical unitsthat were organic elements of air andground combat forces under AAF andAGF headquarters respectively, respon-sibility for nonorganic service units, suchas hospitals, was left to be "directed by theWar Department." 14

The Ground Surgeon believed thatmedical units normally used in combatzones in close support of ground troopsshould be assigned to the Ground Forcesand those normally used in communica-tions zones, to the Services of Supply.15

Mindful of his position as chief medicalofficer of the Army, The Surgeon Generalwanted all hospital units—those thatserved in combat as well as in communi-cations zones—and certain other medicalunits that normally served as parts of fieldarmies, such as medical laboratories anddepots, to be under the jurisdiction of theServices of Supply.16 On the recommen-dation of its Hospitalization and Evacua-

tion Branch, SOS headquarters firstrequested that only general and stationhospital units be placed under SOS con-trol but later adopted The Surgeon Gen-eral's position.17

After considerable investigation andstudy of the larger problem of jurisdictionover service units in general, G-3 took aview that coincided with the Ground Sur-geon's. On 30 May 1942 it announcedthat the three major commands would, ingeneral, train the nondivisional serviceunits which they used.18 On 8 July 1942this principle was extended to cover acti-

11 See below, pp. 106-09, 117-20, 173-76, 182-88.12 In March 1942 AAF Headquarters concurred in

the SOS proposal that SOS have jurisdiction overgeneral and station hospital units and AGF over allother field medical units. Memo, CG SOS for ACofSG-3 WDGS, 26 Mar 42, sub: Med Activities underWD Cir 59, 1942. HD: Wilson files, "Book I, 26 Mar42-26 Sep 42."

13 1st ind SGO 322.4-1, SG to TAG, 5 Feb 42, and2d ind AG 320.2 (1-29-42) MSC-C, TAG to SG, 18Feb 42, on Memo, C of Air Staff for SG, 29 Jan 42,sub: Expansion Program of AAF for Calendar Year1942. 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 Mar42. SG: 322.3-1. (3) Ltr, SG to CG SOS, 28 Oct 42,sub: Recomds in Regard to Activation, Control, andTng of Med Units, with 1 incl. SG: 320.3-1.

17 (1) Memo for Record on Draft Memo, CG SOSfor ACofS G-3 WDGS, 26 Mar 42, sub: Med Activi-ties under WD Cir 59, 1942. HD: Wilson files, "BookI, 26 Mar 42-26 Sep 42." (2) Memo SP 020(3-28-42), CG SOS (init WLW[ilson]) for ACofS G-3WDGS. 17 Apr 42, same sub. Same file. (3) Memo,CG SOS for ACofS G-3 WDGS, 14 May 42, sub:Responsibility for Tng. HRS: G-3/353 (Only) vol. II.(4) For a discussion of the general problem, see Rob-ert R. Palmer, Bell I. Wiley, and William R. Keast,The Procurement and Training of Ground Combat Troops(Washington, 1948), pp. 499-511, in UNITEDSTATES ARMY IN WORLD WAR II.

18 Memo WDGCT 353 (5-30-42), ACofS G-3WDGS for CGs AGF, AAF, and SOS, 30 May 42,sub: Responsibility for Tng. HRS: G-3/320.2 "Acti-vation, vol. I."


vations also.19 As a result, for the rest ofthe war the Services of Supply was re-sponsible for activating and training com-munications zone units. Among them werefixed hospitals, such as general, station,and hospital center units, and certainevacuation units, such as hospital trainsand hospital ship companies. The ArmyGround Forces was similarly responsiblefor combat zone units, including surgicaland evacuation hospitals as well as suchunits as medical regiments, medical bat-talions, medical detachments, and medi-cal supply depots.

With division of responsibility for acti-vating and training service units, AGFheadquarters assumed responsibility forrecommending the number of mobileunits to be included in the troop basis,while The Surgeon General and SOSheadquarters concentrated on units forfixed hospitals. Subsequently, responsi-bility for preparing tables governing theorganization and equipment of hospitalunits was also divided. Since mobile hos-pitals were designed for use in combatzones, AGF headquarters felt that it shouldbe free to make such changes in person-nel and equipment of these hospitals as itfound desirable for tactical reasons.

In September 1942 G-4 proposed thatAGF headquarters should be given re-sponsibility for the preparation of tablesfor all AGF service units.20 General Som-ervell feared that the chiefs of technicalservices, including The Surgeon General,might be bypassed if this proposal wereadopted. On his recommendation, G-4amended its original proposal to requireAGF to consult with SOS when prepar-ing tables for service units.21 Thereafter,responsibility for the preparation of tablesof organization, tables of equipment, andtables of basic allowances for numbered

hospital units was divided, as that for theiractivation and training had been earlier,between AGF and SOS headquarters.22

Even so, The Surgeon General retainedconsiderable authority over the medicalequipment and supplies furnished all hos-pital units, mobile as well as fixed, for oneitem in each table of equipment was theunit assemblage. It contained all items ofmedical equipment required for a hospi-tal, was packed according to MedicalDepartment equipment lists, and wasissued by Medical Department depots as asingle item. While he customarily con-sulted with the Ground Surgeon whenrevising equipment lists, The SurgeonGeneral alone was responsible for theirpreparation and for the packing of unitassemblages.23

Further changes affecting the mannerin which The Surgeon General could dis-charge his responsibility for the medicalcare of the Army occurred as a result ofthe reorganization of the Services of Sup-ply in the summer of 1942. At that timecorps areas were renamed service com-mands and authority formerly concen-

19 Memo WDGCT 320.2 (Activation) (7-1-42),ACofS G-3 WDGS for CGs AAF, AGF, and SOS,8 Jul 42, sub: Responsibility for Activation of Units.HRS: G-3/320.3 "Activation, vol. I."

20 Memo WDGDS 809, ACofS G-4 WDGS for CGSOS, 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 toACofS G-4 WDGS, 25 Sep 42, on Memo WDGDS809, 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-3WDGS, 29 Sep 42, same sub. Same file.

22 (1) AR 310-60, pars 8 and 16, 12 Oct 42. (2) WDMemo W310-9-43, 22 Mar 43, sub: Policies Govern-ing 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 De-leting Certain Items in a 400-bed Evac Hosp [13 Nov42]. SG: 475.5-1.


trated in Washington was decentralized tothem Thus the control of all general hos-pitals, except Walter Reed, was trans-ferred from The Surgeon General to com-manding generals of service commands.For a while the former retained authorityto determine staff allotments for generalhospitals, subject to SOS approval; but inApril 1943, on the recommendation of theSOS Control Division, that function wasalso decentralized to commanding gen-erals of service commands.24 The reor-ganization also diminished the authorityof service command surgeons and alteredthe Surgeon General's relationship withthem. They no longer occupied the posi-tion of staff advisers to their commandersbut were now subordinated as chiefs ofmedical branches to the chiefs of per-sonnel or supply divisions of service com-mand headquarters. Moreover, since com-mand responsibilities were emphasized inthe field, as in Washington, they could nolonger be considered as field representa-tives of The Surgeon General and couldtherefore exercise no authority over hospi-tals not under service command control.Finally, The Surgeon General could—intheory at least—communicate with servicecommand surgeons and hospital com-manders only through command chan-nels—that is, through General Somervelland the commanding generals of servicecommands. This indirect method of in-tercourse was somewhat offset by thepractice of permitting informal directcommunication between the SurgeonGeneral's Office and service commandsurgeons.25

Changes in responsibilities for hospitalconstruction and maintenance also oc-curred, but resulted only partially fromthe reorganizations discussed above. InDecember 1941, in conformity with an act

of Congress, all of The QuartermasterGeneral's construction and maintenanceactivities were transferred to the Chiefof Engineers.26 About five months laterthe War Department concentrated in thelatter responsibility which he had previ-ously shared with The Surgeon General forthe maintenance of hospital plants.27 Afterthe War Department reorganization, rec-ommendations of The Surgeon Generalfor construction of new plants and formajor alterations of existing plants weresubject to review by both the Hospitaliza-tion and Evacuation Branch and the Con-struction Planning Branch of SOS head-quarters. The former considered themfrom the viewpoint of medical needs; thelatter, of Army-wide requirements. Bothbranches were guided by decisions andpolicies of the General Staff and by direc-tives of the War Production Board. Theselection of sites and the internal arrange-ments of new hospitals, as well as altera-tions of existing plants, continued to be ajoint function of The Surgeon General andthe Chief of Engineers. Insistence of the

24 (1) SvC Orgn Manual, 22 Jul 42, sec 403.02, inWD Hq SOS SvC (formerly CA) Reorgn, 22 Jul 42.HRS. (2) Memo, SG for Dir Control Div SOS, 1 Aug42. 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 24Dec 42. (5) Memo, Dir Control Div ASF for CofSASF, 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 theZone of the Interior (1946), HD, pp. 97-99. (2) Ltr,SG to CG SOS, 9 May 42, sub: Med Activities underWD Cir 59, 1942. SG: 020.-1. (3) Memo, Chief Pro-fessional Servs [SGO] for Mr. Corrington Gill, 2 Oct42, sub: Supervision and Coord of Professional Carein Mil Hosps in Continental US. SG: 701.-1. (4) SOSOrgn Manual, 10 Aug 42, sec 403.02. (5) For a fullerdiscussion, 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.


latter and of SOS headquarters upon de-centralization to the field of as much con-struction authority and activity as possible,in order to speed construction, resulted bythe end of 1942 (as will be seen later) inThe Surgeon General's loss of some au-thority he had previously exercised overthe erection and alteration of hospitalplants.28

The Wadhams Committee

Late in 1942 responsibilities and organ-ization for hospitalization, along withmany other aspects of Medical Depart-ment work, were the subject of review andcomment by a civilian committee ap-pointed by the Secretary of War. Thisgroup, which called itself the "Committeeto Study the Medical Department" butwhich will be referred to hereafter for thesake of brevity as the Wadhams Commit-tee (from the name of its chairman, Col.Sanford Wadhams, a retired medical offi-cer), was constituted to "make a thoroughsurvey of professional, administrative, andsupply practices of the Medical Depart-ment." 29 It probed the relation betweenthe Surgeon General's Office and the SOSHospitalization and Evacuation Branch,and testimony presented in that connec-tion placed on record information sum-marized above which might not otherwisehave been available.30 While some of theCommittee's recommendations dealt withthe position of The Surgeon General in theWar Department, they appear to have hadlittle influence on the authority and re-sponsibility of either the Surgeon General'sOffice or major commands for hospitaliza-tion. This subject, along with an accountof the Committee's background and inves-tigation as a whole, is discussed fully else-where.31 Recommendations of the Com-

mittee on policies and procedures forhospitalization had significant effects andwill be discussed at appropriate places infollowing chapters.32

Changes in the Surgeon General's Office

During the early war years changesoccurred in the organization of the Sur-geon General's Office as well as in higherheadquarters, but they affected the divi-sions most concerned with hospitalizationless than others.33 On 21 February 1942the Hospital Construction Subdivision wasraised in status to a division, reflecting therapid expansion of construction activities.34

The next month it was placed, along withthe Hospitalization, Planning, and Train-ing Divisions, in a newly formed Opera-tions Service. In August, to describe itsfunctions more accurately, the Hospitali-zation Division's name was changed toHospitalization and Evacuation.35

The Hospital Construction Divisioncontinued to exercise The Surgeon Gen-eral's advisory supervision over the con-struction, leasing, and maintenance of allestablishments for the care and treatmentof the sick and wounded. Colonel Hall re-mained at its head. To handle wartime

28 (1) Army Hosp Program in Continental US, ex-tract from sec 6, Analysis, Monthly Progress Rpt, dataas 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 theMD, 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, unsignedand unaddressed, 1 Dec 42, sub: Rpt on Admin Devs,SGO. HD:024.-1.

35 An Rpt, 1943, Oprs Serv SGO. HD.


workloads the number of officers in thisDivision was increased between December1941 and December 1942 from 4 to 8; ofcivilian architects, from 4 to 7; and of civil-ian clerks, from 7 to 10. During 1943, 1officer, 1 civilian, and 2 clerks weredropped from the rolls, but a civilian realestate consultant was added, as the hospi-tal construction program neared comple-tion.36 Changes in the Division's branchesreflected shifts in construction policies andproblems. In February 1942 there werethree branches: Planning and Estimates,Construction and Conversion, and Main-tenance and Repairs. In March, whenincreasing emphasis was placed upon theuse of existing buildings, the Constructionand Conversion subdivision was separatedinto two equal branches. Subsequently,the Conversion Branch was likewise sub-divided, becoming the Ground Troop Fa-cilities and Air Corps Facilities Branches.This move was perhaps accounted for bythe expansion and growing independenceof the Air Forces. In the late summer of1942 the Planning and Estimates Branchwas dropped from the Division, foreshad-owing the transfer of its activity to theHospitalization and Evacuation Division.By August, then, the Hospital Construc-tion Division consisted of the Maintenanceand Repair, Civilian Facilities Conversion,Ground Troop Facilities, and Air CorpsFacilities Branches. This organization con-tinued until July 1943.37

The Hospitalization Division, underCol. Harry D. Offutt, limited its activitieslargely to the development of hospitaliza-tion policies, the control of bed credits ingeneral hospitals, and the maintenance ofliaison with other divisions of the Officewhose activities affected the functioning ofhospitals.38 The names of its subdivisionsreflect this fact. In February 1942, they

were the following: Hospital Inspection,Bed Credits, and Liaison. In March,the inactive Inspection subdivision wasdropped. In August, the two remainingsubdivisions became the Bed Credits andEvacuation Branch and the MiscellaneousBranch.39 During 1942 this Division grad-ually took on another function, the peri-odic revision required by SOS headquar-ters of a basic directive for hospitalizationand evacuation operations.40 In Septem-ber 1942 it also took over the job of esti-mating and planning for general hospitalbeds that would be required in the future.41

Except for short periods, in December1942 and again in April 1943, the Divi-sion's staff was limited to four officers andfour clerks until the latter half of 1943.42

At that time, the Division was enlargedand reorganized, under a new chief, toenable it to carry out the functions andactivities which the war placed upon it.43

The Planning and Training Divisionscontinued to be responsible for numberedhospital units. Col. Howard T. Wickertwas chief of the former. It made recom-mendations for the troop basis, for activa-tion schedules, and for medical supportfor task forces and overseas theaters. Italso prepared and revised tables of organi-

3 6 (1) Tynes, Construction Branch, pp. 11-12. (2)Memo, Lt Col Seth O. Craft for Col R.W. Bliss, 8 Jul43. 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 ServSGO, 8 Jul 43. HD: 319.1-2.



zation, tables of equipment, and equip-ment lists. After separation of responsibil-ity for nonorganic service units betweenAGF and SOS headquarters, this Divisionlimited itself primarily to SOS medicalunits but occasionally extended its activi-ties to others when called upon to partici-pate in conferences with the OperationsDivision of the General Staff on the forma-tion of task forces or the deployment ofadditional troops to established theaters.After SOS headquarters was given respon-sibility for training SOS service units, theTraining Division (separated from theOperations Service in August 1942) estab-lished a Unit Training Branch to dischargeits responsibilities in connection with thetraining of hospital and other medicalunits.44

A Dispute About General Planningfor Hospitalization and Evacuation

Closely connected with the War Depart-ment reorganization and arising partlyfrom differences of opinion between theSurgeon General's Office and the SOSHospitalization and Evacuation Branchabout their respective responsibilities wasa controversy over hospitalization andevacuation planning which developedearly in 1942. Within three days after theestablishment of the Services of Supply,Colonel Wilson reported to General Luteson the results of a transcontinental inspec-tion trip which he had undertaken whileassigned to G-4 and which he had initi-ated with a view to having G-4 exercisegreater supervision over hospitalizationand evacuation. He stated that he hadfound no definite basic plan for hospitali-zation and evacuation within the UnitedStates, no plan or system of operations forevacuation from theaters, and no basic

directive or system for activating, training,equipping, and using numbered hospitalunits in the United States. He recom-mended that SOS headquarters give fur-ther attention to the problem of numberedhospital units and overseas evacuation andthat The Surgeon General be directed tosubmit basic plans for hospitalization andevacuation operations for the approval ofSOS headquarters and subsequent publi-cation "for the guidance of all con-cerned." 45 General Lutes approved theproposal, and on 14 March 1942 directedThe Surgeon General to submit suchplans.46 The Surgeon General's Hospitali-zation Division conferred with the Officeof the Chief of Transportation and on31 March 1942 submitted a plan for hos-pitalization and evacuation operations.47

Considering it unacceptable, Colonel Wil-son prepared another which he presentedto General Lutes on 18 April 1942 withthe statement that its preparation hadbeen necessary "because of the incomplete

44 (1) An Rpts, SGO, FY 1942 and 1943, and AnRpt, Oprs Serv SGO, FY 1943. HD. (2) Morgan andWagner, op. cit., pp. 9-23.

45 (1) Memo G-4/24499-178, Col W. M. Good-man, GSC, Chief Planning Br G-4 (init WLW[ilson])for Gen Somervell, 20 Jan 42, sub: Current Status ofHosp and Evac. HD: Wilson files, "Vol. I, 15 May41-20 Jan 42." (2) Memo Old G-4/24499-178, MajW. 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 earlierinterim report see: Memo, same for same, 8 Feb 42,sub: Recent Trip for Study of Hosp and Evac. Samefile.

46 (1) Memo, CG SOS (signed Brig Gen LeRoyLutes) for SG, 14 Mar 42, sub: Basic Plan for HospOprs. SG: 704.-1. (2) Memo, same for same, 14 Mar42, sub: Basic Plan for Evac of Sick and Wounded.Same file.

47 Memo, SG for CG SOS, 31 Mar 42, sub: BasicPlan for Hosp Oprs and Evac of Sick and Wounded,with incl. SG: 704.-1. The first three drafts of thisdocument, as well as proposals submitted by the Chiefof Transportation, are on file HD: 705 (Hosp andEvac Planning).


nature and less understandable form ofvarious plans submitted by The SurgeonGeneral."48 This draft was discussed withthe Surgeon General's Office and then wassent to G-4 on 8 May 1942.49

On the same day General Lutes chargedThe Surgeon General with having failedto prepare hospitalization and evacuationplans either before or after he was sodirected.50 This charge, transmitted toThe Surgeon General with a statement byGeneral Somervell that it was "of courseinexcusable not to have fully maturedbasic hospitalization plans," 51 began acontroversy which lasted for many months.General Magee defended himself both inwriting and in a personal conference withGeneral Somervell. He took the positionthat all contingencies to be covered by theplan called for, except enemy raids andlocal disasters, had already arisen and hadbeen actually handled under existingplans. He believed, furthermore, that thedocument prepared by his Office was notonly adequate but also preferable in somerespects to the SOS draft.52 Later, whendocuments of the SOS Hospitalization andEvacuation Branch emphasizing the lackof plans for hospitalization and evacuationwere presented to the Wadhams Commit-tee, General Magee again defended hisposition, stating that if the allegations weretrue "it would indeed appear that chaoticconditions prevailed, but these assertionsare not supported by facts." AlthoughColonel Wilson insisted that "there wasn'tany planning" early in 1942 he now statedthat The Surgeon General had not been"any more negligent than all the rest ofthe Army," including G-4.53 In its finalreport, the Committee implied approval ofThe Surgeon General's position, but itmade no definite statement clearing himof charges of lack of adequate planning.54

The real picture was neither as black asSOS headquarters painted it nor as whiteas the Surgeon General's Office main-tained. Plans for meeting normal hospitalrequirements for the zone of interior andtheaters of operations were being madecontinuously by the Surgeon General'sOffice. In view of the generous basis onwhich normal beds were authorized in theUnited States, together with the possibili-ties of expansion by setting up wards inbarracks (a method that was almost tradi-tional with the Medical Department), itwould seem that emergency needs alsowere being sufficiently provided for. Since

48 Memo, Maj W. L. Wilson for Gen Lutes, 18 Apr42, 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 forDir Oprs SOS, 30 Apr 42. HRS: ASF Hosp and EvacSec file, "Misc Classified Corresp from Off CG ASF toAGO." (2) Memo, CG SOS for ACofS G-4 WDGS,8 May 42, sub: Hosp and Evac Oprs SOS. HRS: G-4files, "Hosp and Evac Policy."

50 Memo, Brig Gen LeRoy Lutes for Gen Somer-vell, 8 May 42, sub: Activities of SG. SG: 704.-1.

51 Memo, Gen Somervell for Gen Magee, 8 May42. 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 con-tending that there were no plans. ([2d ind SPOPG370.05 (Policy), CG ASF (init LL[utes]) to SG, 19May 42, on Memo, Gen Somervell for Gen Magee, 8May 42. HRS: ASF Hosp and Evac Sec file, "MiscClassified Corresp from Off CG ASF to AGO."])Whether or not this reply was sent to General Mageeis uncertain. No copy of it has been found in SGOfiles. An ink note attached to the copy cited states:"This is in reply to a formal indorsement written bySurg. Gen. in which he took exception to criticismof his lack of a suitable plan. He visited Gen Somer-vell on the subject. Gen S may want to know of thisreply. Lutes." In pencil on this copy is the followingnotation: "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.


no enemy attack or severe epidemic oc-curred, the latter statement can be madewith less certainty than the former. More-over, the Surgeon General's Office wascollaborating with the Chief of Transpor-tation in planning facilities, personnel, andequipment for the evacuation of patientsfrom theaters of operations. But the Medi-cal Department had not prepared a basicdirective for hospitalization and evacua-tion such as SOS headquarters required,nor was any one division in the SurgeonGeneral's Office charged with the prep-aration of comprehensive Army-wideplans for hospitalization and evacuation.Certainly confusion existed as to responsi-bilities under the new War Departmentorganization, but one may questionwhether, under the circumstances, it wasany more incumbent on The SurgeonGeneral than on higher headquarters todefine those responsibilities and to requiresubordinate commanders to submit plansfor hospitalization and evacuation.

The "plan" which Colonel Wilsondrafted differed considerably from the oneprepared by The Surgeon General's Hos-pitalization Division.55 Perhaps this wascaused as much by ambiguity of the SOSdirective requiring the preparation of a"plan" as by The Surgeon General's lackof officers trained in planning, which SOSheadquarters charged. A comparison ofthe two drafts shows that Colonel Wilsonaccepted and incorporated most of the in-formation, pertaining chiefly to establishedpolicies and procedures, which The Sur-geon General's draft contained. Greatestchange was the addition of statements out-lining the responsibilities of various com-manders for hospitalization and evacua-tion and requiring them to submit plans,in specified forms at specific times, to TheSurgeon General, who in turn was to re-

view and co-ordinate them and then sub-mit them along with his own "plan" toSOS headquarters. Reviewing the SOSdraft, G-4 called it "an 'omnibus docu-ment' which undertakes to do a number ofthings," and suggested that two documentsshould be issued in its place: one, a state-ment of basic policies and procedures forhospitalization and evacuation; the other,a directive calling for "data and sub-plansfrom the field." 56 Subsequently, after col-laboration between G-4 and SOS head-quarters, two documents were issued on18 June 1942. One was a General Staffdirective stating in general terms the re-sponsibilities of major commanders forhospitalization and evacuation. This re-mained unchanged for the balance of thewar. The other, revised later on, was anSOS letter with the SOS "plan" as aninclosure.57 Only the plans which thesedocuments required of subordinate agen-cies need to be considered here. Responsi-bilities which they delineated and policiesand procedures which the SOS "plan" an-nounced will be discussed elsewhere inthis volume.58

Subordinate agencies had to include inhospitalization plans tabulations of bedsfor 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 andWounded, with incl 1. SG: 704.-1. (2) Memo, MajW. L. Wilson for Gen Lutes, 18 Apr 42, sub: Hospand 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 attnOprs 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, SecWar to CGs AGF, AAF, SOS, et al., 18 Jun 42, sub:WD Hosp and Evac Policy. HD: 705.-1. (2) LtrSPOPM 322.15, CG SOS to CGs and COs of CAs,PEs, and Gen Hosps and to SG, 18 Jun 42, sub: OprPlans for Mil Hosp and Evac. Same file.

58 See below, pp. 57-58, 81, 88-90, 114, 319-20, forexample.


shortages; reports of provisions made todouble hospital capacities in emergenciesby the use of existing buildings such asapartments, hotels, schools, and dormi-tories; and reports of relations establishedwith other agencies, such as the Office ofCivilian Defense, "under which unilateralor mutual hospitalization support may beplanned." Evacuation plans were to in-clude estimates of persons of all types to beevacuated, both normally and in emer-gencies, along with statements about thestatus of personnel and equipment re-quired for the transportation and care enroute of patients being evacuated.

Hospital, port, and corps area com-manders complied with this directive, andon 30 August 1942 The Surgeon Generaltransmitted their plans, along with his own"comprehensive plan," to SOS headquar-ters.59 The Surgeon General's "plan" wastwofold. It contained a consolidation ofthe tables presented by corps areas and adraft of a "plan" based largely upon theSOS directive issued on 18 June 1942. TheSOS Hospitalization and EvacuationBranch considered this draft acceptable,but revised it before publication, addingstatements to bring the compilation ofpolicies and procedures governing hospi-talization and evacuation up to date andchanging the wording to require The Sur-geon General to submit a directive, ratherthan a "plan," thus making the terminol-ogy conform more closely with the fact.The revised edition of the hospitalization-and-evacuation-operations-planning di-rective was issued by SOS headquartersin November 1942, although it was dated15 September 1942.60 To make subsequentrevisions as required, The Surgeon Gen-eral on 7 November 1942 appointed aboard of officers, with Colonel Offutt aschairman.61 Although it submitted a re-

vised version on 12 February 1943, nonewas published until the end of 1943.62

That version appeared in the form of aWar Department circular.

An evaluation of the importance of the"plan" or directive, as issued in its variousversions, is difficult because of the contro-versial atmosphere in which it was pre-pared. In April 1943 the director of theASF Planning Division stated that the15 September 1942 version was "the firstworld-wide system for operations in thehistory of the War Department, underwhich the sick and wounded might be re-ceived from overseas commands and caredfor and transported ultimately to a gen-eral hospital in the United States."63 Con-sidered objectively this was undoubtedlyan overstatement, but the directive didhave certain values which stand out withconsiderable clarity.

In its initial form the directive helped,at a time when other efforts were beingmade to achieve the same end, to clarifyhospitalization and evacuation responsi-bilities. It was not strictly applicable toGround and Air Forces commanders,however, for it was issued in the first twoversions as an SOS directive only. Whenpublished in later versions as a War De-partment circular, it became binding uponGround, Air, and Service Forces alike. In

59 Memo, SG for CG SOS, 30 Aug 42, sub: OprPlans for Hosp and Evac. SG: 704.-1.

60 (1) Memo SPOPH 322.15, CG SOS for CGs andCOs of SvCs and PEs and for SG, 15 Sep 42, sub: MilHosp and Evac Oprs, with incl 1, same sub. SG:704.-1. (2) Memo. SG for Chief Oprs SOS, 27 Jan43. SG: 705.-1.

61 SG OO 456, 7 Nov 42.

62 (1) Memo, SG for CG SOS, 12 Feb 43, sub: OprPlans for Hosp and Evac. SG: 705.-1. (2) WD Cir316, 6 Dec 43.

63 Memo SPOPI 370.05, Dir Planning Div ASF forACofS for Oprs ASF, 23 Apr 43, sub: Hosp and EvacPlans. HD: Wilson files, "Book IV, 16 Mar 43-17 Jan43."


each version, the directive served as a val-uable reference document, for it assem-bled in one place statements of several pol-icies and procedures that existed only inseparate letters, circulars, and regulations.It was not comprehensive in this respect,nor was it always up to date, for manyadditional policies and procedures had tobe established and old ones changed dur-ing the periods between revisions. In Sep-tember 1942 Colonel Offutt stated that hisDivision could operate effectively underthe current version.64 The following Feb-ruary, when Colonel Wilson visited fieldinstallations to evaluate operations underthe directive, he found that each head-quarters visited, with one exception,thought it clear, understandable, practi-cable, and of definite benefit.65

The value of the subordinate plans sub-mitted in compliance with the basic direc-tive is less clear. Each came to be whatThe Surgeon General's executive officer,Col. John A. Rogers, called one of them inSeptember 1942—"just a plan to betucked away." 66 Each was reviewed bythe hospitalization and evacuation sec-tions of both the Surgeon General's Officeand SOS headquarters? They were thenfiled for future reference.67 That no emer-gency developed to require their use neednot detract from the foresightedness ofhaving emergency expansion plans onhand, but whether those on file wouldhave been adequate for a major disasterseems to have been doubted in the fall of1942.68 Tabulations of shortages of person-nel, equipment, hospital beds, and trans-portation usually arrived too late to haveany appreciable effect upon the supply ofthose elements, for problems of shortageswere handled when they appeared andcould not await the submission at periodicintervals of subordinate plans for hospital-

ization and evacuation. This requirementwas dropped from subsequent versions ofthe directive early in 1944.69

In conclusion, one may questionwhether the benefits derived from the di-rective counterbalanced the friction andbad feeling which its issuance engenderedbetween SOS headquarters and the Sur-geon General's Office. Similar resultsmight have been achieved more harmo-niously if the principals in both agencieshad been more considerate and under-standing in dealing with each other or ifrelationships and responsibilities of theSOS Hospitalization and EvacuationBranch and the Surgeon General's Officehad been more clearly delineated. Suchwas not the case, however, and the con-troversy that developed in this instanceillustrated dangers and difficulties inher-ent in the new structure of the War De-partment and the new position of TheSurgeon General.

64 Diary, Hosp and Evac Br SOS, 22 Sep 42. HD:Wilson files, "Diary."

65 (1) Résumé of Conf, SvCs and Ports, Feb-Mar43, incl 1 to Memo SPOPI 337, CG ASF for SG andCofT, 30 Apr 43, same sub. HD: Wilson files, "BookIV, 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." (ColRobert C. McDonald succeeded Colonel Wilson asChief, Hospital and Evacuation Branch on 6 Febru-ary 1943.)

66 Notes on tel conv between Col E. C.Jones, Surg5th SvC and Col Rogers, 1 Sep 42. HD: Oprs Divfiles.

67 (1) Memo SPOPH 322.15, Chief Hosp and EvacBr SOS for Chief Oprs SOS, 16 Nov 42, sub: SvC andPort Plans for Hosp and Evac Oprs. HD: Wilson files,"Book 2, 26 Sep 42-31 Dec 42." (2) Memo, SG forCG SOS, 30 Aug 42, sub: Oprs Plans for Hosp andEvac. SG: 704.-1. (3) Copies of the subordinate plansare 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 forCG SOS, 30 Aug 42, sub: Oprs Plans for Hosp andEvac. CE: 632. (2) WD Cir 140, 11 Apr 44.

CHAPTER V

Hospital Plantsin the United States

In December 1941 the Army had a totalof approximately 74,250 beds in about 200station hospitals and 14 general hospitalsin the United States.1 During the nexteighteen months it was to build enoughadditional hospitals to house more thanthree times the number provided duringthe fifteen-month period of peacetimemobilization.2 In addition, it was to haveenough hospitals under construction inJune 1943 to house over 65,000 morebeds.3 Concurrently, improvements wouldhave to be made in the cantonment-typehospitals already in operation.4

Types of Construction

Emphasis on Simplicity

With the country at war, speed in con-struction and conservation of buildingmaterials became factors of paramountconsideration. Accordingly the GeneralStaff insisted upon the simplest type ofconstruction. On 29 December 1941 G-4revoked the authority it had previouslygranted to construct hospitals on the two-story semipermanent plan,5 and about amonth later revised the War Departmentconstruction policy. After 6 February 1942all construction at new stations, exceptthat already in the advanced planningstage, was to be a modified form of thetype designed for theaters of operations.6

The Engineers interpreted this policy tomean that in station hospitals all ware-houses and utility shops, and all buildingsused for housing, feeding, and entertain-ing male members of the hospital staffwould be of theater-of-operations-typeconstruction, while those used in the care,treatment, feeding, and recreation of pa-tients and as quarters, messes, and recre-ation rooms for nurses were to be ofcantonment-type construction.7 General

1 Bed Status Rpts, end of last week in Dec 41. Offfiles, Health Rpts Br Med Statistics Div SGO. A fewbeds were reported in Darnall General Hospital, butthey are not included in the number given above be-cause this hospital did not open until March 1942.

2 Gen Hosp Sta HospBeds Available Sep 40 . . . . . . . . . . 4,925 7,391Beds Added Sep 40-Dec 4 1 . . . . . . 10,608 51,345Beds Added Dec 41-Jun 43. . . . . . 38,226 161,279

Source: Bed Status Rpts. Off file, Health Rpts Br MedStatistics 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 hospitalexpansion program was a part, is discussed in JesseA. Remington and Lenore Fine, The Corps of Engi-neers: Construction in the United States, a forthcom-ing volume in the series UNITED STATES ARMYIN WORLD WAR II.

5 (1) See above, pp. 23-24. (2) Ltr AG 632(12-27-41), TAG to SG and CofEngrs, 29 Dec 41, sub: Fire-Resistant Type of Cons in Hosps. SG: 632.-1.

6 Ltr AG 600.12(2-5-42) MO-D-M, TAG to CGsall Depts, CAs, et al., 6 Feb 42, sub: WD Cons Policy.SG: 600.12.

7 Ltr, CofEngrs to TAG, 14 Feb 42, sub: Hosp inT/O Cantonments, with 1st ind AG 600.12 (2-14-42) MO-D, TAG to CofEngrs, 25 Feb 42. CE: 632Pt 2.

HOSPITAL PLANTS IN THE UNITED STATES 69

hospitals, previously expected to be ofsemipermanent construction, were now tobe entirely of cantonment type. This low-ering of standards brought quick protestsfrom The Surgeon General.

The decision to abandon two-story semi-permanent construction for general hospi-tals was modified on 31 December 1941.At The Surgeon General's request, G-4approved its use if neither a loss of timenor a material increase in costs was in-volved.8 During the next two months, theEngineers and The Surgeon General'sconstruction officers disagreed on whethersemipermanent hospitals could be shownto cost no more than cantonment-typehospitals.9 In some instances dual bids forthe erection of a hospital on either planwere called for, and ten hospitals, includ-ing those already begun before the war,were constructed on the semipermanentplan.10 Subsequently the Engineers foundthat the initial cost of semipermanent hos-pitals was "considerably greater," and on16 April 1942 G-4 returned to its positionthat only cantonment-type constructionbe used for general hospitals.11

The decision to use theater-of-opera-tions-type construction for buildings instation hospitals remained unchanged.Buildings of this type were of the lightestpossible frame construction, with exteriorsusually of heavy treated paper or fiber-board. Plumbing was omitted from bar-racks and placed in separate lavatorybuildings. Heat was generally furnishedby stoves in each building rather than bya central heating plant.12 The SurgeonGeneral based his protests against the useof theater-of-operations-type constructionfor hospitals in the United States on itslower quality. He stated that barracksand quarters of that type were unsuitablefor conversion to wards to meet emergency

needs for additional beds, that messeslacked comforts desired for officer-pa-tients, and that kitchens had inadequaterefrigeration and dishwashing facilities.13

The Chief of Engineers admitted that itwould be difficult to use theater-of-opera-tions-type barracks for emergency wards,but believed it unwise to provide betterhousing for Medical Department menthan for other troops. The General Staffagreed, and on 24 February 1942 reiter-ated the policy announced earlier thatmonth.14

Later in the year, as the shortage ofbuilding materials increased, the GeneralStaff proposed an even lower quality ofconstruction 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 Jan42, 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 andthe Semipermanent, Fire-Resistant Type, by Bldgs.(3) Ltr, SG (JRH) to CofEngrs, 7 Feb 42, sub: Fire-resistant Type of Hosp. Comparison with CantonmentTypes. All in SG: 632.-1.

10 (1) D/S G-4/33956, ACofS G-4 WDGS to TAGfor 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, samesub. SG: 632.-1. General hospitals of this type wereBushnell, McCloskey, Kennedy, Valley Forge, andSchick; there were also five station hospitals of thesame type, located at Camps Atterbury (Indiana),Butner (North Carolina), Carson (Colorado), Camp-bell (Kentucky), and White (Oregon).

11 (1) 2nd ind, CofEngrs to TAG, 14 Apr 42, sub:Cons of Hosp, on unknown basic Ltr. CE: 632 Vol.3. (2) Ltr AG 600.12 (4-15-42) MO-DM, TAG toCGs of AGF, AAF, SOS, et al., 16 Apr 42, sub: WDCons Policy, ZI. SG: 600.12.

12 Engineering Manual, OCE, Oct 43, Ch. IX, PtI, par 10-03c.

13 Memo, SG for CofEngrs, 9 Feb 42, sub: ProposedHosp at Centerville and Grenada, Miss. SG: 632.-1.

14 (1) Ltr, CofEngrs to TAG, 14 Feb 42, sub: Hospin 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: WDCons Policy, ZI. SG: 600.12.


1942 the Secretaries of War and Navy andthe Chairman of the War ProductionBoard agreed upon a directive which re-quired construction to be reduced to theminimum in both quantity and quality.15

In conformity with this directive the Gen-eral Staff decided to move units in ad-vanced states of training to field tentcamps and to use existing cantonments forthe training of new units. They proposedto provide hospitalization for field campsin screened and floored tents.16 The Sur-geon General objected and suggestedlimiting hospitalization in tents to onethird of that required for field camps andproviding the rest in cantonment-typebuildings, erected either in field camps oras additions to near-by station hospitals.17

The General Staff approved the limitationof hospitalization in tentage but directedthe use of theater-of-operations-typebuildings for the remainder.18 This meantthat in some places buildings used for thecare and treatment of patients, as well asthose for housing personnel and storingsupplies, were to be of low quality con-struction. Again The Surgeon Generalprotested the use of "a hospital of a lowergrade than the cantonment type unit." 19

While the policy was not changed, thepractice of using tentage and theater-of-operations-type construction for entirehospital plants seems to have been limitedchiefly to AGF maneuver areas.20

Conversion of Existing Buildings

Another method of achieving speed andconservation was to convert existing civil-ian buildings into Army hospitals. Inmobilization plans this method had hadhigh priority and in the fall of 1940 TheSurgeon General had considered its use.21

Soon after war began his construction of-

ficers again started looking for civilianbuildings suitable for conversion.22 On 19March 1942, about the time the decisionwas being made to construct no moresemipermanent hospitals, SOS headquar-ters suggested the acquisition of civilianbuildings to house additional general hos-pital beds.23 A little over a month later theChief of Staff considered the possibility ofabandoning entirely the construction ofnew general hospitals in favor of the civil-ian-facilities-conversion method. He gaveup that idea after The Surgeon General'sConstruction Division and SOS head-quarters pointed out difficulties involved.24

15 Directive for Wartime Cons, 20 May 42, incl toLtr AG 600.12 (5-20-42) MO-SPAD-M, TAG toCGs AAF, Depts, CAs, and C of Tec Servs, 1 Jun42, same sub. SG: 632.-1.

16 Draft Memo WDGCT 600.12, ACofS G-4WDGS for CofS, n d, sub: Housing for 1943 TrpBasis. SG: 632.-1.

17 Memo SG for Col [Lester D.] Flory, Oprs SOS,17 Jul 42, sub: Comments on Housing for the 1943Trp Basis. SG: 632.-1.

18 (1) WD Cir 278, 21 Aug 42. (2) Mil Hosp andEvac Oprs, 15 Sep 42, par 13b (1), incl 1 to LtrSPOPH 322.15, CG SOS to CGs and COs of SvCs,PEs, and to SG, 15 Sep 42, sub: Mil Hosp and EvacOprs. 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 Aug42, sub: Hosp Fac for Fld Cp. SG: 632.-1.

20 (1) See below, pp. 104-06. (2) Tynes, Construc-tion Branch, p. 36.

21 Memo. Act ACofS G-4 WDGS for CofS, 12 Nov40, sub: Gen Hosp Program. HRS: G-4/29135-11.

22 (1) Ltr, Col John R. Hall, SGO to Dr. MorrisFishbein, AMA, 4 Feb 42. SG: 601.-1. (2) Memo, MajAchilles L. Tynes, SGO for SG, 26 Feb 42, sub: Rptof Insp Trip to Monroe and Charlotte, NC. SG:632.-1.

23 Memo SP 632 (3-19-42), CG SOS for CofEngrs,19 Mar 42, sub: Add Gen Hosps. SG: 632.-1.

24 (1) Memo SPEX 632 (5-1-42), [Maj Gen Wil-helm D.] Styer for [Lt Gen Joseph T.] McNarney, 1May 42, sub: Acquisition of Existing Hosps, ... inlieu of Cons of New Gen Hosps. (2) Memo, CGSOS for CofSA, 3 May 42. (3) Memo, JTM[cNarney]for CofSA, 5 May 42. (4) D/S 632 (5-3-42), Dep-CofSA for SG, n d. All in SG: 632.-1. (5) Ltr, SG toCG SOS, 3 May 42. SG:601.-1.


OLIVER GENERAL HOSPITAL converted from the Forest Hills Hotel.

A "Directive for Wartime Construction,"issued two weeks later, confirmed as policythe practice of converting existing build-ings into hospitals whenever practicableand of constructing new buildings other-wise.25

Difficulties involved in the civilian-fa-cilities-conversion method restricted itsuse. Of hundreds of buildings which civil-ians offered to the Medical Department,not over 3 percent were suitable for use ashospitals.26 Many were too small. Somehad corridors, stairways, and doors thatwere too narrow to permit the passageof patients on litters. Others that wereseveral stories high lacked adequate ele-vator service. Still others were in undesir-able locations.27 In some instances, whereboth the buildings and locations were suit-able, local politicians and owners tried toget higher prices than the War Depart-

ment was willing to pay. In others, localcitizens banded together to prevent Armyacquisition because they feared a depre-ciation in neighboring property values.28

Finally, even after suitable buildings werefound and all arrangements for acquisitioncompleted, additions and alterations hadto be made before the Medical Depart-

25 Directive for Wartime Cons, 20 May 42, incl toLtr AG 600.12 (5-20-42) MO-SPAD-M, TAG toCGs 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 ColAlbert 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 forHosp. 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.


TABLE 2—ARMY HOSPITALS ESTABLISHED IN CONVERTED CIVILIAN BUILDINGS BY ENDOF 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 7nds. HD: 632.-1 (Hosp Expansion). (2) Incl, Record of Expansion and Contraction, Hosp ZI, and Hosp Ships, to Memo, Chief ConsBr 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 function-ing hospitals. Despite these difficulties andproblems, the Army acquired enoughcivilian buildings by the end of 1943 tohouse twenty-three hospitals and expandfive others. (Table 2)

Development of One-StorySemipermanent Type Hospital

Concurrently with increasing emphasison conservation of building materials,forces were at work during 1942 which


PLAN FOR TYPE A HOSPITAL

were to cause the War Department to turnagain to the construction of semiperma-nent hospitals. As early as February 1942the Clay Products Association of theSouthwest began a campaign for the useof its materials by the Army, at least inhospital construction.29 In April the Ad-

ministrator of Veterans Affairs protestedagainst the repetition of a World War I

2 9 (1) Ltrs. Norman W. Kelch, Engr-Mgr, ClayProducts Assn of the Southwest to UnderSecWar, 13Feb and 3 Mar 42, sub: Fire-resistive Cons for Can-tonment Type Hosps. (2) Ltr, UnderSecWar toKelch, 19 Mar 42. (3) Ltr, CofEngrs to Kelch, 6 Mar42. All in CE: 632 Pt 1.


BIRMINGHAM GENERAL, A TYPE A HOSPITAL

mistake—the construction of hospitalsthat could not be converted to postwaruse.30 By June shortages of lumber hadbegun to develop in some areas, while sur-pluses of brick and tile had begun to accu-mulate. In some places, therefore, theEngineers began to build cantonment-type hospitals of tile and brick instead oflumber.31 Then, on 10 August 1942, theWar Production Board informed The Sur-geon General of the availability of tile andbrick and urged their use in hospital con-struction. The Surgeon General repliedthat he had always preferred noninflam-mable materials for hospital construc-tion.32 Soon afterward, his representativesjoined the Engineers in work on plans fora new type of hospital.

The chief obstacle to development ofplans for a one-story semipermanent hos-pital, which the Chief of Engineers pro-

posed on 26 August 1942, was a differenceof opinion between his Office and TheSurgeon General's over the internal char-acteristics of various buildings. Feeling itnecessary to hold the cost of constructionas near as possible to that of cantonment-type buildings, the Engineers were proneto limit improvements and refinements tothe absolute minimum. On the other hand,Colonel Hall of The Surgeon General'sConstruction Division saw no reason to

30 Ltrs, Admin of Vet Affairs to CG SOS and toSecWar, 1 Apr 42. SG: 632.-1.

31 (1) Ltr, CofEngrs to SG, 11 Jun 42, sub: Use ofStructural-Tile Exterior Walls at Ft Des Moines andCp Dodge Hosps, with 1st ind, SG to CofEngrs, 15June 42. SG: 632.-1. (2) Exhibit A to Memo, ColJohn R. Hall for SG, 13 Jun 42, sub: Rpt of Fld Tripcovering Insp of 1411-bed Hosp at Cp Atterbury andof the French Lick Hotel Property. HD: Hosp InspRpts, p. 726.

32 (1) Ltr, Chief Bldg Materials Br Oprs WPB toSG, 10 Aug 42. (2) Ltr, SG to WPB, 14 Aug 42, sub:Hosp Cons. Both in SG: 632.-1.


design a third type of hospital if it was notmaterially better than the cantonmenttype and equal, in most respects, to thetwo-story semipermanent type. For ex-ample, he wanted larger and more effi-ciently arranged clinical buildings, strong-er and safer neuropsychiatric wards,increased administrative space, and bet-ter-equipped messes. After numerous con-ferences and what must have seemed tothe Engineers an uncompromising attitudeon the part of the Surgeon General's Of-fice, they composed their differences andduring the winter of 1942-43 a civilianarchitectural firm employed by the Engi-neers completed drawings for the newtype of hospital.33

The Type A hospital, as plants con-structed according to the new design werecalled, came to be considered by the Sur-geon General's Office as the best for emer-gency construction in the zone of interior.Basically, it was the two-story semiper-manent hospital reduced to one-storyform. Being only one story high it wassafer for patients and did not require ex-pensive and unhandy two-story ramps. Itsclinical facilities were more adequate andmore efficiently arranged than those ofthe two-story hospital. It also cost less tobuild. Because wards were placed on bothsides of corridors and were lengthenedfrom 262 to 287 feet, the Type A hospitalcovered a smaller area than other one-story plants. Its chief disadvantage wasthat it was designed on the dispersed-pavilion principle. Before the war's end,twelve hospitals were constructed on thisplan.34 (Table 3)

Modification of the Type A Hospitalfor Postwar Use bythe Veterans Administration

In the spring of 1943 plans for the TypeA hospital were modified as a result of at-

tempts to co-ordinate wartime hospitalconstruction with postwar needs. On 31March 1943 the President directed theFederal Board of Hospitalization to re-view plans for hospital construction of allfederal agencies, including the War andNavy Departments.35 The next month theBoard proposed that the Army build someof its hospitals according to standard plansof the Veterans Administration, for useafter the war. SOS headquarters raised noobjection, but disclaimed any responsibil-ity for justifying and defending this pro-posal.36 Anticipating its approval, TheSurgeon General's construction officersand the Engineers, in collaboration withthe Veterans Administration, preparedlayouts for Type A hospitals which sub-stituted five two-story VA-type wardbuildings for ordinary wards. In May thePresident approved the Federal Board'srecommendation that two Army generalhospitals — McGuire at Richmond, Va.,and Vaughan at Hines, Ill.—be con-structed on that plan.37

Many factors thus shaped the kinds ofhospital plants which the Army acquired

33 (1) Ltr, CofEngrs to SG, sub: One-Story Mason-ry Wall Gen-Hosp, 26 Aug 42, with 3 inds. (2) Ltr,SG to CofEngrs, 12 Nov 42, sub: One-Story MasonryCons Hosp, 1100 Series, Drawings by York andSawyer, 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 L t r , President of US to Sec War, 31 Mar 43.SG: 632.-1.

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

37 (1) Memo, SG for 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, 19May 43, with 1st ind, SG to CofEngrs, 1 Jun 43, sub:Hosp Cons. SG: 632.-1. (4) Ltr, SG to CofEngrs, 7Jun 43, sub: 1785-bed Gen Hosp, Richmond, Va.,Area. SG: 632.-1 (McGuire Gen Hosp)K.


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 ofhospital construction. The basic plan is shown on the opposite page.

Source: Tynes, Construction Branch, p. 49. HD:314.7-2 (Hosp. Const. Br.).


or constructed during World War II. Suchforces as necessity for speed in construc-tion, availability of building materials,pressure of civilian groups, and co-ordina-tion of Army wartime construction withpostwar needs of other Federal agenciesoften seemed stronger than medical con-siderations. The Surgeon General's Officetherefore frequently found itself in con-flict with higher authorities in attemptingto get what it considered to be suitableand satisfactory hospital plants. Whileundesirable cantonment-type plans drawnbefore the war were used for most hospi-tals, better plants were designed and theArmy erected 10 two-story and 12 one-story semipermanent hospitals on newplans as well as 2 designed specifically forpostwar use by the Veterans Administra-tion.

Estimates of Hospital Capacity Needed

Speed in construction and conservationof materials also affected planning for theexpansion of hospitals. During most of1942 speed was so necessary to keep hos-pital capacities abreast of the Army'sgrowth that there was little time for re-examining the basis already establishedfor estimating requirements. Hence, con-servation of building materials was at firstachieved by lowering the quality ratherthan the quantity of construction. More-over the need for speed, along with uncer-tainty about the eventual size of the Armyand the rate of its movement overseas,perhaps accounted partially for the factthat until the end of 1942 little attentionwas given to the co-ordination of stationwith general hospital requirements, ofArmy with Navy requirements, and ofwartime with postwar requirements. Evendisregarding these matters, planning for a

rapid and unprecedented expansion was acomplicated process. In the first part of1942 plans had to be made to meet imme-diate normal requirements. In addition,plans for emergencies were needed be-cause it was feared that sneak attacks,sabotage, or severe epidemics might re-quire hospital beds far in excess of thenumber normally provided. Later, whenemphasis was placed upon reduction inquantity as well as quality of construction,a tendency developed to make long-rangeplans. All three types of planning—nor-mal, emergency, and long-range—wereinevitably interrelated.

Early Plans To Meet Normal Requirements

Plans for station hospitals to house thenumber of beds authorized by the existingbed ratio were automatically included bythe Engineers in general constructionplans for each camp, but planning for theexpansion of general hospitals was differ-ent. Although general hospital beds wereauthorized for 1 percent of the totalstrength of the Army, construction ofplants to accommodate that number didnot automatically follow. Instead TheSurgeon General had to request period-ically the approval of construction tohouse specific numbers of general hospitalbeds. He usually received approval for lessthan the 1 percent asked for. As a stopgapmeasure The Surgeon General on 18 De-cember 1941 recommended the construc-tion of four new general hospitals andannexes to two existing hospitals to pro-vide 6,000 additional beds. The next dayG-4 approved this recommendation.38

38 (1) Ltr, SG to TAG, 18 Dec 41, sub: Location of6,000 Add Gen Hosp Beds. SG: 632.-1. (2) Memo,ACofS G-4 WDGS for TAG. 19 Dec 41, sub: GenHosps. HRS: G-4/29135-11.


MCGUIRE GENERAL, A VA-TYPE HOSPITAL

The following February, after the troopbasis for 1942 was published, The SurgeonGeneral recommended enough additionalbeds (18,600) to make a total by the endof 1942 of 39,600, 1 percent of the plannedstrength of the Army.39 Of these, G-4 au-thorized only 14,000, to be completed by30 September 1942, advising The SurgeonGeneral informally to include further re-quirements in longer-range planning.40

By June 1942 it was possible to project re-quirements to the end of 1943. Informedthat the strength of the Army by that timewould be 6,600,000 men The SurgeonGeneral recommended 30,026 beds in ad-dition to those already available or au-thorized, to make a total of 66,000.41

Although the SOS Hospitalization andEvacuation Branch agreed to this number

for planning purposes, the SOS Construc-tion Planning Branch directed the Engi-neers a few weeks later to construct only23,500.42

When The Surgeon General estimatedtotal general hospital bed requirements,he planned also their distribution amongdifferent hospitals. Before the war all new

39 Ltr, SG to CofEngrs, 3 Feb 42, sub: Add GenHosp Beds. SG: 632.-1.

40 Memo for Record, on Memo, ACofS WDGSG-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 GenHosp Beds. SG: 632.-2.

42 Memo SPOPM 632, Dir Oprs Div SOS (initWLW[ilson]) for Dir Reqmts Div SOS, 17 Jun 42,sub: Add Gen Hosp Beds. HD: Wilson files, "BookI, 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.


general hospitals had been constructed ona 1,000-bed plan. Larger hospitals couldbe operated with a lower ratio of person-nel to beds, and after Pearl Harbor he be-gan to recommend the construction of1,500-bed hospitals.43 During 1942 hospi-tals of this size gradually superseded thoseof 1,000-bed capacity.44 With this begin-ning, the tendency to enlarge general hos-pital capacities was to grow until some ofthem would reach 6,000 by 1945.

When the Army began to emphasizereductions in quantity as well as quality ofconstruction, attention centered momen-tarily on the authorized bed ratio. TheInspector General and the director of theSOS Requirements Division believed thatit was too high.45 In June 1942 there were96,291 beds in general and station hospi-tals, but only about 73,285 were occu-pied.46 According to the authorized ratio,there should have been 129,640 beds.47

Referring to reports on the occupancy ofbeds and to directives limiting construc-tion to the essential minimum, SOS head-quarters called upon The Surgeon Generalfor an analytical study of bed require-ments based on the experience of theprevious ten years, rather than World WarI, with a view to a possible reduction inauthorized ratios.48 Although tables hesubmitted showed the ratio of occupiedbeds to Army strength from 1932 to 1941to have been nearer 3.5 percent than theauthorized ratio, The Surgeon Generalurged that the latter not be reduced. Hepointed out that only 80 percent of thebeds provided should be considered avail-able, since approximately 20 percent ofthe total was lost through "dispersion"—the separation of patients into wards ac-cording to disease, rank, and sex. Hebelieved that a higher proportion of menwould require beds during war than dur-

ing peacetime, because battle casualtieswould need extended periods of hospitalcare, recruits would have higher sick ratesthan seasoned soldiers, and accidentswould occur more frequently under stren-uous training programs.49 By the time ofthis reply higher authorities were consid-ering double bunking in barracks and thiswas to lead to a temporary increase,rather than a reduction, in the authorizedbed ratios.

Planning for Emergencies

Hospital construction for normal usewas so urgent in the first hectic months ofthe war that planning for emergencies wasleft largely to local commanders. The Sur-geon General expected them to meetneeds that might arise by setting up bedsin the solaria of hospital buildings, byplacing more beds in wards than wereusually considered desirable, and by usingas wards the barracks of enlisted hospital-complements and, if necessary, of othertroops. These methods were prescribed in

43 (1) Ltr, SG to TAG, 18 Dec 41, sub: Locationof 6,000 Add Gen Hosp Beds. SG: 632.-1.

44 Ltr, SG to CG SOS, 6 Jun 42, sub: Add GenHosp Beds. SG: 632.-2.

45 Memo for Record, on Memo SPOPM 323.7Hosp, CG SOS for SG, 22 Jun 42, sub: Reqmts andDistr of Hosp Beds. HD: Wilson files, "Book I, 26Mar 42-26 Sep 42."

46 Bed Status Rpts, end of last week in Jun 42. Offfile, Health Rpts Br Med Statistics Div SGO.

47 This figure was arrived at by multiplying thestrength of the Army in the United States by 4 per-cent and the total strength of the Army by 1 percentand adding the results. Of a total strength in June1942 of 3,074,184, there were in the United States2,472,407 officers and men. Figures furnished byStrength Accounting Branch AGO, 25 Oct 47.

48 Memo SPOPM 323.7 Hosp, CG SOS for SG, 22Jun 42, sub: Reqmts and Distr of Hosp Beds. SG:632.-2.

49 1st ind, SG to Dir of Oprs SOS, 25 Jul 42, onMemo 323.7 Hosp, CG SOS for SG, 22 Jun 42, sub:Reqmts and Distr of Hosp Beds. SG: 632.-2.


Army regulations and, upon The SurgeonGeneral's recommendation, the use ofbarracks to expand hospital capacities wasrequired by the SOS directive on hospital-ization and evacuation issued on 18 June1942. Included in the same directive bythe SOS Hospitalization and EvacuationBranch was another provision which TheSurgeon General considered unneces-sary—the requirement that subordinatecommanders plan to double hospital ca-pacities in emergencies by using civilianbuildings such as apartments, hotels,schools, and dormitories.50

In the late summer and fall of 1942 acombination of circumstances focusedattention upon the question of emergencyhospitalization. Plans were being made forthe North African invasion and for thereception in the United States of largenumbers of casualties. Concurrently, as ameans of reducing general constructionrequirements, the Chief of Staff and thecommanding general, Services of Supply,decided to require the double bunking oftroops in existing barracks. The SurgeonGeneral warned them that the resultantreduction in per capita air space mightlead to severe epidemics of respiratory dis-eases.51 General Marshall believed thatthis risk had to be taken, but feared thatexisting beds might be insufficient if anepidemic should occur at the same timecasualties began to flow back from NorthAfrica. On 10 August 1942 he verballydirected The Surgeon General, throughthe latter's executive officer, to plan totake over hotels in an emergency for use asArmy hospitals and to arrange with localphysicians for civilian groups to man them.The next day General Marshall's deputyreferred to this directive in a meeting ofthe General Council (a group of represen-tatives of the General Staff, and of AGF,

AAF, and SOS headquarters) and theSOS Chief of Staff afterward directed TheSurgeon General "to take immediate"steps to enlarge hospital capacities in theevent of an emergency.52

The Office of Civilian Defense wasmaking plans for the emergency hospitali-zation of civilians, earmarking hotels andorganizing "affiliated units" of civilianphysicians and nurses to staff them ifneeded.53 Realizing the possibility of con-flict between OCD plans and GeneralMarshall's directive, General Magee dis-cussed the problem with General Lutesand with Dr. George Baehr, who was incharge of OCD medical activities. He thenpresented it to the Office of DefenseHealth and Welfare Services' Health andMedical Committee, whose function wasto co-ordinate all health and medicalactivities relating to national defense.

Meanwhile, on 27 and 28 August 1942,General Magee transmitted General Mar-shall's directive to service commands.They were already listing hotels that could

50 (1) AR 40-1080, C 2, 16 Mar 40. (2) The Sur-geon General's Plan for Hosp (ZI) and Evac, incl toMemo, SG for CG SOS, 31 Mar 42, sub: Basic Planfor Hosp Oprs and Evac of Sick and Wounded. HRS:ASF Hosp and Evac Sec file, "Misc Classified Correspfrom Off CG ASF to AGO." (3) Memo, Col H. T.Wickert, SGO, for Col [W. L.] Wilson, SOS, 30 Apr42, with incl Memo, SG for Dir Oprs SOS, 30 Apr42. 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: DoubleBunking. All in SG: 632.-1.

52 (1) Extract from Mins of Gen Council, 11 Aug42. HD: Wilson files, 600.13 "Hosp Policy andPlans." (2) Memo, CofSA for President of US, 21Sep 42, sub: Reply to your Memo of Sep 14th ConcUtil of Hotels as Mil Hosps. WDCofSA: 632 (14 Aug42). (3) Memo, Brig Gen Larry B. McAfee for SG,31 Oct 42. HD: 632.-1 "Hosp Expansion." (4) State-ments of SG and his Exec Off, Cmtee to Study theMD, Testimony, pp. 1309ff and 1669ff. HD.

53 Cmtee to Study the MD, 1942, Testimony, pp.984ff. HD.


be taken over in emergencies, in accord-ance with the SOS directive of 18 June1942. To comply with the new directive,they had merely to review those lists, item-ize the medical property that would berequired, and arrange with a local physi-cian to build up a staff for each emergencyhospital.54

The Office of Civilian Defense and theHealth and Medical Committee objectedto this action because it threatened tointerfere with plans for emergency hospi-talization for civilians and posed thedanger of transferring epidemics fromArmy camps into cities. The Office of De-fense Health and Welfare Services theninformed the President of the Army's plan,suggesting that the War Department re-scind its directive and plan to provideemergency hospitalization for militarypersonnel entirely within the confines ofArmy camps and with military profes-sional staffs only.

Meanwhile the plan called for by theChief of Staff was misinterpreted by thePresident, who understood that the Armyintended to take over hotels and developthem into stand-by hospitals in advanceof an emergency. When asked for an ex-planation, General Marshall assured himthat this was not so, but assumed fullresponsibility for having directed the ear-marking of hotels and the organization ofcivilian staffs for emergency use. ThePresident apparently considered this ex-planation satisfactory, for he passed Gen-eral Marshall's letter on to the Office ofDefense Health and Welfare Services withthe single comment, "for your informa-tion."55

After General Marshall's explanation tothe President it was still necessary to solvethe problem of simultaneous planning bythe Army and the Office of Civilian De-fense to use civilian staffs in emergency

hospitals. At first SOS headquarters tookthe position that "any plan to utilize civil-ian medical personnel for military hospi-talization is entirely a planning matter toestablish a potential means to meet majoremergencies. . . ." 56 When this assur-ance failed to satisfy the Office of CivilianDefense, SOS headquarters changed itsposition and, strangely enough, requiredThe Surgeon General to inform theHealth and Medical Committee that ithad never been War Department policyto use civilian staffs to care for militarypatients.57 Meanwhile General Magee hadconferred with General Marshall and withDr. Baehr. He then proposed a compro-

54 (1) Memo, SG for Brig Gen LeRoy Lutes, 21Aug 42, sub: Over-All Plan for Emergency MedCare, Civ and Mil. HD: 632.-1 "Hosp Expansion."(2) Statements by Baehr and Magee, Cmtee to Studythe MD, 1942. Testimony, pp. 984ff and 1669ff. HD.(3) Ltrs, CG SOS per SG to CGs of SvCs, 27 and 28Aug 42, sub: Hosp Expansion. HD: 632.-1.

55 (1) Ltr, Exec Sec, Health and Med Cmtee to DirOff of Def Health and Welfare Servs, 5 Sep 42. HD:632.-1 "Hosp Expansion." (2) Ltr, Dir Off of CivDef to same, 12 Sep 42. Same file. (3) Ltr, Dir Off ofDef Health and Welfare Servs to the President, 10Sep 42. Natl Archives: Record Group 215, Off ofCommunity War Servs, 922.3. (4) Memo, FDR[oose-velt] for Gen Marshall, 14 Sep 42. WDCofSA: 632(14 Aug 42). (5) Memo, CofSA for the President, 21Sep 42, sub: Reply to your Memo. . . . Same file. (6)Memo, FDR[oosevelt] for Hon Paul McNutt, [DirOff of Def Health and Welfare Servs], 3 Oct 42. NatlArchives: Record Group 215, Off of Community WarServs, 922.3.

56 (1) Memo SPOPH 701, Lt Col W. L. Wilson,Chief Hosp and Evac Br SOS for Gen Lutes, 17 Sep42. 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 DirOCD, 9 Oct 42. Natl Archives: Record Group 215,Off of Community War Servs, 922.3.

57 (1) Memo, SG for CG SOS, 8 Oct 42, sub: Plan-ning for Expansion, Army Med Fac. HD: 632.-1"Hosp Expansion." (2) Ltr, Dir OCD to Maj GenGeorge Grunert, Chief Admin Serv SOS, 23 Oct 42.Natl Archives: Record Group 215, Off of CommunityWar 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), Depfor ACofS for Oprs SOS (init WLW[ilson]) for Chief


misc which in his opinion embodied thewishes of General Marshall and met theapproval of Dr. Baehr. According to itsterms the Army would plan to use in anemergency only those hotels which itcould reasonably expect to staff with mili-tary personnel. If civilian doctors andnurses should be needed temporarily theArmy would borrow staffs organized bythe Office of Civilian Defense and theUnited States Public Health Service. Al-though SOS headquarters had disavowedthe use of civilian staffs shortly before, itnow approved a letter to service com-mands on 11 January 1943 explaining thecompromise just mentioned.58 On 22 Feb-ruary Dr. Baehr sent a similar explanationto regional medical officers of OCD.59

Since the contemplated emergency neverdeveloped, the Army had no occasioneither to take over the hotels earmarked orto call upon the Office of Civilian Defensefor emergency staffs.

SOS planning for the emergency ex-pansion of Army hospitals went on con-currently with that directed by GeneralMarshall. On 25 August 1942 the Chiefof the Hospitalization and EvacuationBranch informed General Lutes that noplan existed for assuring the availability ofbeds in case of an epidemic and requestedauthority to prepare one.60 Given the go-ahead signal, he proposed on 9 September1942 that the station hospital bed ratio beraised from 4 percent to 5 percent for thewinter of 1942-43 and that housing foradditional beds thus authorized should beprovided either by converting cantonment-type hospital barracks into wards and con-structing theater-of-operations-type bar-

racks for the displaced enlisted personnelor by constructing additional cantonment-type wards wherever a medical detach-ment already lived in theater-of-opera-tions-type barracks.61 This plan wasapproved, and on 19 September 1942 thecommanding general, Services of Supply,ordered the Chief of Engineers to put itinto effect.62 As further provision for anemergency, the SOS Hospitalization andEvacuation Branch inserted in the revisedversion of the hospitalization and evacu-ation directive dated 15 September 1942a requirement that each hospital plan toprovide additional beds in barracks for 10percent of the troops served.63 Thus eachhospital would be prepared to care for 15percent of its station's strength. The 5 per-cent authorization proved sufficient forthe winter's needs.

In the course of the Army's controversywith the Office of Civilian Defense, Gen-eral Marshall directed General Snyder,the medical officer on The Inspector Gen-eral's staff, to investigate means of meetingrequirements that might develop in anemergency. General Snyder reported thatenough beds existed, on the 4 percent

Admin Serv SOS, 20 Oct 42, same sub. HD: Wilsonfiles, "Book 2, 26 Sep 42-31 Dec 42." (5) MemoSPOPH 632 (11-17-42), ACofS for Oprs SOS (initWLW[ilson]) for same, 22 Nov 42, same sub. Samefile. (6) Ltr, Act SG to Exec Sec, Health and MedCmtee, 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), CGSOS 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, 11Jan 43, same sub. HD: 632.-1.

59 Ltr, Chief Med Off OCD to Regional Med OffsOCD, 22 Feb 43, sub: Cooperation with the Armyin the Care of Mil Casualties. HD: 632.-1.

60 Memo SPOPH 620 (7-4-42) Bks, Col Wilsonfor 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, 9Sep 42, sub: Opr Plans for Hosp and Evac. HD: Wil-son files, "Book I, 26 Mar-26 Sep 42."

62 Memo SPRMC 632 (9-9-42), CG SOS forCofEngrs, 19 Sep 42, sub: Add Hosps. SG: 632.-1.

63 Mil Hosp and Evac Oprs, sec I, par 3b (3), incl1 to Ltr SPOPH 322.15, CG SOS to CGs of SvCs andPEs and to SG, 15 Sep 42, sub: Mil Hosp and EvacOprs. HD: 322.


basis, to meet ordinary requirements plusthose of a minor epidemic. He estimatedthat 7,500 additional beds could be madeavailable by treating minor cases in quar-ters; 6,000, by treating uncomplicatedcases of venereal disease on a duty status;97,000, by caring for convalescent patientsin barracks; 25,000, by reducing the floorarea per bed in existing wards; and a sub-stantial number, by improving adminis-trative procedures and limiting the per-formance of elective operations. In case ofan unusually severe epidemic, all bar-racks, he believed, could be converted intohospitals and troops could be moved intowarehouses, regimental recreation build-ings, and chapels.64 Under an SOS direc-tive, The Surgeon General attempted laterto carry out some of General Snyder'srecommendations for more effective bedutilization.65 His recommendations formeeting the needs of an epidemic neverhad to be put into effect.

Long-Range Planning

Late in 1942 the Army began to try toco-ordinate hospital construction withother requirements and with postwarneeds. To this end SOS headquarters in-sisted that each service forecast its normalneeds as far ahead as possible.66 The Sur-geon General found it difficult to antici-pate station hospital requirements be-cause they depended, as always, upontroop distributions unknown by him. Inaddition, records of existing station hospi-tals were unreliable, those of the divisionsof the Surgeon General's Office differingamong themselves and with records of theEngineers.67 But projection into the futureof general hospital bed requirements wasless difficult.

In forecasting the need for general hos-pital beds in the fall of 1942, The Surgeon

General adopted a new basis for estimates.Plans for the invasion of North Africawere being made and it was expected thatlarge numbers of combat casualties wouldbe returned to the United States. FromWorld War I experience it appeared thatbeds would be needed in general hospitalsin the United States for 1.7 percent of alloverseas forces if patients requiring 120 ormore days of hospitalization were evacu-ated from theaters of operations.68 TheSurgeon General therefore added .7 per-cent of the strength of overseas forces tothe 1 percent of the total strength of theArmy already established as the basis forestimating general hospital bed require-ments. On 26 September 1942 he recom-mended that a total of 96,000 general hos-pital beds be provided by the end of 1943and of 124,800 by the middle of 1944.About two months later, when the pro-jected Army strength was changed, heproposed that the mid-1944 figure be cutto 103,500. SOS headquarters approvedhis recommendations, and until the earlypart of 1943 this figure stood as the num-ber of beds authorized for planning pur-poses, but not for construction.69 (Chart 4)

64 Ltr, IG per Brig Gen Howard McC. Snyder toCofSA, 10 Nov 42, sub: Surv of Hosp Fac and theirUtil. 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 CGSOS, 26 Sep 42, sub: Hosp, Gen Hosps. HD: Wilsonfiles, "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 ArmyMedical 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 DivSGO, 19 Jan 43, sub: Bed Reqmts for FY 1944. Samefile. (3) Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp,Gen Hosps. SG: 323.7-5.


Source: (1) Documents referred to in Chap V, sec "Estimates of Hospital Capacity Needed."(2) Bed Status Reports, Health Reports Br, Med Statistics Div, SGO.

Early in 1943 a combination of circum-stances pointed toward intensified effortsby the General Staff and SOS headquar-ters to limit construction. In January astudy of hospital bed occupancy, preparedby the Surgeon General's Office for inclu-sion in the SOS Monthly Progress Report,showed that estimated requirements hadbeen higher than actual needs. Whilethere was a close correlation between esti-mated requirements and occupied beds instation hospitals, a discrepancy betweenestimated requirements and occupiedbeds in general hospitals had grown from11,000 to 45,000 during 1942. The Sur-geon General explained that this resultedfrom better health and fewer combat

casualties than anticipated.70 In March1943 certain members of Congress threat-ened to investigate the use of all hospitalbeds, both civilian and military, in theUnited States.71 Soon afterward the Sec-retary of the Navy proposed that theArmy and Navy consider the possibilityof making joint use of their hospitals.72

Furthermore, the Surgeon General of the

70 (1) SOS Monthly Progress Rpt, Sec 5, Pt IV,Health, pp. 44-45, 31 Jan 43.

71 Establishing a Select Committee to Investigate Hospi-tal Facilities Within the United States of America, 78thCong, 1st sess on H. Res. 146, 3 March 1943.

72 Memo WDGDS 2857, ACofS G-4 WDGS forCofSA, 15 Mar 43, sub: Joint Army-Navy Use ofAvailable Hosp Accommodations. HRS: G-4 files,"Hosp and Evac Policy."


United States Public Health Service, call-ing attention to the interest of Congressand of the War Production Board in thematter, suggested to Brig. Gen. Frank T.Hines, Administrator of Veterans Affairsand Chairman of the Federal Board ofHospitalization, the desirability of co-or-dinating the hospital construction plan-ning of all Government agencies.73 As aresult, the President on 31 March 1943ordered the War and Navy Departments,the Federal Security Administration, andthe Veterans Administration to submit allplans for additional hospital constructionto the Federal Board of Hospitalizationfor co-ordination and submission to him,through the Bureau of the Budget, for ap-proval.74

Meanwhile, despite a discrepancy be-tween estimated and actual requirementsin 1942 and in the face of growing interestin limiting hospital construction, The Sur-geon General again raised his estimates.On the basis of new troop strength figuresfrom the Bureau of the Budget, he askedSOS headquarters on 11 March 1943 toapprove an increase in authorized generalhospital beds from 96,000 to 102,882 forDecember 1943 and from 103,500 to 110,-693 for July 1944. He also asked approvalof the higher bed ratio which he had beenusing since September 1942.75 Apparentlythe Services of Supply, renamed ArmyService Forces on 12 March 1943, was inno mood to approve either additional bedsor a higher ratio. Instead, its Require-ments Division directed The SurgeonGeneral to review the proposed ratio inthe light of recent war experience and toconsider a reduction of construction re-quirements by the joint use of Army andNavy facilities, the expansion of existinggeneral hospitals, and the conversion ofstation to general hospitals.76

Methods which ASF headquarters sug-gested for reducing hospital constructionproved practicable only in part. A studyof the possibilities of joint Army-Navyhospitalization promised little in the wayof additional beds for Army use.77 Theproposal to reduce the bed ratio got no-where. The director of the ASF ControlDivision agreed with The Surgeon Gen-eral that information on World War IIcasualty rates was insufficient to warranta reduction, and the ASF Hospitalizationand Evacuation Branch interpreted the15 September 1942 directive on hospital-ization and evacuation as giving The Sur-geon General alone the authority to esti-mate bed requirements for overseascasualties.78 Hence, the ASF Require-ments Division accepted The SurgeonGeneral's estimate of requirements andturned to the remaining means of reduc-ing general hospital construction—the useof station hospital beds and the expansionof existing general hospitals.

In a conference attended by representa-tives of the Surgeon General's Office on8 April 1943, the ASF Requirements Divi-

73 Ltr, SG USPHS to Brig Gen Frank T. Hines, 18Mar 43. SG: 632.-1.

74 (1) Ltrs, Franklin D. Roosevelt to SecWar and toDir Bu of Budget, 31 Mar 43. SG: 632.-1. (2) Ltr, DirBu of Budget to Chm Fed Board of Hosp, 2 Apr 43.Same file.

75 Ltr, SG to CG SOS, 11 Mar 43, sub: Hosp, GenHosps. SG: 323.7-5.

76 1st ind, CG ASF to SG, n d, on Ltr, SG to CGSOS, 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: JointArmy-Navy Use of Available Hosp Accommodations.SG: 705.-1.

78 (1) Memo SPOPH 632 (5 Apr 43), ACofS forOprs 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, DirControl Div ASF for CG ASF, 2 Apr 43, sub: Situ-ation with Respect to Army Hosps. SG: 322.15.


sion pointed out that the construction oracquisition of general hospitals to providea total of 83,000 beds had already beenapproved. To provide approximately103,500 beds by December 1943, about20,500 additional beds would be required.On the basis of projected overseas move-ments, 5,400 station hospital beds wouldbe surplus by that time. If they should beconverted to general hospital use, housingfor only 15,100 additional general hospi-tal beds would need to be constructed.Additional general hospital requirementsduring 1944 could be met by using in-creasingly large numbers of surplus sta-tion hospitals for that purpose. ASF head-quarters therefore approved the expan-sion of thirteen existing general hospitalsby 250 beds each, the construction of sevennew general hospitals, and the acquisitionof Pilgrim State Hospital, Brentwood(Long Island), New York, in order to pro-vide the total number of beds required byDecember 1943.79

Reviewing this plan as the Presidenthad directed, the Federal Board approvedthe construction of the thirteen 250-bedannexes, the acquisition of Pilgrim StateHospital, and the construction of two newgeneral hospitals.80 Before it acted on thefive other general hospitals, the Air Forcesgave up certain buildings it had beenusing, including the Chicago Beach Hotelat Chicago and the Haddon Hall Hotel atAtlantic City. Furthermore, ASF head-quarters decided that adjustments in themilitary program would make possible areduction in authorized beds by approxi-mately 7,000. Accordingly on 22 June1943 the commanding general, ArmyService Forces, directed The SurgeonGeneral to withdraw from the FederalBoard requests for approval of 8,750 ad-ditional beds and to provide, instead,

1,810 beds in the two hotels being vacatedby the Air Forces. In the opinion of ASF,this would complete the general hospitalbuilding program in the United States.81

The events just described reveal a pat-tern that was to be repeated later in thewar—increases in estimated bed require-ments by The Surgeon General, publica-tion of statistics showing relatively low oc-cupancy of beds already provided, andsubsequent efforts by higher headquartersto limit or reduce the number authorized.In this instance, such efforts resulted fromattempts to reduce construction costs andsave building materials but later from aneed to conserve personnel. Earlier, asalready noted, the urgent necessity for ad-ditional hospitals precluded doubts aboutestimated requirements as well as co-ordination of hospital construction pro-grams of various federal agencies, bothmilitary and civilian. When such co-ordination was finally undertaken, theArmy program had been virtually com-pleted. Experiences encountered in plan-ning for emergency hospitalization re-vealed the difficulties involved in co-or-dinating plans of the Army with those ofother agencies and in permitting severalWar Department agencies to work inde-pendently on a single problem.

79 (1) Memo, "Basis used by Gen Wood at Conf onHosp, ZI, SOS, 8 Apr 43, attended by Hall, Offutt,Wickert, Welsh," undated and unsigned. HD: SGOOprs 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, CGASF for SG, 10 Apr 43, same sub. SG: 632.-1.

80 Photostat copy, Res adopted by Fed Bd Hosp, 21May 43. SG: 632.-1 (McGuire Gen Hosp)K. See alsopp. 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 forSG, 22 Jun 43, sub: Completion of Gen Hosp Pro-gram. Same file.


Location, Siting, and InternalArrangement of Hospital Plants

In the hospital construction programattention had to be given not only to typesof construction and estimates of the capac-ity needed but also to the location, siting,and internal arrangements of hospitalbuildings. After war was declared the se-lection of locations and sites, especially forgeneral hospitals, became more compli-cated, while the need for speed in con-struction raised again the question ofcontrol over the internal arrangements ofhospitals.

Selection of Locations and Sites

Station hospitals had to be located atcamps whose situation was chosen byhigher authority than the Surgeon Gen-eral's Office, but selection of sites withinthose camps was a joint enterprise of TheSurgeon General and the Chief of Engi-neers. In selecting locations for generalhospitals The Surgeon General had moreauthority but not a free hand. He set upcriteria of his own but was also subject topolicies established by higher authority,to review of ASF headquarters, and to theEngineers' opinion of the suitability ofavailable sites within general areas.

After war began The Surgeon Generalcontinued to regard as important suchfactors as climate, terrain, utilities con-nections, transportation systems, and com-munications networks. Moreover thegrowth of war industries and military in-stallations necessitated more careful in-vestigation than before of available labor,housing, and commodity markets. Fur-thermore there was the well-establishedpolicy of locating general hospitals in

areas near large training camps, in orderto simplify the transfer of patients fromstation to general hospitals. Occasionallythese factors conflicted with each other.For example, cities with adequate hous-ing, labor, and commodity markets werescarce in the South and Southwest, wheremost troops were concentrated.82 A policyof hospitalizing war casualties near theirhomes was not established until the gen-eral hospital construction program hadbeen virtually completed.83 It thereforehad little effect upon hospital locations.If it had been established earlier, moregeneral hospitals might have been locatedin centers of population rather than incenters of troop density and the problemof finding areas with adequate marketsmight have been less difficult.

Early in 1942 G-4 ordered all new gen-eral hospitals to be located between theAtlantic and Pacific coast ranges as asafety masure.84 It was immediately evi-dent that this policy conflicted with thenecessity of placing hospitals near ports ofdebarkation where they could readily re-ceive patients returning from overseastheaters.85 In June 1942, therefore, SOSheadquarters permitted the constructionof some general hospitals near the coaststo support ports of debarkation, but itmade even more restrictive the area forthe location of others by moving itsboundaries inland to a line running from

82 The above information was taken from numer-ous reports of inspection of areas for hospital locations.They are filed in SG: 632.-1 and in HD: Hosp InspRpts.

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 ColJohn R. Hall (Ret), 2 Dec 50. HD: 314 (Correspond-ence on MS) III.

85 Ltr, SG to TAG, 14 Feb 42, sub: Add Gen HospBeds. SG: 632.-1.


Spokane to Phoenix to El Paso to Temple(Texas) to Atlanta to Cleveland.86 Thislimitation was not strictly observed andtoward the end of 1942 General Marshallin a conference with General Magee ver-bally abrogated both the G-4 and SOSrestrictions.87 Of the 51 general hospitalsauthorized, acquired, or constructed be-tween the beginning and end of the war,28 were outside the area prescribed bySOS headquarters, 4 were on its edge and19 were within it.88 Of the 28 outside thearea, 9 were in the populous northeasternsection of the country and 7 were in thePacific Coast area.

Increasing emphasis during 1942 uponthe use of existing civilian buildings forArmy hospitals complicated the process ofsite selection and sometimes interferedwith proper location. In some instancesseveral buildings, such as hotels or civilianhospitals, had to be surveyed for engineer-ing features and potential bed capacitiesbefore a decision could be made either touse one of them or to erect a new Armyplant in the same general area. In the lat-ter case a satisfactory site still had to beselected. Existing buildings were some-times chosen simply because they weresuitable for conversion into Army hospi-tals, even though they were in towns thatwere smaller than The Surgeon Generalconsidered desirable or were outside thearea prescribed by SOS headquarters.89

The Surgeon General's selection of lo-cations for general hospitals had to be re-viewed by SOS headquarters before theEngineers could investigate specific sitesfor their construction. Of eighteen loca-tions which The Surgeon General pro-posed in June 1942, the SOS Hospital-ization and Evacuation Branch changedalmost a third because its chief consideredthem too near the coast or other general

hospitals and too far from adequate railfacilities and large towns.90 During thewinter of 1942 that Branch urged TheSurgeon General rather unsuccessfully tolocate more hospitals in the West, to carefor possible increases in troop concentra-tions and evacuee loads in that area.91

About the same time, the SOS Require-ments Division became involved, insistingupon the speedy selection of locations forall hospitals to be constructed by June1944. This made selection more difficult,according to both The Surgeon Generaland the Chief of Engineers, and in someinstances The Surgeon General found itexpedient to agree to sites which, although

86 Opr Plans for Hosp and Evac, sec I, par 5 c, incl1 to Ltr SPOPM 322.15, CG SOS to CGs and COs ofCAs, PEs and Gen Hosps, and to SG, 18 Jun 42, samesub. HD: 705.-1.

87 1st ind, SG to CG SOS, 15 Jan 43, on MemoSPRMC 632, CG SOS for SG, 18 Dec 42, sub: Hosp,Gen Hosps. SG: 632.-1.

88 General Hospitals established outside the areawere: Ashford, Newton D. Baker, Birmingham,Brooke, Butner, Cushing, Dibble, Deshon, DeWitt,Edwards, England, Finney, Fletcher, Foster, Ham-mond, Halloran, Madigan, Mason, McCaw,McGuire, Moore, Oliver, Pickett, Ream, Rhoads,Torney, Valley Forge, and Woodrow Wilson; thoseinside the area were: Ashburn, Battey, Borden, Bruns,Bushnell, Carson, Gardiner, Glennan, Harmon, Ken-nedy, Mayo, Nichols, Percy Jones, Prisoner-of-WarGeneral Hospital No. 2, Schick, Thayer, Vaughan,Wakeman, and Winter; those on the edge were Bax-ter, Crile, McCloskey, and Northington.

89 (1) Ltr, SG to CG SOS, 3 May 42. SG: 601.-1.(2) Memo CE 632 (Hosps) SPEOT, CofEngrs for CGSOS, 19 Dec 42, sub: Adv Planning for Add GenHosp Fac. SG: 632.-1.

90 Memo SPOPM 632, ACofS for Oprs SOS (initWLW[ilson]) for Dir Reqmts Div SOS, 17 Jun 42,sub: Add Gen Hosps. HD: Wilson files, "Book I, 26Mar 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, onMemo, SG for CG SOS, 26 Sep 42, sub: Hosp, GenHosps. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec42." (2) 5th ind SPOPH 632 (9-26-42), ACofS OprsSOS for ACofS Mat SOS, 5 Dec 42, on same memo.Same file.


less desirable in his opinion, were superiorfor construction purposes.92

Throughout the early war years, localpressure on the War Department some-times complicated the process of select-ing hospital locations and sites but appar-ently did not often sway the judgment ofthose responsible for making the choice.In their attempts to lure additional war-time activities, many communities andcities made attractive offers, including thepresentation of lands for general hospitalsand the extension of utilities lines to theedges of those areas. In some instancesthere seemed to be a buyers' market. Forexample, after The Surgeon Generalplanned to establish a general hospital inthe Fort Worth-Waco (Texas) area, sixcities offered valuable inducements. Fromthe sites offered, The Surgeon General se-lected the one which, in the opinion of hisrepresentative and that of the Chief ofEngineers, seemed best suited for hospitalpurposes.93 In other instances local au-thorities banded together to prevent theestablishment of hospitals in their areas.94

Sometimes United States Senators andRepresentatives also attempted to influ-ence the selection of certain locations. Gen-erally they seem to have met with littlesuccess. For example, Sens. Charles L.McNary and Rufus C. Holman and Rep.Walter M. Pierce were particularly insist-ent upon the establishment of hospitalsnear LeGrande and Hot Lake, Oreg.,rather than at Spokane and Walla Walla,Wash., but after appropriate investiga-tions the latter locations were approved.95

Likewise, Sen. John H. Bankhead andRep. Carter Manasco sought a hospitalfor Jaspar, Ala., a mining town sufferingfrom a lack of war projects, but The Sur-geon General's representative recom-mended that Jaspar not be selected, and

the place finally chosen for the one hospi-tal in Alabama was Tuscaloosa.96 On theother hand, a hospital was located at Mar-tinsburg, W. Va., a city commended forthat purpose by Rep. Jennings Ran-dolph;97 and, as a rule, after The SurgeonGeneral's Construction Division madetentative selections of locations and sites,it discussed them with appropriate Sen-ators and Representatives and securedtheir co-operation and help in dealingwith local authorities.98

In view of the many factors involved, itis not surprising that the process of site se-lection was slow and gave rise to consider-able criticism later in the war. Much ofthis criticism sprang from the fact thatthere were too few hospitals in denselypopulated areas to enable all patients

92 (1) Memo, CG SOS (Dir Reqmts Div) for SG, 18Dec 42, sub: Hosp, Gen Hosps, with 1st ind, SG toCG SOS, 15 Jan 43. SG: 632.-1. (2) Memo CE 632(Hospitals) SPEOT, CofEngrs for CG SOS, 19 Dec42, sub: Adv Planning for Add Gen Hosp Fac. Samefile. (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 Locat-ing Add Gen Hosp ... in North Texas Area, with12 inds. SG: 632.-1. (2) D/S, ACofS G-4 WDGS toTAG, SG, and CG 8th CA, 19 Jan 42, sub: Site forGen 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 GenHosp 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. Hallfor SG, 3 Jun 42, sub: Insp Trip to Oreg, Wash, andCalif. Same file.

96 (1) Memo, Maj Lee C. Gammill for Col John R.Hall, 6 Jul 42, sub: Jaspar, Ala, Hosp Sites. HD: HospInsp Rpts. (2) Memo, Lt Col Achilles L. Tynes forSG, 22 Aug 42, sub: Rpt on Site Bd Surv for Loca-tion of Gen Hosp at Greeneville (sic), SC and Jaspar,Ala. SG:601.-1.

97 Memo, Col John R. Hall for SG, 15 Jun 42, sub:Insp of Proposed Sites Offered by City of Martins-burg, W. Va. HD: Hosp Insp Rpts.

98 Info furnished by Col Hall (Ret), 2 Dec 50. HD:314 (Correspondence on MS) III.


evacuated from overseas theaters to becared for near their homes. It was gener-ally forgotten—or ignored—that most ofthe general hospitals were located to fa-cilitate the transfer of patients from stationhospitals in training camps and that theWar Department did not establish a pol-icy of hospitalizing overseas evacuees neartheir homes until most of the general hos-pitals had been established.

Control over InternalArrangement of Hospitals

The Surgeon General continued to in-sist that building schedules, hospital lay-outs, and floor plans of all new hospitals,plans for all "major" alterations to exist-ing buildings, and all subsequent changesin such plans should be referred to hisOffice for approval.99 On the other hand,the Chief of Engineers attempted, as didThe Quartermaster General before him,to decentralize as much authority as pos-sible in order to save time. Beginning inFebruary 1942, he again raised the ques-tion of having The Surgeon General ap-prove standard building schedules andlayouts for use in the field, without furtherreference to the latter's Office, but appar-ently neither the Chief of Engineers norSOS headquarters wished to challengeThe Surgeon General's position. Whileofficial construction policy letters did notrequire the reference of layouts and plansto his Office, the Engineers generally fol-lowed that practice.100

The extent of The Surgeon General'sauthority over hospital construction wasdiscussed but not defined after reorgan-ization of the Services of Supply in the latesummer of 1942. On 5 August GeneralMagee requested that certain functions be"retained" in his Office, not decentralized

to the field. Among them were the ap-proval of hospital floor plans and layouts,plans for the conversion of civilian build-ings into Army hospitals, and all majoralterations to existing hospital build-ings.101 General Somervell's reply was in-conclusive. He stated that the approval offloor plans and layouts had been and wasat that time a responsibility of the Chiefof Engineers, but that it was the practiceto secure concurrence of the Surgeon Gen-eral's Office in them. Plans for the conver-sion of civilian buildings, he stated, fell ina "twilight zone" that was not well definedeither before or after the reorganization.As for alterations to existing hospitals,General Somervell stated that there wasno clear definition of the word "major."He implied that The Surgeon Generalshould agree with the Chief of Engineersto decentralize authority for alterations toservice commands. If The Surgeon Gen-eral could not trust service command sur-geons to supervise alterations properly,General Somervell concluded, he shouldreplace the surgeons.102

99 (1) Ltr, SG to CofEngrs, 9 Feb 42, sub: HospBldg Schedules. (2) 1st ind, SG to CofEngrs, 1 May43, on Ltr 600.92 (Gen) SPEEG, CofEngrs to SG, 25Apr 42, sub: Typical Hosp Layouts. (3) 1st ind, SG toCofEngrs, 2 Aug 42, on Synopsis Ltr, CofEngrs to SG,28 Jul 42, sub: Auth of Div Engr to Auth Cons. All inSG: 632.-1.

100 (1) Ltr, SG to CofEngrs, 9 Feb 42, sub: HospBldg Schedules. SG: 632.-1. (2) Ltr 600.92 (Gen)SPEEG, CofEngrs to SG, 25 Apr 42, sub: TypicalHosp Layouts. Same file. (3) Ltr AG 600.12 (2-19-42)MO-D-M, TAG to CGs of all Depts and CAs, COsof Exempted Stas, and C of Arms and Servs, 24 Feb42, sub: WD Cons Policy, ZI. HRS: G-4/31751. (4)1st ind, CofEngrs to CG AAF, 25 Aug 42, on Ltr, CGAAF 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 inReorgn of SvCs. SG: 020.-1.

102 1st ind, CG SOS to SG, 15 Aug 42, on Ltr, SGto CG SOS, 5 Aug 42, sub: Liaison in Reorgn of SvCs.SG:020.-1.


Within the same month it became ap-parent that local changes in approvedplans for converting civilian buildings intohospitals needed to be more strictly con-trolled. Aware of the difficulties of suchconversions, The Surgeon General askedauthority on 2 August 1942 to commissionfive civilian architects to serve as adviserson the spot in the alterations required.The commanding general, Services ofSupply, disapproved this request becausethe Chief of Engineers considered it anencroachment upon his responsibility.103

Meanwhile word reached Washingtonthat local engineer and medical officershad made unnecessary and expensivechanges in plans for one of the conver-sions. After a conference on this problemon 14 August 1942 among representativesof the Services of Supply, the Chief ofEngineers, The Surgeon General, and theWar Production Board, General Somer-vell directed that no changes should bemade in approved plans for altering hotelsor other buildings without the writtenconsent of both The Surgeon General andthe Chief of Engineers.104

In following months The Surgeon Gen-eral and the Chief of Engineers agreedupon a partial decentralization of author-ity to approve alterations of existing hos-pitals. On 5 October 1942 the WarDepartment delegated to service com-manders the authority to approve alter-ations costing up to $10,000 on any build-ing, at any one time and place.105 On 13November 1942 The Surgeon Generalsuggested, as he had before, that all"major" alterations to hospital buildings,regardless of cost, be sent to his Office forapproval. He defined "major" alterationsas those requiring structural changes toconvert sections of buildings or entirebuildings from one use to another, to con-

vert ward to office space or vice versa, orto extend buildings into areas expected tobe kept vacant. The Chief of Engineersinsisted that the term "major" changeswould be misleading and suggested thatthe phrase "changes involving more than$10,000" be used instead. Undoubtedlyaware of the War Department's action of5 October 1942, The Surgeon General re-luctantly agreed and on 3 December 1942the Chief of Engineers issued a letter au-thorizing local alterations costing up to$10,000 on hospital buildings, withoutprior approval of The Surgeon General.106

In November 1942 the Wadhams Com-mittee attributed what it considered to beshortcomings in hospital construction par-tially to the limited extent of The SurgeonGeneral's authority but also to the inade-quacy of his own construction staff. Stat-ing that the division of responsibilitybetween the Chief of Engineers and TheSurgeon General had permitted "passingthe buck," it recommended that the latterbe given more authority over construc-tion. At the same time the committee pro-posed that The Surgeon General strength-en his construction staff by adding to it out-standing civilian hospital architects andby 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: Conver-sion of Hotels to Army Hosps. SG: 632.-2. (2) SOSMemo S100-2-42, 27 Aug 42, sub: Limitation onAlterations 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 1stind CE 600.94 (Surg Gen) SPEUU, CofEngrs to SG,n d; 2d ind, SG to CofEngrs, 25 Nov 42, and 3d indCE 600.94 (Surg Gen) SPEUU, CofEngrs to SG, 7Dec 42. SG: 632.-1. (2) Ltr, CofEngrs to CGs of SvCs,3 Dec 42, sub: Nonrecurrent Project Ests InvolvingHosp Bldgs. CE: 632, Pt 2.


experienced in hospital planning. TheSurgeon General naturally agreed thathe should have more authority, but heconcurred with the chief of his HospitalConstruction Division in defending thepractice of placing a doctor at its headand ascribed the division's shortage oftrained architects to the disapproval of hisrequest to commission five to assist in theconversion program.107

Maintenance of Hospital Plants

Responsibility for Maintenance

Even before The Surgeon General lostcontrol over hospital alterations costingless than $10,000, he had also lost author-ity over the expenditure of funds forhospital repair and maintenance. At thebeginning of 1942 funds from three appro-priations were used for hospital mainte-nance. Two of them, the Barracks andQuarters (B&Q) appropriation and theConstruction and Repair of Hospitals(C&RofH) appropriation, were Engineerappropriations; the third, the Medicaland Hospital Department (M&HD) ap-propriation, was made to the Medical De-partment. Funds from the B&Q appro-priation and from the M&HD appropria-tion were controlled exclusively by theEngineers and the Medical Departmentrespectively. Those from the C&RofH ap-propriation were controlled jointly by theChief of Engineers and The Surgeon Gen-eral. B&Q funds paid for such things asfiring boiler plants of hospitals and repair-ing certain buildings occupied and usedby operational personnel. C&RofH fundsprovided for the maintenance of buildingsoccupied and used by patients and for theupkeep of installed equipment. M&HDfunds were used to maintain noninstalledMedical Department equipment and to

meet expenses connected with the pur-chase of medical supplies.108

The use of three funds for hospitalmaintenance produced complications.One was confusion about the fund towhich various expenditures should becharged. In January and February 1942questions arose over whether repairs tohospital barracks should be charged toB&Q or to C&RofH funds.109 Fine dis-tinctions sometimes had to be made inapplying the C&RofH fund rather thanthe M&HD fund and vice versa. For ex-ample, carpenters were employed fromboth. Those paid with M&HD fundscould repair hospital furniture and non-installed equipment, but not buildingsand installed equipment; those paid withC&RofH funds had to do that.110 Anotherproblem arose in the joint administrationof C&RofH funds. Although they wereEngineer funds, their appropriation wasbased on estimates prepared by The Sur-geon General and they were allotted tohospitals on his recommendation. Corpsarea and post surgeons controlled theirexpenditure and reported on it to TheSurgeon General, but post engineer offi-cers performed the work.111

107 (1) Cmtee to Study the MD, 1942, Rpt. HD. (2)Cmtee to Study the MD, 1942-43, Actions onRecomd, Recomd No 31. HD. (3) Memo, Col JohnR. Hall for Exec Off SGO, 3 Dec 42. SG: 632.-1.

108 Tynes, Construction Branch, p. 54. Also see thelanguage 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 andC&RofHA Funds, with 1st ind, SG to CofEngrs, 1Mar 42. (2) Ltr CE 121.2 (Funds) CUC, CofEngrs toSG, 25 Feb 42, sub: Policy for Div of B&QA,C&RofHA and Air Corps Tec Funds, and 1st ind, SGto CofEngrs, 1 Mar 42. Both in SG: 632.-1.

110 Memo, Col F[rancis] C. Tyng for Budget OffWD, 22 Mar 42, sub: Trf of Approp C&RofH froma 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 SepApprop to M&HD, A. SG: 632.-1. (2) AR 40-585,par 3 and 4, 16 Jul 31.


Early in 1942 the Chief of Engineersbegan to simplify the administration of theC&RofH fund. In order to reduce book-keeping, he proposed on 31 January 1942the abandonment of a practice of sub-dividing the fund into several smallerproject-funds.112 He also began to makeallotments directly to district engineers,without securing The Surgeon General'sand corps area surgeons' recommenda-tions.113 Then he directed district engi-neers to prepare estimates of C&RofHfunds in the same way they did those ofB&Q funds.114 The Surgeon General wentalong with these changes, but insisted thatcorps area surgeons be informed of allot-ments made to hospitals and that theycontinue to report to him on all expendi-tures made from such allotments.115

The next month the merger of theC&RofH appropriation with either theB&Q or the M&HD appropriation cameup for consideration. The Chief of Engi-neers wanted the C&RofH fund mergedwith the B&Q fund under his control.Hearing of pending legislation to thateffect, The Surgeon General recommend-ed to the Budget Officer of the War De-partment on 22 March 1942 that theC&RofH and the M&HD appropriationsbe combined into one, under Medical De-partment control. In support of thisrecommendation he pointed out unsatis-factory features of having a fund con-trolled jointly by the Engineers and theMedical Department.116 This action cametoo late, because the merger of C&RofHwith B&Q funds under a single appro-priation called Engineer Service, Army,had already occurred on 5 March 1942.117

The Surgeon General protested againstthis "radical departure" from acceptedpractices, maintaining now that joint con-trol of the C&RofH fund had been satis-factory, that only doctors could determine

the maintenance required for hospitals,and that Congress had always been, andmight be expected to continue to be, moreliberal in appropriating funds for hospitalmaintenance than for the routine mainte-nance of Army posts.118 He failed, how-ever, to keep control over funds expendedfor hospital maintenance, for on 23 May1942 the War Department charged theChief of Engineers with responsibility forrepairs and utilities at general hospitalsand on 9 June 1942 rescinded the Armyregulation which had outlined The Sur-geon General's former authority over hos-pital maintenance.119 With the reorgan-ization of the Services of Supply, the Chiefof Engineers requested The Surgeon Gen-eral on 17 August 1942 to close out all fis-cal transactions pertaining to hospital

112 Memo CE 121.2 (Projects) CUC, CofEngrs forSG, 31 Jan 42, sub: Project Revision. SG: 632.-1.

113 Ltr, Surg 4th CA to SG, 19 Jan 42, sub: C&RofHFunds, with 2d ind, CofEngrs to SG, 13 Feb 42. SG:632.-1 (4th CA) AA.

114 Ltr CE 315 (Forms) CUC, CofEngrs to SG, 27Jan 42. sub: Application of OCE Forms No 395 and395-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.] Craftto Surg 2d CA, 7 Mar 42. SG: 632.-1 (2d CA)AA.(3) Ltr, same to Capt Joe [E.] McKnight, MAC, Offof 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 BudgetOff 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, PublicLaw 474, apvd 5 Mar 42. (2) GAO Acts and Proce-dures Ltr 4236, 7 Mar 42. HD: 121.2.

118 (1) Ltr CE 121.2 (Funds) CUC, CofEngrs to SG,24 Mar 42, sub: Maintenance of Hosp Structures. (2)Memo, SG for Maj Gen T[homas] M. Robins, AsstCofEngrs, 26 Mar 42, sub: Maintenance and Repairof Hosps. (3) Memo CE 600.3 (Gen)-CU, CofEngrsfor SG, 10 Apr 42, sub: Repairs and Util Functions atMD Fac, with 1st ind, SG to CofEngrs, 23 Apr 42. Allin SG: 632.-1.

119 (1) WD Cir 157, 23 May 42. (2) AR 100-80,9 Jun 42.


maintenance and to plan to transfer thefunds, personnel, and equipment used inthat work to the Engineers as of the closeof business on 31 August 1942.120

After responsibility was concentrated inthe Chief of Engineers, the maintenanceand repair of hospitals failed to suffer asthe Surgeon General's Office had antici-pated. The surgeons of several servicecommands reported favorably on the per-formance of maintenance work under thenew system.121 As late as 1945, Col.Achilles L. Tynes, of the Hospital Con-struction Division, pointed out that hospi-tals had experienced no difficulty in get-ting repairs during the war and that itcould not be proved that retention of con-trol of funds by the Medical Departmentwould have been more satisfactory thancontrol by the Engineers.122

Reflooring and Reroofing

Throughout the war, maintenance pro-grams of magnitude had to be carried onconcurrently with new construction pro-grams, largely as the result of the use ofcantonment-type construction in the ma-jority of hospitals built both before andafter the war began. Green pine lumber,the only type available in many cases, wasfrequently used for both flooring and roof-ing. As it dried and warped, it pulled thenails through tar-paper roofing, tearing itand producing leaks, and caused floors toshrink and splinter, leaving them un-sightly, insanitary, and dangerous. Be-ginning late in 1941 and continuingthrough 1942, The Surgeon General andthe Chief of Engineers initiated and car-ried through extensive programs of reroof-ing and reflooring. Asphalt strip shinglesgradually replaced tar-paper roofs, andold floors were covered with layers, first of

plywood and then of linoleum or similarmaterial. In corridors, imitation-rubberstrip-runners were laid to protect floors, toreduce noise, and to increase patients'safety. These costly programs might havebeen avoided had better materials beenavailable and authorized for initial hospi-tal construction.123

Efforts to Increase the Safetyand Comfort of Patients

Despite the War Department's policyof "Spartan simplicity" in constructionand maintenance during 1942 and 1943,the Engineers and the Medical Depart-ment tried to increase the safety and com-fort of patients in hospitals. The practiceof installing automatic sprinkler systemsas protection against fire in cantonment-type wards was continued and extendedto include recreation, mess, post exchange,and clinic buildings as well.124 Numerousrequests from separate hospitals for heat incorridors, to protect patients as well as thepipes of sprinkler systems from extremecold, had prompted The Surgeon General

120 Ltr, Asst CofEngrs to SG, 17 Aug 42, sub: Trf ofRepairs and Util Functions. SG: 632.-1.

121 An Rpts, 1942, Surg 5th, 7th, and 9th SvCs. HD.122 Tynes, Construction Branch, p. 64.123 Correspondence among The Surgeon General,

The Quartermaster General, and the Chief of Engi-neers on these programs is on file in SG: 632.-1; SG:632.-1 (1st thru 9th CAs)AA; and CE: 632 Vol. 3. Alsosee Speech, Lessons Learned from Planning and Con-structing Army Hospitals, by Col Hall, 16 Sep 43(HD: 632.-1), and Tynes, Construction Branch, pp.65-67.

124 (1) 2d ind, SG to TAG, 19 Jan 42, and 3d indAG 671.7 (31 Dec 42) MO-D, TAG to CofEngrs, 26Jan 42, on Synopsis Ltr, Div Engr Carib Div toCofEngrs, 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 SmallHosps. CE: 671.3, Pt 1. (3) SOS Memo S30-2-42,sub: Policy Governing Instl of Automatic SprinklerSysts and Fire Alarm Systs. SG: 671.2.


in October 1941 to reverse an earlier de-cision and request the installation of heat-ing facilities.125 On 4 February 1942 theSecretary of War authorized their installa-tion in the corridors of all cantonment-type hospitals then under construction orplanned.126 Getting approval for the in-stallation of air-cooling systems in hospi-tals in hot southern areas was consider-ably more complicated.

During the first summer that the Armybegan to use cantonment-type hospitalson a wide scale, hospital commanders andcorps area surgeons, especially in areaswith high temperatures, had complainedthat patients suffered from heat in wardsand that the temperature in operatingrooms and clinics was frequently unbear-able.127 The attic space above the low-ceilinged cantonment-type buildings col-lected and held heated air, raising thetemperature in the buildings higher thanon the outside. Dust in new camps oftenmade it necessary to close all windows,and use of sterilizers and developing tanksin clinics and dark rooms increased hu-midity in those sections of hospitals.128

Colonel Offutt, Chief of The SurgeonGeneral's Hospitalization Division, prom-ised in September 1941 that attemptswould be made to correct this situation bythe summer of 1942.129

During the next spring the SurgeonGeneral's Office collaborated with localsurgeons and representatives from manu-facturing concerns in working out systemsemploying mechanical air conditioners,evaporative coolers, and forced-air ventila-tion. The mechanical air conditionerswere self-contained package-type coolers,like those used in restaurants and offices.Outside air was drawn into buildings overcoils containing a refrigerating gas, andair-duct installation was not required.

Evaporative coolers were useful in dryareas of the Southwest, where the hu-midity was extremely low. These devicesdrew hot outside air into buildings throughwet, porous substances; as the moistureevaporated, the air cooled. In the hot andhumid climate of the South and South-east, where evaporative cooling was notpracticable, forced ventilation was used.Exhaust fans in attics blew out hot air,producing a condition in the wards belowsimilar to that found outside in the shadewith a light breeze.130 Using C&RofHfunds allocated by The Surgeon General,local hospital commanders and utilitiesofficers began to install such systems dur-ing the spring of 1942.131

Before this program had gotten very farit encountered a directive, on 20 May

125 Ltr, SG to QMG, 29 Oct 41, sub: Heating ofEnclosed 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-typeHosps, with 1st ind, CofEngrs to TAG, 27 Jan 42, and2d ind, TAG to CofEngrs, 4 Feb 42. CE: 632, Pt I.

127 For example, see: (1) Synopsis Ltr, AF CombatComd Hq to CofAC, 5 Jul 41. SG: 632.-1. (2) 1stwrapper 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 CantonmentHosps. SG: 632.-1 (4th CA)AA.

128 Speech, Lessons Learned from Planning andConstructing 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 Can-tonment Hosps. SG: 632.-1 (4th CA)AA.

130 (1) Speech, Lessons Learned from Planning andConstructing Army Hospitals, by Col Hall, 16 Sep 43.HD: 632.-1. (2) Memo, Col John R. Hall for SG, 16Jun 43, sub: Resume of Procurement of Air-Condi-tioning and Ventilative Equip for Cantonment-TypeHosps. 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 toCofEngrs, 6 Apr 42, sub: Special Features for Ventila-tion of Hosps. (3) Ltr, SG to Various Sta and GenHosps, 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.


1942, severely restricting the use of me-chanical and electrical equipment inArmy construction.132 The Chief of Engi-neers, who by now controlled funds for thepurchase of cooling equipment and wasresponsible for its installation, sought ap-proval of the War Production Board forinstalling the apparatus recommended byThe Surgeon General.133 The Board ap-proved the use of air conditioners in oper-ating rooms, X-ray clinics, and recoverywards, but failed to deal with The Sur-geon General's proposal to install exhaustfans or evaporative coolers in other hospi-tal buildings.134 The supply of fans andcoolers already on hand was believed tobe limited, but no Government agencyactually knew its extent.135 Consequentlythe SOS Resources Division wanted tolimit installation to cases of greatest needand in August 1942 approved only a lim-ited program.136 Early in 1943 a practiceof transferring equipment from nonessen-tial to military uses developed and theWar Production Board ascertained thatdealers had considerable stocks of air-conditioning and mechanical-ventilatingequipment on hand.137 When The SurgeonGeneral resubmitted his proposal in Janu-ary and February,138 therefore, the WarDepartment issued a policy letter on thesubject.

Under the new policy the installation ofcooling equipment from existing inven-tories or from recaptured stocks was per-mitted in areas where the average Julytemperature exceeded 75° Fahrenheit.Depending upon humidity of the area inwhich a hospital was located, either evap-orative coolers or exhaust fans were per-mitted in operating rooms, wards, X-rayrooms, clinics, dispensaries where minoroperations were performed, and patients'mess halls. Where neither of these types

served the purpose, air conditioners mightbe installed in operating rooms, X-rayrooms, flight surgeons' clinics, and re-covery wards. In desert areas, evaporativecoolers might also be used in quarters oc-cupied by personnel on night duty.139

Installation of the long-desired equip-ment now began. Since authority to ap-prove jobs amounting to $10,000 or lesshad been decentralized to service com-mands, the installation of air-conditioningand mechanical-ventilating systems was aresponsibility of local engineers. The Chiefof Engineers and The Surgeon Generaldeveloped guides for their use, and on 15April 1943 the Chief of Engineers in-formed service command engineers ofprocedures to follow in processing requests

132 Directive for Wartime Cons, 20 May 42, incl toLtr AG 600.12 (5-20-42) MO-SPAD-M, TAG toCGs 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 Fanand Blower Sec WPB, 20 Jun 42. CE: 673, Pt 3. (2)Ltr, SG to CofEngrs, sub: Ventilation and Air Condi-tioning 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 Coolingfor Hosp Bldgs. SG: 673.-4. (2) Notes on tel conv be-tween Lt Col Norris G. Kenny and Col John R. Hall,29 Jun 42. Same file.

136 (1) Memo, Dir Resources Div SOS for SG, 30Jun 42, sub: Exception from 'List of Prohibited Itemsfor Cons Work' of Ventilation Fans for Hosps. SG:673.-4. (2) Memo SPRMC 674.4(8-11-42), CG SOSfor CofEngrs, 16 Aug 42, sub: Policy DeterminingInstl 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 andVentilation for Hosps. SG: 673.-4.

138 (1) Memo, SG for Maj Frank Seeter, ResourcesDiv SOS, 23 Jan 42, sub: Ventilative Treatment inCantonment-Type Hosps. SG: 673.-4. (2) Memo, SGfor Production Div SOS, 22 Feb 43, same sub. Samefile.

139 WD Memo W100-4-43, 24 Mar 43, sub: Policyfor Air-Conditioning, Cooling, and Ventilation ofArmy Instls, Continental US. SG: 673.-4.


for that work.140 Although delivery ofunits was delayed in some cases until thefall of 1943, many hospitals had air-cool-ing systems in time for both patients andoperational personnel to benefit from re-duced temperatures during the summer ofthat year.141

Correction of Errorsin Cantonment-Type Hospitals

While improvements already men-tioned were being made, the Engineersand the Medical Department worked tocorrect inadequacies of space for variousfunctions, especially in cantonment-typehospitals. The prewar practice of provid-ing more room for administrative andservice activities, X-ray work, storage,and recreation was continued.142 Actionwas also taken to furnish ear, eye, nose,and throat (EENT) clinics with morespace than that originally planned. Thisoccurred after the War Department estab-lished a policy of giving eye examinationsand spectacles to all soldiers who requiredthem. Existing EENT clinics were en-larged or were abandoned in favor of newones set up in ward buildings.143

In the fall of 1942 the Wadhams Com-mittee found fault particularly with short-age of occupational therapy facilities, in-adequacy of space for post exchange andrecreational activities, and lack of safetyfeatures in neuropsychiatric wards.144 Thechief of The Surgeon General's HospitalConstruction Division, Colonel Hall,agreed that post exchanges and recrea-tional facilities were too small but statedthat War Department construction poli-cies were responsible for that fault. Hebelieved that it was unnecessary and im-practical to have occupational therapyfacilities in station hospitals, because in

his opinion all patients needing occupa-tional therapy should be sent to generalhospitals.145 Nevertheless, in compliancewith an SOS directive, The Surgeon Gen-eral submitted a comprehensive programon 17 January 1943 for the construction ofadditional occupational therapy build-ings, recreation buildings, detachmentdayrooms, post exchanges, libraries,chapels, officers' and nurses' recreationbuildings, and theaters in all hospitals oftwo hundred or more beds.146 SOS head-quarters apparently considered this pro-gram as one going beyond the bounds ofWar Department construction policies,and returned it for reconsideration. After

140 (1) Memo, SG for CofEngrs, 27 Apr 43, sub:Instl Plans for Air Conditioning, Evaporative Cooling,and Mechanical Ventilation. SG: 673.-4. (2) Ltr,CofEngrs to CG 2d SvC attn Dir of Real Estate, Re-pairs, and Utils, 15 Apr 43, same sub. Same file.

141 For example, see: An Rpts, 1943, of Kennedyand Ashburn Gen Hosps and of Sta Hosps at ScottFld and Cps Bowie, Beale, and Maxey. HD.

142 (1) Ltr, SG to CofEngrs, 27 Jan 42, sub: Requestfor Urgent Emergency Cons. SG: 632.-1. (2) Ltr, SGto CofEngrs, 6 Jul 42, sub: Request for WorkingDrawings for Admin Bldg, Type HA-1 and HA-2,with 4 inds. Same file. (3) An Rpts, 1942, Sta Hospsat Cps Dodge and Forrest and 1943, Sta Hosps at CpsBeale, Hale, and Hood. HD.

143 (1) Memo, Col John R. Hall for Chief Profes-sional Serv SGO, 30 Jul 42, sub: Conversion of WardBldg into an Enlarged EENT Clinic. SG: 632.-1. (2)Ltr, SG to CofEngrs, 7 Aug 42, sub: Plans for Conver-sion of a Ward Bldg into an EENT Clinic. Same file.(3) An Rpt, 1942, Sta Hosp at Cp Forrest and 1943,Sta Hosps at Cps Beale, Ellis, Hale, and Hood. HD.

144 (1) Cmtee to Study the MD, 1942-43, Actionson 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 toCG SOS, 15 Dec 42, on extract from Memo, CG SOSfor SG, 26 Nov 42, in Cmtee to Study the MD,1942-43, Actions on Recomd, Recomd Nos 10 and15. HD.

146 Extracts from Ltr, SG to CG SOS, 17 Jan 43,sub: Recreational Fac in Army Hosps, in Cmtee toStudy the MD, 1942-43, Actions on Recomd, RecomdNo 10. HD.


that, it seems to have passed for somemonths among the offices of The Sur-geon General, the Chief of Engineers, andthe SOS Requirements Division,147 andimprovements of the kind asked for werenot approved until the latter half of thewar.

With regard to neuropsychiatric wards,Colonel Hall pointed out that plans fortheir construction had been completely re-vised during 1941. Faults that continuedto exist, he said, resulted either from fail-ure of construction officers to follow speci-fications closely or from the difficulty ofconstructing wards in wooden buildingsso that patients could not escape or com-mit suicide yet at the same time could beeasily removed in case of fire.148 On hisadvice, The Surgeon General recom-mended on 31 December 1942 that theEngineers be instructed to provide allneuropsychiatric wards, including thosealready constructed, with the featurescalled for in revised plans.149 During thefirst half of 1943 the Engineers undertooka program of improving neuropsychiatricwards in compliance with this recom-mendation.150

In the spring of 1943, in order to elimi-nate the need for alterations and additionsto hospitals after completion, plans forsome cantonment-type buildings were re-drawn. This may have resulted from areport made by the Seventh Service Com-mand's Inspector General. Investigatingconstruction projects at hospitals in hisarea, he concluded on 9 March 1943 thatsimilar alterations could be avoided inthe future by a revision of constructionplans.151 Soon after his report reachedWashington, the Engineers began to col-laborate with the Surgeon General'sOffice in revising plans for cantonment-type administration buildings, clinics, and

messes. By the middle of 1943 this projecthad apparently been completed,152 butthis was too late to effect significant sav-ings in hospital alterations, for the majorportion of the hospital construction pro-gram had already been completed.

Conformity of HospitalConstruction to Needs

As hospitals were constructed to meetwartime needs experiences encountered inthe period of peacetime mobilization wererepeated in individual instances. With theArmy growing by leaps and bounds troopssometimes moved into new camps beforehospitals were completed, and old campswere expanded before existing hospitalscould be enlarged. In some areas therewere unexpected delays in construction.For these there were numerous causes.Among them were unfavorable weatherconditions; shortages of equipment such aselectric cables, pumps, motors, and espe-cially high pressure boilers; and labortroubles, including scarcity of laborers anddisputes between employers and em-

147 Cmtee to Study the MD, 1942-43, Actions onRecomd, 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 toCG SOS, 14 Dec 42, on Memo, CG SOS for SG, 26Nov 42, in Cmtee to Study the MD, 1942-43, Actionson Recomd, Recomd No 47. HD.

149 Ltr SPMCC 632.-1, SG (init JRH[all]) to CGSOS, 31 Dec 42, sub: NP Wards. CE: 632, Vol. 3.

150 Ink note, "All items referred to have been takencare of by revised drawings and specifications and bycircular letter and informal conference with SGO,7/29/43," on Ltr, SG to CG SOS, 31 Dec 42, sub: NPWards. CE: 632, Vol. 3.

151 Ltr, IG 7th SvC to IG, 9 Mar 43, sub: ConsPlans, Gen Hosps, with 2 inds. SG: 333.1-1 (7thSvC)AA.

152 (1) Memo, CofEngrs for SG, 24 Mar 43, sub:Hosp Bldg Plans, with 1st ind, SG to CofEngrs, 2 Apr43. SG: 632.-1. (2) Ltr CE 600.13 (Hosp) SPEEW,CofEngrs to SG, 31 Mar 43, sub: Proposed HospMesses, with 3 inds. Same file.


ployees. For posts where actual needs out-stripped hospital construction, The Sur-geon General set aside additional beds ingeneral hospitals and local medical offi-cers resorted to expedients used before thewar to provide adequate hospital care.153

As a whole, construction kept up withactual needs even though it lagged consid-erably behind estimated requirements.During the first year and a half of the warthe number of station hospitals increasedfrom about 200 to more than 425; and thenumber of normal beds (that is, those forwhich 100 square feet of space each wasprovided in ward buildings) rose fromabout 58,725 to over 220,000. During theentire period the total number of stationhospital beds that were occupied through-out the United States was continuouslylower than the total number of normalbeds provided. From December 1942 toMarch 1943, when the incidence of respir-atory diseases increased and the transfer ofpatients from station to general hospitalswas restricted to save places for antici-pated casualties, the number of patients instation hospitals exceeded the number ofnormal beds available but not of normalbeds provided. (Only 80 percent of thebeds provided were considered available,because the necessity of segregating pa-tients into separate wards according todisease, sex, and grade meant that emptybeds in "wrong" wards, amounting as arule to 20 percent of the total, could notbe used.) During the entire period, how-ever, emergency and expansion beds (thatis, those set up on the basis of 72 squarefeet each not only in wards but also inporches, solaria, halls, etc.) made thenumber of all beds available greater thanthe number of beds occupied.154

The number of general hospitals inoperation 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 neverreached the total of normal beds provided,but from April through September 1942in general hospitals the number of oc-cupied beds exceeded the number of nor-mal beds available. This overcrowdingresulted largely from the policy of givingthe station hospital program priority overthat for general hospitals because of themore immediate need for station hospitalbeds. General hospitals, as did station hos-pitals, set up emergency and expansionbeds when they were needed. Older andbetter-established hospitals, such as WalterReed and the Army and Navy GeneralHospital, tended to be more crowded thannewer ones, because the latter had toawait the presence of supplies and equip-ment as well as full complements of per-sonnel before patients could be trans-ferred to them in large numbers. By June1943, as more new general hospitalsopened, the number of available normalbeds outnumbered by a comfortable mar-gin the number of occupied beds.155

(Chart 5)

153 (1) An Rpts, 1942, Surg 1st, 3d, and 4th SvCs.HD. (2) An Rpts, 1942, Sta Hosps at Cps McCoy andAdair and Borden Gen Hosp. HD. (3) Memo CE600.914 (WWGH) SPEOT, CofEngrs for SG, 15 Dec42, sub: Progress at Woodrow Wilson Gen Hosp. SG:632.-1 (WWGH)K. (4) Ltr, CO Valley Forge GenHosp to SG, 17 Oct 42, sub: Completion Date. SG:632.-1 (VFGH)K. (5) Ltr, Col E[rnest] R. Gentry toCol H. D. Offutt, 24 Oct 42. SG: 323.7-5 (BordenGH)K. (6) Rpts on Status of Hosp in US, 1 and 6 Feb43. SG: 632.-1. (7) Memo, SG for CG ASF, 31 Mar43. HD: 632.-2.

154 The above is based on: (1) Bed Status Rpts. Offfile, Health Rpts Br Med Statistics Div SGO. (2) ASFMonthly Progress Rpt, Sec 7, Health, pp. 13-16, 28Feb 43.

155 The above is based on: (1) Bed Status Rpts. Offfile, Health Rpts Br Med Statistics Div SGO. (2) ASFMonthly Progress Rpts, Sec 7, Health, 28 Feb and 31May 43.

CHAPTER VI

Early Adjustments in the Zone

of Interior Hospital System

As the number of hospitals in theUnited States increased, changes occurredin the hospital system—that is, the combi-nation of hospitals of different types oper-ating under and serving different majorcommands. It will be recalled that therewere only two types of zone-of-interiorhospitals at the beginning of the war—station and general hospitals. As theArmy's needs changed with its wartimeexpansion and combat experience, someof these installations developed character-istics or were given functions which madethem differ from the normal. For example,special hospitals were required for prison-ers of war and others had to be preparedto receive combat casualties from theatersof operations. Moreover the desirabilityof establishing a new type of hospital tocare for convalescent patients was con-sidered. Expansion of the Army, alongwith reorganization of the War Depart-ment, also raised questions as to whichcommands should be served by andshould operate hospitals of different types.Therefore, before discussing the develop-ment of special characteristics and func-tions of some hospitals, an explanation ofthe command relationships of station and

general hospitals with higher headquar-ters is in order.

Command Relationships of Hospitals

Station Hospitals

Classified according to major com-mands under which they operated, stationhospitals with few exceptions were eitherArmy Service Forces (called Services ofSupply until March 1943) or Army AirForces hospitals. ASF station hospitals fur-nished hospitalization not only for menand women of the Service Forces but alsofor those of the Army Ground Forces.Hence, large camps such as Fort Bragg(North Carolina) and Fort Jackson (SouthCarolina), with several infantry divisionseach, were served by ASF station hospi-tals. By August 1942 there were 133 ASFstation hospitals; by February 1943, 166.In February they ranged in size from 18to 3,017 beds and had an average capac-ity of 643 beds each. AAF station hospitalswere as numerous as ASF station hospi-tals, but were generally smaller. Locatedat AAF bases and fields and normallyserving only AAF personnel, they num-


bered 103 in August 1942 and 169 in Feb-ruary 1943. On the latter date theyranged in size from 19 to 1,471 beds andhad an average capacity of 233 bedseach.1 Since troops of the Ground Forcesand of defense commands were usuallyhospitalized in ASF hospitals, these com-mands had no "named" station hospitalsunder their jurisdiction, but in a few casesthey established what amounted to hospi-tals of that type in the United States.

Defense command troops were gener-ally dispersed over extensive areas toguard the coasts of the United States. Re-ceiving only emergency medical care intheir own installations, they were ordinar-ily treated in ASF hospitals, or in near-byAir Forces, Navy, and civilian hospitals.In general, this system seems to haveworked well,2 but in the Western DefenseCommand where troops were concen-trated to ward off a sneak Japanese attack,difficulties arose. Delays in the DefenseCommand's decision on troop distribu-tions, as well as overlapping jurisdictionsof the Defense Command, the Ninth Serv-ice Command, and the Army Air Forces,impeded attempts of The Surgeon Gen-eral, the Service Command, and SOSheadquarters to provide adequate facil-ities.3 In April 1942, to meet an immediateneed for beds in the Los Angeles area, theWestern Defense Command arrangedwith the Veterans Administration to takeover its buildings at Sawtelle, Los Angeles,Calif., from which neuropsychiatric pa-tients were being evacuated inland. The73d Evacuation Hospital, a Western De-fense Command unit, then moved in andestablished a 750-bed hospital, which be-came the station hospital for all troops,Service Forces as well as Defense Com-mand, in the area. In the fall of 1942, atthe request of the Western Defense Com-

mand, the Ninth Service Command tookover the operation of this hospital. Al-though a Defense Command unit, it hadactually served as a named station hospi-tal for approximately six months.4

The hospitalization of AGF troops onmaneuvers continued to be provided dur-ing the early war years essentially as be-fore the war. Ground Forces units, such asevacuation hospitals, furnished immediatecare for patients with minor illnesses andinjuries, but transferred those requiringmajor surgery and long-term treatment tonear-by ASF hospitals. This sufficed for asituation in which maneuvers shifted fromplace to place and lasted for a compara-tively short time, but The Surgeon Gen-eral considered different arrangementsnecessary when in the fall of 1942 theGround Forces began almost year-rounduse of two areas, the A. P. Hill MilitaryReservation in Virginia and the DesertTraining Center in California andArizona.

1 Annex B to Memos, SG for CG SOS, 30 Aug 42and 12 Feb 43, sub: Opr Plan for Hosp and Evac. SG:705.-1.

2 (1) An Rpt, 1943, Surg, Northwestern SectorWDC. HD. (2) An Rpt, 1943, Surg WDC. HD. (3)Incl 1 to Ltr, CG WDC to SG, 21 Dec 43, sub: OprPlans for Mil Hosp and Evac. HD: Wilson files, "Hospand 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 ChiefOprs 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 notlocated. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec42." (3) SG: 632.-1 (Cp Haan)C and 632.-1 (Cp Cal-lan)C. (4) See also Memo SPOPH 632, ACofS forOprs 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 toTAG thru CG 9th SvC, 2 Sep 42, sub: Hosp at Saw-telle, Calif, and 4 inds. SG: 632.-1 (Sawtelle, Calif) F.(3) An Rpt, 1942, 73d Evac Hosp. HD.

EARLY ADJUSTMENTS IN THE ZONE OF INTERIOR 105

Although the Ground Forces operateda numbered evacuation hospital on the A.P. Hill Military Reservation for a shorttime, the Third Service Command was re-sponsible for providing fixed hospitaliza-tion for troops in that area. AGF head-quarters maintained that the reservationwas being used only temporarily. TheGround Surgeon believed that it was satis-factory to give emergency care in atemporary hospital, operated by person-nel of numbered units under service com-mand control, and to evacuate patientswith serious illnesses and injuries to theFort Belvoir Station Hospital fifty milesaway. Supporting the Service CommandSurgeon, The Surgeon General main-tained that adequate hospitals should beprovided in the immediate area in whichtroops were quartered, in order to avoidlong ambulance hauls, and that any facil-ities less than those provided in canton-ment-type buildings were unsatisfactoryfor the hospitalization of troops in theUnited States. The War Department Gen-eral Staff supported the position of theGround Forces, while SOS headquartersgave wavering support to the Medical De-partment, alternately approving and dis-approving recommendations of The Sur-geon General. The upshot of the wholematter was that the Third Service Com-mand, failing to secure War Departmentapproval of its plans, continued for aperiod of almost two years to operate inthis area a temporary hospital located inwinterized tents and manned by num-bered station hospital units withoutnurses.5

When the War Department decided tooperate the Desert Training Center (latercalled the California-Arizona ManeuverArea) as a simulated theater of operationsunder the jurisdiction of the Army Ground

Forces, the Ground Surgeon agreed withother officers from AGF and ASF head-quarters that hospitalization should beprovided for it in the same manner as foran actual theater. As a result, engineerunits of the communications zone erectedtheater-of-operations-type buildings forhospitals, and beginning in February 1943,communications zone headquartersmoved in numbered station and generalhospital units to relieve the Ninth ServiceCommand of all responsibility for hospi-talization within the area. By June 1943the communications zone had either inoperation or in the planning stage eight250-bed and one 150-bed station hospitalsand three 1,000-bed general hospitals.Until these were all in operation, theDesert Training Center continued to sendlarge numbers of patients to neighboringASF hospitals. Later, as communicationszone general hospitals began to offerdefinitive medical care, the number of pa-tients evacuated to ASF hospitals de-creased. Supplied with equipment author-ized by tables of basic allowances andmanned by numbered hospital unitswhich had their own nurses with them,these communications zone hospitals con-tinued to provide station and general hos-pital types of care until the California-Arizona Maneuver Area closed in thespring of 1944. This plan of hospitaliza-tion not only gave participating units in-valuable practical experience but alsodemonstrated the possibility of using num-

5 Documents dealing with this extended controversymay be found in the following files: SG: 701.-1 (CpA. 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, and230th Sta Hosps (HD) and Comment by Brig GenFrederick A. Blesse, 5 Dec 50. (HD: 314 [Correspond-ence on MS] III.)


bered hospital units in the zone of interiormedical service.6

General Hospitals

All general hospitals in the UnitedStates were operated by the Army ServiceForces but were planned to care for pa-tients from the Ground, Air, and ServiceForces alike. This arrangement was seri-ously threatened in the fall of 1942 by anattempt of the Air Forces to establish itsown general hospitals. Although unsuc-cessful at the time, this attempt was a fore-runner of others which later in the warhad significant effects upon the hospitalsystem. It deserves consideration here notonly for that reason but also because itillustrates difficulties created by the WarDepartment reorganization of 1942.

Until the fall of that year only fifteengeneral hospitals were in operation butbeginning in September this number grewuntil it reached thirty-one by January1943.7 While new general hospitals wereopening, the Air Forces began to establishin effect—though not in name—separategeneral hospitals for AAF personnel. Hav-ing received authority to recruit its ownphysicians, the Air Forces manned someof its station hospitals with specialists nor-mally assigned only to general hospitals.In the winter of 1942-43 smaller AAF sta-tion hospitals began to transfer patientsto these instead of general hospitals. TheAir Forces also began to transfer to AAFstation hospitals patients returned fromtheaters by airplane. With the develop-ment of such practices certain AAF sta-tion hospitals requested the Surgeon Gen-eral's Office to reduce drastically—if noteliminate altogether—the number of bedsin general hospitals set aside for AAFpatients. Later the Air Surgeon's Office

asked for specialized equipment withwhich to establish fifty-four specialty cen-ters in neurosurgery, orthopedic surgery,thoracic surgery, and deep X-ray therapyin AAF station hospitals.8

The Air Surgeon found legal justifica-tion for such actions in the reorganizationof the War Department, which in hisopinion established the Air Forces as a"command of equal authority" with theService Forces, as well as in the indefiniteterms of current directives governing thetransfer of patients to general hospitals.His attempt to set up separate general hos-pitals for the Air Forces was prompted inpart by a desire to establish a separatemedical department, but it also sprangfrom professional considerations. The AirSurgeon contended that Air Forces men,especially combat crew members, re-quired specialized care which only AAFhospitals could give. He believed thatfliers were often lost to further combatduty because general hospitals unneces-sarily reclassified them for limited service.Furthermore, he insisted that Air Forceshospitals 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-3AGF, 11 Mar 43, sub: Insp of La and DTC Maneu-vers. Ground Med files: 354.2 "Maneuvers." (4)Interv, MD Historian with Col Shambora, 18 Apr 49.HD: 000.71. (5) An Rpts, 1943, 13th, 22d, 34th, and297th Gen Hosps, and 37th, 59th, 94th, 107th, 127th,and 181st Sta Hosps. HD. (6) Sidney L. Meller, TheDesert 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: Unificationof Med Serv of Army by SG. AG: 020 SGO (3-30-43)(1) . (2) Memo, Brig Gen C[harles] C. Hillmanfor SG, 15 Mar 43. sub: Rpt of Observation Trip.HD: 333. (3) Memo, Chief Professional Serv Br AirSurg Off for Chief Sup Div Air Surg Off, 5 May 43.SG: 323.7-5.


than Service Forces hospitals and shouldtherefore, in the interest of economy, givethe highest type of medical care for whichthey were equipped and staffed.9

The Surgeon General disapproved theAir Forces' establishment of separate gen-eral hospitals under any guise, for hewished to maintain a unified medical serv-ice under his direction as chief medicalofficer of the Army. Stating that men ofthe Air Forces were not different fromthose of other arms and services, who alsosuffered from occupational diseases andhazards, he insisted that general hospitalswere adequately staffed and equipped tocare for them as well as for the sick andwounded of the rest of the Army. Permit-ting AAF hospitals to perform the func-tions of general hospitals would make itmore difficult, he stated, to supervise andco-ordinate professional practices andprocedures. It would also result in dupli-cation of hospital buildings (since generalhospitals were already planned to care forthe patients of all major commands) andin an uneconomical use of personnel andequipment. Finally, he argued, havingseparate sets of hospitals for patientsevacuated from theaters of operationswould complicate the evacuation processand would cause confusion in the submis-sion of medical reports.10

The question of whether the Air Forceswould be permitted to establish separategeneral hospitals came to a head early in1943 in connection with a movement ini-tiated by the ASF Chief of Staff to re-affirm The Surgeon General's authorityas chief medical officer of the Army.11 Itreached the General Staff first, and finallythe Secretary of War. G-4 tended to favorthe Air Forces, and while conceding thatopposing contentions of The SurgeonGeneral and the Air Surgeon were both

just, he accepted the latter's view thatAAF hospitals were more efficient thanthose of the Service Forces. He recom-mended, therefore, that the Air Forces begranted "additional authority" to treat allof their own combat personnel, includingevacuees, in AAF hospitals.12 The Officeof the Deputy Chief of Staff went a stepfurther, publishing a directive on 20 June1943 which gave the Air Forces authoritynot only to treat its own combat personnelbut also to operate whatever general hos-pitals were necessary for that purpose.13

Within a week the Air Surgeon's Officerecommended the establishment of fiveAAF general hospitals: three by the con-version of AAF station hospitals and two

9 (1) Memo, Air Surg for CG AAF, n d, sub: [Com-ments on Gen Somervell's Memo of 30 Apr 43 forCofSA], with 2 inds. Asst SecWar for Air: 632(AAFHosp). (2) Brief and Discussion, Tab B, to Memo, Cof Air Staff for CofSA, 7 Oct 42, sub: SpecializedHosp and Recuperative Fac for AAF Pers. AAF: 354.1"Rest Ctrs and Conv Homes." (3) Hubert A. Cole-man, Organization and Administration, AAF Medi-cal Services in the Zone of the Interior (1948), pp.93-94. HD.

10 (1) Memo SPMCB 701.-1, SG for CG SOS, 13Oct 42, sub: Specialized Hosp and Recuperative Facfor AAF Pers. AAF: 354.-1 "Rest Ctrs and ConvHomes"(1). (2) 1st ind, SG to CG ASF, 12 Apr 43,on Memo SPOPH 020(3-30-43), CG ASF for SG, 30Mar 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 ServiceForces (Washington, 1954), pp. 132-37, in UNITEDSTATES ARMY IN WORLD WAR II; Blanche B.Armfield, Organization and Administration (MS forcompanion vol. in Medical Dept, series), HD., andColeman, op. cit., pp. 93-107. Documents concerningit 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 forCofSA, 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 forCGs AAF, AGF, ASF, 20 Jun 43, sub: Med Serv ofArmy. HRS: G-4 file, "Hosp and Evac Policy." TheDeputy Chief of Staff, Lt. Gen. Joseph T. McNarney,was an AAF officer.


by the transfer of the Borden (Oklahoma)and Torney (California) General Hospi-tals to Air Forces' jurisdiction.14 By thistime a new Surgeon General, Maj. Gen.Norman T. Kirk, was in office.15 He at-tacked the problem vigorously, and theentire matter reached the Secretary ofWar, who called representatives of theGeneral Staff, the commanding generalsof the Air and Service Forces, and othersinto conference. General Kirk then pro-posed a compromise which the command-ers of both the Air and Service Forcesaccepted.16

General Kirk admitted that Air Forcescombat crews needed special treatmentand consideration and offered to placeflight surgeons in his Office and in generalhospitals to serve as advisers in that field.He agreed also to the Air Forces' estab-lishment of convalescent centers. The AirForces for its part agreed that all generalhospitals would continue to operate underThe Surgeon General and the command-ing general, Army Service Forces, andthat patients evacuated from theaters ofoperations would be sent to general hos-pitals. The only exception to the latterpoint was that combat crew members suf-fering from operational fatigue alonewould be sent directly to AAF convales-cent centers. These centers were to beequipped and staffed as station hospitals,but one of them, located at Coral Gables,Fla., was authorized to perform a functionof general hospitals—the reclassificationof officers for limited service and the rec-ommendation for their appearance beforeretiring boards. These terms of agreementwere issued on 9 July 1943, with a state-ment that they had been personally ap-proved by the Secretary of War.17 On thesame day, the authority which had beengranted to the Air Forces to establish sep-arate general hospitals was revoked.18

This agreement did not dispose of thequestion of whether or not AAF stationhospitals would give general-hospital-typetreatment to zone of interior patients. Atthe time General Kirk drafted its terms,he had also drafted a statement of policyon the transfer of patients to general hos-pitals, defining more specifically the typesof cases to be transferred. He had intendedto have it included in the 9 July 1943agreement,19 but instead, on 14 July 1943,he requested its publication as a War De-partment circular.20 While maintainingthe traditional responsibility of stationhospital commanders for the selection ofpatients 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. AsstSecWar for Air: 632 (AAF).

15 Gen Kirk assumed office on 1 June 1943.16 (1) Draft memo, prepared by SG, dated 3 Jul 43,

sub: Hosp, with pencil note, "7/3/43 Personally de-livered by Gen Kirk to Gen Somervell." SG: 705.-1and SecWar: SP 632 (3 Jul 43). (2) Memo, CG AAFfor DepCofSA, 5 Jul 43, sub: Hosp. Same files. (3)Memo, [Col] F. M. S[mith] for Gen Somervell, 5 Jul43. HRS: Hq ASF Gen Styer's files, "Med Dept."How the matter reached the Secretary of War is notclear. 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 timeand Mr. Stimson told me that Secretary of Air, Mr.Lovett, had been to him that morning and told himabout the memorandum. That the Air Force couldn'tblame me for bringing it to his attention." Ltr, MajGen Norman T. Kirk to Col Roger G. Prentiss, Jr,19 Nov 50, with incl. HD: 314 (Correspondence onMS) I.

17 (1) Memo WDCSA/632 (9 Jul 43), DepCofSAfor 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, CGASF for CG AAF, 5 Jul 43. HRS: Hq ASF Gen Styer'sfiles, "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 Pntsto Named Gen Hosps. SG: 705.-1.

20 Memo SPMCM 300.5-5, SG for Publications DivAGO, 14 Jul 43. AG: 704.11 (14 Jul 43) (1).


the revised policy left them less discretionin the matter than they had previouslyexercised. Its language was directive ratherthan advisory. The following categories ofpatients must be transferred to generalhospitals: those needing specialized treat-ment of the types for which general hos-pitals had been designated; those whowould be hospitalized for ninety days ormore; those upon whom elective surgeryof a formidable type would be performed;those with specific types of fractures, and,with one exception, those evacuated fromoverseas theaters. Only Air Forces patientson a flying status, evacuated because ofoperational fatigue alone, were to bypassgeneral hospitals and go direct to AirForces convalescent centers.21 This direc-tive combined with the agreement alreadydiscussed to resolve for a time in The Sur-geon General's favor the question of theAir Forces' establishment of separate gen-eral hospitals.

Special Types of ASF Station Hospitals

Although all ASF station hospitals wereessentially alike in the work they did andthe way they operated, a few establishedin the early war years differed in some re-spects from the normal. Among them wereWAAC hospitals, all-Negro hospitals, andhospitals for civilians and prisoners of war.

Hospitals for Waacs

Formation of the Women's Army Auxil-iary Corps in May 1942 emphasized cer-tain problems such as the segregation ofwomen from men in hospitals, the estab-lishment of services not ordinarily foundin Army hospitals, and the procurementof nonstandard drugs (that is, those notformally standardized for Army use) forthe treatment of women. The law estab-

lishing the WAAC directed the Secretaryof War to provide hospitalization for itsmembers "to conform as nearly as prac-ticable to similar services rendered to thepersonnel of the Army" and permitted theuse of "facilities and personnel of theArmy" for this purpose.22 The SurgeonGeneral approved of this policy. He be-lieved that additional wards should beconstructed at established hospitals tosupply enough beds to permit the segrega-tion of men from women and of womenaccording to disease and rank. Because heexpected women to have a higher sickrate, he recommended the provision ofbeds for 5 percent of the strength of theWAAC, rather than for 4 percent, as wasthe case with men. He proposed the pro-curement of a limited number of femalephysicians, first as contract surgeons andlater as commissioned members of theMedical Corps, to serve in hospitals wherethe WAAC patient load was high. Other-wise, he planned to give Waacs the samemedical care as men. As experience withthe hospitalization of Waacs accumulatedand statistics showed their noneffectiverate to be only slightly higher than thatfor men, the Army provided hospital bedsfor them in the same ratio as for men andsent them to the same hospitals, thoughto segregated wards. Nevertheless, threeArmy hospitals were occupied chiefly byfemale 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 forWAAC Pers. HD: 322.5-1 (WAC). (4) Memo, MajMargaret D. Craighill, MC, Liaison Off for WAC forCol [Raymond W.] Bliss, 25 Aug 43, sub: Hosp forWAAC. Same file. (5) Memo, SG for CG SOS, 4 Jan43, sub: Util of Women Doctors. HRS: Hq ASF GenStyer's files, "Med Dept 1943."


At the WAAC training centers—FortDes Moines (Iowa), Daytona Beach(Florida), and Fort Oglethorpe (Geor-gia)—the station hospitals became pre-dominantly WAAC hospitals, staffedlargely by women and caring mainly forwomen. This was especially true at Day-tona Beach. By the end of 1943 its 601-bedhospital had an enlisted complementmade up almost entirely of women, onlyfifty men being assigned for duty in andaround the hospital. At Fort Des Moines,female doctors engaged as contract sur-geons were assigned for duty with theWaacs. At first the development andsupervision of special professional servicesfor women were left largely to local hos-pital commanders. Station hospitals attraining centers developed gynecologicand obstetric services and procured locallyspecial drugs required for the medicalcare of women. In May 1943, approxi-mately a year after the WAAC was estab-lished and a month after Congressauthorized the commissioning of womenphysicians in the Army, The SurgeonGeneral assigned a female Medical Corpsofficer to his Office to supervise the han-dling of medical problems peculiar to fe-male personnel.24

All-Negro Hospitals

The establishment of two all-Negro sta-tion hospitals in the United States camenot as a result of any policy of The Sur-geon General to segregate patients raciallyfor medical care and treatment, butrather as a result of The Surgeon Gen-eral's opposition to the integration ofNegro doctors and nurses with white pro-fessional personnel in the operation of hos-pitals caring for white patients.25 Thisconsideration had already resulted in theestablishment in May 1941 of groups of

all-Negro wards in the hospitals at FortBragg (North Carolina) and Camp Liv-ingston (Louisiana). Perhaps because ofunencouraging reports from these experi-ments, the Army had not extended thepractice to other hospitals. After warstarted, The Surgeon General revived arecommendation, previously disapprovedby the General Staff, that all-Negro hospi-tals be established to employ additionalNegro doctors and nurses. The Staff re-versed its earlier decision, and during 1942an all-Negro station hospital was organ-ized at Fort Huachuca (Arizona), a post atwhich Negro troops were being trained. Aseparate hospital, manned by white doc-tors and nurses, continued in operation tocare for white patients. The year before,the Army Air Forces had established anall-Negro hospital at Tuskegee, Ala.

Establishment of all-Negro hospitals andwards did not signify a general abandon-ment of the Army's long-established policyof nonsegregated treatment. Other hospi-tals manned by white doctors and nursescontinued to treat patients of both races ona nonsegregated basis throughout thewar.26 Nor did it mean that the Medical

24 (1) An Rpts, 1943, Sta Hosps, Daytona Beachand 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 ArmyServ. HD: 210.01. (3) Memo, SG for CG SOS, 4 Jan43, sub: Util of Women Doctors. HRS: Hq ASF GenStyer's files, "Med Dept 1943." (4) Mattie E. Tread-well, The Women's Army Corps (Washington, 1954),Ch. XXXI, in UNITED STATES ARMY INWORLD WAR II. (5) Margaret D. Craighill, His-tory of Women's Medical Unit (1946). HD.

25 For a full discussion of the question of the use ofNegro professional personnel by the Medical Depart-ment, see John H. McMinn and Max Levin, Person-nel (MS for companion Vol. in Medical Departmentseries). HD. Also see Ulysses Lee, The Employmentof Negro Troops, a forthcoming volume in the seriesUNITED STATES ARMY IN WORLD WAR II.

26 (1) Ltr, SG to TAG, 25 Oct 40, sub: Plan for Utilof 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


Department would fail to use Negro en-listed personnel and civilians in otherhospitals. As early as December 1941, forexample, Negro enlisted men were assignedto the medical detachment of at least onestation hospital—that at Chanute Field(Illinois).27 Later Negro enlisted men andwomen were assigned to other Army hos-pitals. While many were employed inhousekeeping and maintenance opera-tions, some were assigned to technical andadministrative duties.28

Before leaving this subject one needs tolook ahead to the later war years. At thattime the practice of using Negro doctorsand nurses on a segregated basis wasmodified. Such civilian groups as the Na-tional Association of Colored GraduateNurses, certain segments of the press, somemembers of Congress, the Negro civilianaide to the Secretary of War, and thePresident's wife (Mrs. Franklin D. Roose-velt) urged The Surgeon General, ASFheadquarters, and the Secretary of War touse more Negro nurses and to use them ona nonsegregated basis.29 In December1943 and again in May 1944 ASF head-quarters directed The Surgeon General toprocure and use additional Negro nurses.30

Accordingly, Negro nurses on duty withthe Army increased from 218 in Decem-ber 1943 to 512 by July 1945. Althoughsome continued to serve with all-Negrohospitals in this country and in theaters ofoperations, others were used on a non-segregated basis in 4 general hospitals, 3regional hospitals, and at least 9 station

hospitals in the United States.31 During1945 nonsegregated use of Negro doctorsoccurred in at least one instance. Whenthe troop strength of Fort Huachuca de-clined, the patient load decreased andprofessional staffs of the two station hospi-tals at that post were reduced accord-ingly. Services of the two then graduallymerged and both doctors and nurses ofthe two races served together to care forwhite as well as Negro personnel.32 Thusthe primary reason for the establishmentof separate all-Negro wards and hospi-

Arthur B. Welsh for [Brig] Gen [Larry B.] McAfee,17 Jan 42. (4) Memo, SG for ACofS G-3 WDGS, 30

Jan 42. (5) Memo, SG for TAG, 16 Mar 42, sub:SecWar's Press Conf on Use of Negro Doctors. Allin HD: 291.2. (6) Memo, ACofS G-1 WDGS forCofSA, 4 Aug 41, sub: Almt of Negro MD Res Offsand 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 FtHuachuca. 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, and730th Med Sanitary Cos. HD. (2) McMinn and Levin,op. cit.

29 Letters to this effect may be found in the follow-ing files: SG: 211 "Nurses, Negro"; OSW: Civ Aide toSecWar, "Nurses"; and AG: 211 "Nurses, Negro."See also Florence A. Blanchfield and Mary W. Stand-lee, The Army Nurse Corps in World War II (1950),pp. 161-205. HD.

30 (1) Memo, CG ASF for SG, 14 Dec 43, sub: Uti-lization of Negro Nurses. SG: 291.2-1. (2) Memo,CofS ASF for SG, 6 May 44, same sub. ASF: 210.31.

31 (1) Memo, Col Florence A. Blanchfield (SGO)for Col Arthur B. Welsh (SGO), 17 Dec 43, sub:Distr of Colored Nurses. SG: 291.2-1. (2) Memo, SGfor 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 Col-ored Graduate Nurses and the National NursingCouncil for War Service, ca. Jan 45. OSW: Civ Aideto SecWar, "Nurses."

32 (1) Memo, Asst Aide to SecWar for SG, 29 Mar45, sub: Staff of Sta Hosp No 1, Ft Huachuca, Ariz.(2) Memo, Dep Chief [of Oprs Serv] for Hosp andDomestic Oprs [SGO] for SG, 8 Jun 45, sub: Rpt ofVisit to Sta Hosp, Ft Huachuca, Ariz. (3) Ltr, CO StaHosp 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 thewar whether the two hospitals at Huachuca were everin fact two separate hospitals or merely two sectionsof one hospital. This arose apparently from the factthat the post surgeon, a white Medical Corps officer,served in addition as commander of the white hospi-tal and exercised at the same time considerableauthority over the commanding officer of the all-Negro hospital. Failure to settle this question resultedin dissatisfaction on the part of the latter. See lettersin the file just cited and in SG: 323.3 (Ft Huachuca)N.


tals—opposition to the integrated use ofNegro and white professional personnel inthe care of both white and Negro pa-tients—had begun to lose some of its forceby the end of the war.

Army Hospitals for Civilians

By the end of 1942 a situation de-veloped which required the establishmentin the United States of several hospitalsfor civilian employees and their families.During 1941 the Army had initiated in-dustrial hygiene programs in Army-ownedplants and depots. Under Medical De-partment supervision, these programs ex-panded rapidly during 1942 to keep pacewith wartime industrial growth. Designedto give only emergency medical care, in-dustrial hygiene facilities were adequatein areas where civilian hospitals wereavailable. Toward the end of 1942, whenthe Ordnance Department establishedstorage depots for explosives in isolatedregions, lack of hospitals retarded em-ployee procurement and increased ab-senteeism. Workers were reluctant tomove with their families to such areas andfailure to receive prompt medical careoften resulted in prolonged illnesses. Tohelp maintain depot production levels,The Surgeon General proposed in Decem-ber 1942 that the Army construct andoperate hospitals in remote areas whichlacked adequate medical facilities. InFebruary 1943 the Secretary of Warauthorized the construction of hospitals atthe Sierra (California), Umatilla (Ore-gon), Black Hills (South Dakota), Tooele(Utah), Sioux (Nebraska), and Navajo(Arizona) Ordnance Depots. Constructedduring 1943, these hospitals operatedunder service command supervision untilafter the end of the war. They differed

from other Army station hospitals in hav-ing a minimum of military personnel as-signed to them, in providing family medi-cal care, including gynecologic and ob-stetric services, and in requiring paymentfor services rendered. Despite recom-mendations of The Surgeon General, simi-lar hospitals were not established in otherplaces. In one instance, permission wasgranted to establish an Army hospital butwas withdrawn partly on account of polit-ical pressure and partly because the com-munity itself, after an extended period oftime, provided additional hospital ac-commodations. In another, authority wasgranted to hospitalize civilian employeesand their families in a near-by Armystation hospital.33

Hospitals for Prisoners of War

Early in 1942, when prospective com-bat operations demanded preparation forthe internment of prisoners of war, TheProvost Marshal General and The Sur-geon General agreed upon basic policiesfor their hospitalization. In compliancewith the Geneva Convention,34 hospitalaccommodations and medical care forprisoners of war were to be equal to thosefor United States troops, and prisoners

33 (1) Ltr, SG to SecWar thru CG SOS, 11 Dec 42,sub: Med Care for Civ Employees of Army-Oper-ated Plants, and their Families, with 4 inds. (2) Ltr,SG to CofS SOS. 21 Jan 43, same sub. (3) MemoWDGDS-2172, SecWar for CG SOS, 9 Feb 43, samesub. All in AG: 701 (9-17-41) (1). (4) W. L. Cooke,Jr, Organization and Administration of PreventiveMedicine 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 forInstls in Ogden, Utah, Area. SG: 632.-1.

34 Article I, Chapter I, Conventions of 1906 and1929. See Army Medical Bulletin, No. 62 (1942), pp. 88and 105.


were to assist in the care of their com-patriots. Promulgated in tentative regula-tions published in April 1942 and re-iterated in September 1943, these policiesgoverned the hospitalization of prisonersthroughout the war. For separate pris-oner-of-war camps, the Army constructedhospitals with beds for 4 percent of theinmates. For prisoners at Army posts,wards surrounded by wire fences wereadded to existing station hospitals.Whether in separate camps or on Armyposts, such hospitals operated under serv-ice command supervision and, except forthe use of captured enemy personnel andcivilian registered nurses, were similar toother service command hospitals. Pris-oners requiring more specialized care thanoffered in station hospitals were transferredto general hospitals.35

Port and Debarkation Hospitals

Hospitals were needed near ports forlarge numbers of transients—troops await-ing shipment overseas as well as patientsbeing returned to general hospitals in theUnited States. In accord with SOS direc-tives, hospitals for ports and staging areaswere exempt from service command juris-diction and operated directly under portcommanders who in turn were subject tocontrol by the Chief of Transportation.36

For most of 1942, many ports lacked ade-quate staging area hospitals and thereforesent patients to others located near by. AtLos Angeles, for example, patients fromthe port were cared for in the WesternDefense Command's 73d Evacuation Hos-pital at Sawtelle. The ports at Charleston,New Orleans, and San Francisco usedStark, LaGarde, and Letterman GeneralHospitals, respectively, while those atBoston and Hampton Roads sent patients

to near-by service command station hospi-tals. During 1942 and 1943 special portand staging area hospitals were con-structed and opened to care for port per-sonnel and transient troops. They differedfrom other station hospitals primarily inthat their surgical services were consider-ably smaller and less important than theirmedical services, because they normallyperformed only emergency surgery for thethousands of troops who passed throughports.37

The kind of hospitals that would beused to receive transient patients return-ing from theaters of operations remaineduncertain until the latter part of 1942.Special debarkation hospitals under portcontrol might be established in existingbuildings with only the personnel andequipment needed to "process" returningpatients—that is, replace their missingrecords, make partial payments of the

35 (1) Memo, Capt Charles M. Huey, Mil IntelAliens Div OPMG for Chief Aliens Div OPMG, 26Dec 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 OffOPMG. (4) Memo, CofS ASF for SG and QMG, 26May 43, sub: Hosp Fac for PW Cps, and 1st ind. SG:632.-1. (5) An Rpts, 1943, Surg, 7th and 8th SvCs.HD. (6) An Rpts, 1943, Sta Hosp PW Cps at Flor-ence, Ariz; Cp Clark, Mo; and Como, Miss. HD. (7)See also: Rene H. Juchli, Record of Events in theTreatment of Prisoners of War, World War II (1945).HD.

36 Mil Hosp and Evac Oprs, incl 1 to Ltr SPOPH322.15, CG SOS to CGs and COs of SvCs and PEsand 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, NewYork, 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; SanFrancisco, 9 Jul and 1 Dec 42; and Seattle, 27 Nov 42.HD: Wilson files. (3) SG: 632.-2, 1942 and 43, (La-Garde GH)K, (Letterman GH)K, and (Stark GH)K.


money due them, classify them accordingto disease or injury, and prepare them forfurther travel to general hospitals. Suchhospitals had been used during WorldWar I,38 and for a while in 1942 it seemedas if SOS headquarters and certain portcommanders expected their revival. OneSOS directive implied that ports mightestablish special debarkation hospitals,39

and Charleston, Seattle, and San Fran-cisco expressed a desire for them.40

The Surgeon General had other plans.During the emergency period he had usedgeneral hospitals near ports—Tilton forNew York, Stark for Charleston, LaGardefor New Orleans, and Letterman for SanFrancisco—to receive and care for pa-tients brought in on ships. After warbegan he continued this system, grantingunlimited bed credits in near-by generalhospitals to ports receiving overseas casu-alties.41 He also located some of the gen-eral hospitals planned early in 1942 incoastal areas, though not in close prox-imity to ports,42 with the expectation thatthey would process patients arriving fromtheaters.

A final decision to this effect came inthe fall of 1942 in connection with plansfor the reception of casualties from theNorth African invasion. At that timewhole trainloads of patients with a varietyof ills could be sent to a single general hos-pital, because hospitals had not yet beendesignated for the specialized treatment ofcertain types of cases nor had the policy ofhospitalizing casualties near their homesbeen established.43 Two alternatives there-fore presented themselves, namely, ship-to-train movements, in which patientswould be transferred directly from shipsto trains for transfer to distant general hos-pitals, and ship-to-hospital movements, inwhich they would be moved from ships to

near-by hospitals before undertaking fur-ther travel.44 The possibility of using ship-to-train movements exclusively, therebyeliminating the need for a debarkationhospital at or near the port, arose atHampton Roads. Piers at that port hadample trackage to accommodate hospitaltrains, making it possible to move patientsunder cover directly from ships to trains.The port commander preferred this pro-cedure, his surgeon explaining that itwould maintain the port as an agency ofmovement, its primary purpose.45 WhileThe Surgeon General and the chief of theSOS Hospitalization and EvacuationBranch recognized the merits of this posi-tion, both felt that some ship-to-hospitalmovement would be unavoidable. Somepatients would require immediate hospi-tal care before further travel; in someinstances 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 Plansfor Mil Hosp and Evac. HD: 705.-1.

40 Opr Plans for Mil Hosp and Evac, Jul 42,Charleston, Seattle, San Francisco, New Orleans, andBoston. HD: Wilson files.

41 For example, see: (1) Ltr, SG to CG NYPE, 18Feb 42, sub: Bed Almts in Gen Hosps. Same file. (2)Ltr. SG to CG 9th CA, 5 Jan 42, sub: Bed Almts inBarnes Gen Hosp. SG: 632.2 (Barnes GH)K. (3) 2dind, SG to CG NYPE, 9 Mar 42, on Ltr, Port SurgSub-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, COCPE 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 McCawGeneral 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 Dec42, sub: Opr Plans for Mil Hosp and Evac. HD: Wil-son files.


interfere with troop movements; in others,casualties might arrive unexpectedly whentrains were unavailable.46 For these rea-sons they overruled the port commander.Since the housing shortage in Norfolkmade impracticable a proposal to takeover a hotel for hospital use, arrangementswere made to use the station hospital atFort Monroe and five hundred beds in theVeterans Administration hospital at Ke-coughtan, Va., for debarkation purposes.47

This action made it clear that some hospi-tal, whatever its kind, would be estab-lished to receive casualties at every port ofdebarkation.

Unlike his counterpart at HamptonRoads, the port commander at New Yorkwanted Halloran General Hospital, beingopened on Staten Island, to serve solely asa debarkation hospital under port con-trol.48 The Chief of Transportation, on theother hand, wished to keep ports free ofthe burden of administering large hospi-tals and on 9 November 1942 announcedthat SOS directives authorized ports tooperate hospitals for assigned personneland transient troops only, not for patientsbeing returned from theaters.49 Concur-rence of the SOS Hospitalization andEvacuation Branch in this interpretationplaced an official stamp of approval onThe Surgeon General's plan to use gen-eral hospitals under service commandcontrol, rather than special hospitalsunder port control, for debarkation ac-tivities.

Most general hospitals located nearports performed dual functions—provid-ing definitive treatment for some patientsand processing others for further travel—until late in the war. This created com-plications. Ports were granted unlimitedbed credits in such hospitals, but near-bystation hospitals also continued to receive

bed credits in them. This overlappingcaused some concern in SOS headquar-ters.50 Investigation showed that HalloranGeneral Hospital kept a list of patientsearmarked for transfer to other generalhospitals when the evacuation load re-quired it.51 Stark, LaGarde, and BarnesGeneral Hospitals simply waited until thenecessity arose and then transferred pa-tients receiving definitive care to othergeneral hospitals located farther awayfrom ports. Others, notably Lettermanand Lovell, kept beds vacant while await-ing the arrival of evacuated casualties.This system occasionally caused the trans-fer of patients needing general hospitalcare to station hospitals. In the opinion ofsome hospital commanders, it was alsowasteful of both professional personneland highly specialized equipment.52 Later,when the evacuation load reached itspeak, The Surgeon General partiallyshared their view, for in 1945, as will beseen later, he proposed the conversion of

46 (1) 1st ind, Chief Hosp and Evac Br SOS toCofT, 18 Nov 42, sub: Evac, on unknown basic Ltr.TC: 370.05(Plans, Policies, Procedures). (2) Ltr, CGHRPE to SG, 10 Nov 42. SG: 705.-1 (HRPE)N.

47 (1) Off memo, signed by Col H. D. Offutt, 9 Nov42. HD: 370.05 "Spec Oprs." (2) Ltr, Act SG to CGHRPE, 14 Nov 42. SG: 705.-1 (HRPE)N.

48 (1) Diary, Chief Hosp and Evac Br SOS, 2 Nov42. HD: Wilson files, "Diary." (2) Ltr, Port SurgNYPE 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 Nov42. HD: Wilson files, "Diary." (2) Ltr, CofT to CGsof 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 BrSOS for ACofS for Oprs SOS, 27 Dec 42, sub: Avail-ability of Hosp Beds for Port of NY. HD: Wilson files,"Book 2, 26 Sep 42-31 Dec 42."

52 An Rpts, 1942 and 43, Halloran, Stark, LaGarde,Barnes, Letterman, and Lovell Gen Hosps. HD.


staging area station hospitals into de-barkation hospitals.53

Designation of General Hospitalsfor Specialised Treatment

Early in 1943 The Surgeon Generalinitiated a formal program of specializa-tion in general hospitals. During WorldWar I the Medical Department hadmanned and equipped certain hospitalsfor the care of particular types of cases.54

In the interval between wars specializa-tion had continued on a limited scale. ByJanuary 1942, for example, deep X-raytherapy had been established as a spe-cialty in the Army and Navy, Fitzsimons,Lawson, Letterman, Walter Reed, andWilliam Beaumont General Hospitals.55

In March 1942 Darnall General Hospitalopened to receive psychotic patients whoneeded closed ward treatment.56 Otherspecialty centers gradually developed athospitals where eminent specialists wereassigned,57 and toward the end of 1942The Surgeon General made it known thathe intended to formalize and extend exist-ing specialization. Apparently he awaitedonly the development of circumstanceswarranting such action.58

In the winter of 1942 that developmentoccurred. Beginning in September newgeneral hospitals opened in increasingnumbers.59 It was soon evident that a lim-ited supply of specialists would prohibitthe staffing of each one for all kinds ofsurgical and medical work. Referring tothis problem, the surgeon of the FourthService Command suggested in January1943 that certain general hospitals in hisarea be equipped and manned to give spe-cialized care in different branches of sur-gery.60 Simultaneously with the openingof the new general hospitals, a transitionfrom defensive to offensive warfare pre-

saged the arrival of large numbers of com-bat casualties requiring complicated sur-gery. Moreover, public insistence uponhospitalization of casualties near theirhomes grew until The Adjutant Generalin December 1942 proposed establishmentof a policy to conform with the demand.61

If adopted and applied too rigidly, such apolicy would conflict with The SurgeonGeneral's unpublished plan to transfercasualties to hospitals specializing in par-ticular diseases or injuries. He thereforemade a counterproposal: patients needingspecialized treatment would be sent togeneral hospitals designated for such,while those requiring prolonged but notspecialized treatment would be transferredto hospitals in the vicinity of their homes.62

53 See below, p. 192.54 The Medical Department . . . in the World War

(1923), vol. V. pp. 171-73.55 SG Ltr 44, 15 May 41, and SG Ltr 1, 2 Jan 42.56 An Rpt, 1942, Darnall Gen Hosp. HD.57 An example of this development was found in

Tilton General Hospital which established a specialneurosurgical section during 1942 and was designateda neurosurgical center in March 1943. An Rpts, 1942and 43, Tilton Gen Hosp. HD.

58 (1) Memo, SG for Dir Control Div SOS, 1 Aug42. SG: 020.-1. (2) Memo, Chief Pers Serv SGO forDir Mil Pers SOS. 2 Dec 42. SG: 323.7-5.

59 Number of GeneralHospitals Reporting

Month Patients WeeklyAugust 1942. . . . . . . . . . . . . . . . . . . . . . . 1 5September 1 9 4 2 . . . . . . . . . . . . . . . . . . . . 1 7October 1942. . . . . . . . . . . . . . . . . . . . . . 1 9November 1 9 4 2 . . . . . . . . . . . . . . . . . . . . 2 2December 1942. . . . . . . . . . . . . . . . . . . . 2 6January 1943. . . . . . . . . . . . . . . . . . . . . . 3 1

60 Ltr, CG 4th SvC (Chief Med Br) to SG, 23 Jan43, 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 BattleCasualties. AG: 701(12-29-42) (1). (2) IAS, TAG toSG, 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.


Approval and publication of this policyon 1 February 1943 63 required the formaldesignation of specialty centers. For sev-eral weeks afterward The Surgeon Gen-eral's Hospitalization and EvacuationDivision worked on this problem,64 and on6 March 1943 the War Department desig-nated nineteen general hospitals for thefollowing specialties: chest surgery, maxil-lofacial and plastic surgery, ophthalmicsurgery and the treatment of the blind,neurosurgery, and the performance ofamputations.65 About two months later,two additional specialties—vascular sur-gery and the treatment of the deaf—wereannounced and another general hospitalwas placed on the list.66 Further extensionof specialization occurred during the laterwar years.

The Question of EstablishingConvalescent Hospitals

During the latter part of 1942 theopinion gained favor both in civilian andmilitary circles that special accommoda-tions for convalescent patients should beprovided either as separate hospitals or asannexes to existing hospitals. Among civil-ians it developed apparently from a desireeither to "do something for the boys" or,in some instances, to dispose of large estateswith questionable market values.67 In theArmy it arose from the need to save bothmanpower and hospital beds. The ideawas not new, for during World War I theMedical Department had conducted "re-construction" programs in general hospi-tals and convalescent centers both in theUnited States and France.68 In the latterhalf of 1942 several widely separated hos-pitals—the Fort Bliss Station Hospital inTexas, the Jefferson Barracks Station Hos-pital in Missouri, and the Lovell General

Hospital in Massachusetts—establishedprograms to harden patients for return toduty, to reduce the period of their conva-lescence, and to salvage for full field dutythose who might otherwise be either dis-charged from the Army or placed in thelimited service category.69 In January 1943the surgeon of the Eighth Service Com-mand recommended the organization ofcasual detachments to recondition conva-lescent patients and salvage psychoneu-rotic soldiers for full duty.70 The surgeonof the Ninth Service Command proposedthe establishment of "overflow installa-tions" to free hospital beds of patients nolonger needing hospital care but not yetready for full military duty.71 In this con-nection, General Snyder, a medical officeron the staff of The Inspector General,found in a survey in November 1942 thatapproximately 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, ColArden Freer, SGO to Col S[anford] W. French, Hq4th SvC. 8 Feb 43. SG: 323.7-5 (4th SvC)AA.

65 WD Memo W40-9-43, 6 Mar 43, sub: GenHosps for Spec Surg Treatment. AG: 705(2-24-43) (1).

66 WD Memo W40-14-43, 28 May 43, sub: GenHosp, 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 SGto Hon Joseph F. Guffey, US Sen, 20 Nov 42. (3) Ltr,Act SG to Hon Lex Green, H. R., 12 Dec 42. All inHD:601.-1.

68 (1) The Medical Department . . . in the World War(1927) , vol. XIII, pp. 79-222. (2) Charles E. Remy,The History of a Convalescent Camp of the AmericanExpeditionary Forces in France (1942). HD.

69 An Rpts, 1942, Sta Hosps at Ft Bliss and Jeffer-son Bks, and Lovell Gen Hosp. HD. Similar actionwas being taken in the European Theater of Opera-tions at the same time. See Memo, Consultant in SurgETO 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.


in Army hospitals were convalescent andcould be cared for in barracks, if neces-sary, to release hospital beds for patientsrequiring close medical supervision.72

While medical officers in the field werebecoming aware of the convalescent prob-lem, it was also receiving attention inWashington. In September 1942 it cameup in the hearings of the Wadhams Com-mittee.73 A month later the Air Forcesrequested authority "to establish and op-erate specialized hospital and recuperativecenters for individualized treatment, re-habilitation, and classification of AirForces personnel."74 The Air Surgeonbelieved that special hospitals should beestablished under Air Forces' control totreat and rehabilitate Air Forces patientssuffering from such conditions as staleness,anoxia, operational fatigue, aeroneurosis,and aero-embolism.75 Surgeon GeneralMagee, on the other hand, strongly dis-approved the establishment by the AirForces not only of general hospitals, asdiscussed earlier, but also of any hospitalsother than the station hospitals which theyalready operated. Moreover, he preferredto carry on reconditioning programs inexisting hospitals. He argued that conva-lescent patients often needed observationand sometimes "active therapeutic man-agement" by doctors fully acquaintedwith their cases and should therefore notbe moved far from hospitals where theyreceived definitive care. He contendedfurthermore that the establishment of con-valescent hospitals would lead to duplica-tion of buildings and a waste of personneland equipment. Hence, he refused to con-cur in the Air Forces' proposal, but gavehis approval instead to the establishmentof nonmedical AAF rest camps. To theWadhams Committee's recommendationfor the establishment of separate convales-

cent accommodations free of the hospitalatmosphere, The Surgeon General repliedon 15 December 1942: "It is the opinionof this office that convalescent sectionsmay be more advantageously operated asintegral parts of military hospitals. . . ."76

Before final action was taken on the AirForces' request, both the Air Surgeon andThe Surgeon General began to initiatereconditioning programs in existing hospi-tals. In November 1942 the WadhamsCommittee recommended this step as wellas the establishment of convalescent hos-pitals.77 The next month, the command-ing general, Army Air Forces, published adirective, prepared by the Air Surgeon,requiring all Air Forces hospitals "to insti-tute recreation and reconditioning pro-grams for convalescent patients."78 InJanuary 1943 The Surgeon General pro-

72 Ltr, Asst to IG (Brig Gen Howard McC. Snyder)to IG, 10 Nov 42, sub: Surv of Hosp Fac and theirUtil. 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 AAFPers. AAF: 354.1 "Rest Ctrs and Conv Homes."

75 (1) Cmtee to Study the MD, 1942, Testimony ofBrig 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 RecuperativeFac for AAF Pers. AAF: 354.1 "Rest Ctrs and ConvHomes."

76 (1) Cmtee to Study the MD, 1942, Testimony ofOffs of SGO. pp. 163-66, 441-42, 460, HD. (2) MemoSPMCB 701.-1, SG for CG SOS, 13 Oct 42, sub: Spe-cialized Hosp and Recuperative Fac for AAF Pers.AAF: 354.1 "Rest Ctrs and Conv Homes" (1). (3) Ex-tract from 1st ind, SG to CG SOS, 15 Dec 42, onextract from Memo, CG SOS for SG, 26 Nov 42, inCmtee to Study the MD, 1942-43, Actions onRecomd, Recomd No 24. HD.

77 Cmtee to Study the MD, 1942-43, Actions onRecomd, Recomd No 14. HD.

78 (1) AAF Memo 25-9, 14 Dec 42, sub: Recrea-tion and Reconditioning for Conv Pnts in AAFHosps. AAF: 300.6. (2) Howard A. Rusk, "Convales-cence and Rehabilitation," Doctors at War, MorrisFishbein, ed. (New York, 1945), pp. 303-04.


posed a War Department circular torequire all fixed hospitals, overseas as wellas in the United States, to inaugurate re-conditioning programs. Fearing that suchprograms would require additional per-sonnel and construction and doubting itsown authority to order their establish-ment, SOS headquarters delayed publica-tion of this directive until 11 February1943.79 Both the Air Forces and War De-partment directives provided for programsof recreation, graded exercises, and drills;the former, for a program of education aswell. Until late 1943 only a few hospitals,among them the station hospitals at CampCrowder (Missouri), Fort Benning (Geor-gia), Jefferson Barracks (Missouri), andthe O'Reilly General Hospital, developedeffective programs.80

Meanwhile the Air Forces' persistencein demanding separate convalescent facil-ities led the General Staff to consider thatproblem. At first G-4 was reluctant topermit the Air Forces to establish even restcenters, proposing instead that they "farmout" convalescents in civilian resort hotels.G-4 felt that the convalescent problemwas one for the future, since the immedi-ate needs of combat zones could be met bythe organization of rest camps in theatersand patients returned to the United Stateseither would be ready for sick leaves athome or would need definitive care ingeneral hospitals.81 Both the Ground andService Forces agreed with this viewpoint82

but the Air Surgeon was striving forauthority to establish "specialized hospitaland recuperative centers."83 Tending toagree with the Air Forces on the need,G-1 on 16 March 1943 recommended theprovision of such facilities not only for theAir Forces but for the Ground and ServiceForces as well.84 Because of conflictingopinions, G-4 called the commanding

generals of the Ground, Service, and AirForces into conference with the GeneralStaff on 7 May 1943.85 The viewpoint ofG-1 prevailed and on 14 June 1943 G-4directed ASF headquarters to investigatethe proposal to establish convalescent fa-cilities, to determine the requirements ofthe Army as a whole, and to take what-ever action appeared desirable.86

Two days before this directive was issuedSurgeon General Kirk had instructed hisHospital Construction Division to preparea program for the establishment of con-valescent annexes at general hospitals. On

79 (1) Ltr SPMCB 300.5-1, SG to TAG, 7 Jan 43,sub: WD Cir, with atchd corresp from various offs inSOS. 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 forACofS G-1 WDGS, 6 Feb 43, sub: Rest and Recu-peration of Mil Pers. AAF: 354.1 "Rest Ctrs andConv Homes."

82 (1) Memo 720 GNGAP-A, CG AGF for ACofSG-1 WDGS, 25 Feb 43, sub: Rest Cps for AGF Pers.AAF: 354.1 "Rest Ctrs and Conv Homes." (2) DFSPGAM/720/Gen (2-8-43)-16, CG SOS for ACofSG-1 WDGS, 27 Feb 43, sub: Rest and Recuperationof Mil Pers. HRS: G-1/354.7(2-8-43).

83 (1) Comment No 2, Air Surg to Dir Base ServAAF, 10 Feb 43, on R&R Sheet, Dir Base Serv AAFto Air Surg, 2 Feb 43, sub: Renaming of Pers RestCtr Projects. AAF: 354.1 "Rest Ctrs and ConvHomes." (2) R&R Sheet, Dep C of Air Staff to AirSurg, 18 Feb 43, sub: Specialized Hosp and Recuper-ative Fac for AAF Pers, with atchd draft Memo, CGAAF for AsstSecWar for Air, 10 Feb 43, and draftMemo, AsstSecWar for Air for SecWar, 15 Feb 43.Same file.

84 Memo, ACofS G-1 WDGS for CofSA, 24 May43, sub: Specialized Treatment for Aircraft CombatCrew 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, OPDWDGS, and CGs AGF, AAF, ASF, n d, and MemoWDGAP/354.7(3-8-43), ACofS G-1 WDGS forCofSA, 25 May 43.

86 Memo WDGDS 4588, ACofS G-4 WDGS for CGASF, 14 Jun 43, sub: Recuperation Ctrs for ConvPnts. Filed as incl to ind dated 29 Jul 43. HD: Wilsonfiles, "Day File, Jul 43."


21 June 1943 ASF headquarters approvedthe program The Surgeon General pre-sented.87 Neither mentioned separate facil-ities for the Air Forces, hoping apparentlyto keep the convalescent care of all pa-tients under their own control. The daybefore, however, a short-lived memoran-dum (already discussed) had granted theAir Forces authority to hospitalize combatcrew members returned from theaters ofoperations and to operate whatever generalhospitals were necessary for that purpose.88

As a part of the compromise settlement ofthis question, it will be recalled, SurgeonGeneral Kirk agreed to the Air Forces'establishment of convalescent centers forthe care of both combat crew members

suffering solely from operational fatigueand other Air Forces patients whose medi-cal care had been completed in generalhospitals, while the Air Surgeon agreed tothe continued operation of all generalhospitals by the Service Forces. The AirForces therefore activated eight convales-cent centers in the latter half of 1943,89

while the Service Forces established con-valescent annexes at each general hospital.Convalescent hospitals as such were notauthorized 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 HospitalAdministration

The outbreak of war and expansion ofthe hospital system produced few changesof consequence in hospital administration.In fact, as in prewar mobilization plan-ning, greatest attention seemed to be de-voted to physical plants, while the internalorganization and administration of hospi-tals remained largely under peacetimepolicies and procedures. The SurgeonGeneral's Office continued to considersuch matters as belonging properly withinthe province of hospital commanders andconcerned itself, as before the war, withattempts to modify administrative proce-dures outside Army hospitals that affectedthe length of time patients occupied hospi-tal beds. In some instances it seemed loathto break with the past, opposing altogetheror accepting reluctantly suggestions forchanges in the organization of hospitalsand in the manner in which they werestaffed. Although it took constructive stepsto eliminate problems involved in supply-ing and equipping new and expanded hos-pitals, a shortage of many items continuedto plague hospital commanders until earlyin 1943.

Question of Simplified Organizationand Internal Administrative Procedures

The practice of leaving the organizationand administration of hospitals largely,

within broad limits already established byArmy regulations and technical manuals,to the discretion of local hospital com-manders continued to result in variationsas numerous as the hospitals themselves,both in the number of services suppliedand in the relation of such services to oneanother and to the commanding officer.1

In some instances hospital commanderstook advantage of the freedom permittedthem and increased the efficiency of theirinstallations by organizing services notordinarily found in military hospitals. Forexample, the Camp Maxey (Texas) andFort Bliss (Texas) Station Hospitals,adopting a practice of civilian medicine,established diagnostic clinics to expeditethe "work-up" of cases and weed out thosenot requiring immediate hospitalization.The clinic at Camp Maxey, the hospitalcommander estimated, saved at least 600hospital admissions during 1942.2 Othercommanding officers showed less initia-tive, organizing and arranging customaryservices in numbers and relations whichthey considered desirable. Thus, in theabsence of specific organizational direc-tives and standard administrative proce-

1 An Rpts, 1942, Sta Hosps at Cps Butner, Maxey,Howze, Cooke, Bowie, and Ft Bliss, and An Rpts,1943, Sta Hosps at Cps Carson, Beale, Lee, Maxey,and Ft Bliss. HD.

2 An Rpt, 1942, Sta Hosp at Cp Maxey, and AnRpts, 1942 and 1943, Sta Hosp at Ft Bliss. HD.


dures, efficient organization and smoothfunctioning depended largely upon the ad-ministrative capabilities of hospital com-manders and their staffs and upon thesupervision and advice they received fromhigher authorities.3

In the fall of 1942 the Wadhams Com-mittee had stated that Army hospitalorganization and administration neededimprovement. It recommended the pro-curement of trained hospital administra-tors for assignment to key positions on thestaffs of hospital commanders and as con-sultants to The Surgeon General and serv-ice command surgeons. It also recom-mended that hospital organization besimplified. Citing a hospital in whichthirty-three sections or services operateddirectly under the commanding officer asproof of need for such action, the Commit-tee suggested a "model organization" inwhich all functions of a hospital would begrouped under the chiefs of three divisions:the Medical, Administrative, and ServiceDivisions.4

The Surgeon General took issue withthese recommendations. He expresseddoubt that any hospital commander hadthirty-three section or division chiefs re-porting directly to him and asserted thatthe hospital organization outlined in Tech-nical Manual 8-260 was the result ofmany years of medico-military hospitaladministration and represented the opin-ion of able officers of the Medical Depart-ment. "No advantage would appear toaccrue," he stated, "for [from?] any majorchange at this time." He was equally op-posed to the proposal to assign special hos-pital administrators to key positions instation and general hospitals. "Lay" ad-ministrators were used in civilian hospi-tals, he stated, only because doctors didnot have time for administrative duties.

He asserted that Medical Corps officerscould administer Army hospitals best,since some functions found in civilian hos-pitals either were lacking in military hos-pitals or were handled by other Armyagencies, such as the Corps of Engineers.He admitted that specialists in hospitaladministration were useful in some posi-tions, pointing out that approximately onehundred had already been commissionedin the Medical Administrative Corps foradministrative work in hospitals. As to theassignment of hospital administrators tohis own Office or to those of service com-mand surgeons, he made no comment.5

Later, after the commanding general,Services of Supply, directed him to takeimmediate action on the Committee'srecommendation, The Surgeon Generalmodified his position. On 16 January 1943he informed General Somervell that hewas negotiating with Dr. Basil C. Mac-Lean, Superintendent of Strong MemorialHospital, Rochester, N. Y, regarding acommission and assignment to his Officeto make a comprehensive survey of mili-tary hospital organization and adminis-tration and to advise him on the procure-ment and assignment of additional hospi-tal administrators from civilian life.6 Dr.MacLean was unable to accept a commis-sion immediately, but on 23 April 1943he was made a lieutenant colonel and as-signed to The Surgeon General's Hospi-talization and Evacuation Division.

3 See An Rpt, 1942, Chief Med Br 8th SvC. HD.4 (1) Cmtee to Study the MD, 1942, Rpt, HD. (2)

Extract from Memo, CG SOS for SG, 26 Nov 42, inCmtee to study the MD, 1942-43. Actions onRecomd, 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 onRecomd, 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 onRecomd, Recomd Nos 26 and 27. HD.

MINOR CHANGES IN HOSPITAL ADMINISTRATION 123

The Surgeon General's reaction to an-other of the Wadhams Committee's rec-ommendations further exemplified hisreluctance to interfere with the internaladministration of hospitals. Finding thatsome diagnostic procedures which re-quired only forty-eight hours in civilianhospitals sometimes took as much as tendays in Army hospitals, the Committeerecommended that "a centralized systemof control of the length of patients' stay beinstituted to record currently the lengthof stay by major professional classificationsfor each hospital, to study the causes ofabnormal occupancy, and to instituteaction to correct undesirable conditions."7

Such a system was already operating ef-fectively in the Second Service Commandand The Surgeon General agreed thatinformation on the time patients stayed inhospitals would be "highly desirable froma statistical point of view." Nevertheless,he believed it "impracticable" to establishsuch a system for all Army hospitals be-cause of the paper work involved, andindicated that he preferred to dependupon professional consultants "inquiringinto unnecessarily long periods of hospi-talization with a view to corrective ac-tion." 8 To supplement their efforts TheSurgeon General issued a circular letteron 9 November 1942, urging hospital com-manders to prevent the padding of recordsby "repetition, verbosity, and inclusion ofextraneous historical material and forms"and to reduce "irrelevant, routine, andrepetitive requests" for laboratory exami-nations.9

Certain changes in the organization ofgeneral hospitals did occur as a result oftheir transfer from control of The SurgeonGeneral to that of service commands inthe fall of 1942. Since few were located onArmy posts, most had post as well as hos-

pital functions, and their commandingofficers were both post and hospital com-manders. Duties of such officers as postcommanders were relatively unimportantcompared with their duties as hospitalcommanders, for post functions of a gen-eral hospital existed only to serve the hos-pital. Nevertheless, after general hospitalsbecame service command installations theorganization of their post function wasexpected to conform with the standardpost organization outlined in the SOS Or-ganization Manual, 30 September 1942.It grouped post activities functionally inseven divisions: Administrative, Personnel,Operations and Training, Supply, Repairsand Utilities, Internal Security and Intel-ligence, and Medical. The result was thatrelatively minor post functions, previouslyorganized as administrative sections orservices, were raised to division status,equal on paper at least to the MedicalDivision. The latter usually comprised allhospital functions, administrative—suchas medical supply, the registrar's office,and the enlisted complement—as well asprofessional. The commanding officer'sdouble role meant that while only someseven division chiefs reported to himdirectly as post commander, in most in-stances the original number of section orbranch chiefs of the Medical Division alsoreported to him directly as chief of that

7 (1) Extract from Memo, CG SOS for SG, 26 Nov42, in Cmtee to Study the MD, 1942-43, Actions onRecomd, Recomd No 25. HD. (2) Cmtee to Study theMD, Rpt, pp. 5, 7, 10, 13. HD.

8 (1) Extract from 1st ind, SG to CG SOS, 15 Dec42, on extract from Memo, CG SOS for SG, 26 Nov42, in Cmtee to Study the MD, 1942-43, Actions onRecomd, Recomd No 25. HD. (2) History, Office ofthe Surgeon, Second Corps Area and Second ServiceCommand from 9 September 1940 to 2 September1945, pp. 8 and 102. HD.

9 SG Ltr 148, 9 Nov 42, sub: Hosp Admin andProfessional Servs.


division—that is, as commander of thehospital.10 (Chart 6)

Efforts To Shorten the Average Periodof Hospitalization

As the number of hospitals increasedand the patient load became heavier, theSurgeon General's Office along with otheragencies of the War Department devotedattention to administrative proceduresoutside Army hospitals which affected theoccupancy of hospital beds. For the mostpart such procedures were those that gov-erned the disposition of patients after com-pletion of treatment—either by return toduty or separation from the Army—andwere hence essentially personnel proce-dures.

Attempts To Speed the Dispositionof Officer-Patients

Two problems arose during the earlywar years in the disposition of officer-pa-tients after hospitalization. The first re-sulted from keeping on active duty, ratherthan retiring, officers qualified for limitedservice only; the other, from loss of touchwith units and organizations to which of-ficers qualified for full duty shouldreturn.11

The procedure for the assignment of of-ficers qualified for limited service only, ineffect in January 1942, required hospitalcommanders to hold officers after com-pletion of treatment while reports of theircases were sent through military channelsto The Adjutant General in Washingtonfor instructions on assignments.12 On 21March 1942 a revision of this procedurecut out some of the correspondence andtime involved by permitting post andcorps area commanders to assign alllimited service officers except those under

the jurisdiction of the Army Air Forces.The latter still had to be reported to thecommanding general, Army Air Forces,for assignment.13

The normal procedure for returninggeneral service officers to their "proper"stations also needed modification. Inmany cases organizations to which theybelonged either had left for overseas serv-ice or had moved to some other locationin the United States, without informingthe hospital or officer concerned. Newassignments had to be made in such cases.On 6 October 1942 the War Departmentissued instructions permitting corps areacommanders to make assignments of allofficers in this category except those be-longing to the Air Forces. The latter, likeAAF limited service officers, could be as-signed only by the commanding general,Army Air Forces.14 These changes re-duced but did not eliminate entirely diffi-culties of hospital commanders in procur-ing assignments for officer-patients.15

A further revision of directives govern-ing the disposition of officers was issuedthe last day of 1942. It tended to expeditethe process. Under the new procedure, allofficers needing hospitalization who be-longed to troop units in the United States,

10 (1) SOS Orgn Manual, 1942, sec 402.02 and406.01. HD. (2) Rpt, Conf of CGs SvCs [SOS], 2dsess, 17 Dec 42, p. 41. HD: 337. (3) An Rpts of thefollowing 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 ofExempted Stas, 21 Jan 42, sub: Physical Fitness ofOffs. AG: 201.6 (1-17-42) (3). (2) AR 40-600, par5 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 Cir24, 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.


who had returned from theaters, or whowere en route to overseas destinations,were transferred at the time they enteredgeneral hospitals to replacement pools oftheir respective arms and services. Uponcompletion of hospital treatment, whetherqualified for general or limited service,

they could be returned to pools to awaitpermanent reassignment. Other officers,for example those of station complements,were not assigned to such pools and hadto be returned to their proper stations. Ineither case, hospitals might dispose of pa-tients as soon as their medical treatment


had been completed, without waiting forhigher headquarters to make assign-ments.16 Nevertheless, some hospital com-manders continued to hold officer-patientsuntil higher headquarters had acted uponthe recommendations of hospital disposi-tion boards.17

Attempts To Speed the Dispositionof Enlisted Men

Delays in the disposition of enlisted men,both those being discharged from the Armyon certificates of disability and those beingreturned to duty for limited service, alsocaused the Medical Department concern.As in the case of officers, such delays re-sulted in part from administrative actionsrequired of headquarters outside hospitals.Attempts were made to remove this causeof delay during the early war years. Later,emphasis was to be placed upon simplify-ing procedures within the hospitals them-selves.

Failure to receive service records and al-lied papers, such as individual clothingand equipment records, of enlisted pa-tients transferred to general hospitals wasone cause of delay. Without such recordshospitals could not release men entitledto discharge from the Army. As early asDecember 1941 some hospitals com-plained about this situation.18 To correctit The Surgeon General secured the issu-ance of a War Department letter requiring"the immediate transfer of such papers toa general hospital when a member of thecommand is transferred thereto." 19 This ofcourse did not solve the problem of pa-tients whose records had been lost or de-stroyed. Several officers, including thecommanding general of Lovell GeneralHospital, the director of training of theServices of Supply, the finance officer of

the New York Port of Embarkation, andrepresentatives of the Surgeon General'sOffice, became interested in it almostsimultaneously.20 On 6 June 1942, there-fore, the War Department published a di-rective permitting hospital personnel of-ficers to prepare payrolls, final pay state-ments, and new service records on thebasis of affidavits of men whose recordshad been lost in disasters either at sea oron land.21 Within a month, both SOSheadquarters and the Chief of Finance de-cided that this policy should be broadenedto include all lost records, whether or notthey had disappeared as a result of mili-tary action.22 This was done by a new WarDepartment directive published on 24July 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 BasilC. MacLean, MC for [Brig] Gen [Raymond W.]Bliss thru Col [Albert H.] Schwichtenberg, 6 Nov 43,sub: Observations Based on Recent Visits of VaryingPeriods to 9 Gen Hosps. SG: Gen Bliss's Off files,"Util of MCs in ZI" (19) #1. In this letter, ColonelMacLean stated: "The wastage in days and dollars isscandalous and can be attributed directly to the stu-pidities of a cumbersome and complex procedurewhich is not easily adaptable to a war time load."

18 (1) Statement of CO Lawson Gen Hosp, Agendaof SGO Conf with COs Gen Hosps, 15 Dec 41. HD:337.-1. (2) Inf memo, SG for TAG [Dec 41], sub: Trfof Pnts. AG: 201.3 (1-23-42) (8).

19 Ltr, TAG to CGs Armies, Army Corps, et al., 29Jan 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 May42, sub: Lost S/R. HRS: G-1/10381. (2) MemoSPTRU 333.1 (5-12-42), Dep Dir Tng SOS for DirMPD SOS, 12 May 42; sub: EM. Same file.

21 (1) 2d ind, CofF to TAG, 2 Jun 42, on Ltr, FinOff, Brooklyn, NY to CofF, thru Fin Off 2d CA, 24May 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.


the discharge of enlisted men on certifi-cates of disability by making it unneces-sary to hold patients in hospitals whilemissing records were located or until newones were issued by The Adjutant Gen-eral.24

At station hospitals a serious cause fordelay in discharging patients for disabilitywas that officials outside hospitals hadboth to initiate and to consummate theaction. Under existing regulations an en-listed man's immediate commandingofficer had to initiate the certificate re-quired for this purpose (WD AGO Form40), and an authority higher than the sta-tion hospital commander, either the postcommander or the service commander,had to approve the certificate and the rec-ommendations of the medical board whoexamined the man.25 When members ofthe Wadhams Committee visited Armyhospitals in the fall of 1942, they foundthat complaints on this score were gen-eral.26 The Committee recommended thatauthority to approve disability dischargesbe vested in all commanders of campshaving a strength of 20,000 or more.27

About the same time, General Snyderfound in a survey which he was makingthat approximately 12 percent of all pa-tients were awaiting disability discharges.To free beds for other patients, he recom-mended that measures be taken to requireorganization commanders to initiate dis-ability certificates promptly and to permitcommanders of all posts having a strengthof 5,000 or more to approve disability dis-charges.28 Accordingly, The SurgeonGeneral prepared a memorandum, pub-lished by the War Department on 30November 1942, requiring "all con-cerned" to insure prompt action by unitcommanders in initiating disability cer-tificates. In December he also secured a

modification of Army regulations to per-mit commanders of all stations with hous-ing capacities of 5,000 or more to grantdisability discharges.29 These actions, par-ticularly the latter, simplified the disposi-tion of such patients and in at least onehospital reduced the average period oftheir stay by almost two thirds, from fifty-eight to twenty-one days.30 Causes for de-lay still existed for papers still had to betransmitted between unit and hospitalcommanders and between hospital andpost commanders.

Early in 1943 G-1 directed SOS tomake a study of War Department regula-tions governing disability discharges "witha view to their clarification and the speedyconsummation of discharges under thisauthority."31 The revision of regulationswhich SOS headquarters subsequentlyproposed 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 Til-ton Gen Hosp, 25 Aug 42. AG: 220.8 (8-1-34) (1). (2)An Rpts, 1942, Torney Gen Hosp, and 1943, LaGardeGen Hosp. HD.

25 AR 615-360, sec II, par 5, 8, 9, 11, 14, and 16, 4Apr 35 and 26 Nov 42.

26 (1) Memo by Dr J. H. Musser, n d, sub: Visit toLouisiana Hosp Instls. Pers files of Dr Lewis H. Weed,Mem of the Wadhams Cmtee. (2) Memo by DrArthur H. Ruggles, n d, sub: Visit with Mr. JamesHamilton to Cp Devens, Mass. Same file.

27 (1) Extract from Memo, CG SOS for SG, 26 Nov42, in Cmtee to Study the MD, 1942-43, Actions onRecomd, Recomd No 12. HD. (2) Cmtee to Study theMD, 1942, Rpt, p. 5. HD.

28 Ltr, Asst IG to IG, 10 Nov 42, sub: Surv of HospFac 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 andtheir Util. IG: 705-Hosp (A). (2) WD Memo W40-9-42, 30 Nov 42, sub: Delays in Processing WD AGOForm 40. Same file. (3) WD Cir 404, sec III, 14Dec 42.

30 An Rpts, 1942, Sta Hosp at Sheppard Fld, andSurg 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.


likely to retard rather than to speed dis-charges. He therefore requested a confer-ence of representatives of his own Officeand of The Adjutant General, The JudgeAdvocate General, the commanding gen-eral of Services of Supply, and the Vet-erans Administration, to consider the en-tire question.32 As a result a revision wasworked out which eliminated some chan-nels of communication and placed timelimits upon the transfer of papers requiredfor disability discharges.33

Under the new procedure, published on16 April 1943, patients were to be trans-ferred (on paper) from their own units tothe station complement of the post onwhich the hospital treating them was lo-cated within forty-eight hours after hospi-tals decided to discharge them. Thus, allsteps leading up to discharges for disabilitywere to be under the control of post com-manders, independent of any action byunit commanders. Station complementcommanders were required to forwarddisability certificates to station hospitalswithin twenty-four hours after they wererequested, and hospital commanders hadto forward all papers, with recommenda-tions, to post commanders within forty-eight hours after action by medical boardsexamining patients. In addition, dischargeof patients was not to be delayed until allrecords of previous medical examinationshad been received. Furthermore, hospitalcommanders were charged with the re-sponsibility, under post commanders, forprocessing all records within the timelimits allowed.34

Under the revised regulation theamount of time needed to process thepapers required for disability dischargeswas reduced appreciably. In the stationhospital at Camp Chaffee (Arkansas) forexample, the time was cut from approxi-

mately eighteen to five days.35 Here, as inother instances, the post commander elim-inated even the transmission of recordsfrom station complement headquarters tohospitals and from hospitals to post head-quarters. He accomplished this by plac-ing detachments to which patients weretransferred to await discharge under thecommand of members of the hospital staffand by permitting hospital commandersto exercise the authority of post com-manders to approve disability discharges.In this way, the entire process of grantingdischarges on certificates of disability wascentralized under station hospital com-manders.36 Such was already the case ingeneral hospitals, because enlisted mentreated in them belonged to detachmentsof patients, rather than to the units towhich they had been assigned previously,and general hospital commanders hadhad authority since September 1941 togrant discharges on certificates of dis-ability. Further simplification of proce-dures within hospitals themselves re-mained to be done during the later waryears.

The disposition of psychotic patients in-volved problems not ordinarily encoun-tered in other disability discharges. Untilthe spring of 1943 patients who becamementally deranged within six months afterinduction and required institutional careafter 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 Mar43, sub: Discharge of EM on CDD. AG:220.8 (2 Jun42) (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 CpChaffee, and Fts Custer, Bragg, and Riley. HD.


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 andtherefore eligible for care by the VeteransAdministration. To arrange for State careof mental patients frequently requiredseveral weeks or else turned out to be im-possible altogether.37 To relieve other hos-pitals of the accumulation of such patientsawaiting discharge, The Surgeon Generalopened Darnall General Hospital on 1March 1942, established additional closedward facilities at Valley Forge and Bush-nell (Utah) General Hospitals in the fallof 1942, and on 12 June 1943 activatedMason General Hospital in buildings ac-quired from the State of New York.38 InMarch 1943 Congress authorized theVeterans Administration to care forpatients regardless of their "line-of-duty"status.39 Thereafter, Army hospitals en-countered less difficulty in disposing ofpsychotic patients, since they could trans-fer any of them to the Veterans Adminis-tration.

More than a year before this Congresshad taken action which might have re-sulted in delaying the disposition of pa-tients. On 12 December 1941 Congressauthorized the Army to retain in its hospi-tals, rather than transfer to the VeteransAdministration, patients whose terms ofservice had expired but who needed con-tinuing hospitalization.40 The extension ofall terms of service, on the following day,for "the duration plus six months," reducedthe importance of this authorization con-siderably.41 The question remained of howlong the Army would keep patients whocould not be returned eventually to activeduty.

Wishing to free as many beds as possi-ble, The Surgeon General appealed to a

policy which the Federal Board of Hospi-talization had established in 1940: theearly transfer to the Veterans Administra-tion of patients who could not be salvagedfor further service.42 The Wadhams Com-mittee, on the other hand, responsive per-haps to a feeling among the public thatthe Army should do everything possiblefor its sick and wounded men, recom-mended that the Army keep all patients,except those who were neuropsychiatric,until they had received maximum thera-peutic benefits.43 This might have provedembarrassing for The Surgeon Generalhad not the Federal Board ruled, in Feb-ruary 1943, that under its 1940 resolutionthe decision as to when patients should betransferred to the Veterans Administrationrested with The Surgeon General.44 Thisruling left him free either to transfer pa-tients as soon as it was determined thatthey could not be returned to duty, thussaving beds for other Army patients, or tokeep them for extended periods of Armyhospitalization as increasing emphasis

37 (1) SG Ltrs 99, 4 Sep 42; 1, 1 Jan 43; and 6, 2 Jan43. (2) An Rpts, 1942, Darnall, Stark, and Tilton GenHosps, 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. Offuttfor Col J. R. Hall, 22 Sep 42. SG: 632.-2. (4) Extractfrom 1st ind, SG to CG SOS, 15 Dec 42, on extractfrom Memo, CG SOS for SG, 26 Nov 42, in Cmtee toStudy the MD, 1942-43, Actions on Recomd, RecomdNo. 22. HD.

39 (1) Public Law 10, 78th Cong, 17 Mar 43, 57Stat 10. (2) AR 615-360, C 4, 16 Apr 43.

40 (1) Public Law 333, 77th Cong., 12 Dec 41, 55Stat 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 ofDisabled 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 onRecomd, Recomd No 29. HD.


came to be placed on Army recondition-ing and rehabilitation during the laterwar years.

Delays in the disposition of enlisted pa-tients occurred also, as in the case of offi-cers, when their organizations had movedto undisclosed destinations or when menwere physically fit for only limited serviceat the end of treatment. Such patientswere found less in station than in generalhospitals, since the latter treated thosewho had the more serious illnesses or in-juries and required longer periods of med-ical care. Both the men whose organiza-tions had moved and those qualified foronly limited service required new assign-ments. To prevent their being held in hos-pitals awaiting assignment by higherheadquarters, meanwhile occupying bedsneeded for other patients, The SurgeonGeneral's Hospitalization Division recom-mended on 22 January 1942 that casualdetachments be set up near all generalhospitals for the immediate assignment,on a temporary basis, of all enlisted pa-tients whose hospitalization had beencompleted.45 Instead of approving thisrecommendation, the Secretary of War,on the advice of the General Staff, directedthat Air Corps (after March 1942, AirForces) enlisted patients be reassigned bythe chief of the Air Corps; others, by corpsarea commanders.46 Two days later, afterColonel Offutt protested that this failed tosolve the problem, the War Departmentsuggested that corps area commandersfurnish hospitals with blocks of availableassignments or that they designate stationsto which enlisted men might be sent tem-porarily, pending permanent assign-ments.47 This procedure worked well insome corps areas. In others, where corpsarea commanders failed to establishcasual detachments under such "permis-

sive regulation," it was less successful inenabling hospitals to speed the dispositionof patients.48

Other Efforts To Shortenthe Period of Hospitalization

The speed-up of dispositions was notthe only way by which beds could besaved for patients who really needed them.The same result could be accomplished bylimiting the treatment given in hospitals.During the winter of 1942-43 The Sur-geon General instituted measures of thattype. Among them were the treatment ofpatients with uncomplicated cases of gon-orrhea on a duty status and the curtail-ment of elective operations.

Although the majority of patients withgonorrhea in civilian life were treated onan out-patient basis, the Army had cus-tomarily hospitalized soldiers with thatdisease.49 In the fall of 1942 such patientsoften remained in hospitals for more thana month and, according to General Sny-der, occupied approximately 6,000 beds.During 1942, some posts in the FourthService Command had begun to use sul-fonamide compounds to treat patientswith gonorrhea on a duty status, thusavoiding long periods of hospitalization.On 10 November 1942 General Snyderrecommended the immediate considera-

45 Ltr, SG to TAG, 22 Jan 42, sub: Disposition ofPnts. 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: Dispo-sition of Pnts. SG: 705.-1. (2) WD Cir 24, 27 Jan 42.

47 Ltr, TAG to CGs of all CAs, 29 Jan 42, sub: Dis-position of Pnts in Gen Hosps. AG: 322.3 Gen Hosp(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 ofthe Venereal Diseases (1948). HD.


tion of standardizing this practice through-out the Army.50 The Surgeon Generalthen requested the appointment of aboard of medical officers to review accu-mulated experience to determine the wis-dom of extending on-duty treatment ofgonorrhea patients.51 By January 1943 theboard had completed its work. It recom-mended that the policy of treating patientswith uncomplicated cases of gonorrhea ona duty status be encouraged, but not re-quired.52 Adoption of this policy reducedthe number of patients in hospitals andthereby lessened both construction andpersonnel requirements.53

At the same time, to achieve the sameend, General Snyder also recommendedthe curtailment of elective operations,such as the repair of hernias, the removalof pilonidal cysts, and the correction ofinternal derangements of knee joints andother preinduction disabilities.54 In con-formity with this recommendation, TheSurgeon General directed hospitals to con-sider for elective operations only men whomight be of definite value to the Armyafterwards.55 Although this directive didnot require a curtailing of elective opera-tions, some hospitals reduced the numberperformed.56 Later during 1943, when themanpower shortage demanded maximumuse of available men, it was necessary torelax this policy.57

Early Changes in the Sizeand Composition of Hospital Staffs

With the war making increasinglyheavy demands upon the Nation's avail-able manpower, zone of interior hospitalsfaced the prospect of having to functionwith staffs that had progressively lowerproportions of Medical Corps officers andable-bodied enlisted men. Although re-ductions were carried to greater lengths

during the latter part of the war, theystarted during its early years and thepractice of replacing physicians and able-bodied enlisted men by personnel in othercategories began at that time.

Throughout 1942 the personnel guidethat had been issued in April 1941 re-mained effective for station hospitals, andthe Surgeon General's Office instructedgeneral hospitals to use tables of organiza-tion of corresponding numbered units astheir guide.58 During the year, his Officenot only revised such tables but in Decem-ber presented for Staff approval newguides for manning both station and gen-eral hospitals in the zone of interior.59

Made partly at the instance of the Gen-eral Staff as a means of reducing theArmy's requirements for physicians,60


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 andtheir Util. IG: 705-Hosp (A). (2) Ltr, SG to CG SOS,19 Nov 42, sub: Apmt of Bd for Investigation of Treat-ment of VD on Duty Status. Same file.

52 WD AGO Memo W40-2-43, 19 Jan 43, sub:Treatment of Individuals with Uncomplicated Gon-orrhea on a Duty Status. HD: 726.1-1.

53 An Rpts, 1942, Sta Hosps at Cp Butner and FtBragg. HD.


55 SG Ltr 167, 30 Nov 42, sub: Performance ofElective Oprs for Pre-Induction Disabilities.

56 An Rpts, 1943, Fletcher Gen Hosp and Sta Hospat Cp Chaffee. HD.

57 SG Ltr 190, 17 Nov 43, sub: Sel of Cases forElective Opr for Pre-Induction Disability.

58 Ltr, Col H. D. Offutt to Col E. R. Gentry, BordenGen Hosp, 4 Nov 42. SG: 323.7-5 (Borden GH)K.

59 Incl 1, Annexes A and B, to Memo, Act SG forDepCofS 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 DivSOS, 1 Apr 42, sub: Availability of Physicians. HRS:G-1/16331-16335. For a full treatment of the questionof the Army's requirements and the availability ofphysicians, see John H. McMinn and Max Levin,Personnel (MS for companion vol. in Medical Dept,series), HD.


TABLE 4—POSITIONS AND RANKS IN ZONE OF INTERIOR HOSPITALS PERMITTED BUT NOTREQUIRED 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 thenumber of Medical Corps officers author-ized for hospitals of various sizes and toincrease the use of Medical Administra-tive Corps officers in administrative posi-tions.

Throughout 1942 allowances of Medi-cal Corps officers for zone of interiorhospitals were considerably higher thanthose later prescribed in the guides. Forexample, on 21 October 1942 the SurgeonGeneral's Office informed the commanderof a 1,500-bed general hospital that hisallotment should consist of eighty officersof the Medical Corps, ten of the MedicalAdministrative Corps, and additionalmembers of other corps.61 An allotmentbased on the revised table of organizationfor numbered general hospitals wouldhave had 23 fewer Medical Corps officers,and one based on the December 1942guide for named hospitals would have had34 fewer Medical Corps officers and 13more Medical Administrative Corps offi-cers. High allotments were somewhat off-set by the fact that in most cases the num-

ber of Medical Corps officers actuallyassigned failed to equal the allowance.Hospital commanders therefore com-plained of shortages, but their complaintsseem to have been based on this discrep-ancy alone and not on a consideration ofall their resources. In addition to assignedphysicians, many hospital commandershad at their disposal medical officers ofunits attached for training as well as thoseawaiting assignment in Medical Depart-ment pools. Moreover, later in the warhospitals had to get along with even fewerassigned Medical Corps officers, and ascommanders continued to assert that theirhospitals provided a high standard ofmedical care their complaints of shortagesof physicians during this period should betaken 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-9thSvCs. HD. (2) An Rpts, 1942, Lovell, Hoff, Billings,Kennedy, and Ashburn Gen Hosps, and Sta Hosps atFts Benning and Belvoir, and Cps Adair, Lee, Bland-ing, and Chaffee. HD.


Replacement of physicians in adminis-trative jobs by Medical AdministrativeCorps officers began in 1942. At the begin-ning of the war the personnel guide fornamed hospitals permitted but did not re-quire the use of Medical AdministrativeCorps officers in certain positions. (Table 4)At that time the Surgeon General's Officeapparently considered them primarily asassistants to Medical Corps officers in themore responsible administrative posi-tions.63 Early in 1942, therefore, physi-cians, sometimes with Medical Adminis-trative Corps assistants, held such positionsas executive officer, registrar, adjutant,mess officer, medical detachment com-mander, and medical supply officer inmany hospitals in the zone of interior. Incompliance with General Staff and SOSdirectives,64 The Surgeon General madeplans during 1942 to use Medical Admin-istrative Corps officers more widely. Firsthe proposed to increase the supply byopening a second Medical AdministrativeCorps officer candidate school.65 Then inJune he requested certain hospital com-manders to make studies of the positionswhich administrative officers could fill.66

Before such studies could be completed, aWar Department directive, issued on therecommendation of SOS headquarters,ordered the commanding generals of theAir and Ground Forces and of corps areasto relieve Medical Corps officers of allduties not requiring professional medicaltraining and to replace them with MedicalAdministrative Corps or Branch Immate-rial officers.67 This action left to individualcommanders the decision as to whichpositions were suitable for administrativeofficers. Generally they were considered tobe those of detachment commander, med-ical supply officer, adjutant, and regis-trar.68 By the end of 1942 service com-

mands reported that administrative offi-cers had replaced physicians in adminis-trative positions to the extent which supplyof the former permitted.69 The qualifyingphrase was important, for a shortage ofMedical Administrative Corps officers foruse in the zone of interior existed through-out 1942 70 and their widespread substitu-

63 (1) Ltr, Act SG to the Hon D. Lane Powers,Mem of Gong, 29 Mar 41. SG: 210.2-1. (2) Ltr, LtCol 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 PersDiv SOS, 1 Apr 42, sub: Availability of Physicians.(2) Memo, ACofS G-1 WDGS for Pers Div SOS, 9May 42, same sub. (3) Memo, CG SOS for SG, 22May 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 SOSfor CofSA, 29 May 42, sub: Increase in ProcurementObjective, MAC, with 2d ind, SG to Chief Pers ServSOS, 6 Jun 42. (3) Memo, CG SOS for CofSA, 5 Jun42, same sub. (4) Ltr, TAG to SG, 13 Jun 42, samesub. 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 Fitz-simons, Army and Navy, Wm. Beaumont, WalterReed, and Lawson Gen Hosps, 29 Jun 42, sub: Con-servation 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 NotRequire Professional Med Tng. AG: 210.31(7-10-42) (4).

68 (1) Ltr, CG 8th CA to TAG, 22 Jul 42, sub: Re-lief of 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 ColArthur J. Redland, 5th SvC, 10 Aug 42. SG: 320.3-1(5th SvC).

69 (1) Rpt, Conf of CGs SvCs [SOS], 2d sess, 17 Dec42, pp. 19, 33, 96. HD: 337. (2) An Rpts, 1942, ChiefMed Br (Surg) 3d and 9th SvCs. HD.

70 (1) Ltr SPMCQ 322.056.-1, SG to TAG, 28 Sep42, sub: Increase in Procurement Objective AUS forDuty 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 MilPers SOS, 13 Oct 42, sub: Procurement Objective,MD. AG: SPGA 210.1 Med 1-20. (4) Memo, Lt Col


tion for Medical Corps officers remainedto be carried out during the later waryears.

Changes in the composition of the en-listed staffs of hospitals were more general.Experience in the employment of civilianshad already demonstrated that able-bodied enlisted men could be replaced bypersonnel of other types. During the firstyear and a half of the war the practice ofsubstitution was extended. Limited serviceenlisted men (that is, those with physicaldefects which disqualified them for servicewith the field forces) and Women's ArmyAuxiliary Corps enlisted women wereadded to civilians as replacements forenlisted men who were physically qualifiedfor general service.

Early in 1942 hospital commandersoften had fewer enlisted men than theyconsidered desirable, and the SurgeonGeneral's Office reported continual short-ages for Medical Department activities.Large numbers were needed for the manynew hospitals opening in the zone of inte-rior. Units going overseas had to have fullcomplements and hospitals called upon tosupply them often had difficulty securingreplacements.71 In July SOS headquartersissued a directive, recommended by theSurgeon General's Office, to give suchhospitals priorities on replacement requisi-tions.72 About the same time it announcedthat the Army would begin in August toinduct limited service men and assignthem directly to hospitals and other zoneof interior installations.73 These measureswere apparently helpful, for by the end of1942 many hospitals reported that theirallotments were full.74 Even so, a few com-

manders complained of shortages,75 butgenerally, complaints were less of short-ages than of difficulties in using limitedservice men and civilians.

Hospitals had had experience with lim-ited service enlisted men as early asDecember 1941, when the War Depart-ment began to transfer physically unfitmen from field force units to zone of inte-rior installations.76 At first hospitals ab-sorbed men of this type readily becausethey were few in number and were used tofill vacancies, supplementing existingforces of able-bodied men. Gradually itbecame the practice to withdraw able-bodied men from hospital staffs for servicewith field forces and to use limited servicemen not as supplements but as substitutesfor them.77 As this happened hospitalcommanders encountered difficulties. The

Basil C. MacLean for Gen Bliss thru Col Schwichten-berg, 6 Nov 43, sub: Observations Based on RecentVisits 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-1WDGS to SG thru Mil Pers Div SOS, 28 Oct 42.Same file. (3) Rpt, SGs Conf with CA and ArmySurgs, 25-28 May 42, pp. 20, 31. HD: 337. (4) AnRpts, 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 LimitedServ EM. SG: 220.31-1.

74 An Rpts, 1942, Hoff, Ashford, Billings, Lovell,Tilton, Hammond. Bushnell, Torney, O'Reilly, andLawson 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 andCp Lee. HD.

76 Ltr AG 220.31 (1 2-18-41) EA-A, TAG to allArmy, CA, and Exempted Sta Comdrs other than ACand C of Armored Force, 23 Dec 41. sub: Clearing FldForce Units of Pers not Physically Qualified for FldServ. SG: 220.31-1.

77 (1) SOS Cir 13, 12 May 42, sub: Absorption ofLimited 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 ofLimited Serv Pers. Same file.


field forces tended to place "problem"men in the limited service category and topromote others just before transfer—ac-tions bound to create morale problems forreceiving hospitals.78 Moreover, limitedservice men were often unable to do a fullday of hard work, and hospitals—operat-ing around the clock—found it difficult toassign all of them to special jobs withintheir physical limitations. Of equal impor-tance, such men had often had no MedicalDepartment training. Hospitals thereforehad to maintain continuous training pro-grams for newcomers. Even so they couldnot always train enough technicians, for inmany instances physical incapacity hap-pened to be coupled with low mentalityand little education.79 By the end of 1942this problem had become so serious thatThe Surgeon General sought a commit-ment from SOS headquarters to assign tothe Medical Department greater numbersof limited service men of good caliber.80

Failing in this, he resorted to the establish-ment in April 1943 of special regiments totrain whatever limited service men theMedical Department might receive.81

As limited service men came to consti-tute a larger part of the enlisted force, hos-pitals gradually began to think of civiliansas supplementing rather than replacingenlisted men. By the end of 1942 manyhospitals with full complements of enlistedmen also had sizable numbers of civilianemployees. In recruiting civilians, hospitalcommanders encountered the same prob-lems they had experienced in 1941. Inaddition, they found it increasingly diffi-cult to maintain stable civilian forces. Asable-bodied civilian employees were in-ducted into the armed services, they hadto be replaced by women and elderly orphysically-handicapped men. Even thewidespread use of civilians of these types

failed to bring stability, for they left hospi-tals in growing numbers to take betterpaying jobs elsewhere. Competition withwar industries and other governmentagencies was keen and hospital wage-scales were frequently lower than thoseprevailing in surrounding areas. As a re-sult, hospital commanders found the useof civilians "very vexatious, time consum-ing, and expensive," 82 and by the end of1942 some of them began to think it wouldbe better to replace civilians with limitedservice men, however unsatisfactory, orwith members of the Women's Army Aux-iliary Corps.83

When the question of using Waacs inArmy hospitals was first raised in thespring of 1942, The Surgeon General ex-pressed opposition because, he said, theiruse would conflict with civilian personnelemployment, would interfere with train-ing of enlisted men, and would create diffi-

78 (1) Ltr AG 220.31(4-1-42)EA-A, TAG to CGAGF, CGs Eastern, Western, Southern, and CentralDef Comds, and all CA Comdrs, 2 Apr 42, sub: Clear-ing Fld Force Units of Pers Not Physically Qualifiedfor 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, CpsRoberts, 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 TngSOS, 3 Dec 42, sub: Asgmt of Class I and Class IILimited Serv Pers to MRTCs. SG: 220.31-1. (2)Memo SPGAE/220.3(12-3-42)-132, Dir Mil PersSOS 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.


culties centering around housing and recre-ation.84 During 1942, as civilians becameincreasingly hard to get and keep and aslimited service men replaced those quali-fied for overseas service in growing num-bers, the idea gradually gained currencyamong hospital commanders, service com-mand surgeons, and members of the Sur-geon General's Office that Waacs, whocould not leave their jobs and who hadsufficient ability and education to absorbtechnical training, were a "better bet"than either civilians or limited service en-listed men.85 Meanwhile, as plans weremade to expand the women's corps, boththe War Department General Staff andSOS headquarters put pressure on all ofthe services, including the Medical De-partment, to use Waacs extensively torelease men for combat duty.86 About thesame time, the Wadhams Committee rec-ommended their employment in hospi-tals.87 Accordingly, early in 1943 the Sur-geon General's Office began to plan fortheir assignment to Medical Departmentinstallations.

At first The Surgeon General decided toconduct experiments at Halloran (NewYork) and Valley Forge (Pennsylvania)General Hospitals to see what jobs Waacscould fill.88 Failing to obtain WAAC unitsfor this purpose, on 26 January 1943 heappointed a board of officers, composed ofthe chief of his Hospitalization Divisionand members of the Personnel and Train-ing Divisions, to study the problem. Soonafterward he requested reports from serv-ice commands, the Air Forces, the Trans-portation Corps, and the Army MedicalCenter on hospital jobs which Waacs couldfill, the numbers needed, and the con-struction required to house them.89 Fromthese surveys The Surgeon General'sboard found that the Air Forces planned

to use Waacs in all hospitals having 200 ormore beds and that the commanders ofSOS hospitals having 500 or more bedsfelt that they could use them to replacefrom 30 to 50 percent of their enlistedmen. Not all hospital commanders, itshould be noted, were enthusiastic aboutusing Waacs, their attitudes depending toa large extent upon what General Grant,the Air Surgeon, called the "personalequation." 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 WAACin Army Hosps, with 1st ind, SG to CG SOS, 14 Apr42; and 2d ind SPTRS 290 (WAAC) (3-21-42), CGSOS 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 StaHosps, and Chief Med Br 3d SvC. HD. (3) Ltr, COValley Forge Gen Hosp to SG, 19 Jan 43, sub: Re-quest Allocation and Asgmt of a WAAC Unit, with1st ind. SG: 322.5-1. (4) Ltr, Col G. F. Lull, SGO toCol 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, CGMRTC, Cp J. T. Robinson, Ark, 22 Feb 43. HD:220.31-1.

86 (1) Memo S635-2-42, 22 Oct 42, sub: Asgmt ofWAAC. 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 Nov42. and from 2d ind, CG SOS to SG, 21 Dec 42, inCmtee to Study the MD, 1942-43, Actions onRecomd, Recomd No 88. HD.

88 (1) Extract from 3d ind, SG to CG SOS, 16 Jan43. on extract from Memo, CG SOS for SG, 26 Nov42. (2) Extract from 1st ind, SG to CG SOS, 8 Mar43, on extract from Memo, CofS SOS for SG, 26 Feb43. Both in Cmtee to Study the MD, 1942-43, Actionson Recomd, Recomd No 88. HD.

89 (1) SG OO 41, 26 Jan 43. (2) Memo, CG SOS perSG 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 Serv-ice Commands. (3) Memos, SG for CG AAF, MDWand AMC, and for CofT, 3 Feb 43, same sub. Samefile.

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.


more than ten thousand Waacs would beneeded for hospitals and in March 1943recommended that WAAC headquartersbe asked what number they could sup-ply.91 The Surgeon General then sent eachservice commander a tabulation of Waacrequirements for hospitals in his com-mand, for inclusion in the Waac requisi-tion which it was anticipated SOS head-quarters would require each to submit.92

Soon afterward, Waac recruiting collapsedand WAAC headquarters could promiseThe Surgeon General, on 2 June 1943,only 150 to 170 women for training eachmonth, beginning in September 1943.93

The extensive use of Waacs in hospitalstherefore had to wait.

Problem of Furnishing Suppliesand Equipment for Hospitals

Providing sufficient medical suppliesand equipment for large numbers of newstation and general hospitals, and for oldhospitals that were expanding with un-precedented rapidity, as well as for dispen-saries, infirmaries, induction stations, andmedical units destined for overseas service,presented the Medical Department aproblem of great magnitude.94 It was par-tially simplified by the practice of issuinghospital assemblages as single items. Usingequipment lists prepared during the emer-gency period, medical depots packedassemblages which included, within thelimits of supplies and equipment available,all items needed to establish hospitals ofvarious sizes and kinds, ranging from25-bed station hospitals to 1,000-bed gen-eral hospitals. As new hospital plants wereconstructed the Surgeon General's Officehad assemblages of appropriate sizesshipped to them. As established hospitalswere expanded, local medical supply offi-

cers requisitioned standard assemblages tofit their needs.95 This system not only savedtime and personnel that would have beenrequired to list the manifold items re-quired for each hospital but also relievedlocal supply officers, many of whom wereunacquainted with tables of equipmentand inexperienced in estimating hospitalneeds, of the necessity of determining whatitems would be required for hospitalexpansions.

Changes in the requisitioning procedureused by hospitals to meet recurrent oper-ational needs became imperative as soonas the wartime expansion began. Beforethe war, hospitals were permitted to makeonly quarterly and emergency requisi-tions, all of which had to be reviewed bycorps area surgeons before being sent todepots for filling. To enable hospitals tomeet urgent needs that resulted fromrapid expansions, as contrasted with emer-gency needs that could not be foreseen,The Surgeon General early in January1942 permitted the submission of "special"requisitions at any time.96 To eliminate anunnecessary step and thus speed the requi-sitioning process, he began a system of

91 Rpt of Proceedings of Bd of Offs, n d, incl 4 toMemo, 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 Mar43, sub: Employment of WAAC in Sta and GenHosps, ZI. HD: 322.5-1.

93 (1) Memo, SG for CG ASF, 2 Jun 43, sub; TecTng 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 isbased on Richard E. Yates, The Procurement andDistribution of Medical Supplies in the Zone of theInterior during World War II (1946), pp. 169-87.HD.

95 (1) Ltr, SG to MD Depots, 2 Feb 42, sub: MedDepot Program for 1942. SG: 475.5-1. (2) SG Ltr 141,2 Nov 42, sub: MD Equip Lists. (3) SG Ltr 156, 24Nov 42, sub: Sup Policies and Procedures, ZI Instls.

96 SG Ltr 2, 8 Jan 42, sub: Requisitions.


direct supply on 10 February 1942. Afterthat date hospital medical supply officerscould submit requisitions directly todepots, without corps area intervention.97

In the early months of the war, theMedical Department continued to behandicapped by a shortage of many items.As a result, depots found it necessary toship incomplete assemblages and partiallyfilled requisitions. Missing items wereplaced on back order, to be shipped whenavailable. Among the items which hospi-tals most frequently failed to receive weredental supplies and equipment, surgicalinstruments and operating room equip-ment, laboratory equipment, X-ray devel-oping-tanks and cassettes, hospital furni-ture including beds, and food carts. Newhospitals suffered most from these short-ages. In a few instances the receipt ofincomplete assemblages delayed theiropening or the opening of some of theirclinics and wards. When hospitals openedwith incomplete equipment they usuallyhad to send surgical patients to near-byhospitals and have dental, laboratory, andX-ray work done elsewhere. To make upfor shortages that continued to exist, theyresorted to borrowing, improvising, andpurchasing in the open market. Some bor-rowed beds from the local quartermasterand such items as X-ray developing-tanks,cassettes, and food carts from other Armyhospitals or from Veterans Administrationfacilities. Others improvised X-ray devel-oping-tanks and food carts. Many hadtheir own "utilities" personnel build miss-ing items of hospital furniture. Sometimes,when money was available, hospitals pur-chased necessary supplies on the localmarket. In some instances, officers usedtheir own instruments and in one case,where there was a shortage of typewriters,civilian typists were required to provide

their own. While these shortages undoubt-edly taxed the ingenuity of hospital com-manders and operating personnel, theyfailed, apparently, to affect medical careadversely, for hospital commandersseemed able to arrange for the use of localcivilian or near-by Army facilities withoutundue difficulty.98

In the latter part of 1942 The SurgeonGeneral intensified his efforts to solvemedical supply problems. Most measurestaken toward that end, such as the im-provement of depot operations, are out-side the scope of this study. Two deserveconsideration here. The requisition systemwas completely revised and placed on amonthly basis, effective 1 January 1943.After that date hospitals submitted sepa-rate monthly requisitions for standard-expendable, standard - nonexpendable,and nonstandard items. They could stillsubmit "special" and emergency requisi-tions.99 Concurrently, the stock-controlsystem was revised. The system formerlyin effect had permitted hospitals to keeplarge stocks on hand and had not requiredaccurate "due in" records. As a resultsome hospitals held in storage items thatwere needed by others, and medical sup-ply officers often did not know which itemsof their requisitions remained to be shippedby depots. In the fall of 1942, therefore,the Surgeon General's Office establishedlower stock levels and devised a new stock-

97 SG Ltr 11, 10 Feb 42, sub: Direct System of Supfor Posts, Cps, and Stas.

98 The above paragraph is based on information inthe 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 GenHosps; and Sta Hosps at Fts Belvoir and Bliss, Shep-pard Fld, and Cps Adair, Atterbury, Butner, Cooke,Howze, Maxey, and McCoy. HD.

99 SG Ltr 156, 24 Nov 42, sub: Sup Policies andProcedures, ZI Instls.


record card for posts and general hospitals.These changes not only produced bettersupply administration but also releasedlarge amounts of supplies and equipmentfor redistribution to hospitals sufferingfrom shortages.100 The combination ofmeasures begun in 1942, along with com-pletion of the hospital expansion programduring 1943, resulted in a greatly im-proved supply situation. During the rest ofthe war hospitals and service commandsurgeons reported generally that requisi-tions were promptly filled and that thesupplies and equipment which they re-

ceived were of good quality and of suffi-cient quantity to meet their needs.101

100 For example, see the following: An Rpts, 1943,Surg 7th SvC, and Sta Hosps at Cps Lee and Maxey.HD.

101 (1) Memo, Dir Sup Planning Div SGO for ActChief, Sup Serv SGO, 22 Dec 43, sub: Rpt of Visits toHosp Instls. SG: 333.1-1. (2) Memo, Dir Distr andReqmts Div SGO for Mr. Edward R. Reynolds, 20Jan 44, sub: Data for Inclusion in ... Rpt on Ac-complishments of SGO. SG: 024.-1. (3) An Rpts atrandom; for example, An Rpts, 1943, Hoff, PercyJones, 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 BirminghamGen Hosps. HD.

CHAPTER VIII

Providing Hospitalizationfor Theaters of Operations

In the first year and a half of the warthe Medical Department had to providehospitalization for reinforced garrisons inoverseas departments and bases, for newforces sent to hold lines of supply andcommunication throughout the world,and for task forces engaged in the first de-fensive-offensive operations against theenemy. Meanwhile it had to organize,train, and equip other units for use whenthe Army should become engaged in full-scale offensives. Early in 1942 the Pacificheld first claim on hospital units sentoverseas. In the summer emphasis shiftedto Europe and North Africa, and there-after hospitals went to those theaters in in-creasing numbers. By the latter part of theyear, after emergency shipments hadbeen made, it was possible to take stock ofhospitalization already furnished to the-aters with a view to establishing a basisfor further planning.

Meeting Early Emergency Needs

Status of Hospital Units and Assemblages

When the Japanese struck Pearl Har-bor the Medical Department had 22 gen-eral, 24 station, 17 evacuation, and 8surgical hospital units that had been acti-vated as training units. Of these, 3 station

hospitals were already overseas and 9 sta-tion, 12 general, 4 evacuation, and 3surgical hospital units included in theWar Department pool of task force unitswere authorized almost 100 percentof their table-of-organization enlistedstrength and from 50 to 75 percent oftheir commissioned strength. The rest hadhalf or less than half of their enlistedstrength and from three to five officerseach. In addition to the training units,affiliated hospital units consisting chieflyof 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 activeduty as needed immediately upon theoutbreak of war, were to be supplied withenlisted personnel, and were then to gointo service without further ado.1 Accord-ing to a report of The Surgeon General inNovember 1941, hospital assemblageshad already been issued to 3 station and 2evacuation hospital units; while assem-blages for 2 general, 11 station, 4 evacua-tion, and 3 surgical hospital units werepacked and ready for immediate issuefrom depots, and those for 10 general, 9

1 See above, pp. 5-6, 40.

HOSPITALIZATION FOR THEATERS OF OPERATIONS 141

station, 17 evacuation, and 5 surgical hos-pital units were being packed but werenot yet ready for issuance.2

Plans for Meeting Emergency Needs

Early in January 1942 The SurgeonGeneral outlined to G-3 the system hewished to use in meeting emergency needs.Affiliated units would be called to activeduty and each would receive approxi-mately one half of its authorized enlistedstrength from a training unit. The rest ofits personnel would be supplied by recep-tion centers, zone of interior installations,and other medical units. Each training unitwhich transferred personnel to an affili-ated unit would retain a cadre, in order totrain additional "fillers" for other affili-ated units. Some training units, especiallystation hospital units, would be sent over-seas as needed, having first been broughtto authorized strength with both enlistedand commissioned personnel transferredfrom other medical units or installations.Each unit would draw individual equip-ment, clothing, and motor transport at itshome station. Only those going overseaswould receive hospital assemblages, pref-erably at ports of embarkation.3

Soon after he had proposed this systemThe Surgeon General realized that modi-fications would be necessary. The activa-tion of training units at reduced strength,a policy adopted on his recommendationin 1941, resulted in the hurried assembly,often at ports of embarkation, of addi-tional personnel to make up the otherhalf of a unit. Members of units goingoverseas therefore frequently had littletime to become acquainted with oneanother's capabilities before embarkation.Installations from which 'Tillers" weredrawn suffered from resulting personnel

and training problems. To obviate thesedifficulties The Surgeon General recom-mended in February 1942 that all train-ing units be activated at full table-of-or-ganization enlisted strength.4 He receivedthe support in March 1942 of the SOSHospitalization and Evacuation Branchand in April of AGF headquarters. InMay G-3 approved the proposal.5

The Surgeon General secured only par-tial approval of his stand in opposition tothe issuance of hospital assemblages be-fore the departure of units for theaters.After completing a survey of storage spacein corps areas, G-4 in December 1941 dis-approved a request that General Mageehad made in November to hold assem-blages in depots until units were assignedmissions involving medical care.6 GeneralMagee then sought approval of his posi-tion in a personal conference with GeneralSomervell, who was at that time the As-sistant Chief of Staff, G-4. On the basis ofhis understanding of the agreementreached then, General Magee resubmit-ted his request.7 Instead of approving it,

2 Ltr, SG to TAG, 5 Nov 41, sub: Equip for MedUnits 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: 326.01-1.

4 (1) Memo, Act SG for ACofS G-3 WDGS, 28 Feb42, sub: Orgn and Dispatch of MD TofOpns Units.SG: 322.3. (2) An Rpts, 1942, of following Gen Hosps:2d, 30th, 42d, 105th, 118th, and 210th, and of follow-ing Sta Hosps: 10th, 12th, 13th, 17th, 151st, 166th,and 172d. HD.

5 (1) Memo G-4/24499-178, Maj William L. Wil-son for [Lt] Gen [LeRoy] Lutes, 12 Mar 42, sub:Basic Plans for Hosp and Evac. HD: Wilson files, "No472, Hosp and Evac, 1941-42." (2) Ltr, CG AGF forCG SOS, 23 Apr 42, sub: Auth of Grades and Ratingsfor MD Tactical Hosp. AG: 221(7-1-41) Sec 1H, Pt1. (3) Ltr, TAG to CGs AGF, AAF, SOS, ArmoredForce, etc., 6 May 42, same sub. Same file.

6 D/S G-4/31793, ACofS G-4 WDGS to SG, 31Dec 41, sub: Comments on Draft of Ltr, 'Current Pol-icies and Procedures for . . . Sups.'HD: 475.5-1.

7 Memo, SG for ACofS G-4 WDGS, 10 Jan 42,sub: Equip for Numbered Hosps. HD: 475.5-1.


as The Surgeon General had expected,G-4 now proposed a compromise. Unitassemblages would be declared controlleditems. As such, they would not be issuedthrough corps areas to units upon requisi-tion but would be issued directly as theWar Department determined. Mean-while, The Surgeon General would makefractional issues of unit equipment fortraining purposes.8

Although he concurred in this compro-mise, officially published on 21 January1942,9 The Surgeon General did not giveup hope that he could continue to holdunit assemblages in medical depots untilnumbered hospitals were assigned opera-tional missions. Once they were declaredcontrolled items, the most practical meth-od of achieving this end would be to se-cure War Department agreement not torequire their issuance prior to that time.This might be done indirectly. Conse-quently, on 24 January 1942 The SurgeonGeneral requested G-4 to include inmovement orders for numbered hospitalunits ordered overseas a paragraph direct-ing The Surgeon General to ship appro-priate assemblages to ports of embarka-tion or staging areas. On 6 February 1942G-4 approved this recommendation.10 Aswill be seen later, neither the 21 January1942 compromise nor the approval of theinclusion of a paragraph in movement or-ders settled the controversy over the issu-ance of equipment.

Methods of Meeting Emergency Needs

In defense areas—the Atlantic bases,the Panama Canal Zone, Alaska, andHawaii—where hospitals already existed,the hospital situation was serious thoughnot critical. To meet emergency needs ex-isting facilities could be expanded and ad-

ditional "provisional" hospitals could beestablished by spreading thin the person-nel and equipment already available.Army patients could also be hospitalizedin civilian institutions wherever they wereavailable.11 Hence few hospital units wentto those areas in the first few months fol-lowing Pearl Harbor. Between 1 Januaryand 30 June 1942, 2 general hospitalswere sent to the Panama Canal Zone and3 general and 4 station hospitals toHawaii to supplement existing and impro-vised hospitals in those areas.12 In addi-tion, troops sent to garrison new bases in-cluded medical detachments to operatethe hospitals needed for their care,13 butthe more pressing needs of other areasgenerally took precedence in the shipmentboth of numbered hospitals and supple-mentary personnel and equipment.14

Troops deployed to protect shippinglanes and to hold the enemy while prepa-rations for the offensive went forward re-

8 Memo for Record on D/S, ACofS G-4 WDGS forTAG, 16 Jan 42, sub: Equip for MD Units, and onMemo, Chief Planning Br G-4 WDGS for Brig GenB. B. Somervell, 16 Jan 42, same sub. HRS:G-4/33344.

9 (1) Memo, SG for ACofS G-4 WDGS, 17 Jan42. SG: 475.5-1. (2) Ltr AG 400 (1-16-42)MD-D-M, TAG to SG, 21 Jan 42, sub: Equip for MDUnits. 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 Feb43, same sub. HRS: G-4/33344.

11 An Rpt, Med Activities Newfoundland BaseComd, 1942; An Rpt, Med Activities Surg TrinidadSector and Base Comd, 1942; An Rpt, Dept SurgPanama Canal Dept, 1942; An Rpt, MD ActivitiesHawaiian Dept, 1942, sec I. HD.

12 Ltr AG 221(1-31-42)EA-C, TAG to CG Hawai-ian Dept, 18 Feb 42, sub: Grades and Ratings, MD,Hawaii. SG: 320.2-1 (Hawaiian Dept) AA.

13 An Rpt, Med Activities US Army Force, Aruba,NWI, 1942, and Hist Record, US Army MD inGreenland, 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.


quired hospitalization in areas that hadno American facilities. The greatest im-mediate need was in the South and South-west Pacific. During the period from 1January to 1 July 1942, inclusive, 2 evacu-ation, 2 surgical, 4 general, and 14 stationhospitals were sent to Australia; 2 evacu-ation, 2 general, and 2 station hospitals toislands in the South Pacific; and 2 stationhospitals to islands other than the Ha-waiian group in the Central Pacific. Dur-ing the same period, 1 general and 1 sta-tion hospital went to Northern Ireland, ageneral hospital to Iceland, and 2 generaland 3 station hospitals to England. InMay and June 1942, hospitals were sentalso to India, to care for troops engaged insupply and service activities there, and toNorthwest Canada, to care for those whowere helping to build the Alcan highway.Meanwhile other hospital units were be-ing earmarked for task forces, especiallyfor the GYMNAST (North Africa), MAGNET(Northern Ireland), and BOLERO (Eng-land) operations. These demands drewheavily upon available units and assem-blages and sometimes made it impossiblefor The Surgeon General and OPD tomeet without modification requests oftheater commanders.15 (Table 5)

In sending numbered hospital unitsoverseas, The Surgeon General departedfrom prewar plans, using training units aswell as affiliated units. This was caused inpart by the character of the war. Stationhospitals, for which no affiliated units hadbeen organized, were needed for defenseforces sent out early in 1942 more thanwere surgical, evacuation, and generalhospitals. Moreover, the earmarking ofsome affiliated hospitals for task forcesthat were formed early but sent out later,or not at all, may have tied up enoughaffiliated units to require the use of train-

ing units in meeting overseas needs be-tween Pearl Harbor and 2 July 1942. Atany rate, all station hospitals and the twosurgical hospitals dispatched during thisperiod were nonaffiliated units. Of thethirty-seven station hospitals sent out, sev-enteen had been activated during 1941and the rest after war began. Both surgi-cal hospitals were nonaffiliated units thathad been activated in 1941. Of the fifteengeneral hospitals shipped, nine were affili-ated units supplied (except for one) withenlisted personnel from training units ac-tivated during 1941. The remainder werenonaffiliated training units activated in1941. Of the 4 evacuation hospital unitssent out, 2 were affiliated units and 2 werenonaffiliated units activated in 1940 and1941. Thus the prior activation and train-ing of normal Army units proved morevaluable in meeting emergency hospitalneeds than did the formation and organi-zation of units affiliated with civilian hos-pitals or schools.

Modification of Hospitalsfor Overseas Areas

Development of New Types of Units

Early in the war it was necessary to de-velop new types of hospitals to meet theneeds of island-type warfare and of mo-torized operations on land. Experience inplanning hospitalization for the earliesttask forces and garrisons for islands in the

15 (1) Memo, Lt Col A[rthur] B. Welsh for BrigGen L[arry] B. McAfee, 1 Apr 42. HD: Welsh Plan-ning file. (2) Memo for Record on IAS, 5 Apr 42, sub:Hosp Units for SUMAC [Australia] and SPOONER[New Zealand]. HRS: WPD 704.2(3-9-42). (3)Memo, Maj A. B. Welsh for Gen Magee, 23 Jan 42,sub: Status of Hosp Units. HD: 320.2 (Trp Basis).


TABLE 5—HOSPITAL UNITS SHIPPED OVER-SEAS, 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 hospitalsthat were smaller and more mobile thanthe only hospital available for that pur-pose—the 250-bed station hospital. As aresult, the Surgeon General's Office andthe medical section of General Headquar-ters collaborated in developing a new typeof hospital, called the field hospital, in thefirst months of 1942. When G-4 calledupon the Surgeon General's Office to de-velop an "island-type hospital," the lattersubmitted the table of organization forthis unit. The General Staff approved thetable and it was published on 28 February1942.16

The field hospital had a headquartersand three hospitalization units. Each ofthe latter could operate independentlywith a capacity of 100 beds. As a singleunit the hospital could care for 380 pa-tients. Staffed to care for minor ills and in-juries and equipped to function in thefield under tents, the field hospital or anyone of its hospitalization units could serveas a fixed hospital on islands, in other iso-lated areas, or at air bases distant fromother facilities. Having sufficient trans-portation to move its own personnel andequipment, any unit of the hospital, whenreinforced with surgical personnel, couldbe used as a mobile hospital to supportground troops in combat or task forces inlanding operations. In addition, the fieldhospital or any of its units, The SurgeonGeneral asserted, could be readily trans-ported by air—an assertion supported by

16 (1) Interv, MD Historian with Brig Gen AlvinL.Gorby, 21 Feb 52. HD: 000.71. (2) Ltr AG 400(1-19-42)MSC-D, TAG to SG, 22 Jan 42, sub: Equipfor Island Type Hosp. SG: 475.5-1. (3) DFG-3/42108, ACofS G-3 WDGS to ACofS G-1 andG-4 WDGS, 17 Feb 42, sub: T/O and E for a FldHosp Unit, with incl. AG: 320.2(10-30-41) (2). (4)History of Organization and Equipment AllowanceBranch [SGO], 1939-44, p. 5. HD.


loading and flight tests during the latterpart of 1942.17

The field hospital thus surpassed inflexibility any other hospital which theMedical Department had. In order tomake units of that type available, SOSheadquarters arranged for the activationof five in April 1942.18 A few months later,when the troop basis was revised, author-ity was granted for the activation of twen-ty-two by the end of 1942.

During the months following the devel-opment of the field hospital, the SurgeonGeneral's Office revised the table of or-ganization for station hospital units toprovide, in effect, additional types of fixedhospitals. At the beginning of the war thestation hospital table of organization pro-vided only for those of 250-, 500-, and750-bed capacities.19 When station hospi-tal units of smaller capacities wereneeded, The Surgeon General had to pre-pare special tables for their activation. InMay 1942, for example, a special table oforganization for a 150-bed station hospitalwas issued.20 Two months later the revisedversion of the regular table was ready forpublication. It provided for station hospi-tals of seventeen different sizes, ranging incapacity from 25 to 900 beds.21 The inclu-sion of station hospital units of varioussizes in the 1943 troop basis simplifiedThe Surgeon General's problem of recom-mending hospital support for small garri-son forces.

At the same time that small fixed-hos-pital units were being supplied for garri-son forces scattered throughout the world,the Surgeon General's Office was develop-ing a combat zone hospital that was moremobile and required less personnel thaneither the 400-bed surgical hospital or the750-bed evacuation hospital. The latterhad no motor transport for its own move-

ment and could be used only in relativelystable situations. The surgical hospital, de-veloped in 1940, was only partially mo-bile. Its surgical unit was authorizedenough transport to move itself but itstwo hospital units had only "utility"vehicles.22

In order to provide a more mobile com-bat zone hospital, The Surgeon Generaldeveloped a 400-bed motorized evacua-tion hospital. Its table of organization,concurred in by the Ground Surgeon andapproved by G-3, was published on 2July 1942.23 This unit, unlike the surgicaland 750-bed evacuation hospitals, at firsthad enough motor transport to move allof its personnel and equipment at onetime. It differed from the surgical hospitalin organization also. It will be recalledthat the latter had three independentunits with separate headquarters—a sur-gical unit and two ward units. The motor-ized evacuation hospital, on the otherhand, had no separate units and only oneheadquarters, but it could be split intotwo self-contained 200-bed surgical hospi-tals. This change in organization resulted

17 (1) Memo, SG for TAG, 1 Feb 42, incl to DFG-3/42108, ACofS G-3 WDGS to ACofS G-1 andG-4 WDGS, 17 Feb 42, sub: T/O and E for FldHosp Unit. AG: 320.2(10-30-41) (2). (2) Ltr, SG toCG 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: Ac-tivation of Fld Hosp Units, with 1st ind, CG SOSto 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 Jul42, sub: T/O for Evac Hosp (Motorized). AG:320.3(10-30-41) (2) Sec 8D. (3) T/O 8-581, EvacHosp, Motorized, 2 Jul 42.


in a saving of both enlisted and commis-sioned personnel—a factor of importancein the development of the new unit.24

The motorized evacuation hospitalsoon superseded the surgical hospital inthe troop basis, although the table of or-ganization of the latter was not rescindeduntil August 1944.25 In August 1942 AGFheadquarters, with the concurrence ofThe Surgeon General and the GroundSurgeon, had surgical hospitals, onlythree of which were used as such duringthe war, redesignated and converted intomotorized evacuation hospitals. In No-vember 1942 units of the new type wereincluded, along with 750-bed evacuationhospitals, as mobile units in the 1943troop basis.26

Since none of the hospital units avail-able at the beginning of the war or devel-oped in Washington in the following yearmet the needs of small combat forcesfighting in Pacific jungles, the SouthwestPacific Area attempted during 1942 tosolve its own problem. To provide surgicalsupport for task forces employed in areaswhere the only practicable means oftransportation was by foot, the chief sur-geon of that area developed a 25-bedportable surgical hospital. It was designedto permit its equipment and supplies to becarried in 35- to 40-pound packs by itsown personnel or by native bearers. Itcould therefore move along with combattroops through jungle trails, either to pre-pare casualties for the long litter-haul tothe rear or to care for them until moreadequate hospitals could be established.In September 1942 SWPA headquartersactivated twenty-six such "provisional"units with personnel taken from other hos-pitals. Receiving reports of this develop-ment, The Surgeon General soon after-ward adopted the portable surgical

hospital as a regular unit. In November1942, forty-eight were included in the1943 troop basis. In May 1943 ASF head-quarters ordered the activation of twentyunder a special table of organizationwhich was published the followingmonth.27

Changes Affectingthe Mobility of Hospitals

By the fall of 1942 circumstances devel-oped which tended to cancel some of theresults of earlier attempts of The SurgeonGeneral to increase the mobility of hospi-tals. Shortages of motor equipment and ofshipping space prompted the GeneralStaff, on 2 October 1942, to direct thethree major commands to reduce themotor vehicles authorized for their respec-tive units.28 In compliance with this orderAGF headquarters reduced the transportof the motorized evacuation hospital(making it a semimobile unit) and theSurgeon General's Office reduced that ofthe field hospital. These hospitals were

24 (1) Comparison of T/O 8-231, 1 Dec 40, andT/O 8-581, 2 Jul 42. (2) See also Off Diary of ColAlbert 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, 15Aug 44.

26 (1) Memo 32.02/29(Med) (R)-GNGCT/(1 Aug42), CG AGF for ACofS G-3 WDGS, 1 Aug 42, sub:Redesignation of Surg Hosp as Evac Hosp, withMemo for Record. Ground Med files: "Maneuvers,1942." (2) Ltr. SG to CG ASF, 26 Apr 43, sub: Statusof 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 May43, sub: Constitution and Activation of Ptbl SurgHosp. AG: 322(5-26-43). (4) T/O & E 8-572S, PtblSurg 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.


left with enough transport for partialmovements only. Each had to employ itsvehicles in shuttle fashion or supplementthem with "pool" vehicles in order tomove from one location to another.29 Re-ductions in allotments of motor vehicles toother hospital units had insignificant ef-fects upon mobility, because their vehicleswere used for administrative purposesonly.30

Other ways of increasing the mobilityof hospitals than by the formation of newunits were reductions in the size andweight of equipment and improvementsin methods of packing it. When war be-gan, equipment lists of all hospitals con-tained types and quantities of items suchas office desks, armchairs, and kitchenequipment which were ordinarily usedonly in hospitals in the United States.31 Inview of shortage of shipping space and theneed for mobility in overseas hospitals,SOS headquarters directed The SurgeonGeneral on 12 March 1942 to eliminateall unnecessary equipment and to reducethe gross weight and cubic displacementof station and general hospital assemblagesby at least 40 percent.32 The SurgeonGeneral replied that his Office hadalready begun that process. On 30 June1942 he reported that the required reduc-tion had been made in station hospitalassemblages and that it would be made inothers at an early date.33 During the fol-lowing summer special boards appointedby The Surgeon General reviewed equip-ment lists of all hospitals, making reduc-tions as they could, and sent the revisedlists to medical depots for use in makingup hospital assemblages. By November1942 The Surgeon General reported tothe Wadhams Committee that the grossweight and cubic displacement of all hos-pitals designed for overseas service had

been reduced by an average of 40 to 42percent.34 By that time many hospitalswith heavy bulky equipment were alreadyin operation in overseas theaters.35

Shortly before The Surgeon Generalreported reductions in the size and weightof hospital equipment, the Ground Sur-geon raised the question of its packing. Heinformed the Surgeon General's Officethat equipment of evacuation hospitalswas so packed that it did not lend itselfreadily to manual handling and speedyunpacking for setups. Meanwhile the 15thEvacuation Hospital, stationed at FortGeorge G. Meade, Maryland, conductedexperiments in packing under the super-vision of the Ground Surgeon.36 The Sur-geon General learned that this hospital

29 (1) T/O 8-510, Fld Hosp, 28 Feb 42 and 8 Apr43; T/O 8-581, Evac Hosp, Motorized, 2 Jul 42; andT/O 8-581, Evac Hosp, Semimobile, 8 Jan 43. (2)1st ind 323.3 GNRQT-1/18390 (10-2-42), CG AGFto TAG, 1 Dec 42, on Ltr, TAG to CGs AGF, AAF,and SOS, 2 Oct 42, sub: Review of Orgn and EquipReqmts. AG: 400 (8-10-42) (1) sec 22. (3) Ltr, SGto 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 Nov42, sub: Improvement of Equip and Orgn. Same file.

30 For example, see T/O 8-550, Gen Hosp, 1 Apr42, and T/E 8-550, Gen Hosp, 19 Mar 43.

31 Memo entitled "Correcting Info as to Confiden-tial Document Submitted by Mr. [Corrington] Gill,Entitled 'Rpt to Cmtee on Data from Files of Hospand Evac Br, Plans Div, SOS,' " submitted as incl toLtr, SG to Col Sanford Wadhams, Chm, Cmtee toStudy 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 30Jun 42. SG: 475.5-1.

34 Memo cited, n. 31.35 (1) Memo SPOPH 701, CG SOS for SG, 19 Oct

42, sub: Info Submitted by Chief Surg SWPA. HD:Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (2)Ltr, Med Insp NATO to SG, 27 Jan 43, sub: Obser-vations on Med Serv in NATO. HD: Wilson files,"Experience in Med Matters from Overseas Forces."

36 Comment by Brig Gen Frederick A. Blesse onfirst draft of this chapter. HD: 314 (Correspondenceon MS) III, Incl 1.


had developed a method of packing itsequipment so that each crate or packagecould be handled by two men and con-tained items used in one particular sectionof a hospital only.37 In November 1942General Magee appointed a board of offi-cers to study this accomplishment andsubmit recommendations for more practi-cal methods of packing and assemblingequipment than those being used by med-ical depots.38 As a result of this investiga-tion, The Surgeon General's Supply Serv-ice drew up specifications for the stand-ardized packing and crating of equipmentof motorized evacuation hospitals.39

Subsequently, during 1943, the systemfound satisfactory for evacuation hospitalswas adopted for other units. Each box,properly marked, now contained suppliesand equipment for use in a particular sec-tion of a hospital only. This systemspeeded unpacking and repacking formovement in the field by making it possi-ble to assemble at a particular spot allsupplies and equipment needed for award, an operating room, or an office,and by making it unnecessary to unpackequipment not required when only part ofa hospital was being established.40

Reductions in the Personnelof Hospital Units

Modifications in tables of organizationof existing hospitals, like changes in equip-ment and motor transport, were requiredby other than medical considerations.During the early part of 1942 both G-1and SOS headquarters put considerablepressure on The Surgeon General to savecommissioned personnel, especially Medi-cal Corps officers, lest there be insufficientnumbers to go around, on the scalealready planned, in a 7,500,000-man

Army. Among the steps they directed himto take was the revision of tables of organ-ization, both to reduce the number of of-ficers authorized and to substitute Medi-cal Administrative Corps for MedicalCorps officers.41 Having already begunthe process of revision, The Surgeon Gen-eral replied that he would continue it.42 InApril the revised tables for general, surgi-cal, and convalescent hospitals and hospi-tal centers were published; in July, thosefor evacuation and station hospitals.43

These revisions resulted in the saving ofMedical Corps officers more by cuts in thenumber of such officers in each unit thanby the substitution of Medical Adminis-trative for Medical Corps officers. Thereason lay perhaps in the fact that tablesof organization for numbered hospitals,unlike personnel guides for zone of interior

37 (1) Ltr, SG to CG SOS, 7 Oct 42, sub: Evac HospEquip. SG: 475.5-1. (2) An Rpt, 15th Evac HospMotorized, 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 Offsto Study Equip of New 400-Bed Motorized EvacHosp.39 (1) Rpt of Bd for . . . a 400-bed Evac Hosp [13

Nov 42]. SG: 475.5-1. (2) Memo, Lt Col R[euel] E.Hewitt for Col F[rancis] C. Tyng, 19 Dec 42. Samefile.

40 (1) Richard E. Yates, The procurement and Dis-tribution of Medical Supplies in the Zone of the In-terior during World War II (1946), p. 146. HD. (2)An Rpt, Med Assembly Unit Atlanta ASF Depot,1943. HD.

41 (1) Memo, ACofS G-1 WDGS for SG thru PersDiv 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 MilPers 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 Apr42; 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.


installations,44 already required the use ofMedical Administrative Corps officers ina considerable proportion of administra-tive positions. The revised tables also re-duced the number of nurses authorizedfor some hospitals. In general, greatestchanges were made in large communica-tions zone units, such as 1,000-bed generaland 750-bed station hospitals. In the for-mer, 17 Medical Corps officers and 15nurses were eliminated; in the latter, 13Medical Corps officers and 15 nurses. Ineach, one Medical Administrative Corpsofficer, one Sanitary Corps officer, andone warrant officer were added as replace-ments for some of the Medical Corps offi-cers eliminated. In smaller communica-tions zone units, such as the 250-bed sta-tion hospital, and in combat zone units,such as the 750-bed evacuation and the400-bed surgical hospital, no personnelreductions were made, but from one tothree Medical Administrative or DentalCorps officers were substituted for a likenumber of Medical Corps officers. Thedevelopment of the 400-bed motorizedevacuation hospital for use in the combatzone resulted in a considerable saving ofboth Medical and Nurse Corps personnel,because the new unit required fifteen phy-sicians and twelve nurses fewer than didthe surgical hospital which it replaced inthe troop basis.45

In the fall of 1942 emphasis shifted fromreductions in the numbers of officers andnurses to those of enlisted men. With agrowing need for manpower economy inthe Army, the General Staff in Octoberdirected the three major commands to re-vise downward their tables of organiza-tion.46 By then responsible for tables ofcombat zone hospital units, AGF head-quarters revised the tables of both the 400-bed and 750-bed evacuation hospitals.

With The Surgeon General's concurrence,the number of enlisted men in a motorizedevacuation hospital was reduced from 248to 217; in a 750-bed unit, from 318 to 308.The revised tables reflected, incidentally,as did others published later, the militari-zation of hospital dietitians and physicaltherapists, who until December 1942 hadserved as civilian employees.47 Cuts in thepersonnel of communications zone hospi-tal units did not occur at this time, be-cause SOS headquarters considered it"inadvisable," in view of revisions oftables within the preceding year, to directany further "arbitrary reduction." 48

Hospital Units in the Troop Basis

Throughout 1942 and 1943 the numberof hospital units in the troop basis in-creased significantly with each of its revi-sions but always remained smaller thanThe Surgeon General considered ade-quate for the Army being mobilized. Us-ing World War I casualty and evacuationexperiences as a basis, The Surgeon Gen-eral estimated that fixed beds should be

44 See above, p. 133.45 T/O 8-508, Sta Hosp, 25 Jul 40; T/O 8-560, Sta

Hosp, 22 Jul 42; T/O 8-507, Gen Hosp, 25 Jul 40;T/O 8-550, Gen Hosp, 1 Apr 42; T/O 8-232, EvacHosp, 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, SurgHosp, 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 forACofS G-3 WDGS, 7 Dec 42, sub: Review of Orgnand Equip Reqmts. AG: 400(8-10-42) (1) sec 22.


provided for 10 to 15 percent of thestrength of each theater of operations.49

He calculated mobile bed requirements inthe early part of 1942 on the basis of 1convalescent, 4 surgical, and 10 evacua-tion hospitals for each type-army. Thetime when these units should be activateddepended upon such factors as the amountof training required by each, the rate oftroop movement to overseas areas, and theamount of combat action which might beencountered.

At the beginning of 1942 both G-3 andthe Chief of Staff believed that the mobili-zation of service units should be delayedbecause the training of divisions requiredmore time than that of nondivisional unitsand a lack of shipping limited forces thatcould be sent overseas during 1942.50

Hence, in the troop basis issued on 17 Jan-uary 1942, which provided for a 71-divi-sion, 3,600,000-man Army by the end ofthe year, there were included only 2 con-valescent, 28 evacuation, 8 surgical, 45general, and 40 station hospital units.51

The Surgeon General urged that addi-tional units be authorized, but the GeneralStaff disapproved. In its opinion the55,000 beds provided for in 45 generaland 40 station hospitals would be ade-quate for the 550,000 troops which, it wasexpected, could be sent overseas during1942.52

In the spring of 1942 plans were madeto send a larger number of troops over-seas during the rest of the year. Underthe BOLERO plan, thirty divisions, or1,000,000 men, were to be sent to theUnited Kingdom for an operation againstthe continent either late in 1942 or early in1943. In May the President raised the sizeof the Army to be mobilized by the end of1942 to 4,350,000.53 The number of unitsoriginally thought requisite in view of

these changes was reduced considerably inthe course of discussions among represen-tatives of SOS and AGF headquarters andthe Surgeon General's Office, and on 23May 1942 SOS headquarters recom-mended to G-3 that 2 convalescent, 6evacuation, 8 surgical, 62 general, 103station, 22 field hospitals and 9 hospitalcenters should be included in the revisedtroop basis, in addition to the units alreadyauthorized.54 G-3 considered the recom-mended number of fixed-hospital units toolarge, but approved it when The SurgeonGeneral explained that BOLERO alonewould require 100,000 beds, or more thanthe number authorized in the additionalunits.55

49 (1) Albert G. Love, "War Casualties," Army Med-ical Bulletin No. 24 (1931), pp. 53-68. (2) Off Diary ofCol Albert G. Love, Chief HD SGO, 6 Mar 42. HD.

50 Kent R. Greenfield, Robert R. Palmer and BellI. Wiley, The Organization of Ground Combat Troops(Washington, 1947), p. 199, in UNITED STATESARMY IN WORLD WAR II.

51 Ltr, TAG to C of Arms and Servs, etc., 17 Jan42, sub: Mob and Tng Plan, 1942. AG: 381(12-27-41) (2).

52 (1) Memo, Act SG for ACofS G-3 WDGS, 28Feb 42, sub: Orgn and Dispatch of MD TofOpnsUnits. 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 AirStaff for SG, 29 Jan 42, sub: Expansion Program ofAAF for Calendar Year 1942. HD: 320.2(Trp Basis).

53 Greenfield et al., op. cit., pp. 201-06. Also seeRay S. Cline, Washington Command Post: The OperationsDivision (Washington, 1951), pp. 143-63, in UNITEDSTATES ARMY IN WORLD WAR II; and Mau-rice Matloff and Edwin M. Snell, Strategic Planning

for Coalition Warfare, 1941-42 (Washington, 1953), pp.190-96, in UNITED STATES ARMY IN WORLDWAR 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 SPOPP320.2 Serv Units (5-23-42), Dep Dir Oprs SOS forACofS G-3 WDGS, 23 May 42, sub: Reqmts of ServUnits. . . . SG: 475.5-1.

55 (1) Memo WDGCT 320.2(5-23-42), ACofS G-3WDGS for CGs AGF and SOS, 25 May 42, sub:Reqmts of Serv Units. . . . SG: 475.5-1. (2) Memo,SG for Oprs Div SOS, 30 May 42, same sub. SG:320.3-1. (3) Memo, ACofS G-3 WDGS for CG SOS,5 Jun 42, same sub. Same file.


During the late summer and fall of 1942plans for the 1943 troop basis, throughwhich a 7,500,000-man Army was to bemobilized by the end of 1943,56 called forsizable increases in the numbers of hospi-tal units of all types. For the support ofground troops in combat, 7 convalescent,20 evacuation, 52 semimobile evacuation,and 48 portable surgical hospitals wereauthorized for activation by December1943. The number of fixed-hospital unitswhich G-3 authorized—52 field, 192 gen-eral, and 327 station hospital units—wasless than The Surgeon General recom-mended.57 G-3's authorization of thesmaller number apparently resulted froma shortage of physicians to staff more. TheSurgeon General believed that enoughbeds and other equipment to care for themaximum estimate of sick and woundedmen would have to be provided in anyevent. He therefore recommended againan increase in authorized units and urgedthat he be permitted, if his recommenda-tion should be disapproved, to procureadequate equipment for overseas hospitalsregardless of the troop basis.58 Both G-3and OPD agreed to the latter propositionand SOS headquarters arranged to assurethe procurement of equipment which TheSurgeon General considered necessary.59

The Question of Equippingand Using Numbered Hospitals

in the Zone of Interior

Throughout 1942 and most of 1943 theSurgeon General's Office and SOS head-quarters were engaged in an inconclusivedispute over the issuance of equipment tonumbered hospital units and the use ofsuch units on a functional basis in theUnited States. This dispute, like the oneover planning for zone of interior hospi-

talization already discussed, exemplifieddifficulties resulting from misunderstand-ing about the respective responsibilities ofthe Surgeon General's Office and the SOSHospitalization and Evacuation Branch.Of more significance, it involved the fol-lowing problems: the method of traininghospital units in the United States, thecontribution of such units to the medicalservice during training periods, andwhether or not such units should receivefull issues of equipment in the UnitedStates.

After war began most hospital units inthe zone of interior continued primarily asschools for tactical training. A few wereissued full assemblages and operated hos-pitals on maneuvers. As a rule, though,under a policy announced in January1942 and already discussed, hospital unitsreceived only field training equipment,soldiers' individual equipment, and motortransport, for use in unit field training. TheSurgeon General expected them to receivetechnical training and experience withprofessional supplies and equipment inzone of interior hospitals. This "parallel"method of training seemed satisfactorywhen only one or two units were locatedon a particular post, but delay in construc-tion of housing for a hospital unit neareach 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 CGSOS, 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: Ade-quacy of Plans for Overseas Hosp. SG: 322.15-1.

59 (1) Memo SPOPH 701(3-6-42), Dir Plans DivASF for Gen [LeRoy] Lutes, 15 Mar 43, sub: Ade-quacy of Plans for Overseas Hosp. HD: Wilson files,"Book III, 1 Jan 43-15 Mar 43." (2) 1st ind, ACofSfor Oprs SOS to SG, 16 Mar 43, on Ltr, SG to CGSOS, 6 Mar 43, same sub. SG: 322.15-1.


thirty-four station hospitals in the UnitedStates, as The Surgeon General re-quested,60 caused units to be grouped onposts wherever troop housing was avail-able. Whenever this happened there wereso many officers and men of numberedunits in each named hospital concernedthat they had to take turns serving along-side of, or "parallel" to, their oppositenumbers.61

This entire system was challenged earlyin 1942. By March Colonel Wilson wasconvinced that hospital units could be bestprepared for overseas service by beingissued complete equipment and by beingrequired to function as hospitals in theUnited States.62 Moreover AGF head-quarters wanted to train unit personnel inthe storage, maintenance, and repair ofhospital equipment and to have hospitalunits self-sufficient in so far as messing andadministration were concerned. In May,therefore, AGF headquarters recom-mended that all hospital units scheduledfor maneuvers and all newly activatedunits be given full issues of equipment forpermanent retention.63 The Surgeon Gen-eral was willing to make some concessionsto the Ground Forces but not to issue com-plete assemblages as SOS headquartersdirected in June and again in August1942. In a paper duel which his Officefought with SOS headquarters over thismatter, The Surgeon General reached apoint by 7 September 1942 of agreeing tothe issuance of housekeeping equipment,but he requested approval of a policy ofwithholding all other equipment in assem-blages until units were assigned to opera-tional missions.64

By this time SOS headquarters haddecided not only to force The SurgeonGeneral to issue complete assemblages toall units but also to require him to employ

units under SOS control in the zone ofinterior medical service. There seem tohave been several reasons for this decision.In September 1942 a report from theSouthwest Pacific Area emphasized thedesirability of issuing equipment to unitsin training to permit them to learn to packand move it easily and to reduce its sizeand weight by eliminating unnecessaryitems.65 Moreover, many units were be-coming restless from long periods of train-ing without opportunities either to func-tion as hospitals or to assist in zone of inte-rior hospital operations; and stories ofdoctors being called from civilian practiceonly to sit and wait around Army camps

60 Memo, Act SG for ACofS G-3 WDGS, 28 Feb42, sub: Orgn and Dispatch of MD TofOpns Units.SG: 322.3-1.

61 (1) For example, see the An Rpts, 1942 and/or1943 of 3d, 6th, 23d, 50th, 79th, and 108th Gen Hospsand An Rpt. 1943. 36th Sta Hosp. HD. (2) Consoli-dated Rpt, SGs Observers for 1942 Maneuvers, trans-mitted to ASF Hq by Memo, SG for Dir Tng ASF, 16Jun 43. Ground Med files: "Rpt of Maneuver Ob-servers, SGO, 1942." (3) Memo, Dir Planning DivASF for Gen Lutes, 4 Aug 43, sub: Sta Hosp in Ma-neuver Areas. Ground Med files: 354.2 "Maneuvers."

62 Memo G-4/24499-178, Maj W. L. Wilson forGen Lutes, 12 Mar 42, sub: Basic Plans for Hosp andEvac. HD: Wilson files, "No 472 , Hosp and Evac,1941-42."

63 Ltr 475.5/49-GNSPL (5-26-42), CG AGF toDir 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; 3dind, CG SOS to SG. 22 Jun 42; 4th ind, SG to DirOprs SOS, 30 Jun 42; 5th ind, CG SOS to SG, 9 Jul42; 6th ind, SG to Dir Oprs SOS, 20 Jul 42; 7th ind,CG SOS to SG, 6 Aug 42; and 8th ind, SG to CGSOS, 7 Sep 42, on Memo 475/826-GNSPL(5-22-42),CG AGF for Dir Oprs SOS, 22 May 42, sub: Equip forMD 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-4USASOS SWPA, 19 Sep 42, sub: Data for Lt Col[Willard S.] Wadelton. HD: Wilson files, "Experiencein Med Matters from Overseas Forces." Colonel Wil-son had asked Colonel Wadelton to get informationfor him on a visit of the latter to SWPA.


began to reach the public and the ArmyInspector General.66

At the same time, it appeared that therewould be insufficient Medical Departmentenlisted men and Medical Corps officersto supply both zone of interior installationsand numbered units with their authorizednumbers, and the General Staff began adrive for more efficient personnel utiliza-tion.67 The chief of the SOS Hospitaliza-tion and Evacuation Branch believed thatpersonnel required for zone of interiorhospitals could be reduced by using num-bered hospital units to help operate suchinstallations. Furthermore, he believedthat a reserve of hospital beds for emer-gencies could be provided by issuingequipment to numbered units.68 In addi-tion, some of the obstacles to assemblage-issuance and unit-use were being re-moved. Although equipment was still inshort supply, the Surgeon General's Officeand SOS headquarters were making re-newed efforts to increase its availability.Housing, including warehouse space forequipment which had been authorized inthe spring of 1942, was expected to beavailable for occupancy between Septem-ber 1942 and January 1943.69 Finally theWadhams Committee was appointed earlyin September 1942, and SOS headquar-ters may have expected its support in thisinstance.70 Whether because of one, some,or all of these reasons, SOS headquarterson 16 September and again on 12 October1942 directed The Surgeon General toprepare a plan for the use of numberedhospital units in the zone of interior medi-cal service and on 17 September 1942requested his comments on the draft of apolicy requiring the issuance of assem-blages to all hospital units in training.71

Receipt of these communications causedconfusion and consternation in the Sur-

geon General's Office. The OperationsService called for comments from othersections—the Supply, Professional, andPersonnel Services and the Hospital Con-struction, Hospitalization, and TrainingDivisions. After several conferences to dis-cuss the action that should be taken, finaldecision was to request no change in thepolicy on the issuance of equipment andto submit no plan for the use of numberedunits. To support this decision, the Sur-geon General's Office marshaled an arrayof arguments. The most important seem tohave been lack of sufficient equipment topermit 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 Sep42, sub: Asgmt, Tng, and Util of TofOpns MedUnits. HD: Wilson files, "Book I, 26 Mar 42-26 Sep42." (2) Diary, Hosp and Evac Br SOS, 25 Sep 42.HD: Wilson files, "Diary." (3) Memo, Dir Mil PersDiv SGO for Dir HD SGO, 14 Apr 44. HD: 326.1-1.

67 See above, pp. 131-37, and Memo, DepCofSAfor SG thru CG SOS, 17 Oct 42, sub: Availability ofPhysicians. SG: 322.05-1.

68 Memo SPOPM 322.15, Chief Hosp and Evac BrSOS for Gen Lutes, 15 Sep 42, sub: Directive for Hospand Evac Oprs. HD: Wilson files, "Book I, 26 Mar42-26 Sep 42."

69 (1) Memo, Chief Hosp and Evac Br SOS for GenLutes, 23 Aug 42. sub: Status of Procurement of MedSupplies. HD: Wilson files, 440 "Med Sups." (2)Memo, CofEngrs for SG, 19 Sep 42, sub: Fld HospUnits. HD: 632 "Housing."

70 Colonel Wilson stated to the Committee that oneof the problems of the Medical Department was thedevelopment of a system for training medical unitswith their equipment before going overseas. Ltr, ChiefHosp and Evac Br Plans Div Oprs SOS for Chm.Cmtee to Study the MD, 21 Oct 42, sub: Med Prob-lems. HD: Wilson files, "Book 2, 26 Sep 42-31 Dec42."

71 (1) Memo SPOPH 320.2, ACofS Oprs SOS (initWLW[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 SPOPH320.2 (9-26-42), ACofS Oprs SOS (same init) to SG,12 Oct 42. on Memo, SG for Oprs Div SOS, 26 Sep42, same sub. HD: 632 "Hosp-Housing." (3) Draft LtrSPOPP 475, CG SOS to SG. 17 Sep 42, sub: Equipfor MD Units. SG: 475.5-1.


units and fear that the zone of interiormedical service would be left in the lurchif numbered units were used to furnish itand were then sent overseas. To these wereadded other arguments. According to theSurgeon General's Office, units neededequipment neither for training nor foremergency hospitalization. Those in train-ing could get experience with equipmentin zone of interior hospitals and equip-ment required for emergencies could beshipped from depots when needed. Unitswere not qualified either to repack equip-ment for overseas shipment or to deter-mine deletions and substitutions to reducetotal weight. The former should be doneby depots to prevent breakage and the lat-ter could be done properly only by quali-fied boards and representatives of TheSurgeon General. Units could not replaceregularly assigned personnel in zone ofinterior hospitals without interruptingcare of the sick and lowering the standardof professional work. Their mere presencenear such hospitals constituted an ade-quate reserve of hospital facilities foremergencies; and their use as units wouldnot reduce zone of interior personnel re-quirements because their members werealready assisting in the medical serviceunder the system of parallel training.Finally, The Surgeon General stated thathe had no reason to believe that unit train-ing was deficient. In requesting that exist-ing policy on assemblage-issuance not bechanged, The Surgeon General's supplyrepresentative explained personally toSOS headquarters the shortage of medicalequipment. In refusing to submit a planfor the use of numbered units, The Sur-geon General called attention to a planfor providing an effective medical servicefor a 7,500,000-man Army with 48,000 to50,000 physicians which he was submit-

ting at the request of the Deputy Chief ofStaff of the Army.72

In this instance, SOS headquartersadopted a more lenient attitude towardThe Surgeon General's action than mighthave been expected. Perhaps this resultedfrom an awareness of the critical aspect ofthe medical supply situation and fromsome hesitancy to push The Surgeon Gen-eral when he had orders from the DeputyChief of Staff of the Army to present a"plan." Perhaps it resulted from the ap-parent inclination of the Wadhams Com-mittee toward The Surgeon General'sposition rather than that of the SOS Hos-pitalization and Evacuation Branch.73 Atany rate, SOS headquarters tabled thedirective requiring a plan for the use ofnumbered units,74 and the chief of itsHospitalization and Evacuation Branchworked out a compromise on the assem-blage-issuance question. He adopted anew definition of assemblages, proposedby the SOS Plans Branch: henceforthassemblages would contain only MedicalDepartment items. Items needed by hos-pitals 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, SGfor Oprs Div SOS, 26 Sep 42, sub: Asgmt, Tng, andUtil of TofOpns Med Units, with 2d ind, Act SG toChief Oprs Div SOS, 14 Nov 42. SG: 320.2. Numer-ous memos from chiefs of various sections of SGOgiving these arguments are in HD: 632 "Hosp-Hous-ing."

73 Cmtee to Study the MD, 1942, Testimony, pp.1869ff. HD. After the war General Lutes stated thatGeneral Somervell personally directed a "lenient at-titude" toward the Surgeon General's Office becauseof the Wadhams Committee's report. He was proceed-ing cautiously. General Lutes stated, to determinewho was correct. Ltr, Lt Gen LeRoy Lutes to ColR[oger] G. Prentiss, Jr, 8 Nov 50. HD: 314 (Corre-spondence 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 Sep42, sub: Asgmt, Tng, and Util of TofOpns MedUnits. SG: 320.2.


as the Quartermaster Corps, would not beincluded in assemblages and would be is-sued whenever units requested them. TheSurgeon General would determine thetime when enough Medical Departmentequipment was available to issue completeassemblages to all units. Until that timehe would make partial issues. Afterward,he would issue complete assemblages to allhospital units under AGF control. Assem-blages for station and general hospitalsunder SOS control would be located inMedical Department depots so that deliv-ery could be made in emergencies withinseven days and so that units in trainingmight readily inspect and study them.75

When the Surgeon General's Office foundeven this policy unsatisfactory, SOS head-quarters delayed announcing it officiallyuntil the medical supply situation had im-proved. Then, on 18 January 1943, SOSheadquarters had the new policy pub-lished.76

At the beginning of the new year a com-bination of circumstances caused a revivalof the question of using numbered units inthe zone of interior. Contrary to whatmight have been expected, the "plan"which The Surgeon General submitted tothe Deputy Chief of Staff on 14 December1942 did not deal with this question, butonly with the bulk allotment of MedicalCorps officers to the three major com-mands.77

Soon afterward, in January 1943, theSOS Director of Training received criti-cism from at least one service command ofdeficiencies in unit training. About thesame time the chief of the SOS Hospitali-zation and Evacuation Branch reportedthat failure to use units while in theUnited States was being criticized pub-licly. He then requested and receivedauthority from his superior officer in SOS

headquarters to collaborate with the SOSTraining Director and the Surgeon Gen-eral's Office in working out a plan toanswer such criticism.78 In a subsequentconference of representatives of the Sur-geon General's Office AGF headquarters,and SOS headquarters, it was "unani-mously agreed," the last reported, thatThe Surgeon General would estimate theamount of medical personnel required forhospital service at each camp of 10,000 orgreater population, would determine theminimum permanent staff required foreach hospital at those camps, and wouldmake a definite plan, based upon OPDshipment schedules, for the use of num-bered units to operate such hospitals underthe supervision of permanent staffs.79 Thechief of the SOS Hospitalization andEvacuation Branch then took a triparound the country and found, he re-ported, that each service command sur-geon agreed that he could operate a satis-

75 (1) Draft memo SPOPH 475(9-26-42), CG SOSfor 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: Wilsonfiles, "Diary." (3) Memo SPOPH 475(9-26-42), ChiefHosp and Evac Br SOS for Chief Plans Br SOS, 2Nov 42, sub: Med Unit Assemblages. HD: Wilsonfiles, "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, "BookIII, 1 Jan 43-15 Mar 43." (2) Memo SPOPH 440,Chief Hosp and Evac Br SOS for Gen Lutes, 27 Jan43, sub: Status of Procurement of Med Sups. Same file.

77 Memo, Act SG for DepCofSA thru Mil Pers DivSOS, 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 SPOPH320.2, Chief Hosp and Evac Br SOS for Gen Lutes,16 Jan 43, sub: Asgmt, Tng, and Util of TofOpnsMed Units. HD: Wilson files, "Book III, 1 Jan 43-15Mar 43."

79 (1) Diary, Hosp and Evac Br SOS, 20 Jan 43.HD: Wilson files, "Diary." (2) Memo, Maj J[ohn] S.Poe for the Record, 21 Jan 43, sub: Conf 4A526 Pen-tagon Bldg, 20 Jan 43. HD: 632 "Hosp-Housing."


factory hospital service under the proposedplan.80

The plan which The Surgeon Generalpresented on 14 April 1943 indicated thatagreement on the subject had not beenunanimous. Instead of providing for theuse of numbered units to operate zone ofinterior hospitals, it called for the use ofmembers of such units, on a two-for-onebasis, to make up deficits in personnel—that is, differences between assigned andauthorized strength in zone of interiorhospitals. "This was done," The SurgeonGeneral stated, "because the primaryfunction of the T/O unit is TRAIN-ING."81

By this time seventy-eight general hos-pitals were reported "back-logged" in theUnited States, with no immediate pros-pect of employment overseas. Both thechief of the ASF Hospitalization and Evac-uation Branch and the ASF Director ofTraining feared that the General Staffwould reduce the number of Medical De-partment units in the troop basis if theywere not fully used.82 Before he could takefurther action toward that end ColonelWilson was succeeded in his position inSOS headquarters by Col. (later Brig.Gen.) Robert C. McDonald, and for atime the question remained in abeyance.

Meanwhile changes occurred in thetraining and use of some hospital units.Completion of housing near zone of inte-rior hospitals made it possible to trainmore personnel than before on a "paral-lel" basis;83 and year-round use by theGround Forces of the A. P. Hill MilitaryReservation and the Desert Training Cen-ter provided opportunities for several unitsto function as hospitals, furnishing medicaland surgical care for patients in thoseareas.84 The issuance of assemblages toevacuation hospital units under the re-

vised policy permitted them to train withfull equipment and work out a system offunctional packing to increase unit mobil-ity.85 Yet as a rule general and station hos-pital units still lacked assemblages in theUnited States and had infrequent oppor-tunities to function as hospitals before go-ing overseas. Meanwhile, the time whichsome of them spent in training lengthenedconsiderably. For example, although affili-ated units had been intended for promptshipment overseas, the fifty-one affiliatedgeneral hospital units that were eventu-ally sent out remained in the UnitedStates for an average of eight months.One, the 27th General Hospital unit,stayed in this country seventeen months.(Tables 6, 7)

The unsolved problems of assemblage-issuance and unit-use faced Surgeon Gen-eral Kirk when he succeeded GeneralMagee in June 1943. Soon afterward hetook them up with Colonel McDonald.Perhaps the entry of new participantsmade solution easier, for neither was un-alterably committed to the position of hispredecessor. In addition, despite his ASFposition, Colonel McDonald identifiedhimself closely with the Medical Depart-ment and held personal views of these

80 Memo SPOPI 337, CG SOS (init WLW[ilson])for SG and CofT, 30 Apr 43, sub: Resume of Confs.HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43."

81 Ltr, SG to CG ASF, 14 Apr 43, sub: Asgmt ofTofOpns Units for Tng. SG: 632.-1.

82 (1) Memo SPOPI 322(4-14-43), ACofS OprsSOS (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 SPTRU370.5 (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.


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 71stGeneral 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 andSG files pertaining to individual units.

problems similar to those advocated by theSurgeon General's Office.86

General Kirk believed that the currentpolicy on assemblage-issuance might bepartly responsible for a problem whichtheaters had reported and complainedof—the receipt of equipment for a single

hospital on several vessels at widely sepa-rated ports.87 In July 1943, therefore, herequested its reconsideration. First he pro-posed a return to the policy advocated by

86 Interv, MD Historian with Brig Gen Robert C.McDonald, Ret, USA, 5 Mar 51. HD: 000.71.

87 An Rpt, Issue Br Sup Serv SGO, FY 1944. HD.


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 theUniversity of Texas but never activated. On 13 September 1942 the 30th Evacuation Hospital was redesignated the 30th EvacuationHospital (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 SurgicalHospital, a unit affiliated with St. Mary's Hospital, Pueblo, Colo., and never activated, had been assigned to the 7th Surgical Hospital. InJuly 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 andSG files pertaining to individual units.

his predecessor—withholding all equip-ment for hospital units until they reachedports of embarkation—and then a com-promise between that and the existingpolicy. Ultimately he withdrew both pro-posals. After an investigation of split ship-ments, Colonel McDonald reported thatthe current policy seemed to have littleeffect in causing such a problem. Further-more, representatives of The SurgeonGeneral agreed that a change in policymight produce a six-to-twelve month pe-

riod of confusion in supply matters.88 Thusthe policy on the issuance of equipment to

88 (1) Ltr, SG to CG ASF, 10 Jul 43, sub: Equipfor Fld Med Units. SG: 475.5-1. (2) 1st ind SPOPI008 (7-10-43), CG ASF to SG, 9 Aug 43, on basicLtr just cited. HD: Wilson files, "Day File, Aug 43."(3) Ltr, SG to CG ASF, 6 Aug 43, sub: Equip for FldMed Units. HRS: ASF Control Div, 334 "ProcedureCmtee, G-58." (4) Diary, Hosp and Evac Br ASF,27 Aug 43. HD: Wilson files, 400 "Med Equip andSups." (5) Memo for Record, 7 Sep 43, on Memo, SGfor Col R. C. McDonald, Plans Div Oprs ASF, 7 Sep43. 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."


numbered medical units, which the Sur-geon General's Office had formerly op-posed, remained in effect for the rest ofthe war.89

General Kirk called for a full discussionof the question of using numbered hospitalunits in the zone of interior medical serv-ice in his first conference with service com-mand surgeons. They agreed that theexisting situation was deplorable. For ex-ample, one stated that it was difficult,when several units were located on a sin-gle post, to schedule their personnel for"parallel training" without having men"falling all over each other." Another,stressing morale, stated that one unit hadbeen in his command "so long that they'veworn out all of their films showing themover and over, and they've worn out alltheir shoes doing the same hikes. . . ."

In general, service command surgeonsseemed favorably inclined toward the pro-posal to use numbered units in the opera-tion of zone of interior hospitals, but sev-eral feared that administrative difficultiesmight arise unless units and their com-manding officers were placed under thecontrol of station surgeons. Others be-lieved that professional problems mightdevelop if numbered units were with-drawn from named hospitals either forfield training or for overseas service with-out adequate personnel being left behindto operate zone of interior hospitals.90 Toavoid such a situation, the Surgeon Gen-eral's Office announced that the adoptionof any plan for the use of numbered unitsto operate zone of interior hospitals wascontingent upon two conditions: first, theassignment of two hospital units to thenamed hospital in which they were toserve, and second, the existence of suitablebarracks to house such units. Colonel Mc-Donald agreed to these conditions and

suggested that the Surgeon General'sOffice prepare a plan for trial on one postThe chief of The Surgeon General's Train-ing Division lacked enthusiasm for thisproposal but agreed to investigate its pos-sibilities.91 Accordingly he drafted a planby November 1943 for consideration byother officers of the Surgeon General'sOffice, but their comments indicated nodiminution of opposition to the basicidea.92

By that time events were taking placewhich were to cause the whole matter tobe dropped. In September 1943 the Gen-eral Staff forbade the use of War Depart-ment funds to build more housing fornumbered hospitals in the United States,thereby denying quarters for the two unitsper named hospital which The SurgeonGeneral had recommended.93 The nextmonth the ASF Hospitalization andEvacuation Branch, which had initiated

89 (1) See above, pp. 45-46, 141-42. (2) Rpt of Sub-cmtee on Employment of Med Resources, Cmtee onMed and Hosp Serv of Armed Forces, Off SecDef, 25May 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 indsfrom 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, Hospand 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 Planfor the Functional Employment of Numbered ASFMed Units. (2) Memo, Maj John S. Poe for no ad-dressee, 10 Nov 43, sub: Comments on Col Wake-man's Proposal. (3) Memo, Col A. B. Welsh for GenR. 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.


and pushed the proposal, was abolished.Of greater importance was the change inconditions that had prompted the pro-posal in the first place. From the middleof 1943 onward the pressing need for hos-pitals overseas caused the departure ofmost units which had been held back aswell as the prompt shipment of othersafter brief periods of training.94 This dis-posed of the argument that services of per-sonnel, especially doctors, were beingwasted. It meant also that fewer and fewerunits were left for use in hospitals at home.Finally, during the latter half of 1943 thetroop population of the United States be-gan to shrink so rapidly that the generalemployment of numbered hospital unitsto assist with medical care in the zone ofinterior perhaps no longer seemed useful.As a result, the long and tedious contro-versy between the Surgeon General's Of-fice and ASF headquarters over the equip-ment and use in the United States of num-bered hospital units reached an inconclu-sive end.

Preparing for the Supportof Offensive Warfare

Shift of Emphasis Away From the Pacific

By about the middle of 1942, when em-phasis in providing hospitalization fortheaters shifted from the Pacific to otherareas of the world, emergency needs re-sulting from the Japanese attack had beenmet and preparations for the invasion ofNorth Africa were under way. To supportthe build-up of troops in the United King-dom and subsequent successful NorthAfrican operations, hospitals went in in-creasing numbers to both the Europeanand the North African theaters in the last

half of 1942 and the early months of 1943.During the same period other units weresent to scattered areas throughout theworld to care for troops engaged in serv-ice functions in support of more activetheaters. Since combat on a large scalehad not yet begun, fixed hospitals wereneeded more than mobile ones, and sta-tion more than general hospitals. For ex-ample, by 15 March 1943 the War De-partment had shipped overseas, accordingto The Surgeon General's records, 140station hospitals, ranging in size from 25-to 750-bed capacity, 27 general hospitals,and 14 field hospitals, but only 2 convales-cent, 3 surgical, 17 750-bed evacuation,and 6 400-bed evacuation hospitals.95

Of those shipped after 30 June 1942, themajor portions were units that had beenactivated and trained after the war began.A few of the units that were activated dur-ing 1941 and were still in the UnitedStates in mid-1942 were sent overseas inthe following months, but the majority ofthe older units continued during the earlywar years as training units, furnishingfiller personnel for others activated during1942 and 1943 or for affiliated units pre-viously organized. (Tables 8, 9, 10, 11.) Asin the first six months of the war, althoughaffiliated units continued to come onactive duty on The Surgeon General's rec-ommendation, many did not go overseasimmediately. For example, although forty-two affiliated general hospital units hadbeen activated by the middle of January1943, only nineteen of them had beenshipped by 15 March 1943. The remain-

94 (1) See below, pp. 218-23. (2) Memo, Dep ChiefOprs Serv SGO for Dir Hosp Div SGO, 17 Feb 44,with incl. SG: 323.3.

95 Table entitled Medical SOS Units as of 15March 1943. SG: 322.05-1.


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 trainingstatus until later in 1943 or early in 1944.(See Table 6)

Negro Hospital Units

Among the hospital units preparedearly in the war for overseas service weretwo with Negro personnel. Their activa-tion and use, like the establishment of all-Negro wards and hospitals in the UnitedStates,96 resulted from The Surgeon Gen-eral's opposition to the integration ofNegro and white personnel in providingmedical service for the Army—a positionin line with the War Department's general

policy on the use of Negro personnel.97 On24 March 1942 the 25th Station Hospital,a 250-bed unit, was organized at FortBragg (North Carolina). All of its memberswere Negroes except four officers—thecommander and his immediate staff. Theuse of white officers to command Negrounits was a common practice of the WarDepartment and was not considered a vio-lation of the policy of segregation. Its

96 See above, pp. 110-12.97 John H. McMinn and Max Levin, Personnel

(MS for companion vol. in Medical Dept, series),HD., and Ulysses Lee, The Employment of NegroTroops, a forthcoming volume in the series UNITEDSTATES ARMY IN WORLD WAR II.


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 laterquestioned, and it was not followed in thecase of other Negro hospital units acti-vated during World War II. An advanceddetachment of the 25th Station Hospitalembarked in May 1942 for Liberia to sup-port a force of construction engineers, per-sonnel of the Air Transport Command andthe Royal Air Force, natives employed bythe Army at Roberts Field, and elementsof a task force charged with protecting anairstrip and American rubber interests.After quarters were constructed overseas,the remainder of the unit, including itsnurses, joined the advanced detachmenton 10 March 1943. About the same timean all-Negro 150-bed unit, the 268th Sta-tion Hospital, was activated at FortHuachuca (Arizona). After a period oftraining, it embarked for the Southwest

Pacific theater in October 1943 and ar-rived in Australia in November.98

Establishing a Basis for Future Planning

Toward the end of 1942 the shift in em-phasis from defensive measures to prep-arations for the offensive made it neces-sary to take stock of hospitalizationalready supplied in order to plan effec-tively for the future. Records of the num-ber of hospital units shipped did notnecessarily represent the number of bedsavailable in the several theaters. In someinstances, for reasons not often divulgedto The Surgeon General, OPD diverted

98 (1) An Rpt, 25th Sta Hosp, 1943, and QuarterlyHist 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 ColBerardinelli, formerly CO of 25th Sta Hosp, 24 Feb50. HD: 000.71.


TABLE 10—USE OF NONAFFILIATED EVACUATION HOSPITAL UNITS ACTIVATED DURING 1940AND 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 thosefor which they were originally earmarked.It sometimes happened that units arrivedat overseas ports without equipment,which was shipped on other vessels, andtherefore could not set up for actual oper-ations. At other times assemblages wereshipped as expansion units, for theaters toissue as needed to numbered hospitals thatwere already operating, to overseas hospi-tals that had operated during peacetimeand were now being expanded, or to pro-visional hospitals that were being estab-lished with theater personnel. Further-more, the U.S. Army was receivinghospitalization in some areas throughreverse lend-lease. Thus The Surgeon

General could not rely upon records ofshipment of hospital units and assem-blages for accurate information aboutbeds available overseas. Nor could he de-pend upon statistical health reports (Med-ical Department Form No. 86ab). De-signed to supply his Office regularly withinformation about admissions and disposi-tions of patients and about available andoccupied beds in all Army hospitals, thesereports often reached Washington onlyafter considerable delay and differed inmany instances from other availablerecords.99

99 Memo, SG for Oprs Div SOS, 31 Oct 42, sub:Bed Capacities for Fixed Hosps at Overseas Bases.SG: 632.2.


TABLE 11—USE OF NONAFFILIATED SURGICAL HOSPITAL UNITS ACTIVATED DURING 1940AND 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 ac-curate and more current information thanhe had, The Surgeon General called uponSOS headquarters for assistance.100 Find-ing that neither SOS headquarters norOPD had accurate records of the bedsavailable in various theaters, the SOSHospitalization and Evacuation Branchrequested the latter, on 6 August 1942, torequire all overseas commanders to submita report on the capacities and numericaldesignations of their fixed hospitals.101

This request was approved and, as the re-ports came in, the Surgeon General's Of-fice, the SOS Hospitalization and Evacua-tion Branch, and OPD were able to getan accurate picture of hospitalizationoverseas at that time. It showed that theratio of fixed beds to troop strength rangedfrom 2.09 percent in some areas to 24.1percent in others.102

Even after reports of overseas bed ca-pacities had been received and tabulated,several obstacles to planning for the futurehad to be removed. In the first place, TheSurgeon General was uncertain about hisauthority to make recommendations con-cerning overseas hospitalization, in viewof the hospitalization and evacuation

policy which was published on 18 June1942 making overseas commanders re-sponsible for "the operation of all medicalfacilities under their control and for futureplanning in connection therewith" (italicsadded).103 Despite this policy, SOS head-quarters assured him that he could makerecommendations about hospitalizationand evacuation in theaters whenever ap-propriate. The Surgeon General also feltthat he received insufficient information,both from higher authorities in the WarDepartment and from surgeons in thea-

100 (1) Memo, SG for Dir Oprs SOS, 11 Jul 42. SG:632.2. (2) Memo, SG for Oprs Div SOS, 29 Jul 42,sub: Fixed Hosp Beds Overseas. HD: 632.-1 "HospOverseas, Bed Status."

101 (1) Memos SPOPM 323.7 and SPOPH 632, CGSOS 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) 1stind, CG SOS to SG, 14 Aug 42, on Memo, SG forOprs Div SOS, 29 Jul 42, sub: Fixed Hosp Beds Over-seas. HD: 632.-1, "Hosp Overseas, Bed Status."

102 (1) Memo SPOPH 632(Hosp), CG SOS for SG,20 Oct 42, sub: Bed Capacities of Fixed Hosps atOverseas Bases. HD: 632.-1 "Hosp Overseas, BedStatus." (2) Memo. SG for Oprs Div SOS, 31 Oct 42,same sub, with 1st ind SPOPH 632(10-31-42), CGSOS to SG, 16 Nov 42. Same file.

103 Ltr AG 704 (6-17-42)MB-D-TS-M, TAG toCGs AGF, AAF, SOS, Theaters, etc., 18 Jun 42, sub:WD Hosp and Evac Policy. HD: 705.-1.


ters, to enable him to plan intelligently andeffectively for overseas hospitalization.While much information he desired fromhigher authorities was classified for secur-ity reasons, the SOS Hospitalization andEvacuation Branch attempted to providehim with more information about oper-ational plans than he had previously re-ceived.104 Furthermore, in collaborationwith the Surgeon General's Office thatBranch took action which led to the estab-lishment in January 1943 of a system ofmonthly reports from overseas commands.Submitted first as sections of the MonthlySanitary Reports and after July 1943 asReports of Essential Technical MedicalData (ETMD's), these reports containedinformation about admission and evacua-tion rates, availability of hospital beds,suitability of hospital units and theirequipment, and other factors of impor-tance to The Surgeon General in planningtheater medical services.105 In addition,beginning with General Magee's trip toNorth Africa in the winter of 1942-43,representatives of the Surgeon General'sOffice made personal inspections of over-seas areas in order to gain firsthand infor-mation about their medical services.106

Further obstacles to planning were lackof sufficient experience with battle casual-ties thus far in World War II to estimateaccurately hospital admission rates andlack of an official evacuation policy—thatis, a policy governing the selection of pa-tients for evacuation to the United Statesin terms of the days of hospitalizationwhich they were expected to require. Intheir absence The Surgeon General usedfor planning purposes the battle-casualtyadmission rates of World War I and as-sumed a policy of returning to the UnitedStates all patients who required 120 ormore days of hospitalization. To establish

a firmer basis for planning, he recom-mended in the spring of 1943 the estab-lishment of an official evacuation policybut such action was not taken until laterin the year.107

In providing hospitals for overseas serv-ice early in the war, the Medical Depart-ment discovered and attempted to correctshortcomings and errors in its prewarplanning. It was discovered early that theactivation and training of normal Armyunits was more valuable in meeting emer-gency hospital needs than the formationand organization of units affiliated withcivilian hospitals and schools. Moreover, itsoon appeared that units planned for the-aters of operations were not suitable for allsituations encountered in a modern globalwar and units of new types had to be de-

104 (1) Memo SPMCP 704.-1, Act SG for Oprs DivSOS, 16 Nov 42, sub: Status of Hosp Overseas, with1st ind SPOPH 701 (11-16-42), ACofS Oprs SOS toSG, 24 Nov 42. (2) Memo SPOPH 701 (11-16-42),CG SOS for ACofS OPD WDGS, 24 Nov 42, samesub. (3) Memo OPD 701 (11-24-42), ACofS OPDWDGS 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 CGsOverseas Comds. SG: 370.2-1. (2) Memo SPOPH440, CG SOS for TAG, 28 Dec 42, sub: ETMD fromOverseas Forces, with Memo for Record. HD: Wilsonfiles, "Book IV, 16 Mar 43-17 Jun 43." (3) Diary,SOS Hosp and Evac Br, 4 Dec 42. HD: Wilson files,"Diary." (4) Ltr AG 350.05 (12-28-42)OB-S-SPOPH-M, TAG to CGs Overseas Comds, 2 Jan 43,sub: ETMD from Overseas Forces. HD: Wilson files,"Experience in Med Matters from Overseas Forces."(5) Ltr AG 350.05 (28 Jun 43)OB-S-D-M, TAG toCGs Overseas Comds, 14 Jul 43, same sub. HD:350.05 "Mil Info."

106 Memo, SG for CG SOS, 12 Jan 43. HRS: HqASF, Gen [Wilhelm D.] Styer's files, "Med Dept."

107 (1) Memo SPMCP 704.-1, Act SG for Oprs DivSOS, 16 Nov 42, sub: Status of Hosp Overseas, with1 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.


veloped—field hospitals, motorized evac-uation hospitals, and portable surgicalhospitals. The size and weight of equip-ment of all hospital units had to be re-duced and new methods of packing had tobe developed in order to increase the mo-bility and transportability of hospitals.Shortages of Medical Corps officers ap-peared and required reductions in thenumber authorized by tables of organiza-tion developed during the emergencyperiod. Shortages of equipment continuedto plague the Medical Department andpartially accounted for The Surgeon Gen-

eral's insistence upon withholding its is-suance until hospital units were assignedto missions involving the care of patients.In this connection, The Surgeon Generalalso resisted demands of higher author-ities to plan for the use of numbered hos-pitals in the zone of interior medical serv-ice. Meanwhile other units were beingactivated and trained, and toward the endof General Magee's administration meas-ures were taken to find out what hospitalfacilities theaters actually had and toplace planning for future needs on asounder basis.

PART THREE

HOSPITALIZATION

IN THE LATER WAR YEARS

MID-1943 TO 1946

Introduction

By the middle of 1943 the peak of thepreparation phase of the war had beenreached, and the United States and itsAllies were ready to assume the offensiveagainst the Axis powers. From then untilthe spring of 1945 troops moved steadilyoverseas, the number in the United Statesdropping from 5,355,683 to 2,753,455 andthe number overseas growing from 1,637,-419 to 5,403,931. In the fall of 1943, onebody of American troops landed in Italy,carrying the offensive from North Africato the European continent; others, bytheir attacks upon islands in the Gilbertand Marshall groups in the Pacific, begana two-pronged drive toward Japan. By themiddle of the following year the Alliesmounted their main attack against Ger-many, landing on the coast of France on6 June 1944. Soon afterward the CentralPacific advance reached the Marianasand Southwest Pacific forces returned tothe Philippines. Despite a German coun-teroffensive in December 1944, Alliedforces moved inexorably toward victory inEurope and on 7 May 1945 Nazi Ger-many surrendered. Meanwhile, Americantroops in the Pacific pushed closer to themain Japanese islands, completing the re-conquest of the Philippines and gainingcontrol of islands in the Ryukyus chain.Then, on 10 August 1945, the JapaneseGovernment sued for peace. Immediatelyafterward the Army's strength began todecline. By the beginning of 1946 thenumber of troops overseas dropped to1,573,620 and of those in the UnitedStates to 1,895,652.1

Combat developments inevitably in-fluenced the provision of hospitalization.With the movement of troops overseas theneed for beds in station hospitals in theUnited States declined rapidly. On theother hand requirements for beds in hos-pitals of all types in theaters as well as inhospitals caring for overseas evacuees inthis country mounted. The number ofcasualties and of soldiers with serious ill-nesses grew with the widening scope andincreasing intensity of combat and the ex-posure of larger groups to disease hazardsin various parts of the world. Estimatingthe number of beds that would be neededunder such circumstances proved to beconsiderably more difficult than calculat-ing the number needed for an Army intraining. Moreover, to meet requirementsfor hospitalization, whatever they mightbe, the Medical Department had onlylimited means. New construction had beencurtailed as the peak of the training phasehad been reached; demands of overseastheaters for troops for combat operationsand of the home front for civilian em-ployees to produce war materials reducedthe manpower pool, both military andcivilian, upon which the Medical Depart-ment could draw; and in the fall of 1943the number of doctors allowed the Armywas limited to 45,000. These limitationsmeant that emphasis had to be placedupon 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.


available. Instead of building new hospi-tal plants, for example, the Medical De-partment had to expand and improvethose already built or use vacated stationhospitals and troop housing. Changes hadto be made in the hospital system to avoidwaste of personnel and equipment. Pol-icies for hospitalization had to be modifiedin order to hold bed requirements to thelowest practical number. And the organ-ization and administrative procedures ofhospitals had to be standardized and sim-plified to permit relatively smaller andmore heterogeneous staffs to operate them.

The task of using limited means effec-tively and of planning their allocation

among major commands in the UnitedStates and among theaters in all parts ofthe world fell to Surgeon General Kirkwhen he succeeded General Magee inJune 1943. General Kirk maintained con-tinuity in the program of hospitalization,preserving many established policies andfurthering developments already begun,but he also evolved new policies to meetchanging situations and established newmethods of operation. Meanwhile, he ex-panded and strengthened his own officeand sought changes in the existing WarDepartment organization to facilitate dis-charge of his responsibility for the healthand medical care of the Army.

CHAPTER IX

Further Changesin Organization andResponsibilities for

HospitalizationRelationship of The Surgeon GeneralWith Other War Department Agencies

With the emergence of problems cre-ated by a shift from the defensive to the of-fensive phase of the war, changes occurredin the organization for hospitalization.One of the most fundamental was implicitin a gradual change in the relationship ofThe Surgeon General with ASF head-quarters and the General Staff. AlthoughThe Surgeon General remained under thejurisdiction of ASF headquarters untilafter the end of the war, there was a grow-ing trend in 1944 and 1945 toward hisrestoration to a position of direct contactwith the General Staff. This trend resultedfrom efforts made by General Kirk to re-gain authority for his office commensuratewith its responsibilities and from gradualresumption by the General Staff of someof the functions assumed earlier by theArmy Service Forces.1

In the last half of 1943 the authorityand responsibility of OPD for logistic mat-ters as well as the strategic direction of the-

ater forces were confirmed and strength-ened. G-1 became concerned about allo-cation of personnel for medical servicethroughout the world, and G-4 devotedgrowing attention to bed requirementsand the hospital system in general. In ad-dition, two Special Staff units, the WarDepartment Manpower Board and theInspector General's Office, took a hand insuch matters.

As this happened ASF headquarterslost some of its former authority andtended to become in some matters merelya formal channel of communication. Fi-nally, early in 1945 this trend culminatedin a War Department circular which,while not removing him from ASF juris-diction, affirmed The Surgeon General'sposition as the chief medical officer of theArmy and officially authorized him todeal directly with the Chief of Staff and

1 For full information on this development see JohnD. Millett, The Organization and Role of the Army Serv-ice Forces (Washington, 1954), Chs. IX and X; andRay S. Cline, Washington Command Post: The Opera-tions Division (Washington, 1951), Ch. XIV; both inUNITED STATES ARMY IN WORLD WAR II.


the General Staff, without interference byASF headquarters, on matters affectingthe health of the Army.2 In approving thepublication of this circular the Secretaryof War announced that it should be fur-ther interpreted as also giving The Sur-geon General direct access to the Secre-tary himself.3

A change in the organization of ASFheadquarters reflected both its decrease ofauthority in phases of hospitalization inwhich the General Staff took a more ac-tive interest as well as a gradual return tothe Surgeon General's Office of certainfunctions connected with hospitalizationand evacuation. In April 1943 the ASFHospitalization and Evacuation Branch,whose head after February 1943 was Col.Robert C. McDonald, was reduced to asection of the Zone of Interior Branch ofthe Planning Division. In the followingNovember the statement of this section'sfunctions was revised to eliminate word-ing that could be interpreted as giving itoperational responsibilities for any aspectof hospitalization. Meanwhile, MedicalDepartment officers who had been as-signed there in 1942 were transferred toother posts, two of them to the SurgeonGeneral's Office. In February 1944 theentire section was abolished and its re-maining functions were transferred toother units of the ASF Planning Division.4

This Division, along with others such asthe Mobilization and Control Divisions,continued to exercise considerable author-ity over hospitals at ASF installations andover ASF hospital units being preparedfor overseas service.5

Another aspect of General Kirk's driveto regain authority with which to dis-charge responsibilities of his office was hiseffort to increase control by the MedicalDepartment in general and by his Office

in particular over medical installations,including hospitals, in service commands.Soon after he took office, General Kirktried to have service command surgeonsrecognized as staff officers of service com-manders rather than as chiefs of medicalbranches under the intermediate controlof supply divisions. His efforts were not atfirst successful, but toward the end of 1943General Somervell directed service com-mand headquarters to conform as closelyas practical to ASF headquarters. In mostservice commands the surgeon was thenelevated, as were other technical serviceheads in the service commands, to a posi-tion as staff officer directly under the serv-ice commander himself.6 After that, theSurgeon General's Office began to achievecloser co-ordination with service commandsurgeons and, through them, to exercisecloser supervision over hospitalization.

Early in 1944 comparative studies ofmatters affecting the operation and ad-ministration of hospitals, such as theamount of personnel assigned to them, theefficiency with which they treated anddisposed of patients, and the number ofbeds which they set up for use, were madeby the Surgeon General's Office, and let-ters calling attention to the implications ofthese studies were sent to service com-mand 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-1file, 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 transferredfrom 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 Zoneof the Interior (1946), HD., pp. 97-99.

7 Such letters are filed in SG: 323.7-5 for each serv-ice command.

FURTHER CHANGES 173

the Surgeon General's Office adopted the"flying circus" method of inspection forhospitals. Representatives of such seg-ments of the Office as the ProfessionalConsultants Divisions, the Nursing Divi-sion, the Supply Service, the PersonnelService, and the Construction Branch,under the leadership of the chief of theHospital Division and accompanied byservice command surgeons or their repre-sentatives, flew from one hospital toanother making thorough inspections oftheir operations. Such inspections achievedcloser co-ordination between offices ofThe Surgeon General and service com-mand surgeons and reduced confusion inthe field which had formerly resulted fromsuccessive inspections by separate indi-viduals and from the receipt of instruc-tions from different staff officers.8

Only minor changes were made in thedivision of responsibility for numberedhospital units between the Ground andService Forces. Upon recommendation ofAGF headquarters and the Surgeon Gen-eral's Office, responsibility for portablesurgical hospitals was lodged with theGround Forces in the winter of 1943-44.9

In the middle of the next year the GroundSurgeon concurred in a recommendationof the Surgeon General's Office for trans-fer of responsibility for convalescent hos-pitals (units designed for the care of short-term patients in combat zones) from theService to the Ground Forces.10 Whereasboth the Surgeon General's Office andASF headquarters joined with the Gen-eral Staff and the Ground Forces in estab-lishing a general basis for the allotment ofmobile hospital units to theaters, AGFheadquarters was primarily responsiblefor the more detailed preparation of mo-bile hospitalization for separate theaters.Planning for fixed hospitalization in thea-

ters for troops of all major commands—Air, Ground, and Service Forces—con-tinued to be, but not without oppositionby the Air Forces, a responsibility of theSurgeon General's Office and ASF head-quarters.11

Uncertainty about the extent of the AirForces' authority over hospitalization con-tinued. Surgeon General Kirk believedthat all hospitals in the United Statesshould be combined into one system un-der his supervision,12 but the Air Surgeonrenewed his efforts to establish a separateand complete hospital system for the AirForces. Activities in this connectioncaused a major change in the zone of in-terior hospital system.13 Attempts to estab-lish separate AAF hospitals in theaters ofoperations, though less successful, exem-plified the Air Surgeon's drive for a com-pletely separate medical service.

8 Tab F, sub: Dev of a New Syst of Hosp Insp, toMemo, Dir Hosp Div SGO and Resources Anal DivSGO for Dir HD SGO thru Chief Oprs Serv SGO,18 Jun 45, sub: Add Mat for An Rpt for FY 1945.HD: 319.1-2. Examples of reports of flying circus in-spections are found in SG: 333.1 for each service com-mand.

9 (1) Memo for Record, by [Col] R. B. S[kinner],26 Aug 43. Ground Med files: Transfer Binder Jour-nal, 1943. (2) 6th ind SPMCP 322.15-17 (Cp Mack-all)C, Chief Oprs Serv SGO to SG, 11 Nov 43, on Ltr,CG Airborne Comd AGF to CG AGF, 4 Sep 43, sub:Ptbl Surg Hosp. AGF: 321 No 5. (3) Memo 353-GNGPS (4 Sep 43), CofS AGF for CofSA attn ACofSG-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 ASFfor CG AGF thru SG, 25 Jul 44, sub: Present Statusof Certain MAC Offs with Conv Hosps, with inds andincls. (2) DF 320.3 (24 Feb 44), Dep ACofS G-3WDGS 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, 14-17Jun 43, p. 7. HD: 337.



Efforts of the Air SurgeonTo Get Separate Hospitals

for Theater Air Commands

Under the War Department reorgani-zation and policies established early in1942, theater air commands, unlikeground commands, had no authority orcontrol over hospital units used in supportof troops in combat zones. Like groundforces, on the other hand, they were de-pendent upon service forces hospitals forthe care of personnel in communicationszones. In some theaters local air and the-ater surgeons arranged for the attachment,but not the assignment, of a limited num-ber of either mobile or fixed hospitals totheater air commands,14 but the Air Sur-geon considered this arrangement unsatis-factory. He wanted theater air commandsto have complete control of their own hos-pitals. The reasons he most often gave forthis position were the loss of control by aircommands of personnel sent to serviceforces hospitals, the loss of man-dayscaused by transferring patients to serviceforces hospitals and awaiting their returnto duty through the replacement system,the lowered morale of air forces personnelwhich resulted from their temporary ab-sence from air commands, and the need ofair forces men for professional care thatwas "directed from an aero-medical view-point." 15 The Surgeon General, on theother hand, believed that supplying fixedhospitals to overseas areas on a theaterbasis, rather than on a major commandbasis, achieved a more effective use ofavailable resources.

In the fall of 1943 the Air Surgeon at-tempted to get numbered hospital unitsincluded in the War Department troopbasis as AAF units. Success would havemeant that such units would be activated

and trained by the Air Forces and wouldbe sent to theaters as air units for use byair commanders and not by theater orcommunications zone commanders. Thisattempt failed because of lack of supportby the Air Staff and opposition of the Sur-geon General's Office and ASF headquar-ters.16 To secure data for use in winninggreater support from the Air Staff and incountering ASF arguments, the Air Sur-geon in March 1944 sent to surgeons of alltheater air commands a questionnaireabout the desirability of separate hospitalsfor air forces personnel.17

Meanwhile there arose the question ofthe assignment to air commands of hospi-tals located in Newfoundland at basestransferred in the fall of 1943 from theNewfoundland Base Command to the AirTransport Command. After severalmonths of negotiations, AAF headquar-ters, ASF headquarters, the Surgeon Gen-

14 (1) Air Evaluation Board, SWPA, The MedicalSupport of Air Warfare in the South and SouthwestPacific, 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 Over-seas Hosp. HD: TAS, "Hosp for AAF Units Over-seas." Also see Ltrs from Air Surg, cited below.

16 (1) Memo, Air Surg for C of Air Staff, 29 Nov43. (2) Comment 2, Col H. C. Chenault, MC, AirSurg Off to AC of Air Staff, Personnel, 6 Dec 43, onabove. (3) Comment 1, Col H. C. Chenault, MC toAC of Air Staff OC & R, 13 Dec 43, sub: Air BaseHosps for Overseas Air Bases in 1944 AAF Trp Basis,on unknown basic memo. (4) Memo, unsigned [CGAAF] for CofSA, n d, sub: Hosp at AF Bases and StasOutside Continental Limits of US. (5) Memo, CGAAF for CG ASF, 16 Feb 44, sub: Med Care of AAFPers, with incl. All in HD: TAS, "Hosp for AAFUnits Overseas." A full discussion of the Air Surgeon'sattempts to get separate hospitals for theater air com-mands is in Hubert A. Coleman, Organization andAdministration, AAF Medical Services in the Zone ofthe Interior (1948), pp. 409-32. HD.

17 Study, unsigned, n d [1944], sub: Study of Over-seas Hosp. HD: TAS, "Hosp for AAF Units Over-seas."

FURTHER CHANGES 175

eral's Office, and the General Staff agreedthat the numbered hospitals at such baseswould be returned to the United Statesand that the North Atlantic Wing of theAir Transport Command would operatedispensaries in their place. While such in-stallations were in reality small hospitals,use of the term "dispensaries" kept nomi-nally intact the War Department policy ofhaving service forces provide fixed hospi-talization for all forces in theaters ofoperations.18

Before this decision had been reachedthe President received complaints aboutthe hospitalization of air troops in theUnited Kingdom, and in March 1944 hesent a committee composed of SurgeonGeneral Kirk, Air Surgeon Grant, and Dr.Edward A. Strecker, a prominent civilianphysician, to investigate the hospital situ-ation there. They found insufficient causefor complaints and in April the Presidentapproved their recommendation that nochange be made in the hospital system inthe European Theater.19

Planning for the B-29 very-long-range-bomber program in April 1944 presenteda favorable opportunity for pressing forseparate air forces hospitals in the Pacific.When an OPD representative stated thatASF hospital units were not available forassignment to the Central Pacific area forthe XXI Bomber Command, AAF head-quarters offered to furnish them. OPDwas on the verge of authorizing it to do sowhen the Surgeon General's Office pro-posed instead the transfer of certain hos-pital units from the less active SouthPacific to the Central Pacific.20

The Air Surgeon then urged the AirStaff to take such "drastic" action that theArmy Chief of Staff would be forced tomake a decision as to whether or not the-ater air forces could have separate hospi-

tals.21 To support his position the Air Sur-geon used replies which he had receivedfrom his March questionnaire. While theydid not show a unanimous desire amongair command surgeons for separate hospi-tals, they gave the Air Surgeon substanti-ating data for his position. The Air Staffremained nonetheless unconvinced of thewisdom or desirability of pressing for sep-arate air forces hospitals generally. In-stead, the Air Staff directed the Air Sur-geon to prepare a study showing the needof the XX Bomber command, at thattime located in India, for separate hospi-tals. Because he found it hard to divorce adesire for separate hospitals in all theatersfrom the question of separate hospitals forthe XX Bomber Command, the Air Sur-geon had difficulty preparing a studywhich the Air Staff would approve. He fi-nally succeeded, only to be turned downby the commanding general of the AirForces, 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 CGASF, 5 Sep 44, on DF OPD 320.2 (30 Aug 44), ACofSOPD WDGS to CG ASF, 30 Aug 44, sub: Designa-tion of Certain AAF Sta Hosps. SG: 322 "Hosp Misc1944."

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, AirSurg, and Dr. Edward A. Strecker for CofSA thru DepTheater Comdr ETOUSA, 20 Mar 44. (4) Ltr,SecWar to The President, 29 Mar 44. (5) Memo, SecWDGS for CG ASF, CG AAF, SG, and Air Surg, 10Apr 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 BomberComd. HD: TAS, "Hosp for AAF Units Overseas."(2) Memo, Dep Dir MOOD SGO for Record, 15 May44. HD: MOOD "Pacific." (3) Memo OPD 320.3PTO (17 May 44), ACofS OPD WDGS for CG ASFand CG AAF, 17 May 44, sub: Air Base Hosps in Sup-port of VLR, with Memo for Record. HD: TAS,"Hosp for AAF Units Overseas."

21 Memo, Air Surg for C of Air Staff, 26 Jun 44,sub: AAF Med Serv and Hosp Overseas. HD: TAS,"Hosp for AAF Units Overseas."


AAF headquarters, that the Army Chiefof Staff opposed "duplicate medical serv-ices." 22 Thus, overseas air forces never re-ceived official authority to establishseparate hospitals. In some theaters theyset up hospitals under the guise of dispen-saries, while in others they operated hos-pitals that were loaned to them by theatercommanders.23

Expanding and Strengtheningthe Surgeon General's Office

Correlative to General Kirk's attemptsto gain greater authority and higher statusfor The Surgeon General was the expan-sion and strengthening of his own Office.24

In July 1943 The Surgeon Generalcombined his Hospitalization and Evacu-ation Division with his Hospital Construc-tion Division to form a single unit: theHospital Administration Division. Pro-posed by ASF headquarters as a means ofsimplifying the organization of the Sur-geon General's Office,25 this step concen-trated related functions—hospital con-struction, hospital administration, andevacuation—under one officer, who wassubordinate in turn to the new chief of theOperations Service, Col. (later Brig. Gen.)Raymond W. Bliss. The new Division,whose director from August 1943 to Au-gust 1945 was Col. Albert H. Schwichten-berg, had four branches. The PoliciesBranch, under Lt. Col. Basil C. MacLeanuntil he was succeeded by Lt. Col. JamesT. McGibony in the fall of 1944, was re-sponsible for establishing and publishingpolicies on hospital administration. TheEvacuation Branch was in charge of thebed-credit system in general hospitals.The Construction Branch, whose newchief after 5 October 1943 was Lt. Col.

(later Col.) Achilles L. Tynes, was respon-sible for co-ordinating the work of theSurgeon General's Office with the Engi-neers in the construction and maintenanceof hospital plants. The fourth branch, theLiaison Branch, was new and was estab-lished to meet needs that had developedin the course of the war. It was chargedwith maintaining liaison with the Trans-portation Corps in the movement of pa-tients, with The Provost Marshal Generalin the hospitalization of prisoners of war,and with the Women's Army Corps in thehospitalization and employment of Wacs.26

During the winter of 1943-44 a majorexpansion and reorganization occurred.Personnel limitations and prospectivecombat-casualty loads complicated prob-lems of planning and providing hospitali-zation for the Army. Furthermore, therewas some belief in both ASF headquartersand the Surgeon General's Office that thelatter should be more active than in thepast in planning hospitalization and in

22 (1) Comments 1 to 12, on Memo, Air Surg for Cof Air Staff. 26 Jun 44, sub: AAF Med Serv and HospOverseas. (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 lettersbetween Col. Walter S. Jensen, MC, Chief Surgeonof 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 weregeneral and affected many units of his Office, onlythose concerned with hospitalization and evacuationwill be considered here. For a discussion of the gen-eral reorganization, see Blanche B. Armfield, Organ-ization and Administration (MS for companion vol.in Medical Dept, series), HD.

25 Memo, SG for CG ASF, 18 Jun 43, sub: Orgn ofSGO, with 1st ind, CG ASF to SG, 1 Jul 43, and 2dind, SG to CG ASF, 7 Jul 43. SG: 024.-1.

26 Morgan and Wagner, op. cit., pp. 28-33. Infor-mation about personnel assignments was taken fromSG office orders and personnel records on file in SGO.

FURTHER CHANGES 177

supervising hospital operations.27 Perhapswith tongue in cheek, the director of TheSurgeon General's Control Division pro-posed in September 1943 that this shouldbe considered a "new activity." 28 At anyrate, early the next year the Surgeon Gen-eral's Office began to negotiate with ASFheadquarters for the transfer of personnelto establish a "Facilities and PersonnelUtilization Branch" in the Hospital Ad-ministration Division. Organized by Dr.Eli Ginzberg, an economist and statis-tician on loan from the ASF Control Divi-sion, this Branch was charged in February1944 with making comprehensive hospi-talization plans, including the calculationof bed and personnel requirements, theutilization of available buildings and per-sonnel, and the modification of the hospi-tal system to achieve greater efficiencyand economy in operations.29 Soon after-ward, in an attempt to achieve greaterco-ordination among operational seg-ments of his Office, The Surgeon Generalreorganized his entire Operations Serv-ice.30 The revamped Service had twodeputy chiefs. One was responsible,among other things, for the provision ofhospitals for theaters of operations, whilethe other dealt with hospitalization andevacuation in the zone of interior.

Under the Deputy Chief for Hospitalsand Domestic Operations were a HospitalDivision and four liaison units. Three ofthe latter had previously existed as sec-tions of the Liaison Branch of the Hospi-tal Administration Division: the Prisoner-of-War Liaison Unit, the Women's Medi-cal Unit, and the Transportation LiaisonUnit. The fourth, the Army Air ForcesLiaison Unit, was mainly a paper unit, forit was headed by the Hospital Divisiondirector who was already charged withmaintaining liaison with the Air Sur-

geon's Office. Like the Hospital Admin-istration Division which it succeeded, theHospital Division had four branches. TheEvacuation and Construction Branchescontinued without change; the PoliciesBranch was renamed the AdministrationBranch; and there was the newly createdFacilities Utilization Branch.31

These changes were more apparentthan real because Colonel Schwichten-berg, who was already serving as chief ofthe Hospital Division, continued in thatpost and became also the Deputy Chieffor Hospitals and Domestic Operations.Thus, chiefs of the branches of the Hospi-tal Division and heads of the liaison unitscontinued under his supervision in muchthe same relationship as before. Thechanges were significant, however, in that(1) the person responsible for hospital ac-tivities was given higher status than for-merly, (2) the new branch of the HospitalDivision, the Facilities Utilization Branch,was charged with making comprehensiveplans for hospitalization in the UnitedStates and with arranging for the execu-tion of those plans with other interestedunits in the Surgeon General's Office, and(3) the amount of personnel available forwork on hospital plans and operationswas increased until there were twenty-three officers and thirty-six civilians un-

27 (1) Memo, Dir Control Div SGO for [Maj] Gen[Norman T.] Kirk, 13 Jan 44, sub: Proposal for Over-all Plan for Most Effective Util of Off Almt, Civ Pers,and Space in the SGO and for Modifications in Pres-ent Orgn. SG: 320.3 GG. (2) Tab A, sub: Estab of aStatistical Management Unit in the Oprs Serv, toMemo cited n. 8.

28 Memo, Dir Control Div SGO for Chief LiaisonBr Oprs Serv SGO, 30 Sep 43. Off file, Gen Bliss' OffSGO, "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.


der the supervision of the Deputy Chieffor Hospitals and Domestic Operations inJuly 1944.32

The Office of the Deputy Chief forPlans and Operations replaced the oldPlans Division, which had been headedsince July 1943 by Col. Arthur B. Welsh.In this Office were three divisions: theMobilization and Overseas OperationsDivision, the Technical Division, and theSpecial Planning Division.

The Mobilization and Overseas Opera-tions Division, developed from a branchof the same name in the former PlansDivision, had three branches. Its TheaterBranch maintained current informationon the status of Medical Department unitsin each overseas theater; made studies ofbed requirements of the several theaters;formulated plans for the employment ofMedical Department units, personnel, andequipment in each theater; and preparedrecommendations to higher commands onchanges in the status or organization ofmedical services overseas. In this work itmaintained close liaison with the ASFPlanning Division. The Troop UnitsBranch planned and recommended thetypes and numbers of ASF medical unitsrequired under current authorizations foreach theater; planned the activation, re-organization, shipment, disbandment andinactivation of such units; and main-tained liaison with the ASF MobilizationDivision. The Inspection Branch, formerlya branch of the Plans Division, continuedto receive and review reports from theatersof operations, such as the reports of essen-tial technical medical data (ETMD's);maintained records of trips of inspectionmade by representatives of the SurgeonGeneral's Office; and interviewed and cir-culated reports of interviews with medicalpersonnel returned from overseas areas.

The Technical Division included amongits many duties the preparation and revi-sion of tables of organization and equip-ment, Medical Department equipmentlists, and tables of allowances.

The Special Planning Division was re-sponsible for plans for the demobilizationof the Medical Department and for themedical care of civilians in occupied coun-tries.33

A separate unit of the Operations Serv-ice, the Strategic and Logistic PlanningUnit, was responsible for determining "theadequacy of all phases of Medical Depart-ment operations, and plans therefor, to theextent necessary to insure timely placingof sufficient personnel, equipment andsupplies to meet all authorized require-ments," 34 from March to November 1944.On the latter date it was absorbed by theMobilization and Overseas OperationsDivision.35

This multiplicity of offices might givean erroneous impression of division of re-sponsibility were it not pointed out thatone man, Colonel Welsh, served at thesame time as Deputy Chief of the entireOperations Service, Deputy Chief forPlans and Operations, and Director of theMobilization and Overseas OperationsDivision.36 (Chart 7.)

Further changes, representing perhapsa 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) AnRpt, Spec Planning Div SGO, FY 1944. (4) An Rpt,Tec Div SGO, FY 1945. All in HD.

34 Memo, Dir Strategic and Logistic PlanningUnit 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.


In May 1944 the Evacuation Branch wasremoved from the Hospital Division andwas merged with the Transportation Liai-son Unit to form a Medical RegulatingUnit under Lt. Col. John C. Fitzpatrick.37

This step combined under one head thecontrol of the use of beds in general hospi-tals and the movement of patients to thosebeds. In August 1944 the Women's Medi-cal Liaison Unit, whose function was moreadvisory than operational, was transferredfrom the office of the Deputy Chief forHospitals and Domestic Operations to thenew Professional Administrative Service.In October 1944 the Facilities UtilizationBranch was removed from the HospitalDivision and given higher status and re-sponsibility, as the Resources Analysis Di-vision, under the direct supervision of thechief of the Operations Service. Its headwas Doctor Ginzberg, who by this timehad been formally transferred from ASFheadquarters to the Surgeon General'sOffice.38 Continuing the trend of central-izing operational activities and separating

administrative from advisory functions,responsibility for the operation of the re-conditioning program was transferred inApril 1945 to the Hospital Division, leav-ing the Reconditioning Consultants Divi-sion free to concentrate in an advisorycapacity on matters of policy.39

Other units in the Surgeon General'sOffice continued to contribute, in varyingdegrees, to hospital operations. Amongthem, the Personnel and Supply Serviceswere perhaps the most important. As in-creasing attention was given to manage-ment techniques, the Control Divisionentered the hospital operations field and,in co-operation with the Hospital Divi-sion, attempted to standardize and sim-plify hospital administrative procedures.40

37 Memo for Record, by Col Tracy S. Voorhees,Dir Control Div SGO, 3 May 44, sub: The MROSet-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.


CHAPTER X

Adjustments and Changes inthe Zone of Interior

Hospital SystemAs the tempo and extent of the war in-

creased, changes and adjustments weremade in the hospital system. Among themore important reasons for them were thenecessity of using limited personnel re-sources—particularly doctors — more ef-fectively than formerly; the continuingefforts of the Air Surgeon to gain greatercontrol over hospitalization of Air Forcesmen; the necessity of caring for large num-bers of prisoners of war; and the growingnumber of patients requiring specializedtreatment and care. In the fall of 1943several groups attempted to solve theproblem of limited personnel resources.Among them were the "Kenner Board," agroup of officers appointed by The Sur-geon General and headed by Brig. Gen.Albert W. Kenner to study Medical De-partment personnel utilization; the Hos-pital and Control Divisions of the SurgeonGeneral's Office; the ASF Control Divi-sion; and the Inspector General's Office.These groups agreed that certain stepswere desirable: reduction in size and num-ber of station hospitals; merger of neigh-boring hospitals to eliminate overlappingand duplication; and removal of convales-cent patients from the wards of general

hospitals. They disagreed on the questionof how to operate two sets of hospitals(those of the Army Air Forces and those ofthe rest of the Army) with a minimum ofduplication of facilities and waste of per-sonnel. Subsequently their opinions werereflected in changes made in the hospitalsystem.1

Closure of Surplus StationHospital Facilities

The first adjustment needed was theclosure of station hospital plants, or partsof them, to keep step with the shrinkage inmilitary population as troops moved over-

1 (1) Mins of Mtgs and Rpt of Bd of Off to Studythe Util of MC Offs, 17 Sep 43-6 Nov 43. HD: 334"Kenner Bd." (2) Memo, Dr. Eli Ginzberg, ControlDiv ASF for Chief Oprs Serv SGO thru Dir ControlDiv ASF, 30 Nov 43, sub: Surv of Gen Hosps. SG:333.1-1. (3) Memo, Lt Col Basil C. MacLean, HospAdmin Div SGO for Gen [Raymond W.] Bliss thruCol [Albert H.] Schwichtenberg, 6 Nov 43, sub: Ob-servations Based on Recent Visits ... to 9 GenHosps. Off file, Gen Bliss' Off SGO, "Util of MCs inZI" (19)#1. (4) Notes on Visit to McCloskey,O'Reilly, and Percy Jones Gen Hosps, 11 Dec 43, byCol 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 Persin ZI Instls. AG: 320.2 (18 Apr 44) (1).


seas. When this was done doctors nolonger needed to care for troops in train-ing could be released for assignment eitherto hospitals scheduled for overseas serviceor to general hospitals in this country. Inthe fall of 1943 both the Surgeon Gen-eral's and the Air Surgeon's Offices madesurveys to this end.2 By the close of theyear "considerable reductions" had beenmade in the sizes of AAF hospitals, andthe Surgeon General's Office was plan-ning a general procedure for adjustingcapacities of all station hospitals to thetroop populations which they served.3 Toavoid overcrowding in hospital plants thatwere by then larger than needed, TheSurgeon General's Hospital Administra-tion Division proposed a resumption ofthe practice of placing beds in wards onlyand of allotting to each bed 100 squarefeet of floor space, a practice which hadbeen abandoned earlier when the need forbeds was greater. This Division also rec-ommended that local commanders be heldresponsible for reducing the sizes of stationhospitals to authorized capacities.4

ASF headquarters and the GeneralStaff approved these proposals and pub-lished regulations to effect them early in1944.5 Concurrently The Surgeon Gen-eral's Facilities Utilization Branch beganto urge service command surgeons to in-crease efforts to shrink station hospitalsunder their supervision.6 To judge theprogress made, The Surgeon Generalchanged the way in which station hospitalbeds were reported in the summer of 1944.Until that time hospitals reported "con-structed capacities"—that is, the numberof beds which plants were constructed tohold—and hence reports showed neitherthe number of beds actually in use nor thenumber currently authorized. Under thenew system they reported "authorized

beds"—that is, beds for which were allot-ted supplies and personnel. The first suchreports revealed that considerable prog-ress had been made in the contraction ofstation hospitals.7 On 26 May 1944 thereported capacity (constructed capacity)of all AAF and ASF station hospitals hadbeen about 259,000, or 6.2 percent of thezone of interior troop strength. By 7 July1944 the "authorized capacity" of stationhospitals was reported to be about 134,000(3.3 percent of the troop strength at thattime) and of station and regional hospitalstogether about 198,000 (4.9 percent).8

Establishment of Regional Hospitals

Closure of surplus AAF and ASF sta-tion hospitals did not eliminate the prob-lem of operating dual sets of hospitals (forthe Air Forces and for the rest of theArmy) without duplication of plants and

2 (1) Ltr, Asst to Chief Med Br S&S Div Hq 9thSvC to COs ASF Hosps 9th SvC, 26 Oct 43, sub: Utilof Hosp Fac. SG: 632.-1. (2) Ltr, SG to CG 2d SvCattn SvC Surg, 23 Dec 43, sub: Anal of Data Obtainedin Recent Questionnaire of SG on Req Hosp. SG:705.-1 (2d SvC)AA. (3) Tabs C and D of Memo, CGAAF (Air Surg) for CofSA attn G-4, 7 Oct 44, sub:Reduction of ZI Hosps. HRS: G-4 file, "Hosp andEvac 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 Dec43, 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, 9Jun 44. (3) ASF Cir 196, 27 Jun 44.

6 Ltr, CG ASF by SG (Oprs Serv Hosp Div, FacUtil Br) to CGs SvCs attn SvC Surg, 28 Apr 44, sub:Redesignation of Sta Hosp Bed Capacities. HD: Re-sources Anal Div file, "Hosp."

7 Form SG-396, Weekly Health Report, was re-vised 1 May 1944. The revised version was first usedin Report 27, vol. IV, for the week ending 7 July1944. Weekly Rpts, AML.

8 (1) Weekly Health Rpts, vol. IV, No 21, and No27. AML. (2) ASF Monthly Progress Rpt, Sec 7,Health, 31 Jul 44, p. 34, compared bed capacities ofASF sta hosps as of 26 May 44 and 30 Jun 44.

ADJUSTMENTS IN ZONE OF INTERIOR 183

waste of personnel, and attempts to solveit led to a major change in the hospitalsystem early in 1944. Although prohibitedfrom operating general hospitals and car-ing for overseas patients, the Air Forces, itwill be recalled, had built up station hos-pitals to the point where many werestaffed and equipped to give general-hos-pital-type care, and the Air Surgeon op-posed transferring Air Forces patients togeneral hospitals, operated by the ServiceForces, when there were AAF station hos-pitals capable of treating and caring forthem. On the other hand, Surgeon Gen-eral Kirk opposed separate Air Forces sta-tion hospitals.9 If they were to continue,he contended, their staffs should be re-duced in quantity and quality to the levelrequired to care for only minor ills and in-juries, and patients from the Air Forces aswell as from the rest of the Army who re-quired treatment for serious ills andinjuries should be concentrated, alongwith specialists to treat them, in generalhospitals. In the fall of 1943 he attemptedto achieve this goal (1) by requesting theGeneral Staff either to permit him to re-assign doctors from AAF hospitals as hesaw fit or to direct the Air Forces to releasespecialists for duty with the ServiceForces10 and (2) by proposing a revision ofthe policy governing transfer of patientsto general hospitals. ASF headquartersapproved the latter suggestion and a re-vised policy was published in November1943. In addition to establishing criteriafor the selection of cases for transfer togeneral hospitals, this policy clearly lim-ited station hospitals to such operations asappendectomies, herniotomies, and thetreatment of simple fractures of the ex-tremities.11 The inference was that spe-cialists were not needed in station hospi-tals.

Almost immediately the Air Forces pro-tested that such restrictions would reducetheir hospitals to dispensaries and wouldwaste the skills and abilities of theirstaffs.12 Despite The Surgeon General'sinsistence that, on the contrary, MedicalCorps officers would be used more effec-tively if specialists and patients requiringspecialized care were concentrated ratherthan scattered,13 the Deputy Chief of Staffof the Army directed a compromise be-tween the positions of the Air Surgeon andThe Surgeon General. The Air Forceswere to release some medical officers forASF assignments but the policy on thetransfer of patients to general hospitalswas to be revised to permit AAF stationhospitals to perform any operations, how-ever complicated, for which they had ade-quate staffs.14

Early in 1944 The Inspector Generalreopened the question of the manning anduse of AAF station hospitals. Reporting ona 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 Sep43, with 1st ind, CG ASF to CofSA, 13 Sep 43. HRS:Hq ASF Gen Styer's files, "Med Dept." (2) MemoSPGAP 320.2 (8 Nov 43), Dir MPD ASF for ACofSG-1 WDGS, 8 Nov 43, sub: Critical Shortage of MedSpecialists 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 GenHosps. AG: 704.11 (10 Nov 43) (1). (2) WD Cir 304,22 Nov 43.

12 Memo, CG AAF for ACofS G-1 WDGS, 2 Dec43, 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, SGto CG ASF, 15 Dec 43, sub: MC Offs for Asgmt toASF T/O Units. All in AG: 704.11 (2 Dec 43).

14 (1) Memo WDCSA 705 (24 Dec 43) DepCofSAfor ACofS G-1 WDGS, 24 Dec 43, sub: Sec 2, WDCir 304, 22 Nov 43. AG: 704.11 (2 Dec 43). (2) WDCir 12, 10 Jan 44.


recommended on 13 January 1944 thatAAF station hospitals that were staffedand equipped to serve as general hospitalsshould be used in that capacity for pa-tients not only from the Air Forces butfrom the Service and Ground Forces aswell. The Deputy Chief of Staff accord-ingly directed the commanding generalsof the Air and Service Forces to preparea combined plan for hospitalization "on aregional and military population basis, ir-respective of command or service jurisdic-tional boundaries." 15

To comply with this directive and stillmaintain the status quo, The SurgeonGeneral drew up a plan based upon theSecretary of War's policy of permittingonly the Service Forces to operate generalhospitals and of assigning all overseasevacuees, with few exceptions, to theircare. He proposed that general hospitalsshould be of two types, those staffed forspecialized treatment and those staffed for"all work," and that station hospitals ofboth the Air and Service Forces should bestaffed according to manning tables ap-plicable to both alike.16 The Air Surgeon,on the other hand, attempted to use thisopportunity to get authority to operatehospitals equal in all respects to those ofthe Service Forces. He proposed that hos-pitals be designated as specialized hospi-tals, regional hospitals, and station hospi-tals; and that they be staffed on the basisof their workloads and functions insteadof by manning tables.17 Since none wereto be called general hospitals, none wouldbe restricted by the Secretary of War'spolicy and hospitals of all three typescould presumably be operated by both theAir and Service Forces.

When representatives of the Air Sur-geon and The Surgeon General could notagree upon a plan to submit to the Deputy

Chief of Staff, the Air Forces designatedcertain of their installations as "regionalhospitals" and called attention to this de-velopment as their way of complying withthe directive.18 Subsequently, the entireproblem of agreement upon a joint planwas referred to the Chiefs of Staff of theAir and Service Forces for solution.19

The outcome was a major change in thehospital system. Agreed upon by the AAFand ASF Chiefs of Staff, approved by theDeputy Chief of Staff of the Army, andauthorized in April 1944, it represented acompromise between the proposals of TheSurgeon General and the Air Surgeon. Tothe familiar station and general hospitalswere now added the regional hospital, anentirely new species, and the convalescenthospital, an outgrowth of the convalescentcenters and annexes already in use on asmall scale. The Service Forces alone wereto continue to operate general hospitals,but both the Air and Service Forces wereto operate station, regional, and convales-

15 (1) Ltr IG 333.-Med Pers, IG to DepCofSA, 13Jan 44, sub: Util of Med Off Pers in ZI Instls. (2)Memo, DepCofSA for CGs ASF and AAF, 26 Jan44, 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 ofMed Off Pers in ZI Instls, in Rpt to CG ASF fromSG, Plan for Util of Med Off Pers in ZI, 29 Feb 44.HD: 322.051-1.

17 (1) Memo, Hq AAF for SG, 26 Feb 44, sub: Pro-posed Plan, SGO, for the Util of MC Offs in ZI. Offfile, Gen Bliss' Off SGO, "Util of MCs in ZI" (19) #1.(2) Draft Memo, CGs AAF and ASF for DepCofSA,[Feb 44], sub: Util of Med Off Pers in ZI Instls, pre-pared by Hq AAF. HD: Resources Anal Div files,"Hosp."

18 (1) A History of Medical Administration andPractice in the Fourth Air Force (1945), vol. I, pp.43-44. HD: TAS. (2) An Rpt, 1944, AAF RegionalHosp Maxwell Fld. HD. (3) Draft Memo, CGs AAFand ASF for DepCofSA, [Feb 44], sub: Util of MedOff Pers in ZI Instls, prepared by Hq AAF. HD: Re-sources Anal Div files, "Hosp."

19 History of Control Division, ASF, 1942-45, App,p. 246. HD.


cent hospitals. Regional hospitals were tobe staffed not only to care for patients re-quiring merely the treatment usuallygiven in station hospitals but also to serveas general hospitals for zone of interior pa-tients. General hospitals were to have themost highly specialized staffs and to themwere to be transferred all patients evacu-ated from theaters of operations, exceptthose needing only convalescent care.General hospitals were also to accept pa-tients from the zone of interior whoneeded specialized treatment not given inregional hospitals. Hospitals of all fourtypes were to serve troops on an area basis,irrespective of the command to which thetroops or the hospital belonged, and a hos-pital was to transfer patients to anotherhaving better qualified personnel only ifpatients needed treatment which thetransferring hospital was not staffed togive.20 Thus, while the Service Forces re-tained the right to operate all general hos-pitals and in them to care for all theaterof operations evacuees who needed furtherhospital treatment, the Air Forces gainedthe right to operate regional hospitalswhich were, in effect, general hospitals forzone of interior patients.

Although this change in the hospitalsystem did not achieve integration of Airand Service Forces hospitalization, it didproduce certain advantages. In June theWar Department designated as regionalhospitals thirty AAF and thirty ASF sta-tion hospitals agreed upon between TheSurgeon General and the Air Surgeon.21

Soon afterward both The Surgeon Generaland the Air Surgeon issued directives cov-ering the transfer of patients from stationto regional hospitals.22 For several monthsASF station hospitals had difficulty inadjusting to the idea of transferring com-plicated cases to regional instead of gen-

eral hospitals, and there was little joint useof hospitals by the Air and ServiceForces;23 but by the latter part of 1944 TheInspector General reported that the estab-lishment of regional hospitals had elimi-nated much duplication.24 During 1945,when the patient load became heavy be-cause of the influx of patients from theatersof operations, the care of the more seriousand complicated cases from the zone ofinterior in regional hospitals permittedgeneral hospitals to devote themselvesalmost entirely to the treatment of overseasevacuees.25

The question of whether regional hospi-tals could take over still more of the gen-eral hospital load—and perhaps becomegeneral hospitals themselves—came upearly in 1945. When The Surgeon Generalasked for about 70,000 more beds in gen-

20 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 regionalhospitals was adjusted later as the need arose. Forexample, see WD Cirs 352, 30 Aug 44, and 115, 11Apr 45.

22 (1) Ltr, SG to CGs SvCs attn SvC Surg, 6 Jul 44,sub: Bed Credits in Regional and Gen Hosps, Tab Gto IG Rpt, 28 Dec 44. (2) Ltr, CG AAF (Air Surg) toCG Tng Comd AAF, 2 Sep 44, sub: Bed Credits. (3)AAF Reg 25-17, 6 Jun 44, sub: AAF Hosp and Evacin Continental US. All in HRS: WDCSA 632 (25 Sep44), "Hosp in ZI."

23 (1) Ltr, CG ASF (Dep SG) to CG 9th SvC, 21 Sep

44, sub: Specialized Hosp. SG: 323.3 (9th SvC)AA.Similar letters found under same file number for dif-ferent service commands. (2) Memo, 1st Lt Robert J.Myers, AUS, Med Stat Div SGO for Capt Edward A.Lew, 18 Sep 44, sub: Distr of Pnts in Regional Hospsas 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) CaseNo 28, "Hosp Fac in ZI."

25 (1) Tab B of Memo, Dir Hosp Div and Dir Re-sources Anal Div SGO for Dir HD SGO thru ChiefOprs Serv SGO, 18 Jun 45, sub: Add Mat for An Rptfor FY 1945. HD: 319.1-2. (2) Interv, MD Historianwith Lt Col James T. McGibony, MC, formerly ChiefHosp Div SGO, 20 Feb 50. HD: 000.71.


eral and convalescent hospitals to handlethe growing influx of patients from over-seas, G-4 directed the Air Forces to inves-tigate the possibility of caring for overseaspatients in AAF regional hospitals.26 Tak-ing the position that maximum use had tobe made of all available beds in order tojustify requests for additional beds in gen-eral and convalescent hospitals, G-4 laterdirected that overseas casualties should beplaced in 4,000 beds in AAF regional hos-pitals which the Air Surgeon offered forthat purpose. G-4 stated that this was anemergency measure and did not alter cur-rent policies (presumably the policy estab-lished by the Secretary of War in 1943that all overseas patients, with minor ex-ceptions, should be treated in general hos-pitals).27 The Air Surgeon, who formerlyhad attempted to get separate generalhospitals for the Air Forces and wanted tocare for overseas casualties in AAF hospi-tals, urged immediate compliance withG-4's directive.28

The Surgeon General opposed thismove. Having previously estimated thatthere were 12,000 vacant beds in AAF andASF regional hospitals, he agreed thatregional hospitals could be used for thepurpose proposed but held that there werecertain objections to doing so and that theexpedient should be resorted to only in anemergency which, he contended, had notyet arisen.29 ASF headquarters supportedThe Surgeon General and appealed G-4'sdirective to the Deputy Chief of Staff. Thelatter referred the question for investiga-tion on 19 March 1945 to The InspectorGeneral, who recommended two monthslater (14 May) that vacant beds in bothASF and AAF regional hospitals should beused in the manner proposed by G-4. G-4then sought the Secretary of War's ap-proval of a directive making this recom-

mendation effective. On 20 June the Sec-retary met with G-4 and The SurgeonGeneral, whose opinions on The InspectorGeneral's report he had already received.By that time "events had overtaken thisdisagreement," G-4 reported, for the warin Europe had ended, and "there was nolonger a necessity" of using regional hospi-tal beds to take the load off the generalhospital system. The Surgeon General con-curred with this statement and the originaldemand was accordingly dropped.30

This development did not alter the factthat occupancy of general hospital beds atthe end of June—despite provision of addi-

26 Memo WDGDS 7486, ACofS G-4 WDGS forCG AAF, 11 Jan 45, sub: Care of Add Pnts at AAFRegional Hosps. HRS: G-4 file, "Hosp and EvacPolicy."

27 (1) Memo, CG AAF (Air Surg) for ACofS G-4WDGS, 13 Feb 45, sub: Care of Overseas Casualtiesin AAF Regional Hosps. HRS: G-4 file, "Hosp andEvac Policy." (2) Memo WDGDS 9049, Dep ACofSG-4 for CG AAF and ASF, 27 Feb 45, same sub.HRS: G-4 file, "Hosp, vol. II." (3) Memo, Lt ColC. A. Dixon, G-4 for ACofS G-4 WDGS, 3 Mar 45,sub: Conf on Use of AAF Regional Hosp Beds. Samefile.

28 Memo, Air Surg for ACofS G-4 WDGS, 22 Mar45, sub: Progress Rpt on Care of Overseas Casualtiesin AAF Regional Hosps. HD: TAS 210.721b, "Careof Overseas Casualties in AAF Hosps." Other memo-randums on this subject are in the same file.

29 T/S, Act SG to ACofS G-4 WDGS thru CGASF, 22 Feb 45, sub: Care of Overseas Casualties inAAF Regional Hosps. HRS: G-4 file, "Hosp, vol. II."

30 (1) 1st ind SPOPG (27 Feb 45), CG ASF toDepCofSA, 5 Mar 45, on Memo WDGS 9049, DepACofS G-4 WDGS for CGs ASF and AAF, 27 Feb 45,sub: Care of Overseas Casualties in AAF RegionalHosps. HRS: Hq ASF Planning Div file, 700 "Hospand 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 WDSIG333.9-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 forACofS G-4 WDGS, 2 1 Jun 45, sub: Conf with Sec-War on Rpt of Surv of ZI Hosps, with incl, Memo,Col Kyle (aide to SecWar) for SecWar [31 May 45],sub: ZI Hosps. HRS: G-4 file, "Hosp, vol. IV."


tional beds in the first half of 1945, placinglarge numbers of general hospital patientson leave and furlough for 90 days, andadoption of measures to speed the disposi-tion of patients—ran above what was nor-mally considered the saturation point (80percent of capacity) while the occupancyof regional hospital beds was considerablylower.31 Whether this situation was prefer-able to redistributing the patient loaddepended on the cogency of argumentsagainst the suitability of regional hospitalsfor handling overseas patients. Severalwere of doubtful weight, such as that theuse of these hospitals would "not havefacilitated" observance of the War Depart-ment's policy of hospitalizing patients neartheir homes. On this point the InspectorGeneral's Office and indeed The SurgeonGeneral's own Resources Analysis Divi-sion estimated that 15 to 20 percent of thebeds available in regional hospitals werelocated in areas where population wasdense but general hospital beds few innumber. To the argument that existingspace in general hospitals (that is, on 5March 1945) was still adequate, the replymight have been that it was being kept sopartly by establishing additional beds ingeneral hospitals which The Surgeon Gen-eral had requested. It was also arguedthat filling the beds of regional hospitalswith long-term patients would use up ex-cess capacity needed to provide extra hos-pitalization for troops that would bereturned from Europe for redeployment tothe Pacific. To this the Inspector General'sOffice replied that the need in the lattercase would arise only after the peak loadhad been passed. Nor did the InspectorGeneral's Office agree with The SurgeonGeneral's contention that difficultieswould result from mixing overseas patientswith those from the zone of interior in

regional hospitals. Greater importancemay or may not be attached to The Sur-geon General's argument that the admin-istrative difficulties of adding a largenumber of hospitals to those already treat-ing overseas patients would have out-weighed the gain of 12,000 beds. But itcould not be denied, of course, that "diver-sion of patients from the general hospitalsystem would prevent control of treatmentby the agency now charged with theircare."32

This last argument perhaps held the keyto the entire matter. After the establish-ment of regional hospitals to serve in effectas general hospitals for zone of interiorpatients, the chief remaining distinctionbetween hospital systems of the Air andService Forces was that ASF general hos-pitals, but no AAF hospitals at all, wereauthorized to care for patients returningfrom overseas areas for further medical

31 See below, pp. 210-12. Normally a hospital wasconsidered full when 80 percent of its beds were oc-cupied, because some of its beds were always requiredfor dispersion. In August 1944 the Facilities Utiliza-tion Branch, SGO, proposed reducing the "dispersionfactor" in estimating requirements from 20 to 15 per-cent because of a "liberal furlough policy." (Memo,Eli Ginzberg for SG, 18 Aug 44. HD: Resources AnalDiv file, "Hosp.") In estimating requirements in Jan-uary 1945 no beds for dispersion were included "onthe assumption that furloughs will provide the neces-sary number of empty beds." (Memo, Asst SG for ActDir Plans and Oprs ASF, 8 Jan 45, sub: Gen HospProgram, ZI. SG: 323.3.)

32 (1) 1st ind SPOPG (27 Feb 45), CG ASF toDepCofSA, 5 Mar 45, on Memo WDGDS 9049, DepACofS G-4 WDGS for CGs ASF and AAF, 27 Feb45, sub: Care of Overseas Casualties in AAF RegionalHosps. HRS: Hq ASF Planning Div file, 700 "Hospand Evac." (2) T/S, Act SG to Dep ACofS G-4WDGS 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: Rptof Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May45). (4) Memo, Dir Resources Anal Div SGO forChief Oprs Serv SGO, 20 Jan 45, sub: Sta and Re-gional Hosp Backup for Gen Hosp Syst. SG: 632.2.


and surgical treatment. To have placedsome of them in AAF regional hospitalswould have narrowed if not eliminatedthat distinction. An officer who partici-pated in these transactions afterward inter-preted the controversy in these terms—thedesire of the Air Surgeon to eliminate thatdistinction and the determination of TheSurgeon General to maintain it.33 Thisview seems plausible when the previousefforts of the Air Surgeon to secure a hos-pital system equal to that of the ServiceForces are considered. It may also derivecolor from the fact that The Surgeon Gen-eral, in tracing for the benefit of the Secre-tary of War the events leading up to thecontroversy, started with a reference to theAir Surgeon's attempt to secure generalhospitals for AAF casualties in 1943.34

Further evidence to support such an inter-pretation is the accusation by the Air Sur-geon and members of his staff that TheSurgeon General was using delaying tac-tics. They charged that while he agreed toemploy regional hospital beds for overseascasualties in an emergency he deliberatelyspun out negotiations in an effort to avoidtaking that step at all.35 In any event, thedistinction between general and regionalhospitals remained, and it continued to bethe official policy of the Army to treatoverseas evacuees in general hospitalsonly.

Development of Convalescent Hospitals

Convalescent hospitals were first author-ized as types of Army hospitals in the zoneof interior in April 1944, but their originlay in the early war years.36 Under author-ity granted by the Secretary of War in July1943, the Air Forces announced the estab-lishment of eight convalescent centers inSeptember 1943. They were to operate in

conjunction with station hospitals andwere to rehabilitate AAF patients who hadbeen treated in other hospitals or who hadbeen evacuated from theaters of opera-tions solely because of operational fa-tigue.37 In June 1943 the Service Forcesbegan to establish convalescent annexes inhospital barracks, leased schools and inns,or vacated Army housing. Operated asparts of general hospitals, such annexesnormally housed convalescent patientsonly from the hospitals to which they be-longed, but one of them—the convalescentannex of England General Hospital, set upin leased hotels with a capacity for 2,600patients—served as a convalescent centerfor patients from other general hospitals aswell.38 Partly because of difficulties in find-ing suitable housing for annexes, the pro-gram was slow in getting under way andconvalescent patients accounted for ap-proximately 75 percent of the patient loadof general hospitals in the fall of 1943.Groups studying the hospital system atthat time agreed that convalescent pa-tients should be removed from the wards

33 Interv, MD Historian with Col John C. Fitzpat-rick, MC, formerly MRO, SGO, 18 Apr 50. HD:000.71.

34 Memo, Chief Planning Br G-4 for ACofS G-4WDGS, 21 Jun 45, sub: Conf with SecWar on Rpt ofSurv 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 OverseasCasualties in AAF Hosps." (2) Memo, [Lt Col AlonzoA. 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 MemoSPRMC 632 (19 Oct 43), CG ASF for CofEngrs, 27Oct 43, sub: Auth for Estab of Conv Retraining Unitsat 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.


of general hospitals to permit fuller use ofthe latter's highly specialized staffs.39

During 1944 the convalescent hospitalprogram received impetus from severalsources. Early that year, after his Officehad estimated the patient load for 1944,The Surgeon General requested that addi-tional beds be provided in convalescent"facilities," rather than in general hospi-tals, to save personnel and to permit thereconditioning of patients for return toduty in a nonhospital atmosphere. InMarch ASF headquarters approved thisproposal, and during subsequent monthsservice commands, acting under ASFauthority, established convalescent centersin vacated barracks at Daytona Beach(Florida), Camp Lockett (California),Camp Carson (Colorado), Camp Atter-bury (Indiana), Fort Sam Houston (Tex-as), Fort Custer (Michigan), and FortDevens (Massachusetts).40

Meanwhile, a War Department circularauthorized convalescent hospitals, as dis-tinct from convalescent centers, annexes,and facilities. Accordingly, in June 1944the War Department designated as con-valescent hospitals two ASF and five AAFconvalescent centers which The SurgeonGeneral and the Air Surgeon selected forthat purpose. Two months later, thirteenadditional ASF convalescent centers weredesignated as hospitals, and subsequentlyother changes were made in the numberin operation.41 These hospitals remainedin an experimental stage for the rest of1944. Those of ASF served as places forhousing and feeding ambulatory patientsand for preparing them through physicaland military training for return to duty.Changes in barracks provided for suchhospitals were held to a minimum. Theytherefore lacked classrooms, shops, andgymnasiums that were later—in 1945—

considered essential. In addition, the scopeof activities of convalescent hospitals wasnot clearly defined; their organization wasnot precisely outlined by higher authori-ties; and they had little personnel andequipment of their own.42

An exception to this general situationwas the Old Farms Convalescent Hospital,in Avon, Conn. Established in May 1944as a result of The Surgeon General's andthe President's interest in the rehabilita-tion of blinded war casualties, this hospitalsoon afterward received personnel andequipment for a social-adjustment train-ing program which continued throughoutthe war.43

In the fall and winter of 1944 severalevents brought the convalescent hospitalprogram to full fruition. During a move-ment of higher authorities to reduce thenumbers of beds in the United States, G-4took up the matter of convalescent hospi-tals and in November, as a part of a com-promise solution of the bed requirementproblem, authorized 40,000 beds in AAF

39 (1) Memo, unsigned and unaddressed, 23 Aug43, sub: Status of Program for Estab of Conv Retrain-ing Units. SG: 632.-1. (2) Memo, Dir Hosp AdminDiv 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 CGASF, 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 ConvHosp. 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 ConvHosps." (2) Memo, Eli Ginzberg for Pres WDMB, 23Aug 44. HRS: ASF Planning Div file, 700 "ZI Hosp."(3) ASF Monthly Progress Rpt, Sec 7, Health, 31 May44. (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.


and ASF convalescent hospitals.44 Thisestablished a basis for the procurement ofpersonnel and equipment for such instal-lations. A few weeks later, on 4 December1944, the President directed the Secretaryof War to permit no overseas casualty tobe discharged from the service until hehad received "the maximum benefits ofhospitalization and convalescent facili-ties," including "physical and psychologi-cal rehabilitation, vocational guidance,prevocational training and resocializa-tion." 45 Such unlimited support from theCommander in Chief helped the MedicalDepartment to get necessary means for anelaborate convalescent program, whichThe Surgeon General's ReconditioningConsultants Division announced in De-cember 1944.46

During the first half of 1945, ASF con-valescent hospitals were supplied withpersonnel and equipment of their own;the barracks in which they were locatedwere remodeled; shops, classrooms, gym-nasiums and recreational facilities wereprovided; and elaborate programs consist-ing of technical and prevocational train-ing, general education, vocational coun-seling, occupational therapy, recreation,athletics, and entertainment were set up.47

Thus, toward the end of the war, emphasisin the convalescent program shifted fromthe preparation of patients for return toduty to their preparation for return tocivilian life.

The operation of convalescent hospitalswas a major factor in enabling the Med-ical Department to care for the peak loadof patients in the summer of 1945. It con-tributed to maximum use of specialists ingeneral hospitals. Furthermore, convales-cent hospitals provided a better psycho-logical environment for the care of manypatients, especially those suffering fromneuropsychiatric disorders, than did gen-

eral hospitals.48 Their value in the treat-ment of medical and minor surgical cases,however, was questioned in the middle of1945,49 and general hospitals graduallyadopted a practice of discharging patientsof those types directly to civilian life.

Merger of Adjacent Hospitals

Besides suggesting the removal of con-valescent patients from general hospitals,groups studying the hospital system in thefall of 1943 proposed the merger of adja-cent hospitals into single installations. Theestablishment of regional hospitals accom-plished this in part, for in some cases near-by station hospitals were either wholly orpartially merged with regional hospitals.50

In the same period the Ninth ServiceCommand consolidated the VancouverBarracks Station Hospital with BarnesGeneral Hospital, which was located onthe same post.51 The next April The Sur-

44 Memo, ACofS G-4 WDGS for CGs ASF andAAF, 17 Nov 44, sub: ZI Hosps. SG: 322 "HospMisc."

45 Ltr, Franklin D. Roosevelt to SecWar, 4 Dec 44.HRS: ASF Control Div file, 705 "Cut-back in Genand Conv Fac."

46 (1) ASF Cir 419, 22 Dec 44, sub: Conv Hosp Re-vised Program. (2) TM 8-290, Educ Reconditioning,Dec 44. (3) TM 8-291, Occupational Therapy, Dec44. (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) MemoWDSIG 333.9 Hosp Fac (2), IG for DepCofSA, 14May 45, sub: Rpt of Surv of ZI Hosps. SG: 333WDCSA 632 (14 May 45). (4) An Rpts of ConvHosps 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 ChiefOprs Serv SGO, 7 Jun 45, sub: Criteria for Reductionin Hosp Fac. SG: 323.3 "Hosp."

50 Memo, IG for DepCofSA, 28 Dec 44, sub: HospFac in ZI. HRS: WDCSA 632 (25 Sep 44).

51 1st ind, CG 9th.SvC to CG ASF attn SG, 22 Sep43, on Ltr, SG to CG 9th SvC, 24 Aug 43, sub: Com-bination of Sta Hosp with Gen Hosp. SG: 323.7-5(Barnes GH)K.


geon General's Facilities UtilizationBranch made a study of other sets of gen-eral and station hospitals located on thesame Army posts, comparing personnelrequired to operate them as separate in-stallations with that needed for theiroperation as consolidated hospitals. It ap-peared that fewer Medical Corps officers,particularly specialists, and fewer nurseswould be needed if station hospitals weremerged with near-by general hospitals.52

The Surgeon General's Office anticipatedmore efficient operation from the super-vision of the activities of two installationsby one rather than two commanding of-ficers. Moreover, the commanders of gen-eral hospitals were subject to less controlby post commanders than were those ofstation hospitals—an advantage from TheSurgeon General's viewpoint. The merg-ers were not expected to increase the num-ber of general hospital beds immediately,because general hospitals thus enlargedwould still have to care for troops stationedon their posts. Later as troops moved over-seas, beds formerly used for station hospi-tal patients could be transferred to generalhospital use.53 Accordingly, five stationhospitals were consolidated with five gen-eral hospitals in the summer of 1944, asfollows: Fort Devens Station Hospitalwith Lovell General Hospital, Fort DixStation Hospital with Tilton General Hos-pital, Fort Bliss Station Hospital withWilliam Beaumont General Hospital,Fort Benjamin Harrison Station Hospitalwith Billings General Hospital, and DanteHospital in San Francisco with LettermanGeneral Hospital.54

Attempts To Limit the Use of GeneralHospitals as Debarkation Hospitals

Another change in the hospital systemoccurred when The Surgeon Generalmodified the existing practice of using gen-

eral hospitals located near ports as receiv-ing and evacuation hospitals. Throughoutthe later war years Halloran, Stark, andLetterman General Hospitals continuedto serve as debarkation hospitals, the lat-ter two being devoted almost exclusivelyto that function as the evacuation loadgrew heavier. At various times during1944 and 1945 other general hospitals—Lovell, Barnes, McGuire, Birmingham,LaGarde, Madigan, and Mason—servedalso in that way.55 General hospitals ac-cepted their roles as receiving and evacua-tion, or debarkation hospitals reluctantlybecause the processing of patients intransit did not require the fullest use ofspecialized equipment and staffs and be-cause hospitals engaged in that functionhad alternating periods of activity andidleness, depending upon the arrival ofships with patients.56 Several officers inthe Surgeon General's Office were alsodissatisfied with the practice of having

52 Memo, Chief Fac Util Br SGO for Chief OprsServ SGO, 24 Apr 44, sub: Pers Study of Five Con-tiguous Sets of Sta and Gen Hosps. HD: ResourcesAnal Div file, "Hosp."

53 (1) Ltr, SG to Fed Bd Hosp, 27 Jun 44, sub: Com-bination of Named Gen Hosp and Adj Sta Hosp. SG:323.7-5. (2) Draft Ltr, SecWar (prepared by SGO) toFed Bd Hosp, 12 Jul 44. SG: 322 "Hosp." (3) Interv,MD Historian with Maj Gen Norman T. Kirk, 20Nov 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 Aug44; and No 40, 6 Oct 44. AML. (2) An Rpt, FY 1945,Hosp and Dom Oprs, SGO. HD. (3) Memo, Dir Re-sources Anal Div SGO for Dir HD SGO, 25 Sep 45,sub: Operational Problems and Accomplishments inMed Serv, World War II. HD: 319 "Hosp." (4)Memo, SG for WDMB, 4 Oct 44, sub: DebarkationHosps. SG: 322 "Hosp."

56 (1) Memo, CO Halloran Gen Hosp for CG 2dSvC attn Surg, 21 Feb 44, sub: Increased Bed Capac-ity. SG: 632.2 (Halloran GH)K. (2) Diary, HospAdmin Div SGO, 11 Jan 44. HD: 024.7-3. (3) S/S,SG to CG ASF, 25 Nov 44, sub: 300-Bed Expansionby Conversion, McGuire Gen Hosp, with inds. SG:632.-1 (McGuire GH)K.


general hospitals perform dual functions.The Medical Regulating Officer, for ex-ample, thought that this practice inter-fered with efficient operation of the evac-uation system, and others agreed withhospital commanders that it was wastefulof both personnel and equipment.57 Whenchanges in the hospital system were beingconsidered early in 1944. The SurgeonGeneral proposed establishment of a newtype of hospital, to be known as a receiv-ing and evacuation hospital and to bemanned and equipped to perform onlythe processing of patients in transit.58 Thisproposal was not accepted, and the circu-lar outlining the revised hospital systemin April 1944 provided for the continueduse of existing types of hospitals—station,general, or regional—for debarkationpurposes.59 After that, in the summer of1944, Stark, Letterman, and Halloranseparated general hospital functions fromdebarkation work, becoming to that ex-tent two hospitals in one.60

As the need for beds in both generaland debarkation hospitals increased, TheSurgeon General attempted to keep to aminimum the use of general hospitals fordebarkation processing. In the summer of1944 he secured approval of ASF head-quarters to use the Camp Edwards StationHospital, instead of Lovell General Hos-pital, as a debarkation hospital for theport of Boston. This action, he explained,would make available more general hos-pital beds in New England, a heavilypopulated section with only two generalhospitals. It would also help to economizein the use of Medical Corps officers, sincedebarkation hospitals required less elab-orate staffs than general hospitals.61 In thewinter of 1944, as he planned to meethigher bed requirements which his Officehad estimated for 1945, The Surgeon

General proposed to use other station hos-pitals—those located at staging areas andoperated by the Chief of Transportation—to free some general hospitals of debar-kation work and to provide additionaldebarkation beds that would be neededfor the anticipated load of casualties.62 Asurvey made by the Inspector General'sOffice had already shown that stagingarea hospitals were being used onlyslightly, since few troops were beingmoved overseas.63 The Chief of Transpor-tation agreed to convert hospitals in thestaging areas of the ports of Boston (CampMyles Standish), New York (Camp Kil-mer and Camp Shanks), and HamptonRoads (Camp Patrick Henry) into de-barkation hospitals.64 This action made it

57 (1) Memo, Lt Col John C. Fitzpatrick, MRO, forCol A. H. Schwichtenberg, Hosp Div SGO, 23 May44. TC: 370.05. (2) Memo, Same for Chief Oprs ServSGO, 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. Schwichten-berg, Dir Hosp Admin Div, 2 Feb 44, sub: The MoreEfficient 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 Planfor 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 GenHosp. Off file, Gen Bliss' Off SGO, "Util of ArmyHosp 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, 8Jan 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 No28, "Hosp Fac in ZI."

64 (1) 1st ind SPTOM 632, CofT to SG, 17 Jan 45,on Memo, SG for Med Liaison Off, OCofT, 9 Jan 45.SG: 632. (2) Diary. Lt Col H. A. Huncilman, Plan-ning Div ASF, 25, 27, and 29 Jan 45. HRS: Hq ASFPlanning Div file, 700 "ZI Hosps." (3) Diary, HospDiv SGO, 31 Jan 45. HD: 024.7-3.


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 Hal-loran General Hospital to debarkationwork and made it possible to free all ofMcGuire General Hospital and the CampEdwards Station Hospital, which was con-verted into a general hospital, for special-ized medical and surgical treatment.(Table 12) Later in 1945 the Camp HaanRegional Hospital took over from Bir-mingham General Hospital the processingof patients debarked at Los Angeles.65

Thus, the Surgeon General's Office triedgradually to limit the practice of using

general hospital facilities for debarkationwork.

As the evacuation of patients by air in-creased during 1944 and 1945 the AirForces selected certain station and region-al hospitals located near important land-ing fields to receive and process patients

65 (1) Memo, Dir Resources Anal Div SGO for Maj[James J.] Souder, 22 Mar 45, sub: Debarkation Beds.HD: Resources Anal Div file, "Hosp." (2) Diary,Hosp Div SGO, 7 and 11 Apr 45. HD: 024.7-3. (3)Memo, CG ASF for CofEngrs, 11 Apr 45, sub: PntUnloading Fac, Cp Haan Hosp. SG: 322 "Hosp."


brought to them. By October 1944 bedswere set aside in eleven AAF hospitals forthis purpose.66 Six were used for debark-ing patients in emergencies only. Theother five, located at Mitchel Field (NewYork), Coral Gables (Florida), HamiltonField (California), Great Falls (Montana),and Portland (Oregon), were devoted al-most exclusively to processing patientsevacuated by air.67 In the late spring of1945 the Air Forces, with the concurrenceof The Surgeon General, planned toestablish a new type of zone of interior in-stallation, called a holding facility, at theFairfield-Suisun Field (California). It wasdesigned to perform only one function—the processing of patients who were intransit to other hospitals for definitivetreatment.68 Although the war ended be-fore it was constructed, its approval repre-sented a further development in the move-ment toward the use of less elaboratefacilities than general hospitals for debar-kation purposes.

Extension of the Practice ofEstablishing Specialized Centers

Extension and further development ofthe practice of establishing centers forspecialized treatment in general hospitalsconstituted another adjustment in the hos-pital system during the later war years.Until the middle of 1944 specialty centersin general hospitals took up only a smallproportion of their total beds and wereestablished piecemeal to meet needs asthey arose, without regard to eventual re-quirements for beds for specialized treat-ment. This situation came about becausean army in training needed less specializedcare than one in combat, because it wasdifficult to predict types and amount ofspecialized treatment that would be

needed, and because hospitals themselvesopened successively rather than all to-gether. By the time of the invasion ofEurope, the peak patient load had beenestimated and the last of the general hos-pitals, with the exception of four tempo-rary ones authorized in 1945, were aboutto begin operation. Enough experiencein hospital admissions had accumulatedto permit a breakdown of the anticipatedpatient load in terms of types of wounds,diseases, and injuries. Furthermore, an in-creasing shortage of specialists made theirconcentration for maximum use more im-perative than ever. Thus, whatever theneed for a thoroughgoing program earlier,it became more important and easier toformulate one by the middle of 1944.Therefore, in the summer of that year TheSurgeon General's Facilities UtilizationBranch collaborated with his professionalconsultants in a study of the need for spe-cialized centers and in the preparation ofa comprehensive plan to meet it.69

The general features of this plan, an-nounced in a War Department circular inAugust 1944, remained unchangedthrough the remainder of the war. Related

66 AAF Debarkation Hosp, incl to Memo, SG forWDMB, 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 No28, "Hosp Fac in ZI."

68 (1) S/S, CG AAF to ACofS G-4 WDGS, CofSA,and SecWar, 27 Apr 45, sub: Debarkation Hosp, Fair-field-Suisun Army Air 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, Chair-man Fed Bd Hosp, 15 May 45. All in HRS: OCS 632.

69 (1) Ltr, SG to CG 4th SvC attn SvC Surg, 14 Jun44, sub: Specialized Gen Hosp. SG: 323.7-5 (4thSvC)AA. Similar letters were sent to the rest of theservice 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.


specialties were grouped in the same hos-pital to improve the quality of professionalcare. For example, neurosurgical andneurologic centers were established to-gether, and centers for general medicinewere set up in hospitals specializing in thetreatment of arthritis, tuberculosis, andrheumatic fever. Attempts were made tolocate specialty centers in relation to pop-ulation density, to permit compliance asfar as possible with the policy of hospital-izing patients near their homes. Successin such attempts was limited by at leasttwo factors: (1) there were proportionatelyfewer general hospitals in densely popu-lated areas such as the Northeast thanthere were in the South and Southwest,where they had been located initially toserve large concentrations of troops intraining, and (2) it was either possible ordesirable to establish only a limited num-ber of centers—in some instances as fewas two—in certain specialties such as tu-berculosis, arthritis, and treatment of theblind.

The size of centers increased as thepatient load grew. Although professionalconsultants of the Surgeon General'sOffice believed that they should be keptreasonably small, the Facilities UtilizationBranch considered it more economical ofpersonnel, particularly specialists, to limitthe number but increase the size of cen-ters. In the fall of 1944, for example, am-putation centers were increased from 500to 750 beds each and neurosurgical cen-ters from 250 to 500. Subsequently, tocare for the peak patient load, capacitieswere further increased, some centers hav-ing 2,000 or more beds.

Centers for additional specialties wereestablished to meet new needs and achievefuller use of specialists of all kinds. Forexample, patients suffering from tropical

diseases and trench foot became so nu-merous as to warrant the designation ofcenters for the treatment of those condi-tions, and a shortage of internistsprompted the establishment of generalmedicine as a specialty. General andorthopedic surgery also became special-ties as the field of surgery was narrowedby the establishment of centers for varioussurgical specialties. As a result, the majorportion of beds in general hospitals wasgradually given over to specialized treat-ment, and general hospitals became ineffect specialized hospitals. By the time thepeak patient load was reached in June1945, there were 234 centers for 21 spe-cialties with a total of 132,178 beds in 65general hospitals in the United States.70

General Hospitals for Prisoners of War

A further change in the hospital systemresulted from the capture by Americanforces of large numbers of prisoners of war.For German and Italian prisoners whobecame sick or were injured while in in-ternment camps in this country, the sys-tem of hospitalization formerly establishedwas changed only slightly during the lat-ter half of the war. Such prisoners con-tinued to be treated in station hospitalslocated either in internment camps or onnear-by Army posts and, when theyneeded a higher type of care, in general

70 (1) See last note above. (2) WD Cir 347, 25 Aug44. (3) ASF Cir 284, 30 Aug 44. (4) Ltr SPMCH323.3 (7th SvC)AA, SG to CG 7th SvC attn Surg, 10Aug 44, sub: Specialized Gen Hosps. HD: ResourcesAnal Div file, "Hosp." (5) Tab B to Memo, Dir HospDiv 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 PatientCapacities in General Hospitals by Specialty as of30 June 1945," prepared by Resources Analysis Divi-sion, 30 June 1945. Off file, Resources Analysis Div,SGO.


hospitals operated for U. S. Army pa-tients. All Japanese prisoners were con-centrated, since they were few in number,in the station hospital at Camp McCoy,Wis.71

In the second half of 1943 the offices ofThe Surgeon General and The ProvostMarshal General collaborated in estab-lishing procedures for the reception, ex-amination, and transportation of a newcategory of prisoners—those evacuated aspatients from theaters of operations.72

Early the next year they restated theseprocedures and designated five generalhospitals located near ports to receive andsort such patients and to transfer them toother hospitals for further treatment. Atthe same time, they specified certain gen-eral hospitals for the care of tuberculous,insane, blind, and deaf prisoners; and, inorder to simplify the observance of secu-rity and administrative regulations, theyadopted a practice of concentrating allprisoners who needed general-hospital-type care—those evacuated as patientsfrom theaters of operations as well as thosetransferred from internment camps—inone general hospital if possible, and in notmore than three in any instance, in eachservice command.73 These steps did notsolve all problems. Some general hospitalscontinued to be inadequately prepared tocarry out security measures; and eventhough prisoners were concentrated morethan formerly, they were still scatteredamong hospitals in nine service com-mands. Such dispersal made difficult thework of a commission charged with deter-mining the eligibility of some prisoners forrepatriation as well as that of a group re-sponsible for certifying others for "pro-tected status" as medical personnel, underthe terms of the Geneva Convention.74

In anticipation of an influx of prisoner-

of-war patients after the invasion of Eu-rope and in the hope of solving some ofthe administrative problems caused by theexisting system of hospitalization, TheSurgeon General's liaison officer with TheProvost Marshal General proposed in July1944 that at least one general hospital bedevoted exclusively to German prisonersof war. It could be used to sort incomingpatients, to treat those needing general-hospital-type care, to process those eligiblefor repatriation, and to hold others await-ing certification as protected personnel.75

His superior, the Deputy Chief for Hospi-tals and Domestic Operations, adoptedthis idea and announced on 21 July 1944that The Surgeon General was designat-ing Glennan General Hospital as a Ger-man prisoner-of-war general hospital.76

Two months later The Surgeon Generalasked for an entire Army post for use as asecond 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, PMGto CG each SvC, 4 Jan 45, in An Rpt, FY 1945, PWLiaison Unit SGO. HD. (4) Diary, Hosp Div SGO,7 Oct 44. HD: 024.7-3. (5) Hosp, Evac, and Disposi-tion of PW Pnts in US, by Lt Col James T.McGibony, MC. HD: 383.6.

72 WD 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, 10Apr 44, sub: Immed Designation of Cp for Receptionof Protected Pers and Repatriable PW. (3) Ltr, sameto PMG, 13 May 44, sub: Rpt of Third RepatriationMove, German PW. (4) Ltr, same to Dir Hosp AdminDiv SGO, 13 Aug 44, sub: Rpt of Handling PW asObserved at NYPE and Halloran Gen Hosp. All inHD: 319.1-2.

75 Memo, Chief PW Liaison Unit SGO for SGattn Col A. H. Schwichtenberg, 17 Jul 44, sub: Re-ception, Hosp, Treatment, and Disposition of Pntsamong PW and Protected Pers. HD: 319.1-2.

76 Memo, Dep Chief for Hosp and Dom Oprs SGOfor PMG, 21 Jul 44, sub: Hosp Fac for PW. HD: Re-sources Anal Div file, "Hosp."


pressure at this time to reduce the numberof beds in hospitals in the United States,ASF headquarters suggested the use ofvacant beds in existing hospitals instead.The Surgeon General objected to this pro-posal, averring that all existing generalhospital beds—according to his esti-mates—would be needed by the end ofthe year for American patients, that thetreatment of prisoner-of-war patients whoneeded general-hospital-type care in sta-tion hospitals would violate the terms ofthe Geneva Convention, and that the dis-persion of prisoner-patients among manyregional and station hospitals was wastefulof both medical and police personnel.Early in October, therefore, ASF head-quarters and G-4 approved the designa-tion of the station hospital at Camp Forrest(Tennessee) as Prisoner of War GeneralHospital No. 2.7 7 The establishment of athird prisoner-of-war general hospital wasmade unnecessary by a change in policy.At the end of October 1944 the Chief ofStaff directed the European theater not totransfer prisoner-of-war patients to theUnited States except rabid Nazis andthose desired for questioning for intel-ligence purposes.78 After V-E Day, therepatriation of prisoners made it possibleto return Glennan General Hospital to thetreatment of Americans in June 1945, todiscontinue the general hospital at CampForrest in December 1945, and to closethat camp itself in April 1946.79

The operation of two general hospitalsdevoted exclusively to the care of prisoner-of-war patients simplified administrativeand security problems and ultimatelysaved American medical personnel. Pris-oner-patients arriving at ports in thiscountry were transferred to either Glen-nan or Camp Forrest. There they weresorted into three groups. Those who were

convalescent were transferred to conva-lescent annexes; those requiring care foronly minor ills or injuries were sent tonear-by prisoner-of-war station hospitals;and those requiring more specialized treat-ment were kept at one of the prisoner-of-war general hospitals. In addition,prisoners who were eligible for repatria-tion or for certification as protected per-sonnel were held in special facilities atthese hospitals. After their eligibility hadbeen verified, the former were returned toGermany and the latter were assigned tothe staffs of prisoner-of-war hospitals tocare for their compatriots.80 For a time,prisoner-of-war general hospitals hadduplicate staffs of American and Germanpersonnel. In January 1945 the chief ofThe Surgeon General's Prisoner of WarLiaison Unit reported that the Germanstaffs of such hospitals were requesting re-patriation because they were given littleopportunity to do actual medical andsurgical work. He recommended the re-moval of all American medical personnelexcept the minimum required for keysupervisory positions. The next month theSurgeon General's Office issued directives

77 (1) Memo, SG for CG ASF, 13 Sep 44, sub: AddHosp Fac for PW Pnts. SG: 383.6. (2) Memo, SG forCofS ASF, 4 Oct 44, sub: Hosp Fac for German PWPnts. SG: 322 "Hosp." (3) Diary, Hosp Div SGO, 6Oct 44. HD: 024.7-3.

78 (1) Rad CM-OUT-53129, Marshall to Eisen-hower, 27 Oct 44. SG: 383.6. (2) Memo SPMOC383.6 (30 Oct 44), CG ASF for SG, n d, sub: HospFac for German PW Pnts. Same file.

79 (1) Diary, Hosp Admin Br Hosp Div SGO, 8May 45. HD: 024.7-3. (2) Diary, PW Liaison UnitSGO, 24 May 45. Same file. (3) Hosp, Evac, and Dis-position of PW Pnts in the US, by Col McGibony,MC. HD: 383.6.

80 (1) Diary, Hosp Div SGO, 7 Oct 44. HD: 024.7-3. (2) Memo, Chief Med Liaison Br for Asst PMG, 27Jan 45, sub: Study of Enemy Repatriation. HD:319.1-2. (3) Ltr, Chief PW Med Liaison Unit SGOto SG and PMG, 7 Apr 45, sub: Rpt of Visit to PWGen Hosp No 2, Cp Forrest, Tenn. Same file.


to require compliance with this recom-mendation.81

Establishment of Hospital Centers

A final change in the hospital systemwas the establishment of hospital centers.During 1944 convalescent hospitals wereopened in several instances on the sameposts as general hospitals. With the expan-sions of 1945 these hospitals grew beyondall previous expectations. For example, byApril 1945 the Percy Jones General andConvalescent Hospitals, with their an-nexes, had a strength, including both pa-tients and operating personnel, of morethan 16,500. This was greater than thatof an infantry division. These installationsoccupied not only the Percy Jones Gen-eral Hospital building, located in BattleCreek, Mich., but also almost all of FortCuster, which was situated near by. Inmost instances such installations operatedunder separate commanders. Each hadits own administrative organization foractivities such as receiving and disposingof patients; feeding, clothing, and payingboth patients and operating personnel;and handling mail, personnel records, andlegal problems. Each exercised adminis-trative control over its own patients, re-quiring the transfer of records and achange of command every time a patientwas transferred from one to the other.82

Early in 1945, the chief of the SurgeonGeneral's Operations Service decided thatcombination of such installations under ahospital center commander would sim-plify the administration of supply andservice activities and would permit thetransfer of patients between adjacent gen-eral and convalescent hospitals withoutred tape. This had proved to be true whenhospital centers were established overseas.Meanwhile, the Percy Jones General Hos-

pital had already begun to centralizeunder a single head each activity commonto both hospitals. Therefore the Opera-tions Service sent representatives to ob-serve its organization and operations, andto discuss with its commander plans forestablishing hospital centers. These rep-resentatives found merit in such central-ization, and the Surgeon General's Officedecided to apply it to other installations.83

In establishing hospital centers theMedical Department encountered severaldifficulties. There was opposition in theGeneral Staff, because G-3 feared thatadditional personnel would be requestedto man hospital center headquarters.84

The Surgeon General's Office believedthat the integration of activities commonto both general and convalescent hospitalsunder a single command would actuallysave personnel and therefore agreed to acondition imposed by the General Staff inapproving hospital centers. Personnel forcenter headquarters would be a part of,and not an addition to, that already pro-vided for general and convalescent hospi-tals.85 On 11 April 1945 the War Depart-

81 (1) Memo SPMGO(4)383.6, Chief Med LiaisonBr SGO for Dep Chief Hosp and Dom Oprs SGO, 8Jan 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, FY1945, Hosp and Dom Oprs SGO. HD.

82 An Rpts, 1945, Percy Jones, Wakeman, and CpsButner 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 Jus-tification for Publication, prepared by SGO, 24 Feb45, 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, samesub. (4) DF WDGDS 11065, ACofS G-4 WDGS toTAG, 2 Apr 45, same sub. All in AG: 705 (4-3-44)(1). (5) WD Cir 105, 4 Apr 45.


merit announced that nine hospital cen-ters, each composed of a general and aconvalescent hospital, would be estab-lished at Camp Pickett, Va.; Camp But-ner, N. C.; Camp Edwards, Mass.; CampCarson, Colo.; Camp Atterbury, Ind.;Fort Custer, Mich.; Fort Sam Houston,Tex.; Fort Lewis, Wash.; and Camp For-rest, Tenn.86 Local commanders then raninto problems in consolidating and reor-ganizing general and convalescent hospi-tals into hospital centers. Lacking authori-tative standard guides, center commandersproceeded according to their own ideas orthe demands of the local situation to setup organizations, establish administrativeprocedures, and work out relationshipswith subordinate components, on the onehand, and with post headquarters, on theother.87

Despite these difficulties the establish-ment and operation of hospital centersproved advantageous. The administrationof supply and service activities by centerheadquarters freed hospital commandersof administrative detail, saved personnel,and avoided duplication of effort in thosefields. Centralization also made it easy toshift personnel between hospitals as it wasneeded. Finally, the operation of a singleregistrar's office for both general and con-valescent hospitals made it possible tomove patients from one to the other bysimple inter-ward transfers, rather thanby the complicated procedures requiredwhen they were moved between separateinstallations.88

The establishment of hospital centersrepresented the last of a succession of ad-justments in the hospital system duringthe war. While most of them wereprompted primarily by the necessity ofusing limited resources effectively, otherconsiderations entered in. For exampleregional hospitals developed partially fromattempts of the Air Forces to establish acompletely separate medical service whileconvalescent hospitals received an addi-tional impetus from a belief that convales-cent patients could best be restored tophysical condition for full duty or preparedfor return to civilian life in an installationwith a nonhospital atmosphere. Some ofthe changes made in the latter part of thewar, such as specialization in general hos-pitals, had their origins earlier and weredesigned to improve the quality of hospitalcare. Others, such as the merger of adja-cent station and general hospitals and theestablishment of hospital centers, were ex-pected to improve administration. Sincemost of the changes were the result of war-time demands, when peace came the needfor them no longer existed and the hospitalsystem in the United States reverted to itsprewar 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, TheOrganization of the Medical Department in the Zoneof the Interior (1946), pp. 162-64. HD.

88 An Rpts, 1945, Percy Jones, Wakeman, and CpsCarson and Butner Hosp Ctrs; and An Rpt, FY 1945,Hosp and Dom Oprs SGO. HD.

CHAPTER XI

Bed Requirements in the Zoneof Interior

While most changes in the hospital sys-tem, discussed in the foregoing chapter,were expected to conserve medical re-sources, especially physicians, they obvi-ously were not expected to reduce the totalnumber of beds that would be needed. Insome instances, such changes actuallytended to increase bed requirements, forpolicies making it impossible to place pa-tients of a particular type in any availablevacant bed occasionally required the pro-vision of more beds than otherwise needed.Under current policies, for example, va-cant beds in regional hospitals could notbe used for overseas patients to reduce thenumber of additional beds required ingeneral hospitals. Also, vacant beds in sta-tion hospitals could not be used forprisoner-of-war patients requiring general-hospital-type care to avoid the establish-ment of special prisoner-of-war generalhospitals. Furthermore, the practice ofproviding different types of hospitals fordifferent types of patients complicated thecalculation of requirements, since bedsneeded for different groups had to be esti-mated separately. Another factor whichincreased the difficulty of estimating bedrequirements was the transition from thedefensive to the offensive phase of the war.Because of uncertainty about the tempoand scope of combat operations and aboutthe kind of warfare to be encountered itwas always more difficult to predict num-

bers of combat casualties than numbers ofpatients resulting from the normal inci-dence of diseases and accidental injuries.Nevertheless, estimates had to be madeand it was important to make them asaccurate as possible. Failure to haveenough beds at any particular momentwould not only subject The Surgeon Gen-eral and the Army to severe criticism butwould also jeopardize the treatment ofAmerican casualties. To have more bedsthan were needed would waste personneland might mean, in the face of the ceilingimposed upon Medical Corps officers, in-adequate manning of the hospitals pro-vided. The Surgeon General's Office, ASFheadquarters, the General Staff, and otheragencies of the Government participatedin determining bed requirements, and dif-ferences of opinion that arose among themillustrated the complexity of the process.

Despite the restrictive personnel situ-ation in the fall of 1943, The SurgeonGeneral's Hospital Division continued toconsider the problem of meeting bed re-quirements primarily in terms of construc-tion. Following the former practice of fig-uring bed requirements on the basis ofWorld War I experience, it estimated thatthe number of required station hospitalbeds would decrease from about 256,000in December 1943 to about 80,000 in De-cember 1945, but that the number of bedsneeded in general hospitals would increase

BED REQUIREMENTS IN THE ZONE OF INTERIOR 201

from about 98,500 to over 122,000 in thesame period.1 To meet the anticipatedneed for general hospital beds, The Sur-geon General in September 1943 requestedASF headquarters to earmark and retainfunds that had been appropriated but notused for the construction of approximatelyfifteen additional general hospitals. Thelatter refused, insisting that any additionalgeneral hospital beds that would be neededcould be established without further con-struction in station hospital buildings thatwould become surplus as troops movedoverseas.2

First Attempt To Base Requirementson an Estimate of the Patient Load

Late in 1943 the prospect of the inva-sion of Europe, along with limited amountsof available personnel, and uncertaintyabout the patient load, necessitated amore realistic appraisal of requirementsand resources than any formerly made.The Surgeon General borrowed personnelfrom ASF headquarters, it will be recalled,to establish a special group in his Officefor this purpose. In the winter of 1943-44this group, later known as the FacilitiesUtilization Branch, attempted to predictthe size of the patient load throughout theworld during 1944.3 It admitted that itwas "up against the difficulty of workingwith figures that had little firmness," 4 andits calculations rested upon a series ofestimates: the number of troops to be en-gaged in combat; the rate at which troopsin theaters would suffer wounds, acciden-tal injuries, and diseases; and the propor-tion of patients in theaters that would beevacuated to the United States.

Some of the estimates were based oncurrent World War II information whileothers rested primarily upon World War Iexperience. Projected troop strengths fortheaters were known, but the proportion

of troops to be engaged in combat had tobe estimated. Records were available toshow the rate at which disease and non-battle injuries occurred, but informationabout World War II battle-injury rateswas meager. To estimate these rates theexperience of the Meuse-Argonne fightingin World War I was combined with that ofthe Tunisian campaign (1943), Tarawaoperation (1943), and the German cam-paign in Russia (1941). Information aboutthe German campaign, incidentally, wasfound in a study prepared by the Office ofStrategic Services. The proportion of over-seas patients who would be evacuated tothe United States was estimated on thebasis of World War I experience, "rein-forced by the derived estimate of the Ger-man experience in the Russian campaign."This estimate—30 percent of estimatedbattle casualties and 3 percent of estimateddisease and nonbattle-injury cases—dif-fered only slightly from figures for WorldWar I. These estimates were used to cal-culate the number of patients who wouldneed beds in theaters of operations as wellas the number who would be evacuated tothe United States. To arrive at the numberof patients from the zone of interior who

1 (1) Memo, SG (Hosp Cons Br) for CofEngrs, 24Aug 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 ofAppropriated 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 DomOprs SGO. HD. (2) Tab A, sub: Estab of a StatisticalManagement Unit in the Oprs Serv, to Memo, DirHosp Div SGO and Dir Resources Anal Div SGO forDir HD SGO, 18 Jun 45, sub: Add Mat for An Rptfor FY 1945. HD: 319.1-2. (3) Ltr, [Dr.] Eli Ginzbergto Col Calvin H. Goddard, 2 Jan 52. HD: 314 (Corre-spondence on MS)V.

4 Hosp and Evac: A Re-estimate of the Pnt Loadand Fac, Feb 44, Introduction, p. 1. HD: 705.-1.


would need beds in general hospitals, re-cent experience in transfers from stationhospitals (0.5 percent of the troop popula-tion) was applied to the projected strengthfor 1944.

From the calculations and interpreta-tions of this study the Surgeon General'sOffice estimated that 140,000 beds wouldbe required during 1944 to accommodatepatients evacuated from theaters of oper-ations and transferred from zone of in-terior hospitals. Such patients would nor-mally have been provided for in generalhospitals, but on this occasion The Sur-geon General did not ask for an increasein general hospital beds to 140,000 or evento the 115,000 which, according to hisprevious calculations on the old percent-age basis, would be needed by the end of1944. Instead, in view of the limited num-ber of physicians available and the factthat about 75 percent of the patients ingeneral hospitals were convalescent, heaccepted the existing authorization of100,000 general hospital beds and pro-posed in February 1944 that an additional40,000 beds be provided in convalescent"facilities." Such facilities could be oper-ated either as annexes of general hospitalsor as separate installations and would re-quire lower ratios of personnel (especiallyphysicians) to patients than did generalhospitals.5

Suspecting that The Surgeon General'sfigures were too high, ASF headquartersmade a thoroughgoing study of its own.Its Planning Division conferred with rep-resentatives of the Surgeon General's Of-fice, the Office of the Chief of Transporta-tion, and other interested staff divisions ofASF headquarters. It also communicatedwith the chief surgeons of the Europeanand North African theaters. Differentagencies, using battle-casualty admissionrates that varied widely, arrived nonethe-

less at similar estimates of the patient load,particularly for the first ninety days of op-erations on the European continent.6 InMarch 1944, therefore, ASF headquartersfor the most part approved The SurgeonGeneral's recommendation. It authorizedthe conversion of vacant barracks to pro-vide 25,000 beds for convalescent patientsand agreed to earmark space for 25,000more if needed.7 The Surgeon Generalthen began to establish convalescent facil-ities thus authorized but ASF headquar-ters apparently did not seek approval ofthe General Staff (G-4) for the expansion.As a result the Medical Department failedto get adequate personnel and equipmentfor the facilities that were established untilthe approval of G-4 was finally obtainedin the fall of 1944.

Movement To Reduce the Number ofHospital Beds in the United States

During the spring and summer of 1944other problems, such as changes in thehospital system and the provision of med-ical support for theaters of operations,8

demanded more attention than zone of5 The above two paragraphs are based on the fol-

lowing: (1) Hosp and Evac: A Re-estimate of the PntLoad and Fac, Feb 44. HD: 705.-1. (2) Memo, SG forDir Plans and Oprs ASF, 22 Feb 44, sub: Hosp andEvac. HRS: Hq ASF Planning Div Program Br file,"Hosp and Evac, vol. 3." (3) Ltr, Eli Ginzberg to ColCalvin H. Goddard, 2 Jan 52, HD: 314 (Correspond-ence on MS)V.

6 (1) Memo, Dir Plans and Oprs ASF for Dir Plan-ning Div ASF, 28 Feb 44, sub: Hosp and Evac. HRS:Hq ASF Gen Lutes' files, "Hosp and Evac, 1943-46."(2) Memo, Dir Planning Div ASF for Dir Plans andOprs ASF, 1 Mar 44, sub: Hosp and Evac. HRS: HqASF Planning Div Program Br file, "Hosp and Evac,vol. 3." (3) Memo, Dir Planning Div ASF for ChiefZI Br Planning Div ASF, 2 Mar 44, same sub. Samefile. (4) Hosp and Evac: An Anal, Mar 44. HRS: HqASF Planning Div Program Br file.

7 Memo, CofS ASF for Dir Plans and Oprs ASF, 28Mar 44, sub: Conf on Hosp and Evac. HRS: ASFPlanning Div Program Br file, "Hosp and Evac, vol.3."

8 See above, pp. 181-99, and below, pp. 214-37.


interior bed requirements, but graduallya tendency developed among many agen-cies to question the need for all of the bedspreviously authorized. By the fall of 1944this tendency developed into a generalmovement to reduce their number.

The demand to reduce the number ofbeds in zone of interior hospitals arose atfirst from observation of the low rate of oc-cupancy. Statistics published by the Sur-geon General's Office showed that onlyabout half of the beds in all hospitals inthe United States were used during mostof 1944.9 (Chart 8.) Furthermore, opti-mism about an early end of the war madeit seem unlikely to officers in ASF head-quarters and the General Staff that theoccupancy rate would increase appre-ciably.10 Meanwhile various expedientswere being used to supply theaters withtheir quotas of beds, among them the ship-ment of hospital units without full com-plements of professional personnel.11 TheDeputy Chief of Staff expressed the opin-ion that this practice would be unneces-sary if medical personnel and facilitieswere properly used. He therefore directedThe Inspector General in September 1944to investigate duplication of hospitaliza-tion in the United States.12 By that timeASF headquarters, the War DepartmentManpower Board, and divisions of theGeneral Staff had already begun to maketheir own estimates of bed requirements inthe zone of interior.

A reduction in the authorized ratio ofstation hospital beds had been made sev-eral days before the Deputy Chief of Staffcriticized the use of medical resources. Asearly as May 1944, in the course of discus-sions with the General Staff about nurserequirements, The Surgeon General's Fa-cilities Utilization Branch had informallyproposed a reduction from 4 to 3.6 per-cent of troop strength.13 The General Staff

accepted this suggestion immediately, butit was not until 20 September 1944 that anew ratio of 3.5 percent—formally pro-posed by The Surgeon General in Au-gust—was established by War Depart-ment directive.14 The same directive,however, authorized for the first time aratio for regional hospital beds: 0.5 per-cent of troop strength. Formerly used toestimate the number of beds in generalhospitals needed to care for zone of in-terior patients transferred from stationhospitals, this figure was adopted becausesuch patients were eventually to be trans-ferred to regional instead of general hos-pitals. Since no corresponding reductionwas made in the number of beds author-ized for general hospitals it is difficult tosee that the reduction in the station hospi-tal bed ratio meant any reduction in thetotal number of beds authorized. In anyevent, this action must have seemed toauthorities higher than The Surgeon Gen-eral as only a step in the right direction.

The ASF Director of Plans and Oper-ations proposed a reduction in the number

9 (1) Weekly Health Rpts, vol. IV, Nos 1-39, 1944.AML. (2) ASF Monthly Progress Rpts, Sec 7, Health,Mar-Aug 44.

10 (1) Remarks by Col Albert H. Schwichtenberg,MC, in Notes on Conf of AAF Comd Surgs, Off ofAir Surg, 16-20 Apr 45. SG: 337. (2) Interv, MD His-torian with Lt Col James T. McGibony, MC, 20 Feb50. 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: HospFac in ZI. HRS: WDCSA 632 (25 Sep 44), Case 28,"Hosp Fac in ZI."

13 Memo SPMCH 211 Nurses, Eli Ginzberg forMaj Armour, G-3 WDGS, 25 May 44, sub: Almt ofNurses. HRS: G-3 files, 210-219 incl, "vol. II."

14 (1) DF, Dep ACofS G-3 WDGS to WDMB, G-1and G-4, 10 Jun 44, sub: Almt of Nurses. HRS: G-3files, 210-219 incl, "vol. II." (2) Memo, SG (init E.G[inzberg]) for ACofS G-3 and G-4 WDGS thru CGASF, 29 Aug 44. SG: 632.2. (3) Memo WDGCT 211(26 May 44), Dep ACofS G-3 WDGS for CG ASF, 18Sep 44, sub: Almt of Nurses. Same file. (4) AR 40-1080, C 3, 20 Sep 44.


of beds in all hospitals on 4 September1944. Pointing to the low occupancy rate,to the expectation that regional hospitalswould relieve general hospitals of zone ofinterior patients, and to the fact that bat-tle casualties and their evacuation fromoverseas had been less than estimated, hecalled upon The Surgeon General to ana-lyze the entire hospital program with aview to reducing the number of beds instation and regional hospitals by 25 per-cent and in general hospitals to 80,000.15

To effect this reduction would have meantclosing from twelve to twenty general hos-pitals—a proposal made verbally by theWar Department Manpower Board dur-ing the same month.16

The Surgeon General agreed that toomany station hospital beds had been pro-vided, but he pointed out that he had al-ready begun to reduce their number. Inopposing other reductions he emphasizedfuture possibilities. He called attention tothe tendency of sick rates and hospitaloccupancy to be higher in winter than insummer, to the likelihood of heavier battlecasualties, to the prolongation of the warbeyond what had been expected, to theexpectation that patients from overseaswould need longer periods of hospitaliza-tion in the United States than anticipated,and to the prospect that more beds wouldbe needed in all types of zone of interiorhospitals when the war in Europe endedand redeployment to the Pacific began.He also pointed out that the transfer ofpatients from Europe and North Africahad hardly begun because of the Euro-pean theater's opposition to evacuatingpatients in troop transports and NorthAfrica's lack of adequate shipping.17 Thebed surplus, in short, was only temporaryand earlier estimates would prove correct.These arguments failed to change theopinion of the ASF Director of Plans and

Operations, but on 25 September 1944 hisproposal to require The Surgeon Generalto make the desired reductions wasquashed by General Somervell, who con-sidered it unwise to order such cuts in theface of The Surgeon General's opposi-tion.18

Two days before, on 23 September1944, G-4 directed both AAF and ASFheadquarters to reduce the beds in stationand regional hospitals to the number au-thorized by the new ratios (3.5 and 0.5percent of troop strength respectively) andto plan a further reduction of 25 percentin each—the same cut proposed earlier byASF headquarters.19 Later G-4 appar-ently directed ASF headquarters to planreductions in the number of general hospi-tal beds also.20 The Air Surgeon and TheSurgeon General readily agreed to reducebeds to current authorizations, but theyobjected to a further lowering of the bedratio. Such action, they said, would allowno vacant beds for dispersion or epidemics.It would limit beds in station hospitals to2.6 percent and in regional hospitals to

15 Memo SPOPP 632 (23 Aug 44), CG ASF (DirPlans and Oprs) for SG, 4 Sep 44, sub: ZI Hosp Pro-gram. HRS: ASF Planning Div file, 700 "ZI Hosp."

16 (1) Remarks by Col Schwichtenberg, MC, inNotes on Conf of AAF Comd Surgs, Off of Air Surg,16-20 Apr 45. SG: 337. (2) Transcription of writtenanswers by Maj Gen Norman T. Kirk, USA, Ret, toquestions in Ltr of 10 Nov 50, from Editor, Hist MedDept in World War II. HD: 314 (Correspondence onMS)I.

17 Memo, SG (init E. G[inzberg]) for CG ASF, 15Sep 44, sub: ZI Hosp Program. HRS: Hq ASF Plan-ning Div file, 700 "ZI Hosp."

18 (1) Memo, Dir Plans and Oprs ASF for CG ASF,23 Sep 44, sub: ZI Hosp Program, with incl. HRS:ASF Planning Div file, 700 "ZI Hosp." (2) MRS,[Gen] Somervell to [Maj Gen Wilhelm D.] Styer, 25Sep 44, atchd to Memo just cited. Same file.

19 Memo WDGDS 3221, ACofS G-4 WDGS forCGs AAF, AGF, ASF, 23 Sep 44, sub: Reduction ofZI Hosp. SG: 322 "Hosp Misc."

20 S/S WDGDS 4166, ACofS G-4 WDGS toDepCofSA, 20 Oct 44, sub: ZI Hosp Reqmts. HRS:G-4 files, "Hosp and Evac Policy."


0.4 percent of troop strength, while bedsactually occupied in station hospitalsranged from 2.5 to 2.7 percent of troopstrength.21 While this argument was inprogress the question of general-hospitalbed requirements was being discussedamong G-4, The Surgeon General, andthe War Department Manpower Board.

In these discussions the ManpowerBoard raised two new issues: the proprietyof lumping together the capacities of alltypes of hospitals when considering pres-ent and future needs and of counting bedsin convalescent facilities as part of theseresources. The Manpower Board followedboth practices. It considered all beds inconvalescent facilities as hospital beds andadded to them the beds in station, region-al, and general hospitals to arrive at atotal number of beds already established.Comparing the number of patients in allhospitals with this total, the Board con-cluded that a surplus of 78,000 beds existedin the United States.22 The Surgeon Gen-eral contended that beds in convalescentfacilities should not be considered as hospi-tal beds, since the Board had until thenrefused to allocate personnel for them. Heinsisted, moreover, that beds in hospitalsof different types were not interchange-able. For example, under existing policiesvacant beds in station and regional hospi-tals could not be used for overseas evac-uees. Nor were all beds in general hospi-tals available for the treatment of suchpatients. Some were used for prisoners ofwar, non-Army patients, and Army pa-tients from surrounding areas who neededonly minor care and treatment, whileothers had to be set aside to receiveevacuees in transit from ports to hospitalsof definitive treatment. He argued, there-fore, that the Manpower Board's conclu-sion about a surplus of hospital beds wasinvalid.23

The final decision which the GeneralStaff made in the face of conflicting argu-ments proved to be a compromise. Afterfurther study by G-4 of the beds requiredin all types of hospitals, the Staff agreed inNovember 1944 to authorize 40,000 con-valescent beds—10,500 of them in AAFhospitals. This was substantially the num-ber recommended by The Surgeon Gen-eral and the Air Surgeon and already setup in convalescent hospitals. The Man-power Board now reluctantly agreed toprovide staffs for them. Moreover, theStaff required no cut in the existing num-ber of beds in general hospitals or in theratio authorized for regional hospitals. Onthe other hand it directed a cut in theratio of station hospital beds, but only from3.5 to 3 percent of troop strength insteadof to the 2.6 percent first suggested.24 TheAir Surgeon apparently considered this

21 (1) Memo, CG AAF for CofSA attn G-4, 30 Sep44, sub: Reduction of ZI Hosp. HRS: G-4 files,"Hosp and Evac Policy." (2) Memo, CG AAF (AirSurg) for CofSA attn G-4 Div, 7 Oct 44, same sub.Same file. (3) T/S SPMC 322 Hosp, SG to Dir Plansand Oprs ASF, 30 Sep 44, same sub. HRS: Hq ASFPlanning Div file, 700 "ZI Hosp." (4) Memo, SG(init E. G[inzberg]) for Dir Plans and Oprs ASF, 25Oct 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 forCofSA, 16 Oct 44, sub: ZI Hosp Reqmts. HRS: G-4files, "Hosp and Evac Policy."

23 (1) Memo, Eli Ginzberg, Spec Asst, Dir Hosp DivSGO for Pres WDMB, 23 Aug 44. (2) Memo, SG forCG ASF, 15 Sep 44, sub: ZI Hosp Program. (3) InfMemo, Dir Resources Anal Div SGO for Lt Col Hun-cilman (ASF), 26 Dec 44, sub: Background for Staff-ing Conv Hosps. All in HRS: Hq ASF Planning Divfile, 700 "ZI Hosp."

24 (1) S/S WDGDS 4166, ACofS G-4 WDGS toDep CofSA, 20 Oct 44, sub: ZI Hosp Reqmts. (2) S/SWDGDS 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]) forACofS G-4 WDGS, 2 Nov 44, sub: Reqmts for ASFConv Fac. (5) S/S WDSMB 323.3 (Hosp), PresWDMB to CofSA, 13 Nov 44, sub: ZI Hosps. All inHRS: G-4 files, "Hosp and Evac Policy."


compromise satisfactory, but The SurgeonGeneral's representatives insisted that noreduction at all should be made.25 In an-nouncing the Staffs decision on 17 No-vember 1944, G-4 directed both AAF andASF headquarters to study the hospitalsituation further in the light of actual ex-perience and to submit by 15 January 1945any recommendations which they mighthave on changes in requirements.26

Changes in the Manner of Reporting Beds

The movement to reduce the number ofhospital beds caused a change in themethod of reporting them. ASF head-quarters decided that "unrefined data" onhospitalization, published by the SurgeonGeneral's Office in Weekly Health Re-ports and in ASF Monthly Progress Re-ports, gave erroneous impressions andmade it difficult to arrive at sound conclu-sions about the adequacy of hospital facil-ities.27 Earlier the Surgeon General's Of-fice had warned that a distinction neededto be made between the total number ofbeds in general hospitals and the smallernumber available for "true general-hospi-tal cases." To obtain the latter figure onemust subtract from the total the numberof beds necessarily vacant because of thepractice of distributing patients into wardsaccording to disease, sex, and rank, as wellas those set aside for other purposes—suchas the care of station-hospital-type pa-tients, civilians, veterans, and Navy per-sonnel, and the debarkation processing ofpatients arriving from theaters of opera-tions.28 This implied that to get a true pic-ture of hospitalization not only the capac-ity of hospitals by type but their capacityto handle particular types of patientsshould be known, and that the number ofbeds set aside for special purposes and lostthrough dispersion should be taken intoaccount.

The Surgeon General's regular reportsbegan to take notice of this latter factorin statistics for the end of September 1944.Previously he had reported the number ofbeds authorized (which was reasonablyclose to the number normally available)and the number occupied. Now he addeda figure for "effective beds" in generalhospitals. It was obtained by subtractingan allowance for dispersion and for "de-barkation beds" from the number of au-thorized beds. The following month hepresented similar figures for regional andstation hospitals, and at the same timegave the percentage of effective beds occu-pied in each class of hospital. This per-centage, for all general hospitals, was 76.5;the percentage of authorized beds thatwere occupied (a figure previously givenbut now dropped) would have been 58.1.The next month, instead of reportingsimply beds occupied, The Surgeon Gen-eral showed "patients remaining," a fig-ure which included not only the numberof patients occupying beds but also thenumber temporarily absent on sick leave,on furlough, and without leave. The ratioof "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 attnG-4, 7 Oct 44, sub: Reduction of ZI Hosps. HRS:G-4 files, "Hosp and Evac Policy." (2) Diary, Plansand 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 [WilliamB.] Higgins, G-4, 31 Oct 44, sub: Sta and Reg HospBed Reqmts. SG: 632.2.

26 Memo WDGDS 5391, ACofS G-4 WDGS forCGs AAF and ASF, 17 Nov 44, sub: ZI Hosps. SG:322 "Hosp Misc."

27 (1) Memo SPOPP 705, CG ASF for SG, 20 Nov44, sub: Data on Status of Hosp Beds and Pers, ZI.AG: 323.3 (4 Sep 44) (1). (2) Memo, Maj Gen W. D.Styer for Gen Lutes, 9 Nov 44. HRS: Hq ASF Plan-ning Div file, 700 "ZI Hosp."

28 Memo, Eli Ginzberg, Spec Asst, Dir Hosp DivSGO for Pres WDMB, 23 Aug 44. HRS: Hq ASFPlanning Div file, 700 "ZI Hosp."


91.3 percent. The ratio of beds occupiedto "effective beds" would have been 73.9percent; of beds occupied to beds author-ized, 56.4 percent.29 Thus, although therewas little change in actual occupancy, thenew system of reporting makes it appearthat hospitals were being more fullyutilized than formerly.

By this time (November 1944) a seriesof conferences on bed reporting had al-ready started under the auspices of ASFheadquarters,30 and in February 1945conclusions were reached regarding theother factor considered necessary to a truepresentation of the hospital situation. Inthat month the Surgeon General's Officeand the ASF Planning Division agreedupon a system of reporting beds, patients,and operating personnel in terms of typesof care or types of beds, regardless of theirlocation in particular types of hospitals.31

Four months later the ASF MonthlyProgress Report carried such information.It showed that although there were 213,-373 beds in general and convalescent hos-pitals, only 180,760 were used as generaland convalescent hospital beds.32

Meeting Increased Requirementsfor the Peak Patient Load

Meanwhile the tide had long sinceturned in the drive to reduce hospital bedcapacity. Not long after G-4's compro-mise decision of 17 November 1944, TheSurgeon General's Resources AnalysisDivision made a new study of bed require-ments that showed a need for more beds ingeneral and convalescent hospitals thanG-4 had authorized. There were severalreasons for this study: completion by theMedical Regulating Officer of new esti-mates of patients to be evacuated fromtheaters during 1945, the prospect that re-deployment would interfere with the useof station hospital buildings for any pos-

sible overflow from general hospitals, andG-4's directive that further recommenda-tions about bed requirements be submittedby 15 January 1945.33

In this study the Resources AnalysisDivision concentrated upon general andconvalescent hospitals rather than uponstation and regional hospitals, for therewas little possibility either that G-4 wouldraise the bed ratio for the last two or thatthe Surgeon General's Office would rec-ommend reducing it. In estimating re-quirements for beds in general andconvalescent hospitals, the Division calcu-lated the numbers of beds that would beneeded for three groups of patients: de-barkees, zone of interior and non-Armypatients, and overseas patients. The mini-mum number of debarkation beds needed,it was assumed, was one half the antic-ipated monthly evacuee load, or approxi-mately 17,500. Experience showed that33,000 beds in general hospitals were usedby zone of interior and non-Army patients

29 ASF Monthly Progress Rpts, Sec 7, Health, 30Sep, 31 Oct, and 30 Nov 44.

30 (1) Memo SPOPP 720 (9 Nov 44), Dir Plans andOprs ASF for CofS ASF, 30 Nov 44, sub: Status ofHosp Beds and Med Pers, ZI. AG: 323.3 (4 Sep44)(1). (2) Diary, ASF Planning Div (Lt Col H. A.Huncilman), 28 Nov 44. HRS: Hq ASF Planning Divfile, 700 "ZI Hosp." (3) Memo SPOPP 700, Dir Plan-ning Div for Gen Wood, 26 Dec 44, sub: ZI Hosps.HRS: Hq ASF Planning Div file, "Hosp and Evac."(4) Memo, Maj W. H. Hastings (ASF) for Lt ColH. A. Huncilman, 25 Jan 45, sub: Hosp OccupancyData for Monthly Progress Rpt. HRS: Hq ASF Plan-ning Div file, 700 "ZI Hosp."

31 ASF Cir 68, 26 Feb 45.

32 ASF Monthly Progress Rpt, Sec 7, Health, 30Jun 45.

33 (1) Interv, MD Historian with Col John C. Fitz-patrick, MC, formerly MRO, SGO, 18 Apr 50. HD:000.71. (2) Memo, Eli Ginzberg for the Record, 28Nov 44. HD: 560.-2 (Hosp Ships). (3) Memo for Rec-ord on Memo, CG ASF for SG, 13 Dec 44, sub: GenHosp Program, ZI. HRS: Hq ASF Planning Div file,"Hosp and Evac." Documents dealing with conflict-ing claims to the use of station hospitals are in HRS:G-4 file, 602.3. (4) Memo SPOPP 322, CG ASF forSG, 7 Dec 44. sub: ZI Hosps. SG: 322 "Hosp Misc."


despite the policy of transferring compli-cated cases from station to regional, in-stead of general, hospitals. Beds for over-seas evacuees receiving definitive treat-ment were computed on the basis of thenumber to be brought in each month, asforecast in the study made by the MedicalRegulating Officer, and on the averagelength of time they were expected to stayin hospitals. From these calculations, itappeared that patients in general and con-valescent hospitals would reach a peaknumber of 198,000 in August 1945. If 17,-500 beds were set aside for debarkationprocessing, a total of about 215,000 bedswould then be needed. Additional bedsfor dispersion were not included in thisnumber because it was anticipated thatthe patient load would ordinarily be lowerthan the estimated peak and that manypatients would leave beds vacant whenthey went on leaves and furloughs.34

This study led The Surgeon General on8 January 1945 to ask for 70,000 addition-al general and convalescent hospital beds.He proposed that 49,500 of them shouldbe in general hospitals and that theyshould be provided as follows: 10,000 byconverting the convalescent annexes ofgeneral hospitals into wards; 17,500 byusing hospital barracks for patients insteadof enlisted men of the medical detach-ment, for whom other housing would beprovided; 8,000 by placing ambulatorypatients of general hospitals in post bar-racks; 9,000 by converting four stationhospitals into temporary general hospitals;and 5,000 by using beds in staging areahospitals for debarkation purposes, thusfreeing an equal number of beds in gen-eral hospitals for patients needing pro-longed care. The Surgeon General sug-gested that about 20,500 additional bedsin convalescent hospitals could be pro-vided by using vacant barracks located

near by. In this connection it should benoted that he followed a policy of expand-ing existing hospitals rather than estab-lishing new ones because smaller ratios ofpersonnel to patients were required forlarge than for small installations andscarce specialists were used more advan-tageously by concentrating rather thandispersing them.35

A combination of circumstances inter-vened in December 1944 and January1945 to cause the General Staff to considerfavorably this request. In mid-Decemberthe Battle of the Bulge put to flight allthoughts of an early end to the war inEurope. About the same time, approvalby the Joint Chiefs of Staff of the MedicalRegulating Officer's estimates of evacueesto be received during 1945 made it appearthat the number of patients in zone of in-terior hospitals would increase. In addi-tion, a directive from the Chief of Staff on3 December 1944 requiring the Europeantheater to use transports for evacuationassured the early return to the UnitedStates of many patients from that area.36

Of perhaps more importance, the Secre-tary of War wrote to the Chief of Staffearly 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 Edwardsas a Debarkation Hosp. HRS: G-4 file, 602.3. (2)Memo, Asst SG for Act Dir Plans and Oprs ASF, 8Jan 45, sub: Gen Hosp Program, ZI with tabs andincls. HRS: Hq ASF Planning Div file, "Hosp andEvac." (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 OprsASF, 8 Jan 45, sub: Gen Hosp Program, ZI, with TabsA-J. HRS: Hq ASF Planning Div file, "Hosp andEvac." (2) Memo, SG for CG ASF, 4 Jan 45, sub: Genand Conv Hosps. Same file. (3) Memo, SG for ColPrichard, 22 Feb 45, sub: Background Info Coveringthe 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 Doc-ument 1199, 16 Dec 44. SG: 560.2. (3) Rad CM-OUT-72113 (3 Dec 44), CofSA to CG Hq ComZETO and CG UK Base Sec, 3 Dec 44. SG: 560.2.


have erred [in forecasting requirements] Iwant to make sure that we have erred onthe side of too much."37 Finally, The Sur-geon General's Resources Analysis Divi-sion seems to have established better rela-tions than formerly with the War Depart-ment Manpower Board and a new DeputyChief of Staff of the Army, per haps in-clined to be more favorable to The Sur-geon General's position than his predeces-sor, had taken office in October 1944.38

During the early part of January 1945,Surgeon General Kirk vigorously pushedhis program for additional beds in per-sonal conferences with the commandinggeneral of the Service Forces, members ofthe General Staff, the Deputy Chief ofStaff, the Chief of Staff, and perhaps alsothe Secretary of War. On 20 January 1945it was approved.39

In succeeding months G-4 and TheSurgeon General differed about the num-ber of additional beds actually required.G-4 suggested, it will be recalled, that thenumber might be reduced by placingoverseas patients in vacant beds in AAFregional hospitals. The Air Forces offeredbeds for that purpose and emphasized,along with G-4, the desirability of usingthem to reduce the number of additionalbeds required in other hospitals. WhenThe Surgeon General and ASF headquar-ters argued that no emergency existed torequire such use of regional hospitals, G-4asked ASF headquarters on 3 April 1945for a justification of the number of bedsauthorized in January.40

Meanwhile the Surgeon General's Of-fice had reappraised its former estimate ofrequirements. Beginning in December1944 the number of evacuees arriving inthe United States from all theaters in-creased each month until in March 1945it surpassed by about 12,000 the monthlyaverage on which planning at the end of

December had been based.41 This trendindicated that the peak load in generaland convalescent hospitals would occurin June, two months earlier than previ-ously expected, and that it would behigher by 46,000 patients than the 198,-000 estimated in December 1944. Accord-ingly, in the latter part of March 1945 theSurgeon General's Office asked ASF

37 Memo, SecWar for CofS, n d, included as Tab Bto Memo, WDCSA 700 (13 Jan 45), Asst DepCofSAfor ACofS G-1, G-2, G-3, G-4, and OPD WDGSand 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 Jan45. HD: 024.7-3. Lt. Gen. Joseph T. McNarney wassucceeded by Lt. Gen. Thomas T. Handy as DeputyChief of Staff, United States Army, in October 1944.Info supplied by OCS files.

39 General Kirk had a conference with the Chief ofStaff on 26 December 1944, with the commandinggeneral, ASF, on 5 and 8 January 1945, and withmembers of the General Staff and the Deputy Chiefof Staff on 18 January 1945. (1) Memo WDCSA 632(26 Dec 44). Gen George C. Marshall for GenThomas T. Handy, 26 Dec 44. HRS: OCS 632. (2)Notes for Gen Kirk on Conf with Gen Marshall, Sum-mary, 25 Dec 44. HD: Resources Anal Div file,"Hosp." (3) MRS SPGAA 705 (4 Jan 45), MPD ASFfor Dir Plans and Oprs ASF, 11 Jan 45, sub: Gen andConv Hosps. HRS: Hq ASF Planning Div files, "Hospand Evac." (4) Weekly Diary, Resources Anal Div,SGO, 13 Jan 45. HD: 024.7-3. (5) Memo, Lt ColHuncilman, ASF for the Record, 19 Jan 45. HRS: HqASF Planning Div files, "Hosp and Evac." (6) DFWDGDS 7623, SecWar (G-4) to CG ASF, 20 Jan 45,sub: Gen Hosp Program, ZI. HD: Resources Anal Divfile, "Hosp."

40 (1) See above, pp. 185-86. (2) DF WDGDS11208, ACofS G-4 WDGS to CG ASF, 3 Apr 45, sub:Gen Hosp Program for ZI. HRS: Hq ASF PlanningDiv file, 700 ''Hosp."

41 The increase by month from November 1944through March 1945 was as follows:

Total PatientsYear and Month Returned to U.S.

November 1944 . . . . . . . . . . . . . . . . . . . . . . 19,700December 1944 . . . . . . . . . . . . . . . . . . . . . . 32,511January 1945 . . . . . . . . . . . . . . . . . . . . . . . . 33,382February 1945 . . . . . . . . . . . . . . . . . . . . . . . 38,251March 1945 . . . . . . . . . . . . . . . . . . . . . . . . . 44,845

These figures are from statistics compiled by the Medi-cal Regulating Officer on the basis of monthly reports byport surgeons and the Air Transport Division. History. . . Medical Regulating Service. . . .


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 debar-kation beds and for 25,000 additional con-valescent beds.42 Perhaps in recognition ofthe inconsistency of requesting additionalbeds at a time when they were arguingthat no emergency existed to require theuse of vacant beds in regional hospitalsfor overseas patients, representatives of theSurgeon General's Office and ASF head-quarters agreed in conference on 5 April1945 not to pass this request on to G-4.Instead, they would care for the highernumber of patients in beds already au-thorized by placing more patients onleave and furlough, by speeding the dis-position of cases being treated, and bylimiting general and convalescent hospi-tals more strictly to overseas patients. ASFheadquarters agreed to some additionalconstruction to increase the capacity ofexisting debarkation facilities and justi-fied the beds authorized in January by ex-plaining to G-4 the upward trend inpatient evacuation.43

The peak patient load in the zone of in-

terior occurred at the end of June 1945,approximately two months after V-EDay.44 An analysis of hospital-occupancyfigures at that time shows that all beds ingeneral, convalescent, and regional hospi-tals were needed and that even moremight have been required if many pa-tients had not been placed on leave orfurlough. For example, the patient censusof general, convalescent, and regional hos-

42 (1) Memo, SG for Dir Plans and Oprs ASF, 19Mar 45, sub: Temp Debarkation Reqmts. SG: 632.2.(2) Memo, SG for CG ASF, 23 Mar 45, sub: GenHosp Program, ZI. SG: 322 "Hosp."

43 (1) Memo, SG for CG ASF, 6 Apr 45, sub: GenHosp Program, ZI, with 1st ind. SG: 322 "Hosp." (2)1st ind, CG ASF to ACofS G-4 WDGS, 9 Apr 45, onDF 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 WeeklyHospitalization Reports that include both Army andnon-Army patients as of midnight of Friday of eachweek. Statistical Review, World War II: A Summary ofASF Activities, prepared by the Statistics Branch, Con-trol Division, ASF, lists the average number of Armypatients each month and shows the peak load occur-ring during July.


pitals was 283,306, while the number ofbeds in those hospitals was only 263,027.Of these beds, 203,070 were occupied.The rest of the patients—80,236—wereabsent from hospitals on leave or fur-lough. Not all hospitals were equallyused, and the patient load was unevenlydistributed. General hospitals were filledbeyond the saturation point, normallyconsidered to be 80 percent of their totalbed capacities, and had more than 62,000patients on leave. Regional hospitals, onthe other hand, were only 73.4-percentoccupied, and had few patients on leave.This suggests either that beds in these hos-pitals might have been reduced in numberor that some might have been used foroverseas patients to relieve general hospi-tals of part of their heavy load. In general,ASF hospitals showed higher occupancy

ratios than did those of the Air Forces.This raises the question of whether thenumber of beds in the latter might havebeen reduced or vacant beds in them usedfor more non-AAF personnel. The low oc-cupancy of both AAF and ASF stationhospital beds indicates that the Staff hadbeen justified in reducing their ratio to 3percent and in suggesting even furtherreductions.

A more even distribution of patientsand a fuller utilization of all hospitalswould have been achieved, perhaps, bymodifications of existing hospitalizationpolicies but this was precluded chiefly bythe separation of zone of interior hospitalsinto AAF and ASF hospitals and by thestruggle for power between The SurgeonGeneral and the Air Surgeon. (Table 13,Charts 9, 10)

CHAPTER XII

Estimating and MeetingRequirements of Theaters

for Hospital BedsAlthough estimates of beds required for

theaters were generally made separatelyfrom those for the zone of interior, devel-opments attending the estimation of re-quirements for both areas were in somerespects similar. Such similarities occurreddespite the fact that co-ordination betweeninterested divisions of the Surgeon Gen-eral's Office was incomplete.

Until the late summer of 1943 the PlansDivision of the Surgeon General's Officecontinued to plan hospitalization for ac-tive overseas theaters on the basis of a 10-to 15-percent ratio of fixed beds to troopstrength.1 One reason for this high ratiowas that the director of the Division,aware of public criticism which the Medi-cal Department would incur if it everfailed to have enough beds, desired tohave a sufficient number to meet promptlya greatly accelerated build-up of troopsoverseas and still have enough left to con-stitute a safety factor.2 Another reason ofequal cogency was that sufficient informa-tion about various factors that affectedbed requirements during World War IIwas not yet available to justify the estab-lishment of lower ratios than those de-rived from World War I experience.

Factors Influencing Bed Requirements

Among the factors that influenced bedrequirements were: (1) overseas troopstrengths, both actual and projected; (2)disease and nonbattle-injury hospital-admission rates; (3) battle-casualty hospi-tal-admission rates; (4) the average lengthof time patients stayed in hospitals; and(5) evacuation policies. While troopstrengths and admission rates for diseaseand nonbattle-injury cases could be de-termined with reasonable accuracy, ad-mission rates for battle casualties could beestimated only roughly and were there-fore uncertain at best. The average lengthof time that patients stayed in hospitalsdepended upon some factors that were un-controllable, such as the severity ofwounds and the seriousness of illnesses,and upon others, such as evacuation poli-

1 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 ColonelWelsh the safety factor was an undeployed reservewithin the United States for use in case the enemyemployed atomic, chemical, or biological weaponseffectively.

REQUIREMENTS OF THEATERS FOR HOSPITAL BEDS 215

cies, that could be determined by the WarDepartment.

Evacuation policies governed the num-bers and types of patients to be trans-ferred from theaters to the zone of interiorand were expressed in terms of days. Forexample, a theater which evacuated allpatients requiring 120 or more days ofhospitalization was said to have a "120-day policy." Under such a policy a thea-ter would retain for treatment in its ownhospitals all patients who, it was expected,could be returned to duty within 120 daysand would evacuate the balance, not atthe end of the 120-day period, but as soonas they were able to travel and convey-ances were available. Under a 120-daypolicy the average length of stay ofpatients in theater hospitals was shorterthan under a 180-day policy and morepatients were evacuated to the zone ofinterior. It was estimated, for example,that 30 percent of all battle-casualtypatients were returned to the United Statesunder the former, while only 20 percentwere returned under the latter. Thus theevacuation policy affected the number ofhospital beds required in theaters. It alsoaffected the number needed in the UnitedStates to hospitalize evacuees, the amountof transportation required for patients, andthe number of replacements needed bytheaters. From a theater commander'sviewpoint, the ideal arrangement was tohospitalize in theaters those patients whocould be returned to duty within a "rea-sonable" period of time, thus reducing thenumber of replacements needed, and toevacuate the rest as soon as possible, thusreducing the number of hospital units andthe amount of equipment shipped into andused in the theater. The Surgeon Generalbelieved that a 120-day policy more nearlyapproached the ideal than did any other.3

Establishment of OfficialEvacuation Policies

Although the Surgeon General's Officeand ASF headquarters had tried to getofficial evacuation policies established inthe spring of 1943, final action was delayeduntil August. Being of vital concern totheaters, evacuation policies were nor-mally established by the War Departmentonly after consultation with theater head-quarters, and several months were re-quired to get comments on a proposal ofThe Surgeon General in May 1943 that a120-day policy be officially adopted.4

These replies revealed that all theatersexcept the European and Asiatic (China-Burma-India) agreed upon the desirabilityof that policy. Having enough beds tooperate under a 180-day policy, both theEuropean and Asiatic theaters preferredthe latter. It permitted them to return toduty a greater proportion of experiencedpersonnel. It also enabled them to saveshipping required both to evacuate pa-tients to the United States and to returnreplacements to theaters. In addition, theEuropean theater favored a 180-day pol-icy because it lacked hospital ships forevacuation and its chief surgeon opposedreturning patients to the United States intransports. Although the South Pacific,Southwest Pacific, and North African the-aters preferred a 120-day policy, they re-quested permission to continue operationsunder a 90-day policy because of short -

3 (1) ASF Monthly Progress Rpt, Sec 7, Health, 31Dec 44, pp. 29-34. HD. (2) Memo SPOPP 370.05, DirPlanning Div ASF for Dir Plans and Oprs ASF, 24Jan 45, sub: Review of "Elements of an Evac Policy."HRS: ASF Hq Planning Div File, 370.05 "Hosp andEvac."

4 WD Memo W40-12-43, Evac Policy for OverseasComds, 8 May 43. HD: Wilson files, 008 "Policy reEvac for Overseas." See p. 165.


ages of beds. After analysis of these replies,the War Department announced on 28August 1943 that it was establishing a 180-day policy for the European and Asiatictheaters and a 120-day policy for all othersto become effective as soon as requiredhospital and transportation facilities wereavailable.5

Establishment of Bed Ratiosfor Theaters of Operations

A few days before theater evacuationpolicies were announced, official bed ratioshad been authorized for theaters for thefirst time in World War II. Early in August1943, when the Surgeon General's Officeand the General Staff were concernedabout means of meeting the needs of theArmy with the number of physiciansauthorized, The Inspector General re-ported that members of his staff, includingGeneral Snyder, had found in a survey ofNorth African operations that battle-casualty rates had been lower than antici-pated and that hospitalization require-ments had been met during the first twocampaigns with less than half the numberof beds originally considered essential.6 Inview of this report the Deputy Chief ofStaff of the Army directed OPD to surveybed requirements of all theaters "in thelight of experience to date." Meanwhile,OPD was to limit the total number of bedsshipped overseas, whether in fixed or mo-bile hospitals, to 8 percent of theater troopstrengths.7

In the study that followed, both OPDand the Surgeon General's Office agreedthat fixed and mobile beds should be esti-mated and authorized separately becausethey served different purposes. Designedto support divisions in combat, mobilehospitals cared for patients requiring only

short-duration treatment before return toduty and prepared others for evacuationto the rear. Thus sufficient numbers offixed hospital beds were needed in therear to take over patients whom mobilehospitals could not return to duty. Bothoffices agreed also that theaters should besupplied with "50-percent expansionequipment"—that is, with enough equip-ment to permit each fixed hospital to ex-pand its bed capacity for short periods oftime by 50 percent, without any increasein its authorized personnel. This wouldprovide a safety factor for emergencies.Both offices further agreed that combatoperations up to that time furnished aninsufficient basis for estimating future ratesof battle-casualty admissions, but theydiffered as to how this should affect theestablishment of fixed-bed ratios. A com-putation by the Surgeon General's Officeof beds needed in each theater for diseaseand nonbattle-injury cases, based on expe-rience between the last of 1941 and theearly part of 1943, did not alter its opinionthat the 10- to 15-percent ratio should stillbe adhered to. It therefore recommendedthat this ratio be officially authorized. Be-lieving that fewer beds would suffice, OPDused The Surgeon General's rates for dis-ease and nonbattle injuries along withlimited information available about WorldWar II battle-casualty rates to develop

5 WD Memo W40-19-43, Policy on Evac of S&Wfrom Overseas Comds, 28 Aug 43. HD: Wilson files,008 "Policy re Evac from Overseas Comds." Repliesof theaters to the War Department memorandum of 8May 43 are found in SG: 705.-1.

6 (1) Memo, IG for DepCofSA, 10 Aug 43, sub: Estsof Battle Casualties as Affecting Repls and Plans forEvac and Hosp. HRS: OPD, 700 "ETO." (2) Memo,IG for DepCofSA, 10 Aug 43, sub: Surv of the Orgnand Opr of the MD Fac in NATOUSA and Sicily.Same file.

7 Memo WDCSA 333 (10 Aug 43), DepCofSA forACofS OPD WDGS, 13 Aug 43, sub: Surv of theOrgn and Opr of the MD. HRS: OPD, 700 "ETO."


other ratios of fixed beds that ranged froma low of 4 percent for one theater to a highof 10 percent for others. Abandoning itsformer position because of the limitednumber of physicians now available, theSurgeon General's Office concurred inrecommending these ratios.

As a result, on 24 August 1943, theDeputy Chief of Staff approved the pro-posal to authorize fixed and mobile bedsseparately, agreed to supply all theaterswith 50-percent expansion equipment, andauthorized ratios of fixed beds as follows:8 percent for the European and Asiatic(China-Burma-India) theaters, 10 percentfor the South and Southwest Pacific the-aters, 6.6 percent for the North Africantheater, 6 percent for the Middle East-Central-African theater, and 4 percent forthe American (the Western Hemisphere,exclusive of the United States) theater.8 Ashort time later a ratio of 7 percent wasestablished for the Central Pacific,9 andthe 8 percent ratio for the Asiatic theater,which at first applied only to Americantroop strength, was revised in February1944 to provide 8 percent each for theAmerican forces and the Chinese Army inIndia.10 In establishing such ratios theDeputy Chief of Staff announced that hewas not thereby authorizing additions tothe troop basis. It remained to be seenwhether quotas of beds authorized forvarious theaters could be met with unitsalready included in the troop basis.

Mobile bed requirements were agreedupon in a conference which OPD heldwith representatives of G-3, G-4, ASFheadquarters, the Ground Surgeon, andThe Surgeon General, and were approvedon 23 August 1943 by the Deputy Chief ofStaff. For planning purposes, beds wereauthorized in evacuation hospitals for 3percent, and in convalescent hospitals for

1 percent, of the troops in combat zones.Although there was misunderstandingabout what this meant in terms of units, itwas generally considered that one 400-bedevacuation hospital would be supplied forevery division (except airborne divisions,which were not authorized evacuationhospitals) and for each group of army orcorps troops equivalent in number to adivision; that one 3,000-bed convalescenthospital would be supplied for each groupof nine divisions; and that three portablesurgical hospitals would be supplied,whenever theaters used them, for eachdivision. If 750-bed evacuation hospitalswere used, they were to be supplied innumbers sufficient to give a quantity ofbeds equal to that authorized in 400-bedhospitals. It was expected that portablesurgical hospitals would be used only inthe Pacific and Asiatic theaters and thatconvalescent hospitals would be used asmobile units chiefly in the European andNorth African theaters.11 In addition, spe-

8 (1) Memo, SG for ACofS OPD WDGS, 17 Aug43, sub: Fixed Hosp, Overseas. SG: 701.-1. (2) Memo,Act ACofS OPD for DepCofSA, 20 Aug 43, sub: Survof Orgn and Opr of the MD, with notation: "Ap-proved as amended," by order of SecWar, by ColW. A. Schulgren, Asst Sec WDGS, 24 Aug 43. HRS:OPD, 700 "ETO."

9 This ratio was established before April 1944. SeeMemo, CG ASF for CofSA thru ACofS G-4 WDGS,10 Apr 44, sub: Overseas Hosp. HRS: ASF PlanningDiv Program Br file, "Hosp, Apr 44."

10 (1) Memo OPD 632 (19 Sep 43), ACofS OPDWDGS for DepCofSA, 24 Sep 43, sub: Hosp—AsiaticTheater. HRS: WDCSA 632. (2) DF OPD 632 (22Oct 43), ACofS OPD WDGS to TAG, 1 Feb 44, sub:Hosp in the Asiatic Theater (Beds). HRS: G-4 file,"Hosp and Evac Policy."

11 (1) Memo, [Col] R[obert] B. S[kinner] for Rec-ord, 26 Aug 43. Ground Med files: Chronological file(Col Skinner). (2) Memo, Act ACofS OPD WDGS forDepCofSA, 28 Aug 43, sub: Surv of the Orgn andOpr of the MD. HRS: OPD, 700 "ETO." (3) Memo,Col A[rthur] B. Welsh for Record, 7 Sep 43. SG:632.-2.


cial provision had to be made for the hos-pitalization of Chinese troops in theAsiatic theater. For the Chinese Army inIndia (which had an authorized strengthof 57,000) beds were authorized in evacu-ation hospitals on a 2-percent ratio; andfor the Chinese Army in China, beds wereauthorized in portable surgical hospitalsat the rate of one such unit for each oftwenty-seven divisions.12

Ratios of mobile beds authorized at thistime remained unchanged during thewar; 13 but some theaters never receivedfull quotas and therefore had to improvisemobile hospitals, while others found it de-sirable to use, in addition to authorizedmobile hospital units, some fixed hospitalunits (field hospitals) as mobile hospitals.14

Efforts to Provide TheatersWith Authorized Quotas of Beds

After bed ratios and evacuation policieswere established, adjustments had to bemade in hospital facilities in each theater.Some, notably the South Pacific, CentralPacific, and European theaters, had lessthan their authorized quotas of mobilebeds. Others, the Southwest Pacific, Asi-atic, and North African, had more.15 Afew areas, for example Alaska and theMiddle East, had more fixed beds thanauthorized, while others—the European,North African, Pacific and Asiatic the-aters—had fewer.16 Theaters that had toomany mobile and too few fixed beds werepermitted either to convert excess mobilehospital units into fixed hospital units, aswas done in the Southwest Pacific area,17

or to use mobile units as fixed units, with-out conversion or reorganization, as wasdone in the Asiatic and North Africantheaters.18

When these changes did not erase defi-cits of fixed beds, other methods of increas-ing capacities were employed. The mostobvious was to send additional hospitalunits to theaters. Between September andDecember 1943, 24 general hospital units,10 field hospital units, and 39 station hos-pital units were shipped from the UnitedStates,19 but they were insufficient to sup-ply all theaters with authorized bedcapacities.

Another method was to enlarge hospi-tals already in theaters by increasingcapacities authorized various units bytables of organization and equipment.This was economical of personnel. In thefall of 1943 a 750-bed station hospital, forexample, required 40 officers (of whom 24were Medical Corps officers), 75 nurses,and 392 enlisted men, while three 250-bed

12 (1) Memo OPD 632 (19 Sep 43), ACofS OPDWDGS for DepCofSA, 24 Sep 43, sub: Hosp—AsiaticTheater. HRS: WDCSA 632. (2) DF OPD 632 (22Oct 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 Jan45, sub: The Med Mission Reappraised. HRS: G-4file, "Hosp and Evac, vol. II."

14 These developments will be discussed fully in avolume planned for this series on hospitalization andevacuation in theaters of operations.

15 Table Showing Mobile Hosp Units in Theaters,Tab X to Memo. Act ACofS OPD WDGS forDepCofSA, 28 Aug 43, sub: Surv of Orgn and Opr ofthe 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 forOverseas Comds (Hosp Units). SG: 320.2. (2) Ltr AG322 (14 Oct 43) OB-I-SPMOU-M, TAG to Comdr-In-Chief SWPA, 18 Oct 43, sub: Reorgn and Redes-ignation of Certain Hosp Units, SWPA. SG: 320.3-1.

18 (1) DF OPD 632 (22 Oct 43), ACofS OPDWDGS to TAG, 1 Feb 44, sub: Hosp—Asiatic The-ater (Beds). HRS: G-4 file, "Hosp and Evac Policy."(2) Rpt, Asst Comdt MFSS, Carlisle Bks to SG, 29Nov 43, sub: Visit to ETO and NATO, 1 Sep-24 Oct43. SG: 333.1.

19 An Rpt, MOOD SGO, FY 1944. HD.


station hospitals required 63 officers (ofwhom 39 were Medical Corps officers), 90nurses, and 450 enlisted men.20 For thisreason the Surgeon General's Office hadproposed as early as the summer of 1943that from 66% to 80 percent of all fixedbeds should be in general hospitals (1,000-bed capacity) and the remainder insmaller units.21 In the fall of 1943 the Cen-tral Pacific theater enlarged the table-of-organization capacities of some of its hos-pitals in order to provide additional fixedbeds with a minimum of additional per-sonnel,22 and in December 1943 The Sur-geon General asked other theaters to dolikewise.23

A third method of increasing numbersof fixed beds was to expand hospitals be-yond table-of-organization capacities—that is, to have a 1,000-bed general hospi-tal, for example, set up beds and tempo-rarily care for more than 1,000 patientswithout any increase in personnel. Antici-pated in the provision that theaters beauthorized 50-percent expansion equip-ment, this method was used in many in-stances, particularly in the SouthwestPacific and North African theaters, in thefall and winter of 1943.24

If bed capacities were not increasedsufficiently by these means, theaters werepermitted temporary "reductions" in offi-cial evacuation policies to enable them totransfer mope patients to the UnitedStates. The South Pacific theater, for ex-ample, operated under a 60-day evacu-ation policy until January 1944 andchanged to a 90-day policy in February,while the North African theater followed a90-day policy until May 1944.25

Although some theaters objected tousing the expedients discussed above,26 allsucceeded in meeting hospitalization needsduring the winter of 1943-44. While none

having a deficit of fixed beds in the fall of1943 reached its authorized quota by theend of the year, only one—the NorthAfrican theater—had more patients thanit did table-of-organization beds.27

While efforts were being made to supplytheaters with authorized quotas of fixedbeds, the Surgeon General's Plans Divi-sion was looking toward the future. Astheaters built up troop strengths andplanned combat operations, they calledupon the War Department for specifictypes and numbers of units to meet antici-pated needs. The OPD and G-3 Divisionsof the General Staff, attempting to meettheater requests if possible, periodicallyissued a "Six Months Forecast"—a docu-ment showing units needed and the time

20 See T/O 8-560, Sta Hosp, 22 Jul 42 with C 1, 5Sep 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: Wilsonfiles, "Day File, Jun 43." (2) Memo for Record onDraft Memo, Asst to CofS ASF for ACofS OPDWDGS, 23 Jun 43, sub: Proposed Rad for CertainOverseas Theaters Concerning Fixed Hosp Policy.Same file. It is not readily apparent how such a per-centage could be applied generally, unless the essen-tial difference between functions of general and sta-tion hospitals were to be ignored.

22 Ltr AG 322 (24 Sep 43)OB-I-SPMOU-M,TAG to CG USAFCPA, SG, and Chiefs of TecServs, 28 Sep 43, sub: Reorgn of Sta and Gen Hospsin CPA. SG: 320.3-1.

23 (1) Diary, MOOB SGO, 4-10 Dec 43. HD:024.7-5, "MOOB Diary." (2) Rad CM-OUT-8738(23 Dec 43), CG ASF to theater commanders. SG:322.15-1.

24 (1) Notes atchd to Memo, Col William L. Wil-son, MC for Chief Control Div [SGO], 1 Nov 43, sub:Visit to SWPA. SG: 333.1-1 (Aust) F. (2) Rad CM-IN-9494 (15 Jan 44), Algiers to AGWAR, 14 Jan 44.SG: 322.15-1.

25 (1) Rad CM-IN-18720 (25 May 44), CGNATO to WD, 24 May 44. HRS: G-4 file, "Hospand Evac Policy." (2) Rad CM-OUT-42858 (28May 44), WD to CG NATO, 27 May 44. Same file.

26 Theater objections will be discussed in a volumeplanned for this series on hospitalization and evacua-tion in theaters of operations.

27 See Chart 11.


of their shipment.28 Hospital units listed inthe "Forecast" did not always exist in thiscountry, and it was sometimes necessary tomake adjustments among units alreadyactivated. The Surgeon General's PlansDivision proposed such action. For exam-ple, in November 1943 the Mobilizationand Overseas Operations Branch made astudy of units required by the eighth revi-sion of the "Forecast" and found thatmore station hospital units of 750-, 250-,200-, 150-, 100-, and 25-bed capacitieshad been activated than were needed butthat fewer general and field hospital unitshad been activated than were required.The Surgeon General's Office then recom-mended the inactivation and reorganiza-tion of certain station hospital units inorder to supply personnel for the requirednumber of general and field hospitals.29

ASF headquarters approved this recom-mendation and orders were issued to makeit effective. At successive times later, as forexample in September 1944, the SurgeonGeneral's Office suggested similar actionto insure the availability of units in thetypes and sizes desired by theaters.30

In addition to recommending adjust-ments among types of hospital units beingprepared for overseas service, the SurgeonGeneral's Office took other actions in thefall of 1943 to meet future needs. After theDeputy Chief of Staff authorized 50-percent expansion equipment for fixedhospitals in theaters, the Mobilization andOverseas Operations Branch co-operatedwith the Supply Service of the SurgeonGeneral's Office in securing authority toprocure the equipment thus authorized.31

In addition, the troop basis of 1944 was re-viewed and G-3 agreed to increase thenumber of fixed hospital units included init to provide 20,000 additional beds. Evenso, the troop basis did not list enough units

to supply all theaters with quotas author-ized by the Deputy Chief of Staff in August1943.32 Finally, and not of least impor-tance, under a system of telegraphic re-porting initiated in July 1943, the SurgeonGeneral's Office began to receive fromtheaters fuller, more accurate, and morecurrent data on which to base studies ofadmission rates.33

Problems encountered in the fall andwinter of 1943 in providing theaters withauthorized quotas of fixed beds weremerely a preview of 1944. The increasingscope and intensity of combat operationscreated more pressing needs for hospitali-zation and at the same time, by using upmore personnel in the form of replace-ments, accentuated the shortage of menfor assignment to hospital units. From theearly part of 1944 this shortage was sogreat that it became one of the controllingfactors in planning overseas hospitaliza-tion. Early in February 1944 the SurgeonGeneral's Office warned ASF headquar-

28 An example of this document, Twentieth Revi-sion of the Six Months Forecast, Units and Availabil-ity, Data as of 20 Oct 44, Based on OPD Reqmts 5Oct 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 Non-Div Med Units. SG: 322.3-1.

30 Ltr, SG to CG ASF, 8 Sep 44, sub: Reorgn ofMed Units. SG: 320.3-1.

31 (1) Memo, SG for ACofS OPD WDGS, thru CGASF, 9 Dec 43, sub: Recommended Changes in Vic-tory Program Trp Basis, Revision of 22 Nov 43, withind. SG: 322.15-1. (2) Memo, Act Chief Sup ServSGO for SG, 28 Dec 43, sub: Fixed Beds Overseas inArmy Sup Program. SG: G32.-2. (3) Memo, DepChief Oprs Serv SGO for SG, 30 Dec 43. SG: 632.-2.

32 Memo for Record on DF, ACofS G-3 WDGS toACofS OPD WDGS, 26 Jan 44. HR 3: G-3 file, 700-800.

33 Memo WDGDS 6442, Act ACofS G-4 WDGSfor CG ASF, 7 Sep 43, sub: Hosp in Overseas Thea-ters, with 1st ind, SG to ACofS G-4 WDGS, 17 Sep43. SG: 701.-1.


ters that it would be impossible to meettheater requirements unless enlisted menwere supplied in sufficient numbers toactivate and train the units authorized.34

Soon afterward ASF headquarters in-formed G-3 that the Service Forces had72,813 fewer men than were needed toactivate units according to schedule andthat 27,160 men were needed for MedicalDepartment units alone.35 Urgent requestsfrom ASF headquarters for more menwere of little avail, and during the firstfour months of 1944 only 12 general, 1 sta-tion, and 11 field hospital units were acti-vated. In May the Medical Departmentreceived its first substantial allotment ofpersonnel for numbered hospitals during1944 and activated that month 11 generaland 3 field hospital units. Then, duringsubsequent months, as a result of the pol-icy of releasing from zone of interior instal-lations men who were qualified for over-seas service, additional men became avail-able, and during the five months begin-ning with June and ending with October98 general, 8 station, and 43 field hospitalunits were activated.36 Thus few hospitalunits were activated during 1944 until thelatter half of the year.

The Medical Department also had diffi-culty in procuring enough Medical Corpsofficers to man the units activated. Asearly as February 1944 the director of theSurgeon General's Military PersonnelDivision stated that there would not beenough Medical Corps specialists to staffhospitals being sent overseas and that someunits would have to be shipped withoutspecialists.37 A month later the SurgeonGeneral's Office reported to ASF head-quarters that physicians to staff forty gen-eral hospital units then in training couldnot be procured until June and that fullofficer strength for nine of the general hos-

pitals activated in March would not beavailable until August.38

Use of Negro Hospital Units

The use of Negro personnel—doctors,nurses, and enlisted men—to help relievethe general personnel shortage and meettheater needs for hospital units was com-plicated by existing policies and practicesand by the attitude of theater command-ers and surgeons.39 Following a practiceadopted early in the war—the organiza-tion of all-Negro units to provide oppor-tunities for the use of Negro doctors andnurses—the War Department activated athird Negro hospital unit—the 335th Sta-tion Hospital—in August 1943. Mean-while the 268th Station Hospital unit,which had been activated five monthsearlier, completed its training and inOctober 1943 embarked for the SouthwestPacific.40

34 (1) Ltr, SG to CG ASF, 15 Feb 44, sub: Projec-tion 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 thruACofS OPD WDGS, 18 Mar 44, sub: Projection ofNon-Div Med Units, with incls. HRS: Hq ASF, LtGen LeR. Lutes' file, "Hosp and Evac, Jun 43 thruDec 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 Destinedfor Shipment to ETO. SG: 320.3-1.

38 Memo, Dir Mob Div ASF for Dir Plans and OprsASF, 25 Mar 44, sub: Status of Med Units. HRS: HqASF, Lt Gen LeR. Lutes' file, "Hosp and Evac, Jun43 thru Dec 46."

39 These questions will be discussed fully in John H.McMinn and Max Levin, Personnel (MS for com-panion vol. in Medical Dept, series), HD. Also seeUlysses Lee, The Employment of Negro Troops,forthcoming volume in UNITED STATES ARMYIN WORLD WAR II.

40 (1) An Rpt, 335th Sta Hosp, 1944. HD. (2)Quarterly Rpt, 268th Sta Hosp, Jul 44. HD.


With the need to use Negro personnelincreasing as difficulties in meeting theaterrequirements mounted, the War Depart-ment in January 1944 requested all the-aters to state whether or not they woulduse all-Negro hospital units. Most repliednegatively. Fearing loss of the services ofthe 335th Station Hospital unit, The Sur-geon General in May 1944 appealed toASF headquarters for "efforts [to] bemade to obtain an appropriate assign-ment" for it.41 The same month he ap-pealed personally to the chief surgeon ofthe European theater to use Negro nursesin at least one hospital.42 The chief sur-geon agreed, and in July 1944 sixty-threeNegro nurses, among whom were somewho had formerly served with the 25thStation Hospital in Africa and had beenreturned to the United States at the end of1943, arrived in the European theater.After a period of training they wereassigned in September to replace whitenurses in the 168th Station Hospital.43

Meanwhile an assignment for the 335thStation Hospital had been found. In June1944 the chief surgeon of the China-Burma-India theater made a trip to Wash-ington to explain in person his desperateneed for additional hospital units. Amongthe means of meeting the need, in view ofthe general shortage of units for shipmentoverseas, the low priority of the China-Burma-India theater, and the demands ofother theaters, the use of the 335th Sta-tion Hospital was proposed. The theatersurgeon agreed to accept this unit with anoverstrength of sufficient size to permit theorganization of an additional hospital inthe theater.44 As a result the 335th StationHospital embarked in August 1944 andwas stationed on the Stillwell Road afterits arrival in Asia. According to plan, itwas reorganized in December 1944 and its

capacity was reduced from 150 to 100beds. The personnel thus made surplus,along with that carried as overstrength,was used to form another 100-bed all-Negro hospital unit—the 383d StationHospital. Both units continued to servetogether as one hospital until the 383d wassent to the Philippines in August 1945.45

Thus, although Negroes served in theMedical Department overseas in organicmedical units of divisions and in suchother units as sanitary companies, the useof Negro professional personnel in hospitalunits was limited to the 25th Station Hos-pital (a Negro unit with four white officersin command and supervisory positions),the 268th, 335th, and 383d Station Hospi-tals (all-Negro units), and the 168th Sta-tion Hospital (a white unit with Negronurses).

Estimating Requirementsfor Major Combat Operations

Before the full impact of personnelshortages was felt, the Surgeon General'sOffice began early in 1944 to estimate hos-pitalization and evacuation requirementsfor full-scale combat operations. In No-vember and December 1943 the Com-

41 Memo, SG for Dir Planning Div ASF, 17 May44, sub: Overseas Employment of 335th Sta Hosp(Colored). AG: 370.05 (335th Sta Hosp) 1944-1.

42 Ltr, SG to Chief Surg, ETOUSA, 16 May 44.HD: ETO file, "Kirk-Hawley Corresp."

43 An Rpt, 168th Sta Hosp, 1944. HD.44 (1) Memo for Record, 30 Jun 44, sub: Hosp in

CBI, by Chief Theater Br MOOD SGO. HD: 024"MOOD (CBI)." (2) Ltr, Col Robert P. Williams,Theater Surg USAF in CBI to Col George E. Arm-strong, Dep Theater Surg USAF in CBI, 30 Jun 44.Same file. (3) Interv, MD Historian with Brig GenRobert P. Williams, 13 and 15 Feb 50. HD: 000.71.

45 (1) An Rpt, 335th Sta Hosp, 1944. HD. (2) FinalRpt, 383d Sta Hosp, Jul 45. HD. (3) AG Unit Card,383d Sta Hosp. Orgn and Directory Sec, Oprs Br,Admin Servs Div, AGO.


bined Chiefs of Staff met with PresidentRoosevelt and Prime Minister Churchillat the SEXTANT conference in Cairo andthen with the President, the Prime Minis-ter, and Marshal Stalin at Teheran.46 Thedecision of these conferences to mountboth OVERLORD (the invasion of Europefrom England) and ANVIL (the invasion ofSouthern France from bases in the Medi-terranean) during May 1944 focused at-tention on the European and North Afri-can theaters,47 and twice during the win-ter of 1943-44 the Surgeon General'sOffice made studies of their need for hos-pital beds. On the basis of the first, madeby the Mobilization and Overseas Oper-ations Branch,48 The Surgeon Generalrecommended to ASF headquarters thatNorth Africa be supplied with additionalhospital units and with additional per-sonnel for existing units to raise its bedcapacity to its authorized quota, and toG-4 that the current bed ratios of both theEuropean and North African theaters beraised.49 Both recommendations were dis-approved. OPD was handling requestsfrom North Africa for additional person-nel and hospital units. Because of theshortage of personnel in the United States,it proposed that the North African theaterincrease is fixed-bed capacity by usingpersonnel already in the theater to expandexisting hospitals.50 G-4 disapproved rais-ing current bed ratios because it believedhospital units supplied under them wouldprovide sufficient beds for the early phasesof operations on the European continent.If additional beds should then be needed,they could be sent later. Meanwhile, boththeaters could use expansion equipmentto increase capacities of existing hospitalsfor emergencies, and the European thea-ter, if it should have a shortage of beds,could reduce its evacuation policy from

180 to 120 days and thus send a largerproportion of patients to the UnitedStates.51

The Surgeon General "strongly urged"that the decision not to send additionalpersonnel and units to North Africa be re-considered. He concurred in the decisionnot to raise bed ratios, but recommendedthat it be considered temporary, pendingaccumulation of more definite informa-tion about needs. Furthermore, he warnedthat evacuation facilities (ships andplanes) would have to be adequate to re-move patients from theaters if they werenot given additional beds.52 Meanwhile,his office had begun another study of theneeds of overseas theaters.

The second study, made by the Facil-ities Utilization Branch of the HospitalAdministration Division in connectionwith its attempt to estimate the number ofbeds that would be needed in the UnitedStates, 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 DivProgram Br file, "Gen, vol. 2, 17 Jul 44." The inva-sions 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 CGASF, 11 Jan 44, sub: Fixed Bed Hosps, NATO andETO. HRS: G-4 file, "Hosp and Evac Policy."

49 Memo, SG for Dir Planning Div ASF, 17 Jan 44,sub: Serv Units for NA Forces. HRS: Hq ASF Plan-ning Div Program Br file, "Hosp and Evac, vol. 3."

50 Rad CM-OUT-8230 (21 Jan 44), ACofS OPDWDGS to CG NATO, 20 Jan 44. SG: 322.15-1.

51 DF WDGDS 9381, ACofS G-4 WDGS to ACofSOPD WDGS and CG ASF, 11 Jan 44, sub: Fixed BedHosps, NATO and ETO. HRS: G-4 file, "Hosp andEvac Policy."

52 (1) Memo, SG for CG ASF, 17 Feb 44, sub: ServUnits for NA forces. HRS: Hq ASF Planning Div Pro-gram Br file, "Hosp and Evac, vol. 3." (2) T/S, SG toACofS G-4 WDGS thru CG ASF Planning Div, 9Feb 44, sub: Fixed Bed Hosps, NATO and ETO. SG:632.2.


all theaters as well as of the United Statesfor hospitalization and evacuation facil-ities. Among the general conclusionsdrawn from this study were the following:under existing plans there would be ashortage of beds in both the European andNorth African theaters after the mountingof OVERLORD and ANVIL; the number ofpatients that would be brought back tothe United States each month would riseto 40,000, of whom 60 to 70 percent wouldbe in the "helpless" category; there wouldbe a shortage of space on transports andhospital ships for evacuation from theEuropean and North African theaters;using only the evacuation facilitiesplanned, not more than 20 percent of allpatients would be returned on hospitalships; and air evacuation offered littlepromise of supplementing ships in view ofpast accomplishments.53 Ultimately actionwas taken upon each of these problems,but only those pertaining to theater hospi-talization will be discussed at this point.

Decisions concerning overseas hospital-ization were made at a conference on 28March 1944. At that time General Somer-vell directed (1) that the number of bedssupplied to Europe and North Africaunder existing ratios should be increased,(2) that the General Staff should be re-quested to raise the authorized ratio forNorth Africa from 6.6 to 8.5 percent, and(3) that bed requirements for all theatersshould be reviewed.54 Plans to supply ad-ditional beds to Europe and North Africawere colored by the shortage of personneland of trained hospital units in the UnitedStates. To furnish the European theaterwith a total of ninety-one general hospitalsby the end of July, some had to be shippedbefore completion of training.55 Theshortage of fixed beds in North Africa wasalleviated, as OPD had suggested earlier,

by expanding table-of-organization ca-pacities of existing hospitals with person-nel available in the theater. With WarDepartment approval, that theater inac-tivated six 250-bed station hospitals andwith personnel formerly assigned to themexpanded twelve 1,000-bed general hospi-tals to 1,500-bed capacities and five to2,000-bed capacities. This increased thefixed-bed capacity by 9,500 beds andbrought the ratio of available beds totroops up to 6.4 percent.56

The question of raising the ratio forNorth Africa became involved in a gen-eral review of bed requirements for alltheaters because the General Staff refusedto consider the former before completionof the latter.57 Prepared by the ASF Plan-ning Division and the Strategic LogisticsPlanning Unit of the Surgeon General's

53 (1) Hosp and Evac: A Re-estimate of the PntLoad 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, "Hospand Evac, vol. 3."

54 (1) Memo, CG ASF for Dir Planning Div ASF,28 Mar 44, sub: Hosp. HRS: Hq ASF Planning DivProgram 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 forCol Bogart, ASF, 4 Apr 44, sub: ETO Hosp. HRS:Hq ASF Planning Div Program Br file, "Hosp andEvac, vol. 3."

56 (1) Rad CM-IN-16542 (23 Mar 44), CG USAFNATO 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. Samefile. (3) Memo SPOPI 632, Dir Plans and Oprs ASFfor ACofS G-3 WDGS, 29 Mar 44, sub: Expansion ofGen Hosps in NATO. HRS: Hq ASF Planning DivProgram 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: HqASF Planning Div Program Br file. "Hosp and Evac,Apr 44." (2) Memo WDGSA/371 NATO (31 Mar44), CofSA for CG ASF thru ACofS OPD WDGS, 4Apr 44, sub: Deficiency of Fixed Hosp Units inNATO. HRS: Hq ASF Planning Div Program Br file,"Hosp and Evac, vol. 3."


Office, the general review was presentedto the General Staff on 10 April 1944.58

It was based upon recommendations oftheaters, the average occupancy of beds intheaters during the previous six months,and the number of hospital units includedin the troop basis. It represented an at-tempt to balance bed requirements againstthe number of hospital units already au-thorized.

Most of its proposals were accepted byG-4: that the bed ratio of the SouthwestPacific should be reduced from 10 to 8percent, and of the Central Pacific from 7to 5 percent, and that ratios for the Euro-pean, Middle East, and American thea-ters should remain unchanged. G-4rejected the proposal to raise the NorthAfrican bed ratio above 6.6 percent, stat-ing that the theater had gotten alongsatisfactorily on it and that the invasion ofSouthern France was uncertain. NorthAfrica's later request (in May 1944) tochange its evacuation policy from 90 to120 days indicates that this decision was

justified. G-4 also believed that the SouthPacific ratio should be reduced from 10 to6 percent (since the theater itself hadrecommended only 5 percent) instead ofto 7 percent as ASF headquarters and theSurgeon General's Office proposed. Whilethe two latter authorities recommendedthat the China-Burma-India ratio be re-duced from 8 to 7 percent, G-4 thoughtthat beds for the Chinese Army in Indiashould remain at 8 percent and that theratio for American troops only should bereduced to 7 percent.

The Deputy Chief of Staff approvedG-4's findings. This meant that 351,528of the 370,500 beds in units in the troopbasis 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 unforeseencontingencies.59

Movement To Reduce Authorized Bed Ratios

Continuing Difficulty in ProvidingAuthorized Quotas of Beds

Although beds authorized for theatersin the spring of 1944 did not exceed thenumber in hospital units in the troopbasis, personnel shortages made it difficultto supply theaters with authorized quotas.A method formerly used—expansion ofthe table-of-organization capacities of thehospitals already in theaters—was appliedagain, particularly in the Southwest Pa-cific, where the closure of small hospitalsreleased enough officers to expand capac-ities of larger hospitals by 7,250 beds andto permit the assignment elsewhere of 259Medical Corps officers.60 Occasionally,reductions in bed ratios and in troop

58 (1) Memo, Dep Dir Plans and Oprs ASF for CGASF, 4 Apr 44, sub: Overseas Hosp. HRS: Hq ASFPlanning Div Program Br file, "Hosp and Evac, vol.3." (2) Memo, Dir Strategic Logistics Planning UnitSGO for Chief Oprs Serv SGO, 6 Jun 44, sub: Rpt ofAccomplishments of SGO. HD: 319.1-2 (MOODOprs Serv SGO).

59 (1) Memo, CG ASF for CofSA thru ACofS G-4WDGS, 10 Apr 44, sub: Overseas Hosp, with TabsA-F. HRS: Hq ASF Planning Div Program Br file,"Hosp and Evac, Apr 44." (2) Memo WDGS 13077,ACofS G-4 WDGS for CG ASF, 27 Apr 44, sub:Overseas Hosp. HRS: Hq ASF Planning Div Pro-gram Br file, "Staybacks, 14 Apr-8 Aug 44." (3)Memo, Dep Dir Plans and Oprs ASF for SG, 29 Apr44, sub: Overseas Hosp. Same file. (4) Rad CM-OUT-42858 (28 Mar 44), Marshall to CG USAFNATO, 27 May 44. HRS: G-4 file, "Hosp and EvacPolicy."

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 ServSGO for SG, 5 Sep 44, sub: Anal of CM-IN-2287 (3Sep 44) for SWPA. Same file. (3) An Rpt, MOODSGO, FY 1945. HD.


strengths of one theater released hospitalunits for transfer elsewhere. In the sum-mer of 1944, for example, units no longerneeded in the South Pacific area weretransferred to the China-Burma-India,Central Pacific, and Southwest Pacifictheaters.61 Moreover, changes in the zoneof interior hospital system were expectednot only to use personnel more efficientlyat home but also to release some physi-cians for assignment to units earmarkedfor theaters. In addition, ratios of doctors,nurses, and enlisted men to beds were de-creased in numbered hospital units as wellas in zone of interior hospitals.62 Further-more, hospitals were "short-shipped" tothe European theater—that is, beforecompletion of training and without bal-anced or full staffs of physicians. In suchcases, the theater was expected to com-plete the training of units and to supplymissing specialists and other MedicalCorps officers. Such personnel was be-lieved to be available from several sources:from affiliated hospital units overstaffedwith specialists and already in the theater,from hospital units in the theater thatwere being reorganized under revisedtables of organization; and from infantryregiments where Medical AdministrativeCorps officers were replacing MedicalCorps officers as battalion surgeons' as-sistants.63 Finally, it was recognized thatauthorized bed quotas of theaters in someinstances could not be met even by ex-pedients just discussed, and that a theaterwould then have "to take care of its ownrequirements." 64

Review of Requirementsof European Theater

As difficulties were encountered in thesummer and early fall of 1944 in meeting

authorized fixed-bed quotas, The SurgeonGeneral's Mobilization and Overseas Op-erations Division began to review theneeds of theaters to see if estimates hadbeen too high and if authorized bed ratiosmight therefore be lowered. As early as

July 1944 there were "preliminary indica-tions" that ratios authorized for both theEuropean and the Southwest Pacific thea-ters could be lowered,65 but a directive ofthe Deputy Chief of Staff that require-ments of the European theater be re-viewed 30 days after the initial landing inFrance (or the mounting of OVERLORD)

61 (1) Rad WARX 62981, Marshall to Comdr-in-Chief SWPA; CG USAF CPA; CG USAF SPA; CGUSAF CBI. 10 Jul 44, sub: Movement of Ptbl SurgHosp in Pacific. (2) Rad WARX 72125, Marshall toCG USAF CBI, 26 Jul 44, sub: Departure of 18thand 142d Gen Hosps from SPA. (3) Rad CM-IN-25976, 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 OprsASF for Act CofS ASF, 21 Jul 44, sub: Status of Hospunits. 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 May44. 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), Mar-shall to Eisenhower, 8 Aug 44. Same file. (6) RadCM-IN-2778 (30 Aug 44), Eisenhower to WD, 29Aug 44. Same file. (7) Memo, SG for ACofS OPDWDGS 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 andOprs ASF for Joint Logistics Plans Cmtee, 6 May 44,sub: Med Reqmts—Twentieth AF. HRS: Hq ASFPlanning Div file, "Hosp and Evac." (2) Memo, LtCol Lamar C. Bevil for Col Arthur B. Welsh, 18 Aug44, sub: Est of Med Situation in CBI. HD: MOOD"CBI." (3) Draft rad, ACofS OPD WDGS to CGUSAF NATO, 12 Jul 44, with Memo for Record.HRS: OPD, 632 "Security Sec I."

65 Memo, Act Dir Plans and Oprs ASF for ActCofS ASF, 25 Jul 44, sub: Hosp Reqmts, ETO. HRS:Hq ASF Planning Div Program Br file, "Staybacks,15 Apr 44-8 Aug 44."


focused attention upon that theater.66

During July 1944 the Surgeon General'sOffice analyzed reports of hospital admis-sions for the first 32 days of operations inFrance and computed actual hospital ad-mission rates for that period. This analysisshowed that the average battle-casualtyrate had been lower than anticipated—51per 1,000 per month instead of 60—al-though during one week it had been ashigh as 89 per 1,000. Other studies showedthat the average length of time that pa-tients stayed in hospitals in the NorthAfrican theater between the fall of 1942and the middle of 1944 was 23.7 days.This was shorter than the average in Eu-rope during World War I—27.29 days. Ifadmission rates in the future should ap-proximate those of the 32-day period ofoperations in France and if the averagenumber of days patients stayed in hospi-tals should be as low as in the North Afri-can theater, the European theater wouldneed fewer beds than at first anticipated.The Surgeon General's Office computedthe number that would be required undera variety of combinations of admissionrates, lengths of stay, and evacuation poli-cies, and then calculated bed ratios thatmight be required under different sets ofcircumstances. It appeared that, under a180-day evacuation policy, the highestratio that would be needed under the mostunfavorable circumstances was 12.05 per-cent and the lowest, under more favorablecircumstances, was 5.46. Under a 120-daypolicy, the highest would be 8.06 and thelowest, 3.90 percent. It was thought thatsuch ratios would provide sufficient bedsnot only for all patients hospitalized bythe Army, including civilians and prison-ers of war, but also for their dispersion inwards. The Surgeon General thereforeconsidered it safe to reduce the bed ratio

of the European theater from 8 to 7 per-cent if at the same time the evacuationpolicy should be reduced from 180 to 120days.67

ASF headquarters arrived at the sameconclusion after taking into considerationcertain additional facts. General and con-valescent hospitals in the United Stateshad about half of their beds empty duringthe first half of 1944.68 At the same time,the European theater was not sending tothe United States as many patients as itcould on returning troop transports.69

Presumably a reduction in the evacuationpolicy would require the theater to returna great number of patients to the zone ofinterior and would therefore result infuller use of available evacuation space ontransports and of hospital beds in theUnited States. It would also make possiblea reduction in the bed ratio of the Euro-pean theater and, consequently, in thenumber of hospital units that would haveto be sent there. In view of these consider-ations, ASF headquarters recommendedon 11 August 1944 that the authorizedbed ratio for the European theater be re-duced from 8 to 7 percent and that itsevacuation policy be lowered from 180 to120 days.70 The Deputy Chief of Staff ap-

66 Memo with Memo for Record SPOPP 337, Plansand Oprs ASF for ACofS OPD WDGS, 1 Jul 44, sub:Fixed Hosp Data, with incls. HRS: Hq ASF PlanningDiv, "Hosp and Evac."

67 (1) Ltr, SG to CG ASF, 1 Aug 44, sub: OverseasHosp, with 2 incls. HRS: Hq ASF Planning Div Pro-gram Br file, "Hosp and Evac." (2) An Rpt, MOODSGO, 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 (MROFitzpatrick Staybacks, 1 May 44-29 Oct 44).

70 3d ind SPOPP 370.05 (8 Aug 44), Plans andOprs ASF to ACofS G-4 WDGS, 11 Aug 44, withMemo for Record, on Ltr, SG to CG ASF, 1 Aug 44,sub: Overseas Hosp. HRS: Hq ASF Planning Div,"Hosp and Evac."


proved this recommendation and the WarDepartment informed the theater of thechanges on 5 October 1944.71

Shift of Attention to the Pacific

The review of fixed-bed requirementsof the European theater had hardly beencompleted when the Chief of Staff of theArmy Service Forces, returning from avisit to the Pacific, turned attention in thatdirection.72 He reported that increasedoperations against islands nearer the Jap-anese homeland and the necessity of car-ing for civilians on such islands might re-quire more hospitals than those alreadyplanned for the Pacific. ASF headquartersthen directed The Surgeon General on 8September 1944 to re-examine plans forhospitalization and evacuation in thatarea.73

In complying with this directive TheSurgeon General's Mobilization andOverseas Operations Division computedbed ratios by a different method from thatused for the European theater. From sta-tistical reports it determined the actualratio of occupied beds to troop strengthduring 1943 and 1944 and to this ratio itadded estimated ratios of beds to troopstrength to provide for casualties from in-creased combat operations, for dispersionwithin hospitals, for dispersion of hospitalswithin theaters (that is, to permit somebeds to be vacant or unused either becausehospitals were situated in places with littleor no combat or because they were beingmoved from one place to another), for sol-diers of Allied armies, for prisoners of war,and for patients evacuated from mobilehospitals to permit such units to move. Forexample, in the Southwest Pacific area theratio of occupied beds had been 3.75 per-cent; to this ratio were added the follow-ing: 1.00 percent for increased operation-

al requirements, .90 percent for hospitaldispersion, .45 percent for theater disper-sion, .45 percent for Allied soldiers andprisoners of war, and .45 percent for pa-tients from mobile hospitals.74 The sum ofthese ratios was 7.00 percent and was con-sidered the ratio of fixed beds to troopstrength that would be required for theSouthwest Pacific area. Ratios for otherareas of the Pacific were also computedaccording to this method and on 14 Sep-tember 1944 The Surgeon General recom-mended a reduction in the ratio for theSouthwest Pacific from 8 to 7 percent andan increase in that for the Pacific Oceanareas (a theater formed in August 1944 bythe combination of the Central and SouthPacific areas) from 6 percent in the SouthPacific and 5 percent in the Central Pa-cific to 7 percent for the entire area. At thesame time he recommended that the 120-day evacuation policy should remain ineffect and that the Army Medical Depart-ment should continue free of responsibilityfor the care of civilians in occupiedislands.75

71 Memo AG 704 (30 Sep 44) OB-S-SPOPP, TAGfor CG ETO, 5 Oct 44, sub: Hosp and Evac Policyfor the ETO. HD: MOOD "ETO."

72 Memo, CofS ASF for SG, 27 Aug 44. HRS: HqASF 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: HqASF Planning Div, "Hosp and Evac."

74 The reason for adding in the ratio of beds totroop strength to provide beds for patients evacuatedfrom mobile hospital units to permit them to move isnot clear. Actually, one of the chief functions of fixedhospitals was to receive patients evacuated from mo-bile hospitals to insure mobility. This had beenpointed out by the Surgeon General's Office in Au-gust 1943, and as a result the General Staff hadagreed that fixed- and mobile-bed requirementswould be computed separately.

75 1st ind, SG to Dir Plans and Oprs ASF, 14 Sep44, on Memo SPOPP 632.2, Dir Plans and Oprs ASFfor SG, 8 Sep 44, sub: Hosp and Evac, POA andSWPA. HRS: Hq ASF Planning Div, "Hosp andEvac."


ASF headquarters approved these rec-ommendations, with minor modifications,but the General Staff took no final actionupon them because a new study of hospi-tal bed requirements for all theaters soonsuperseded the study of requirements forthe Pacific.76

The Manpower BoardEstimates Requirements

The drive of the War Department Man-power Board to save personnel by reduc-ing the number of hospitals in the Army—a drive which threatened the closure ofsome hospitals in the United States in thefall of 1944—extended to overseas areasalso.77 The method which the Board usedto compute theater bed requirementsdiffered from The Surgeon General's. TheBoard proposed that the average nonef-fective rate (that is, the number of personsper 1,000 per day unfit for duty because ofsickness or other disability) be convertedinto a ratio for authorizing fixed beds.Thus the number of authorized fixed bedswould equal but not exceed the number ofnoneffectives. The Board contended thatthis method would provide sufficient hos-pitalization for all theaters, since bedswere not actually needed for all noneffec-tives (some being treated in quarters) andsince all hospitals could expand author-ized capacities by 50 percent. If any thea-ter should by chance accumulate morepatients than beds, the Board stated, itcould transfer greater numbers of patientsto the United States, because in theBoard's opinion evacuation facilities andzone of interior hospital capacities alreadyexceeded requirements. Arriving on thebasis of statistics published by the SurgeonGeneral's Office at an average noneffec-tive rate of 50, the Board concluded that

not more than 250,000 beds were neededfor the 5,000,000 troops in all theaters ofoperations. It therefore advocated delet-ing from the troop basis fixed hospitalunits containing 120,000 beds in excess ofthis number.78

On the basis of this study, G-3 recom-mended on 29 September 1944 that all in-active general, station, and field hospitalunits (having authorized capacities total-ing 44,000 beds) should be deleted fromthe troop basis; that no further fixed hos-pital units be sent to theaters of opera-tions; that the active units in training inthe United States, with a total authorizedcapacity of 20,000 beds, be kept in thiscountry in the strategic reserve; and thatthe bed requirements of all theaters be re-studied by 1 November 1944.79

Although OPD believed that these rec-ommendations were "premature," 80 G-4directed ASF headquarters on 11 October1944 to make an immediate review offixed-bed requirements of all theaters onthe basis of "the latest and most completecurrent experience data available to TheSurgeon General" and warned that it was"particularly desired that no attempt bemade 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 ASFPlanning Div, "Hosp and Evac." (2) Memo WDGDS3710, 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: FixedHosp Reqmts for Overseas Theaters. HRS: G-4 file,"Hosp and Evac Policy."

79 Memo WDGCT 705.1 (29 Sep 44), ACofS G-3WDGS 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-4WDGS, 7 Oct 44, sub: Fixed Bed Reqmts, withMemo for Record. HRS: OPD, 632 "Security Sec I."


present figures on fixed bed hospitaliza-tion for theaters." 81

General Review of Bed Requirements

The study which the Surgeon General'sOffice prepared in compliance with theG-4 directive was impressive. It includedestimates of requirements of all theatersarrived at by two methods—the "admis-sion rate" method used earlier for the Eu-ropean theater and the "beds occupied"method used earlier for the Pacific. Eachwas supposed to serve as a check on theother. All estimates were based upon cer-tain principles or assumptions which theMobilization and Overseas OperationsDivision considered important. First, hos-pitals could operate with 50 percent morepatients than authorized beds for onlyshort emergency periods and hence expan-sion capacities could not be consideredavailable for normal needs. Second, bedsfor dispersion would be needed withinhospitals and within theaters. Vacant bedsin contagious wards could not be used forsurgical patients, for example, and somehospitals would always be only partiallyfilled because the shifting fortunes of wartemporarily left them on quiet fronts.Finally, though evacuation policies mightbe changed in emergencies to permit the-aters to transfer larger proportions of pa-tients to the United States, the mainte-nance of policies already established wasdesirable.

As much as possible this study wasbased upon World War II statistics, but insome instances rates and ratios still had tobe estimated without the benefit of suchdata. For estimates by the "admissionrate" method the Mobilization and Over-seas Operations Division used actual ad-mission rates for disease and nonbattle-

injury patients for the period from July1943 to June 1944 for most theaters. Insome instances, these rates had to be ad-justed. For example, the daily admissionrate (the number of patients admitted tohospitals per 1,000 men per day) fordisease and nonbattle injuries for the Pa-cific Ocean area had been 1.7, but inanticipation of higher disease incidence infuture operations nearer Japan an admis-sion rate of 2 was used. While the lengthof stay in hospitals—also used in thismethod—differed from one theater andfrom one time to another, ranging from 18to 21 days, the actual average length ofstay in hospitals in all theaters duringWorld War II was used. In estimates of re-quirements by the "beds occupied" meth-od the ratio of occupied beds to theatertroop strength during 1943 and 1944 wasconsidered as a base to which were addedratios of beds for patients resulting fromincreased operations; those needed fortransient, Navy, Allied, and prisoner-of-war patients; and those required for dis-persion. The ratio of occupied beds wasactual, based on statistical reports, but theother ratios were estimated.

Different ratios of beds for the same the-ater resulted from the use of the twomethods of estimating requirements. Forthe European theater under a 120-dayevacuation policy, for example, a ratio of7.73 percent was needed according to esti-mates made by the "admission rate"method and of 7 percent according to the"beds occupied" method. Lower ratios ofbeds would be needed with 90-, 60-, or 30-day evacuation policies. Because zone ofinterior hospitalization and evacuation

81 DF WDGDS 3918, ACofS G-4 WDGS to CGASF, 11 Oct 44, sub: Fixed Bed Reqmts for OverseasTheaters, with 1 incl. HRS: Hq ASF Planning Div,"Hosp and Evac." Also, SG: 632.2 "Bed Reqmts."


facilities had been planned on the basis ofa 120-day evacuation policy and becausesuch a policy seemed more economical ofpersonnel and shipping than lower ones,The Surgeon General recommended thatthe 120-day policy be continued and thatestimated ratios of beds required under itbe approved. Those ratios were the sameas the ones already authorized for all the-aters except the American, China-Burma-India, Southwest Pacific, and Central Pa-cific. For the first three of these, The Sur-geon General proposed reductions inratios from 4, 7, and 8 percent to 3, 6, and7 percent respectively. For the last, he pro-posed an increase from 5 to 6 percent. Inaddition, he recommended that beds beprovided in hospital units in the strategicreserve for 4 percent of the troops in thatreserve. He proposed further that theatersbe asked what evacuation policies andbed ratios they wanted and that, untiltheir answers were received, no reductionshould be made in the number of units inthe troop basis, no personnel should bediverted from training for those units, andhospital units should continue to beshipped overseas as planned. ASF head-quarters approved this study and its rec-ommendations.82

Faced with varying estimates of bed re-quirements made by the War DepartmentManpower Board and G-3 on the onehand and by the Surgeon General's Officeand ASF headquarters on the other, G-4had the problem of considering both andof arriving at recommendations that couldbe presented to the Deputy Chief of Stafffor approval. As a result of conferenceswith representatives of The Surgeon Gen-eral and G-3,83 and of analyses of the dif-ferent studies, G-4 arrived at a compro-mise which favored The Surgeon Generaland on 2 November 1944 sent the follow-

ing recommendations to the Deputy Chiefof Staff: (1) that the bed ratios recom-mended by The Surgeon General beapproved, with minor exceptions; (2) thatthe evacuation policies already authorizedremain in effect; (3) that the shipment ofhospital units to the European theater beslowed down in order to permit them to bebetter staffed and trained and to see ifthey were actually needed; and (4) thatthe four general hospital units and thefour field hospital units that were in thetroop basis but were not scheduled byOPD for shipment to any theater bedeleted. On 22 November 1944, the Dep-uty Chief of Staff approved G-4's recom-mendations. The bed ratios thus author-ized were as follows: for the European andSouthwest Pacific theaters, 7 percent; forthe Mediterranean theater (formerlyNorth African), 6.6 percent; for thePacific Ocean areas (formerly the Centraland South Pacific), 6 percent; for theMiddle Eastern theater, 6 percent; for theChina and India-Burma theaters, 6 per-cent for all American troops and for102,000 Chinese troops in India; and forthe American theater, 3 percent.84

82 (1) 1st ind, SG to CG ASF, 18 Oct 44, with TabsA through D, on Memo SPOPP 370.05, CG ASF forSG, 13 Oct 44, sub: Fixed Bed Reqmts for OverseasTheaters, with 1 incl. (2) 1st ind SPOPP 705, CG ASFto ACofS G-4 WDGS, 24 Oct 44, with Memo forRecord, on DF WDGDS 3918, ACofS G-4 WDGS toCG ASF, 11 Oct 44, sub: Fixed Bed Reqmts for Over-seas Theaters. Both in HRS: Hq ASF Planning divfile, "Hosp and Evac."

83 DF WDGDS 4602, Act ACofS G-4 WDGS toACofS G-3 WDGS, 1 Nov 44, sub: Fixed BedReqmts, with Memo for Record. HRS: G-4 file,"Hosp and Evac Policy."

84 (1) Memo WDGDS 4434, Act ACofS G-4WDGS for DepCofSA, 2 Nov 44, sub: Fixed HospBed Allowances for Overseas Theaters, with Tab A.HRS: Hq ASF Planning Div, "Hosp and Evac." (2)Memo WDGDS 4477, ACofS G-4 WDGS for CGASF, 22 Nov 44, sub as above. Same file.


This re-examination of the needs oftheaters for fixed beds achieved in part thedesired end—saving of personnel througha reduction in the number of hospitalunits the Army would have. While it wasbeing made, the General Staff deleted sixgeneral hospital units from the troop basis.Afterward it deleted four more generaland four field hospitals.85 These wereunits which OPD had not scheduled forshipment but which the Surgeon General'sOffice wished to hold in the United Statesas an undeployed reserve. The shipmentof hospital units to the European theaterwas also slowed down. With the concur-rence of that theater, the General Staffplanned to send 11 general hospital unitsto Europe during the last two months of1944, instead of 30 that were scheduled,and to send the remaining 19 early in1945.86 Although these actions may havehelped the Medical Department, they didnot solve all problems caused by person-nel shortages and it was still necessary toship hospital units with less than full com-plements of personnel. For example,eleven of the general hospitals sent toEurope during the winter of 1944-45 hadno nurses assigned to them upon departurefrom the United States.87

Experiences of theaters in hospitaliza-tion from November 1944 to May 1945showed that enough fixed beds were sup-plied to meet actual requirements. Duringthis period only two theaters, the South-west Pacific and the Asiatic, failed to re-ceive enough beds to fill authorizedquotas. The others had numbers thateither exceeded quotas consistently orreached them and then wavered slightlyabove or below. Even during periods whentheaters had fewer beds than authorized,they also had fewer patients than thenumber of fixed beds present, with one ex-

ception—the European theater. (See Chart11.) In the winter of 1944-45, its patientload increased rapidly and by January andFebruary 1945 the number of patientsoccupying fixed beds was greater than thenumber of normal beds present in the the-ater.88 For a short time, then, attentionwas centered upon this problem. (Table14.)

The Problem of the European Theaterin the Winter of 1944-45

The situation in which there were morepatients than normal fixed beds in theEuropean theater arose from a variety ofcauses. During November and December1944 hospital admissions increased rap-idly. In addition, stoppage by the WarDepartment in the fall of 1944 of thetransfer (with few exceptions) of prisoner-of-war patients to the United States re-sulted in the accumulation of 14,000German patients in theater hospitals bythe end of December. Furthermore, fail-ure of the European theater to followevacuation policies set by the War Depart-ment (because of a shortage of hospitalships and the chief surgeon's opposition tothe use of transports for evacuation) cre-ated a backlog of Army patients awaiting

85 (1) Memo SPMDA 322.05, SG for SecWar, 10Jan 45, sub: Med Mission Reappraised. HRS: G-4file, "Hosp. vol. II." (2) Memo for Record on Memo,CG ASF (SG) for CofSA, 17 Dec 44, sub: Adequacyof Hosp and Evac, ETO. HRS: Hq ASF Planning Divfile, "Hosp and Evac."

86 (1) Memo WDGDS 4434, Act ACofS G-4WDGS for DepCofSA, 2 Nov 44, sub: Fixed HospBed Allowances for Overseas Theaters. HRS: HqASF Planning Div file, "Hosp and Evac." (2) MRS,Col Durward G. Hall (SGO) to Gen [George F.] Lullthen Col A[rthur] B. Welsh then Col Carl [C.] Sox,14 Nov (1944?). SG: 322 "Hosp Misc."

87 Memo, Chief Atlantic Sec Theater Br MOODSGO for Record, 8 Mar 45, sub: Substitution of En-listed Technicians for Nurses in ETO Hosps. HD:MOOD "ETO."

88 An Rpt. SG, FY 1945, pp. 53-54. HD.


transfer to the zone of interior. Mean-while, the theater actually had fewer fixedbeds than it was credited with, becausemany of its field hospitals (normallycounted as fixed hospitals) were being usedas forward-area surgical hospitals andevacuation holding units.89 Informed ofthis situation early in December 1944,90

the General Staff, ASF headquarters, andthe Surgeon General's Office turned theirattention to a solution of some of the the-ater's problems.

Difficulties of the War Department inmeeting authorized quotas of fixed bedsfor all theaters precluded shipment toEurope of more hospitals than alreadyscheduled. Therefore, G-4 decided thatthe European theater would have to carefor prisoner-of-war patients in hospitalsthat were manned primarily by capturedGerman medical personnel. On 28 De-cember 1944 the War Department in-formed the theater of this decision,91 andby February 1945 it had in operation orin the process of organization prisoner-of-war hospitals containing 13,000 beds.92

Failure of the theater to use vacantevacuation space on troop transportsthreatened not only to continue to con-tribute to a shortage of beds in Europeand insufficient use of those in the UnitedStates but also to create a serious evacua-tion problem. If patients were not evacu-ated as they accumulated it would be dif-ficult to get them out of the theater afterthe defeat of Germany, because transportswould then be diverted to the Pacific andhospital ships would be unable to movethe patient load as rapidly as desirable.On 3 December 1944, therefore, the Chiefof Staff of the Army ordered the com-manding general of the European theaterto use all evacuation space on transports,even if it required the theater to lower its

evacuation policy to 90 days or less.93 As aresult, the theater evacuated patientsunder a 120-day policy in January, a 90-day policy in February, and a 60-day pol-icy in March and April.94 By thus trans-ferring a larger proportion of its patientload to the zone of interior, the Europeantheater reduced its requirements for addi-tional beds and contributed at the sametime to the more effective use of beds ingeneral hospitals in the United States.

To enable the theater to establish asmany fixed beds as it was credited withhaving, The Surgeon General proposedthat it be authorized additional fixed bedsto replace those in field hospitals beingused as mobile units.95 The General Staffapproved this proposal, and on 25 Decem-ber 1944 the War Department authorizedboth the European and Mediterraneantheaters to subtract from fixed-bed totalsthe beds in field hospitals being used asmobile units and to replace them by ex-panding table-of-organization capacitiesof station and general hospitals alreadypresent.96 Later, ASF headquarters pro-

89 (1) An Rpt, MOOD SGO, FY 1945. HD. (2) In-terv MD Historian with [Maj] Gen [Paul R.] Hawley,18 Apr 50. HD: 000.71.

90 Ltr SHAEF 704-3 Med, SHAEF to CofSA thruACofS G-4 WDGS, 4 Dec 44. SG: 632.2.

91 Rad, ACofS OPD WDGS to CG ComZ ETOand CG USAF MTO, 28 Dec 44. HRS: Hq ASFPlanning 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) RadCM-OUT-7211 3 (3 Dec 44), CofSA to CG ComZETO and CG UK Base Sec, 3 Dec 44. SG: 560.2.

94 Administrative and Logistical History of theMedical Service, Communication Zone-ETO, Ch 13,"Evacuation," pp. 32-34. HD.

95 Memo, SG for CG ASF, 13 Dec 44. HRS: HqASF Somervell file, "SG 1944."

96 Rad OPD 632 (26 Dec 44), ACofS OPD WDGSto CG ComZ ETO and CG USAF MTO, 26 Dec 44,sub: Hosp. HRS: Hq ASF Planning Div, "Hosp andEvac."


posed that other theaters be given similarauthority.97

In addition to the measures just dis-cussed, at the suggestion of the Chief ofStaff G-4 sent to Europe one of its repre-sentatives, Col. (later Brig. Gen.) Craw-ford F. Sams, a Medical Corps officer, todiscuss with the chief surgeon of the thea-ter and the chief medical officer of SHAEFthe most effective use of the beds present.98

The situation in Europe was thereby soalleviated that by March it was possible todivert to the Pacific six of the general hos-pitals scheduled earlier for shipment toEurope.99

Meeting the needs of theaters for hospi-talization in the latter part of the war wascharacterized by efforts to estimate re-quirements as realistically as possible andby the necessity of using a variety of ex-pedients to provide quotas of beds actuallyauthorized. Establishment in the secondhalf of 1943 of official evacuation policiesand bed ratios for various theaters placedplanning on a sounder basis than formerly.The first ratios established were basedonly partially upon World War II experi-ence; but as statistics of casualty and dis-ease incidence accumulated they werestudied repeatedly to determine whetheror not ratios could be lowered. Though a

reduction was at times possible, shortagesof personnel continued to require sometheaters to meet their quotas partially byexpanding the table-of-organization ca-pacities of some units, using the emer-gency expansion of others, and employingunits shipped from the zone of interior in-completely trained and staffed. Towardthe end of 1944 it was necessary to forcethe European theater to observe War De-partment policies on evacuation in orderto relieve the load on theater hospitals bytransferring part of it to the United States.That theater also had to use other ex-pedients, such as the employment of cap-tured enemy personnel in the the treat-ment of prisoners of war, in order to havesufficient fixed beds for American Armypatients.

97 Memo SPOPP 705, Act Dir Plans and Oprs ASFfor ACofS OPD WDGS, 5 Jan 43, sub: Adequacy ofHosp in TofOpns—Deletion of Fld Hosps from AuthFixed Beds, with Memo for Record. HRS: Hq ASFPlanning 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 OprsASF, 24 Mar 45, sub: Hosps in ETO. HRS: Hq ASFControl Div files, 323.3 "Hosps." (2) An Rpt, MOODSGO, FY 1945. (3) Memo, Chief Planning Br G-4WDGS for ACofS G-4 WDGS, 3 Apr 45, sub: Diver-sion of Hosps. HRS: G-4 files, "Hosp, vol. III."

CHAPTER XIII

Changes in Policies andProcedures Affecting

the Occupancy of Hospital Bedsin the Zone of Interior

An important feature of attempts tomeet hospital requirements with limitedresources was an extension of the practicebegun on a small scale during the earlywar years of keeping patients who did notactually need hospital care from occupy-ing beds. This could be done by limitingadmissions and shortening length of stay.

Problem of Limiting HospitalAdmissions

More was done to shorten periods ofpatient-stay than to limit admissions. Twofactors worked against the latter: (1) theMedical Department's practice of admit-ting patients to hospitals before perform-ing complete diagnostic procedures and(2) policies of the General Staff governingdischarges from the Army. Normally, zoneof interior patients were sent to hospitalsafter only preliminary examinations bydispensary physicians and were then givenmore thorough examinations by hospitalstaffs. Early in the war, it will be recalled,some hospitals had established diagnostic

clinics for the examination of patients be-fore their admission to wards. This prac-tice did not become general, and hospitalscontinued to admit patients first and toperform diagnostic procedures afterward.1

Some policies of the General Staff tendedto increase rather than to limit hospitaladmissions. In July 1943, for example, theStaff issued a directive, against The Sur-geon General's advice, to discharge fromthe Army men who did not meet minimumphysical standards. This flooded hospitalswith patients whose disabilities had to beobserved and evaluated before they couldbe given disability discharges.2 Towardthe end of 1943, when a manpower short-

1 See above, p. 121. Annual reports of hospitalsare silent, with few exceptions, on the establishmentof diagnostic clinics. See also Federal Medical Services—A Report with Recommendations, prepared for the Com-mission on Organization of the Executive Branch ofthe Government [Hoover Commission] by the Com-mittee on Federal Medical Services (Washington,1949), pp. 20-21.

2 (1) WD Cir 161, 14 Jul 43. (2) An Rpt, 1943, FtBragg 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 menwho could serve usefully in military as-signments, despite minor ailments, shouldbe kept in the Army.3 While this reducedthe disability-discharge load, it increasedthe number of men who returned to hos-pitals repeatedly with the same complaintsand led to a tug of war between line offi-cers and the Medical Department overwhether those who were not physicallydisabled but were noneffective should begiven medical or administrative dis-charges.4 The Staff finally attempted tosolve this problem by making it easier inthe latter half of 1944 for line officers togrant administrative discharges and byauthorizing in the spring of 1945 the dis-charge at separation centers of all combat-wounded enlisted men in the limited serv-ice category.5 To some extent these actionsrelieved hospitals of the care of men whodid not need actual treatment at a timewhen these installations were reachingtheir peak load.6

Measures to Shorten the Lengthof Patient-Stay

Shortening the time spent by patients inhospitals was another way of limiting oc-cupancy of beds to patients actually need-ing hospital care. Controlling the length ofstay in an effort to limit the occupancy ofbeds to patients actually needing hospitalcare was a complicated and difficult proc-ess, for many factors affected it, sometending to increase and others to shortenit. Among them—aside from the serious-ness of patients' wounds, injuries, and ill-nesses—were the speed with whichpatients were transferred to proper typesof medical installations, the degree of re-covery they were expected to achievewhile in Army hospitals, the efficiency

with which hospitals completed diagnosesand treatments, and the administrativeproblems that were encountered in dispos-ing of patients after completion of treat-ment. Beginning in the fall of 1943 theSurgeon General's Office devoted moreattention than formerly to these factors inparticular and to the length of stay ingeneral.

The attention given to the general prob-lem is illustrated by studies made in theSurgeon General's Office and letters sentto service commands. During 1944 and1945 the Facilities Utilization Branch andits successor, the Resources Analysis Divi-sion, made monthly studies of the lengthof time different hospitals kept patientsbefore disposing of them. In the absence ofmore reliable data, the Branch measuredthe average duration of patient-stay bymeans of an "activity index." This indexwas the ratio of total patient days to thesum of hospital admissions and disposi-tions. Over a long period of time a num-ber twice the size of the activity index wasconsidered a close approximation of thenumber of days that the average patientspent 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, SGfor CG ASF, 1 Sep 44, sub: Disposition of Inapt andInadaptable. SG: 300.3. (4) Memo, Dep SG forACofS G-1 WDGS, 26 Sep 44, sub: WD Cir 370(1944) II-EM. SG: 300.-5. (5) Memo, SG for CGASF, 23 Mar 45, sub: Gen Hosp Program, ZI. SG:322 "Hosp."

5 (1) WD Cir 370, 12 Sep 44. (2) AR 615-368 andAR 615-369, 20 Jul 44. (3) WD Cir 71 ,6 Mar 45.

6 (1) Memo, Dir NP Consultants Div SGO for DirResources Anal Div SGO, 27 Nov 44, sub: Dischargeof EM. SG: 220.811-1. (2) An Rpt, 1944, Surg 7thSvC. HD. (3) An Rpts, 1945, Baxter Gen Hosp andFt Bragg Sta Hosp. HD.

7 Draft article for ASF Monthly Progress Rpt, Sec7, Health, entitled "The Disposition of Patients inHospitals of Selected Size Groups [31 May 44]." HD:Resources Anal Div file, "Hosp."


index was therefore an indication that ahospital was treating and disposing ofpatients promptly. Monthly announce-ments of hospitals' activity indices keptbefore service command surgeons the im-portance of avoiding unnecessarily longpatient-stays.8 This indirect pressure uponhospitals seemed insufficient after thepatient load began to increase rapidly inthe spring of 1945. In March, therefore,The Surgeon General urged general andconvalescent hospital commanders, aswell as service command surgeons, to ac-celerate dispositions.9 The followingmonth he established tentative monthlyquotas for the disposition of patients fromconvalescent hospitals.10 Meanwhile, dur-ing the preceding year and a half, atten-tion had been given to various individualfactors which influenced the length ofpatient-stay.

One of these was the transfer of patientsbetween hospitals. Failure to transfer pa-tients promptly from station hospitals tobetter staffed and better equipped hospi-tals, after it had been determined that theyneeded a higher type of care than thatafforded in station hospitals, retarded theirrecovery. On the other hand, unnecessarytransfers of patients between hospitals ofdifferent types consumed the time of hos-pitals involved, put an extra load on over-burdened transportation facilities, andincreased the time patients stayed on hos-pital rolls by causing repetitive physicalexaminations and more administrativepaper work. Several steps were thereforetaken to regulate the transfer of patients.In the fall of 1943 the Deputy Chief ofStaff ruled that zone of interior patientsneed not be transferred from station togeneral hospitals merely because their in-juries or illnesses were of particular types,provided station hospitals were equipped

and staffed to give them the care andtreatment they needed.11 In the spring of1944, when regional hospitals were au-thorized, a policy was established underwhich patients were to be transferred"without any more delay than is compati-ble with sound professional judgment" tothe "nearest adequate medical installa-tions," regardless of their type—whetherregional, convalescent, or general hospi-tals—and regardless of the commandunder which they operated.12 To imple-ment this policy, both the Air Surgeonand The Surgeon General applied to re-gional hospitals the bed credit systemwhich had been developed earlier to facili-tate the transfer of patients from station togeneral hospitals.13 Soon afterward TheSurgeon General established the MedicalRegulating Unit (mentioned elsewhere) tocontrol the transfer to general hospitals ofpatients debarked at ports in the UnitedStates. This office, in turn, devised anelaborate system by which general andconvalescent hospitals reported vacantbeds and debarkation hospitals reportedpatients received, indicating by code theirsex, rank, home address, and disability.14

Theoretically this system assured the trans-fer of patients directly to hospitals staffed

8 These letters are found in SG: 323.7-5 (eachservice 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 ofDisposition 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 Divand Dir Resources Anal Div SGO thru Chief of OprsServ SGO for Dir HD SGO, 18 Jun 45, sub: Add Matfor An Rpt for FY 1945. HD: 319.1-2.



and equipped to care for their particularills and injuries but it was not completelysuccessful.

A study by the Resources Analysis Divi-sion early in 1945 showed that forty-fiveout of fifty-nine general hospitals were re-ceiving patients who should have beensent to other medical installations. "Be-yond a doubt," a report on the study con-tinued, "there are a large number ofoverseas patients being transferred fromthe debarkation hospitals to the generalhospitals who need little or no further sur-gical or medical treatment and couldequally as well be cared for in convalescenthospitals. These cases consume a largeamount of time in the general hospitals inexamination and working up plus all theadministration detail and the time in-volved in disposition." 15

Another factor which affected the lengthof stay in Army hospitals was the degree ofrecovery which patients were expected toattain before being discharged. Those re-turned to duty were expected to be able todo an effective day's work as soon as theyrejoined their outfits. To shorten the con-valescent phase of hospitalization, TheSurgeon General emphasized during 1944the reconditioning program initiated theyear before. Although no statistical studieswere made of the effect of this program onthe average period of hospitalization, manyhospital commanders believed that it wasshortened.16 Patients who could not bereclaimed for military service could betransferred to Veterans Administrationhospitals if they needed further care. Inthe early part of the war, it had beenSurgeon General Magee's policy to trans-fer such patients as soon as the MedicalDepartment determined that they couldnot be restored to duty, thus shorteningthe time they stayed in Army hospitals.17

During 1943 public pressure upon theArmy to keep patients for final treat-ment, along with the inability of Vet-

erans Administration hospitals to accom-modate large numbers of them1 8 causeda change in policy that tended to lengthenthe period of patient-stay. In December1943 Army hospitals began to keep allpatients whose disabilities were incurred inline of duty, except those who were tuber-culous or psychotic, until their definitivetreatment had been completed.19 As seri-ously wounded casualties began to fill hos-pital beds during 1944, this policy had tobe clarified for it was difficult to knowwhen the definitive treatment of those withchronic disabilities was completed. In thefall of that year it was announced thatsuch patients would be kept in Army hos-pitals until they had reached the "maxi-mum degree of recovery." 20 In the follow-ing December, the President confirmedthis policy and broadened its applicationto include patients whose disabilities hadnot been incurred in line of duty.21 Hospi-tal commanders interpreted this directive"very broadly," and by March 1945, as

15 Memo, J. S. Murtaugh [Resources Anal Div,SGO] for Dr [Eli] Ginzberg, 16 Mar 45, sub: Sum-mary of Replies to the Furlough and DispositionStudy. Off file, Resources Anal Div, SGO.

16 Richard L. Loughlin, [History of] Recondition-ing [in the U.S. Army in World War II], (1946), pp.198-208. HD.

17 (1) See above, pp. 129-30. (2) AR 615-360, C4,16 Apr 43.

18 Ltr, Dep SG to Mr Donald G. Urquhart, Veter-ans of Foreign Wars of US, 24 Mar 44. SG: 220.-811-1.

19 (1) WD AGO Form 026, prepared by Col Wil-liam B. Foster, MC, SGO, 15 Nov 43, sub: Requestand Justification for Publication. AG: 220.8 (2 Jun42) (2) Sec 2. (2) AR 615-360, C 16, 15 Dec 43.

20 (1) WD Cir 423, 27 Oct 44. (2) ASF Cir 374, 13Nov 44.

21 Ltr, Franklin D. Roosevelt to SecWar, 4 Dec 44.HRS: Hq ASF Control Div, 705 "Cutback in Genand Conv Fac."


the patient-load neared its peak, The Sur-geon General concluded that they wereholding patients longer than necessary.22

Two months later his Office attempted todefine more precisely the term "maximumdegree of recovery." This term, it was ex-plained, referred to the point in a patient'streatment when progress appeared to haveleveled off and no further substantial im-provement could be anticipated. Patientsreaching that point, even though they hadnot made full compensatory adjustment todisabilities, were not to be kept longer inArmy hospitals.23

A third factor affecting the length oftime patients stayed in hospitals was theefficiency with which hospital staffs madediagnoses and initiated treatment. In thefall of 1943 representatives of the SurgeonGeneral's Office and the ASF ControlDivision complained that hospitals weredelaying diagnoses and treatment by hav-ing unnecessary laboratory work per-formed for each patient.24 At that timeThe Surgeon General urged hospitals toinsist upon its elimination. A few monthslater he suggested that service commandsurgeons require hospitals to keep wardcharts showing the duration of patient-stay, as a reminder that unnecessary pro-cedures should be avoided and requisitemedical treatment given promptly. Some,and perhaps all, service commands ac-cepted this suggestion.25

A fourth factor affecting length of staywas the administrative work involved indisposition of patients, either by return toduty or by separation from the service.Their return to units or organizations fromwhich they entered hospitals created noproblem, but the reassignment of otherswho were physically unqualified for dutywith their former units or whose units hadgone overseas was fraught with delays.

Reassignment was primarily an Army per-sonnel procedure over which the MedicalDepartment had no control. It was compli-cated by the fact that patients belonged todifferent major commands (Ground, Serv-ice, and Air Forces), were qualified fordifferent types of duty (limited or fullduty), came from different areas (theatersof operations or the zone of interior), andwere of separate ranks (commissioned orenlisted). Because of these complications,directives governing the reassignment ofmen and women who had been hospital-ized were numerous, frequently changed,often obscure in meaning, and sometimesin conflict with one another. Attemptswere made to correct this situation, butthe general problem so far as it pertainedto Ground and Service Forces personnelremained unsolved throughout the war.26

The Air Forces, on the other hand,adopted a system of assignment in the fallof 1944 that was simple and effective. AAFheadquarters placed liaison officers insome AAF regional hospitals and, withthe concurrence of ASF headquarters, ineach general and ASF regional hospital.

22 Memo, SG for CG ASF, 23 Mar 45, sub: GenHosp Program, ZI. SG: 322 "Hosp."

23 Ltr, SG to CGs all SvCs attn COs Hosp Ctrs, GenHosps, and Conv Hosps, 28 May 45, sub: Med Clari-fication of Disposition Policy. HD.

24 (1) Rpt of SGs Pers Bd, 3 Nov 43. HD. (2)Memo, Dr Eli Ginzberg, ASF Control Div for ChiefOprs Serv SGO thru Dir Control Div ASF, 30 Nov43, sub: Surv of Gen Hosps. SG: 333.1-1.

25 (1) SG Ltr 193, 30 Nov 43. (2) Ltr, SG (initA. H. S[chwichtenberg]) to Surg 2d SvC, 8 Feb 44,sub: Prompt Prof and Admin Practice in ArmyHosps. SG: 705 (2d SvC)AA. Similar letters were sentto other service command surgeons. (3) Ltr, CG 5thSvC (Asst SvC Surg) to SG, 30 Mar 44, sub: PromptProf 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, 14Mar 45, sub: Improvement in Hosp Admin Proce-dures. SG: 300.7. (3) History of Control Division,ASF, 1942-45, App, p. 199.


These officers acted as representatives ofthe commanding general, Army AirForces, reassigning both commissionedand enlisted personnel of the Air Forces.Subsequently it was reported that they re-turned flying officers to duty in the FourthAir Force in 10 percent of the time formerlyrequired.27

Aside from the necessity of securingreassignments, there was another cause fordelay in returning patients to duty: theadministrative procedure for the physicalreclassification of officers. In July 1943 theGeneral Staff directed that officers foundby hospital disposition boards to be per-manently incapacitated for full militaryservice should appear before Army retir-ing boards instead of being returned toduty in limited service assignments.28 Thismeant that such an officer had to be keptin a hospital while its commander for-warded recommendations of his disposi-tion board to service command headquar-ters; the service commander issued ordersfor the appearance of the officer before aretiring board; the board assembled andconsidered the case, and sent its findingsto Washington for review by The SurgeonGeneral, The Adjutant General, and theSecretary of War's Separation Board; andThe Adjutant General issued orders for theofficer's disposition. In the fall of 1944 theSurgeon General's Office, ASF headquar-ters, and the Adjutant General's Officeattempted to find a way to avoid keepingsuch officers in hospitals after their treat-ment had been completed. The AdjutantGeneral proposed returning them to theirprevious stations or to replacement poolsafter appearance before retiring boards, toawait there the decision of agencies inWashington.29 The ASF proposal, whichwent further than this, was approved bythe General Staff. On 14 October 1944 a

War Department circular authorized hos-pital and station commanders to return toduty officers recommended for limitedservice by disposition boards, without re-ferring them, except in a few cases, toretiring boards.30 This change in proce-dure reduced the length of stay in hospi-tals of officers in this category to such anextent that it saved, according to the esti-mate of ASF headquarters, 1,000 hospitalbeds annually.31

Improvements in Disability Dischargeand Retirement Procedures

Officers and men whose physical dis-abilities prohibited return to duty wereeither retired or discharged from the serv-ice. Since both retirement and dischargefor disability were personnel as well asmedical administrative procedures, theyinvolved agencies other than the MedicalDepartment. Their simplification wastherefore a complicated process and some-

27 (1) A History of Medical Administration andPractice in the Fourth Air Force (1945), vol. I, pp. 79-81. HD: TAS. (2) Ltr, CG AAF to CG ASF, 25 Aug44, sub: Disposition of AAF Pnts in Gen Hosps andCertain ASF Hosps. AG: 705(25 Aug 44)(1). (3) ASFCir 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'ReillyGen Hosps. HD.

28 Rad, ACofS G-1 WDGS to SvC Comdrs, Retir-ing 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 (6Sep 44), TAG to SG, 8 Sep 44, sub: Disposition ofOffs 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, 25Sep 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 ProceduresStudies Made by or jointly with Control Div ASF, 13Apr 45. HRS: Hq ASF Control Div file, "Est AdminSavings Resulting from Procedural Revisions."


times slow, but for the Medical Depart-ment it was important because any delayin either procedure wasted beds by length-ening the stay of patients in hospitals.

Despite earlier attempts to removecauses for delays, the disability dischargeprocedure took more time than was con-sidered necessary and in the fall of 1943 32

both the Surgeon General's Office andASF headquarters began studies to sim-plify and standardize it. Because its Con-trol Division was engaged in a more gen-eral study of Army administrative proce-dures, ASF headquarters directed TheSurgeon General to discontinue his study.The ASF Control Division proceededthereafter, with assistance from the Sur-geon General's Office, to develop and testa revised procedure for disability dis-charges.33 In March 1944 this procedurewas published in a tentative manual andeach service command was directed toinstall it in one general and one stationhospital for further testing. Reports fromsuch tests were favorable, and on 24 July1944 ASF directed all of its hospitals tobegin using the new procedure. Sixmonths later a War Department manualmade it official for use in hospitals of theAir Forces as well as of the Service Forces.34

The new procedure for disability dis-charges covered actions taken within hos-pitals themselves, since measures adoptedearlier had reduced administrative actionsrequired by headquarters other than hos-pitals.35 This goal was more completelyachieved during 1944 when additionalpost commanders delegated to hospitalcommanders their functions relative to dis-ability discharges, and the War Depart-ment delegated to commanders of regionaland convalescent hospitals, as it had earlierto those of general hospitals, authority togrant discharges without reference to

higher headquarters.36 Under the newprocedure, administrative actions withinhospitals were simplified and speeded up.Hospital commanders were permitted torequest records of former physical exami-nations and medical treatments from theAdjutant General's Office and from otherhospitals as soon as ward officers made adiagnosis indicating eventual disabilitydischarge, rather than after completion oftreatment. This move was expected toeliminate delays in the consideration ofcases by CDD (Certificate of Disabilityfor Discharge) boards. To reduce the workof these boards and of all officers who par-ticipated in the procedure, paper workrequired for disability discharges was sim-plified. Separate forms and letters previ-

32 (1) Memo, Dr Eli Ginzberg, Control Div ASF forChief Oprs Serv SGO thru Dir Control Div ASF, 30Nov 43, sub: Surv of Gen Hosps. SG: 333.1-1. (2)Notes on Visit to McCloskey, O'Reilly, and PercyJones Gen Hosps, 11 Dec 43, by Col Tracy S. Voor-hees, Control Div SGO. Same file.

33 (1) Memo, SG (Control Div) for Dir Control DivASF, 29 Oct 43, sub: Delays in Discharging Pntsfrom Hosps. (2) Memo, SG (Control Div) for CGArmy Med Ctr, 29 Oct 43, sub: Delays in CDD Pro-cedure. (3) Memo, CG ASF (Control Div) for SGattn Dir Control Div, 5 Nov 43, sub: Delays in Dis-charging Pnts from Hosps. (4) Memo, Act Dir Con-trol Div SGO for Brig Gen Edward S. Greenbaum,Off of UnderSecWar, 16 Feb 44, sub: Improvementsin CDD Procedures. All in SG: 220.811-1. (5) AnRpt, 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 1stSvC, 17 Mar 44, sub: Estab of Pilot Instl CoveringDischarges and Release from AD. SG: 220.811-1.Similar letters were sent to each service command. (3)Draft of Tentative Procedures — Discharge and Re-lease from AD, Hq ASF, 5 Mar 44. AG: 220.8. (4)ASF Cir 217, 13 Jul 44. (5) TM 12-235, Enl Pers—Discharge and Release from AD (Other than at Sep-aration 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 RegionalHosps. 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.


ously used were eliminated or consoli-dated, and copies of different forms andthe number of signatures required on themwere limited. All forms were set up accord-ing to standard typewriter spacing to facil-itate preparation and, in some instances,rubber stamp entries were authorized.37

To insure speedy, well co-ordinated actionby all hospital officers concerned with dis-charges, a time schedule was established.It listed the actions taken by each officeron the days following the admission ofpatients to hospitals, the day before theCDD board meeting, the day of the meet-ing, and the three following days. Finally,the manual on the discharge procedureshowed graphically each step in a dis-ability discharge.

Except in procuring adequate suppliesof new forms, hospitals encountered littledifficulty in installing the new procedure.Their reaction was almost immediatelyfavorable. For example, by the end of1944 one of them reported that disabilitydischarges were "no longer a matter ofconcern." 38 The Surgeon General's Officelikewise was pleased with the new proce-dure and with the saving in hospital bedswhich it produced.39 According to an esti-mate of the ASF Control Division in April1945, this saving amounted to an averageof seventeen days for each disability dis-charge and to a total of 6,205,000 hospitalbed-days (the equivalent of seventeen1,000-bed hospitals) annually.40

As in the case of disability dischargesfor enlisted men, several agencies becameconcerned in the fall of 1943 about thetime used in retiring officers for disability.Among them were the Adjutant General'sOffice, the Surgeon General's Office, andASF headquarters.41 During the next twoyears they worked together to speed theretirement process and thereby to shorten

the period of hospitalization of officers dis-abled for military duty. One method wasto shorten the time that elapsed betweencompletion of an officer's treatment andhis appearance before a retiring board. Inthe middle of 1943 the procedure for get-ting an officer before a retiring board wascomplicated. After completion of treat-ment, his case was reviewed by a hospitaldisposition board. If the board recom-mended retirement, its recommendationwas sent to higher headquarters, such asthat of a service command, for review. Ifthat headquarters approved the recom-mendation, it ordered the officer to gobefore a retiring board. At that point, thehospital requested his personnel recordsfrom the Adjutant General's Office. Afterthey arrived, the retiring board could con-sider the officer's case. In the fall and win-ter of 1943 steps were taken to get records

37 (1) TM 12-235, Enl Pers—Discharge and Re-lease from AD (Other than at Separation Ctrs), 1 Jan45. (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. Lettersfrom hospitals reporting on the new procedure, datedMay-June 1944, are filed in HRS: Hq ASF ControlDiv file, "Disability Discharge Corresp." See also: AnRpts, 1944, Fts Jackson and Bragg Regional Hospsand Ashford Gen Hosp. HD.

39 An Rpt, FY 1944, Control Div SGO, and AnRpt, FY 1945, Hosp and Dom Oprs SGO. HD.

40 Rpt, Economies Effected through ProceduresStudies Made by or jointly with Control Div ASF, 13Apr 45. HRS: Hq ASF Control Div file, "Est AdminSavings Resulting from Procedural Revisions."

41 (1) T/S, Dir Control Div AGO to Chief Insp andInvestigation Br AGO, 28 Aug 43, sub: RetirementProcedures Affecting Offs. AG: 210.85 (12-17-42)(1).(2) Memo, SG for Gen Malin Craig, Pres Army Re-tiring Bd, 30 Aug 43. SG: 334.6-1. (3) Memo, DirControl Div SGO for Brig Gen Charles C. Hillman,SGO, 8 Sep 43, sub: Retiring Bd Procedures. Samefile. (4) Memo, Lt Col Basil C. MacLean, SGO forGen [Raymond W.] Bliss thru Col A. H. Schwichten-berg, 6 Nov 43, sub: Observations Based on RecentVisits to Gen Hosps. Off files, Gen Bliss' Off SGO,"Util of MCs in ZI" (19) #1.


from the Adjutant General's Office at anearlier point in the proceedings. In Sep-tember, on The Surgeon General's recom-mendation, the General Staff authorizedhospitals to request records of officers assoon as disposition boards recommendedtheir appearance before retiring boards.42

Later, on recommendation of the ASFControl Division, the Staff permitted hos-pitals to request these records as soon as itbecame obvious that officers would beconsidered for retirement, even thoughtheir cases had not been reviewed by dis-position boards.43 In the latter half of 1944another cause for delay was eliminatedwhen the Staff authorized hospital com-manders to order officers to appear beforeretiring boards without reference to higher-headquarters.44

Another method of speeding the retire-ment of officers was to prevent the devel-opment of backlogs of work for retiringboards. This could be done, in part atleast, by increasing the number of suchboards. Until the middle of 1943 retiringboards were few in number and could beappointed only by the Secretary of War.45

In June of that year the Secretary dele-gated appointment authority to command-ing generals of service commands anddirected them to establish retiring boardsat all general hospitals. Four months laterthe commanding general of the Air Forces,receiving similar authority, was directedto set up a retiring board at each AAFconvalescent center.46 In the middle of1944 the right to have retiring boards wasextended to all convalescent and regionalhospitals.47 Later, in October 1944, thenumber of cases referred to such boardswas limited when, in connection with themovement to shorten the period of hospi-talization of officers being physically re-classified for limited duty only, retiring

boards were relieved of the considerationof such cases.48

An additional way of speeding officerretirements was to reduce the paper workof retiring boards. In the latter part of1944 the ASF Control Division developeda standard form for such boards to use inreporting their proceedings.49 Followingthe success of the new manual on disabil-ity-discharge procedures, the same Divi-sion developed and published in 1945 atechnical manual on the retirement andreclassification of officers.50 This manual,like that on the disability-discharge pro-cedure, gave detailed instructions in dia-grammatic and other explanatory formson the completion of all administrativeactions in the retirement process andestablished a time schedule to be followedby officers concerned. As a result, accord-ing to ASF headquarters, the period ofhospitalization of officers awaiting disabil-

42 (1) Memo SPMCH 300.3-1, Exec Off SGO forPublication Div AGO thru Procedure Br SGO, 7 Aug43, 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, 18Dec 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 toDir Control Div AGO, 26 Jul 44, sub: Reasgmt ofPers 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 ofAuth to Appoint Retiring Bds. SG: 334.6-1.

47 (1) AR 605-250, C 1, 22 Jun 44. (2) Mins, SvCConf, Ft Leonard Wood, Mo, 27-29 Jul 44. HD.

48 See above, p. 243.49 Memo, CG ASF (Dir Control Div ASF) for SG,

9 Oct 44, sub: Form for the Proceedings of Army Re-tiring Bds. SG: 315 "Gen."

50 (1) Draft of Proposed WD Technical Manual,TM 12-245, Physical Reclassification and Retirementof Offs, 1 Jun 45. Off file, Physical Standards Div,SGO. (2) Tentative WD Technical Manual, TM 12-245, Physical Reclassification, Retirement, and Re-tirement Benefits for Offs, 1 Oct 45. Same file.


ity retirements was reduced enough to save4,700 beds annually.51

The simplification and standardizationof procedures for disability discharges andretirements were the culmination of effortsbegun early in the war to limit the occu-pancy of hospital beds to persons actuallyneeding them. Earlier measures to reformthese procedures affected actions takenoutside hospitals but were a necessaryfoundation for the later ones which weremainly intended to improve action withinthe hospitals themselves. Other efforts torestrict patients in hospitals to those need-ing medical and surgical treatment were

less successful. Little if anything was doneto screen patients by physical examinationbefore admission to hospitals. The reas-signment of those returning to duty con-tinued to cause difficulty and delays indisposition. And the policy of giving allpatients "maximum hospitalization,"whether their disabilities had been in-curred in line of duty or not, tended tolengthen the average period of hospitaliza-tion and hence to increase the occupancyof beds by men who could be of no furtherservice to the Army.

51 History of Control Division, ASF, 1942-45, App.pp. 481-83. HD.

CHAPTER XIV

Changes in Size and Make-Upof Staffs of Zone ofInterior Hospitals

Changes in policies and procedures af-fecting the occupancy of beds resulted inpart from limitations upon the amount ofpersonnel available for the hospitals. Onesuch limitation was a definite requirementthat hospitals get along on proportionatelysmaller staffs than accustomed to. Al-though the Manpower Board and ASFheadquarters were chiefly responsible forthis development, the Surgeon General'sOffice participated indirectly. Establishedin March 1943 to advise the Chief of Staffon personnel matters,1 the ManpowerBoard analyzed the functions of hospitalsin the United States, as it did those ofother installations, and developed "yard-sticks" by which to measure their person-nel requirements.2 Using these yardsticks,the Board estimated the total amount ofmilitary and civilian personnel which ASFinstallations needed, and the GeneralStaff normally accepted the Board's esti-mates in making personnel authorizations.ASF headquarters then subdivided itsquota among service commands. Servicecommanders in turn authorized person-nel for subordinate installations whichthen took similar action.3 Under this sys-tem, despite its nominally advisory capac-ity the Manpower Board exercised a rigid

control over the personnel which the Serv-ice Forces received, and subordinate com-mands might or might not authorize asmuch for hospitals as the ManpowerBoard's yardsticks showed they needed.4

To provide a guide for subordinate com-mands in manning hospitals, and perhapsto influence service commanders in mak-ing authorizations, the Surgeon General'sOffice developed manning tables for gen-eral, regional, and station hospitals ofvarious sizes and obtained sanction forthem in a War Department circular issuedin the spring of 1944.5 They agreed gener-

1 (1) Memo W600-27-43, 11 Mar 43, sub: WDManpower Bd. (2) Ltr, CofSA to CG SOS, 12 Mar43, same sub. Both in SG: 322.7-1 (Bds, etc.).

2 (1) WDMB Yardstick No 7 for Measuring PersReqmts 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 (2dSvC)AA, SG for CG ASF, 10 Apr 45, sub: StrengthAuth, MD. HRS: ASF SPGA 320.2 "Med."

4 For example, see Diary, Hosp Div SGO, 28 Sep44 and 16 Mar 45. HD: 024.7-5.

5 (1) Memo, Gilbert W. Beebe, Control Div SGOfor Col Tracy S. Voorhees, Control Div SGO, 31 Oct43. SG: 632.-2. (2) Memo SPMCH 300.5-5, SG forCofS ASF, 19 Apr 44, sub: Pers Strength Tables forMed Instls in ZI. AG: 320.3 (18 Apr 44)(1). (3) WDCir 209, 26 May 44.

STAFFS OF ZONE OF INTERIOR HOSPITALS 249

ally with the Manpower Board's yard-sticks and with recommendations madeby the Inspector General's Office. Whilethey were not compulsory they served asguides supplied by the Medical Depart-ment for the reduction of hospital staffs.6

General Nature of Changes

The general reduction made in hospitalstaffs can be illustrated by changes in theratio of employees to beds. In July 1943the average number of employees (mili-tary and civilian) per 100 beds in generalhospitals was 94. At that time 58.6 percentof all beds in general hospitals were occu-pied. Therefore the number of employeesper 100 occupied beds was 160. By July1944 the average number of employeesper 100 beds in all general hospitals haddropped to 68.6. At that time, however,only 42 percent of the beds were occupied,and therefore the number of employeesper 100 occupied beds was 160—the sameas a year before. About a year later (June1945), when 81.4 percent of all generalhospital beds were occupied and the num-ber of patients on the rolls of general hos-pitals (those absent from hospitals on leaveor furlough as well as those occupyingbeds) was 122 percent of their bed capac-ities, the average number of employees per100 beds was 71.1, but the average per100 occupied beds was only 87. Thus, bythe middle of 1945 the staffs of Army gen-eral hospitals in the United States hadbeen reduced to the point where they hadroughly only about half as many peopleto care for patients as in former years.7

Another general change in hospitalstaffs during the latter half of the war wasthe widespread substitution of civilians,Wacs, and limited service personnel forthe enlisted men, officers, and nurses who

were taken out of zone of interior hospitalsfor overseas assignments. This change re-sulted from a War Department policygoverning the use of personnel by theService Forces, reiterated by ASF head-quarters in June 1943. In general, menqualified for overseas service were to bereleased as rapidly as possible from assign-ment to all zone of interior installations.In replacing them commanders were notto assign men to positions that could befilled by women; they were not to assignmilitary persons, male or female, to thosethat could be filled by civilians; and theywere not to assign officers to duties thatcould be performed by enlisted persons orcivilians.8 Compliance with this policyhad two effects upon hospital staffs. In thefirst place, as officers, nurses, and menwere withdrawn from hospitals for over-seas service, hospital staffs were subject toa continuous personnel turnover. For ex-ample, during 1944 Birmingham GeneralHospital gained 53 Medical Corps officers,but lost 33; it gained 177 nurses, but lost89; and it gained 758 enlisted men, butlost 416.9 Redeployment following V-EDay and demobilization following V-J

6 (1) Memo, SG for DepCofSA thru CG ASF, 10May 44, sub: Pers Strength Tables. ... (2) Memo,WDMB for ACofS G-4 WDGS, 25 Apr 44, sub: Analof 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) StatisticalHealth Rpts. Off file, Med Statistics Div, SGO. In1939 civilian hospitals in the United States had anaverage of 83 employees per 100 beds and 12 1 em-ployees per 100 patients. See Warren P. Morrill,"Ratio of Personnel to Patients." Hospitals (The Jour-nal of the American Hospital Association), XIV(1940), pp. 47-49.

8 ASF Cir 39, 11 Jun 43.9 An Rpt, 1944, Birmingham Gen Hosp. See also

An Rpts, 1944 and 45, Ashford, Wakeman, Baker,and Lovell Gen Hosps and Waltham, Ft Geo. G.Meade, Cps Bowie, Crowder, and Shelby RegionalHosps. HD.


Day gave impetus to this turnover. Sec-ondly, as hospitals replaced persons quali-fied for overseas service with those in othercategories, their staffs gradually becameheterogeneous mixtures of doctors, admin-istrative officers, Army nurses, civiliannurses, paid nurses' aides, voluntarynurses' aides, general and limited servicemen, Wacs, skilled and unskilled civilians,and prisoners of war. Some of the prob-lems involved in the reduction, turnover,and replacement of personnel in particu-lar categories will now be considered.

Wider Use of Administrative Officers

Medical Corps officers available for as-signment to zone of interior hospitals werelimited in number. According to manningtables, the proper ratio of physicians tobeds ranged from 2.5 per 100 in a 1,000-bed general hospital to 2 per 100 in a4,000-bed installation. During 1944 theactual average ratio for all general hos-pitals was approximately 2.6 per 100 beds.The next year, with the expansion of thehospital system, that ratio dropped toabout 2.3 per 100 and remained thereuntil November 1945.10 Hospital com-manders apparently accepted the fact thatadditional doctors were not available, forthey complained about shortages duringthis period less than earlier. In a few in-stances hospital commanders and servicecommand surgeons reported that thequality of professional care declined. Inothers they called attention to the needfor more specialists, such as neuropsychi-atrists, orthopedic surgeons, and neuro-surgeons.11 More frequently, they com-plained about constant changes in pro-fessional staffs and about the inferior qual-ity of replacements received.12 Despitethese complaints, there seem to have beenenough Medical Corps officers to care

adequately for all patients provided theywere relieved of administrative work andpermitted to devote full time and atten-tion to professional activities.13

The chief method of relieving physi-cians of administrative work was the moreextensive use of Medical AdministrativeCorps officers. It will be recalled that sub-stitution of these for Medical Corps offi-cers in strictly administrative positionshad begun during the early war years, buthad not reached widespread proportions.In the fall of 1943 a strict limitation uponthe number of Army physicians combinedwith an increasing supply of Medical Ad-ministrative Corps officers to suggest toboth the Surgeon General's Office and themedical officer on The Inspector Gen-eral's staff a wider use of administrativeofficers, not only in administrative workunconnected with medical practice butalso in jobs having semiprofessional as-pects.14 In November 1943, therefore, TheSurgeon General proposed that MedicalAdministrative Corps officers be usedthroughout the Army in many positions

10 Tables on basic data and ratios in gen hosps. Offfile. 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; AnRpt, 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 RegionalHosps. 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 15Mar 45, sub: Med Pers and Hosp Fac in ZI. IG:333.9-Med Pers (2). (2) Memo WDSIG 333.9-HospFac (2), Act IG for DepCofSA, 14 May 45, sub: Rptof Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May45). (3) Mins, 6th Conf of SvC Comdrs, EdgewaterPark, Miss, 1-3 Feb 45. HD: 337.

14 (1) Mins, Mtg of Bd of Offs to Study Util of MCOffs, 17 Sep 43. (2) Ltr IG 333.0-Med Pers, IG toDepCofSA, 13 Jan 44, sub: Util of Med Off Pers inZI Instls. Both in Off file, Gen Bliss' Off SGO, "Utilof MCs in ZI" (19) #1 and (20) #2.


previously held by doctors, such as bat-talion surgeons' assistants in the field andregistrars in hospitals.15 The GeneralStaff approved this proposal.16 In May1944 this policy was reflected in hospitalmanning tables prepared by the SurgeonGeneral's Office.17

The demand for Medical Administra-tive Corps officers to fill positions assignedto them under the new policy created atemporary shortage in the latter part of1944. Gradually, as the supply of such of-ficers increased they took over all custo-mary administrative positions in hospitalsin the zone of interior, except those ofexecutive officer and commanding officer,as well as new positions established tohandle such additional wartime functionsas legal assistance, personal affairs, voca-tional counseling, and reconditioning. Inaddition, during 1944 and 1945 some hos-pital commanders appointed Medical Ad-ministrative Corps officers as assistants todoctors to relieve them of duties not di-rectly connected with the treatment ofpatients. In such positions, Medical Ad-ministrative Corps officers assumed re-sponsibility for all property in hospitalwards, for the cleanliness of wards, andfor the discipline of patients; grantedpasses, leaves, and furloughs to patients;and in some instances assigned and super-vised the work of enlisted and civilianward employees. Thus, by the end of thewar Medical Administrative Corps offi-cers, whose use had been almost negligiblein 1942, had become an important part ofArmy hospital staffs.18

Alleviation of the "Shortage"of Army Nurses

During 1944 and the early part of 1945hospital commanders and service com-mand surgeons complained loudly of an

"acute shortage" of Army nurses; but bythe middle of 1945, they reported, theshortage had been eliminated and therewere plenty of nurses for the rest of theyear.19 During the first four months of1944 (for which figures are available) theaverage number of beds per Army nursein general hospitals ranged from 21.2 to23.8, but the average number of patientsper Army nurse was between 10.1 and13.7. In June 1945, when the peak patientload was reached, the average number ofbeds per nurse in general hospitals was13.7, but the average number of occupiedbeds per nurse (11.2) remained about thesame as the year before.20 If one con-siders the general situation, and that onlyin terms of the ratio of occupied beds tonurses, there seems to have been no morereason for complaint in 1944 than laterwhen hospitals reported that the shortagehad been eliminated. At any rate, thevalidity of complaints made in 1944 wasopenly questioned by the commander ofthe Fifth Service Command.21

15 Memo SPMCT 353.-1, SG for CG ASF, 25 Nov43, sub: Conservation of MG Offs. AG: 320.2(10-30-41)(2) T/Os.

16 DF WDGCT 322(25 Nov 43), ACofS G-3WDGS to TAG, 1 Mar 44, sub: Conservation of MGOffs. 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, andWakeman Gen Hosps and Cps Barkeley, Shelby andFt McClellan Regional Hosps; An Rpt, 1945, 5th SvCSurg; An Rpts, 1945, Birmingham, Crile, and LovellGen Hosps. HD.

19 An Rpts, 1944, 2d, 3d, 4th, 5th, and 9th SvCSurgs; An Rpts, 1945, 2d, 5th, 7th, and 9th SvC Surgs;An Rpts, 1944 and 45, Ashford, Fitzsimons, Baker,Halloran, O'Reilly, Baxter, Beaumont, Lovell, Bir-mingham, and Wakeman Gen Hosps and Waltham,Cps Barkeley, Crowder, and Shelby, and Ft McClel-lan Regional Hosps. HD.

20 Tables on basic data and ratios of gen hosps. Offfile, Resources Anal Div SGO. See Charts 8, 9, and10, and Table 13.

21 Mins, 6th Conf of SvC Comdrs, Edgewater Park,Miss, 1-3 Feb 45, pp. 202-03. HD: 337.


Hospital commanders may have beencomplaining about a potential rather thanan actual shortage of nurses, but whetherpotential or actual there were reasons fortheir belief that it was serious. In the firstplace, the authorized ratio of nurses tobeds during 1944 was lower than that towhich hospitals had been accustomed.Early that year the Deputy Chief of Staffof the Army ordered it reduced from onefor every ten beds to one for every fifteen.22

Next, the number of nurses actually as-signed to hospitals during 1944 was oftenlower than the number authorized23 andthere was thus a shortage of nurses to fillauthorized quotas. If hospitals had beencalled upon to operate at full capacity atthat time, they might have encounteredserious difficulties. Furthermore, at thetime when hospitals were required to ad-just to lower ratios of nurses, their enlistedstaffs were reduced also and some of theirtrained technicians were withdrawn foroverseas service.24 This situation perhapscontributed to a feeling on the part ofnurses themselves that they were short-handed and overworked, a feeling possi-bly heightened by the fact that nurses hadto devote attention to new activities, suchas the educational and physical recondi-tioning programs, that were being intro-duced during 1944.25 Finally, the continu-ous turnover of personnel interfered withthe achievement of stable, well-organizedstaffs to operate hospital wards. Whateverthe reason, there was a widespread beliefin Army hospitals during 1944 and theearly part of 1945 that there was an"acute shortage" of nurses; and the Medi-cal Department, from the Surgeon Gen-eral's Office down, tried to alleviate thatcondition.26

A number of measures were adopted toinsure an adequate nursing service for the

Army's patients. Some, such as the elimi-nation of inessential nursing records andthe concentration of patients requiringcontinuous nursing care in as few wardsas possible, were administrative.27 Others,such as the employment of civilian regis-tered nurses and senior student nurses,were designed to supplement the profes-sional nursing service.28 By April 1945there were in general hospitals more than2,000 cadet nurses and more than 1,000civilian nurses.29 A measure that was pro-

22 (1) DF WDGAP 320.21, ACofS G-1 WDGS toCG 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 Instlsin ZI. AG: 320.2(18 Apr 44)(1). (3) WD Cir 209, 26May 44.

23 For example, see Conf, Post Surgs and COs ofGen 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 thenursing "shortage" in the winter of 1944-45. In gen-eral, the authors indicate that the Medical Depart-ment's estimate of nurse requirements was unrealis-tically high. In an interview on 20 November 1951General Kirk stated that the Medical Departmentwas "always short"' of nurses until a draft was pro-posed in the winter of 1944-45. (HD: 314 Corre-spondence on MS) V. The question of whether or notthere was a shortage of nurses in zone of interior hos-pitals was only part of a larger question of a shortageof nurses for use in theaters of operations as well asin the zone of interior. This question will be discussedmore fully in John H. McMinn and Max Levin, Per-sonnel (MS for companion vol. in Medical Dept.series), HD.

27 (1) Mins, Conf of Post Surgs and COs of GenHosps, 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 SvCSurgs; 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. Offfile, Resources Anal Div SGO.


posed, but not adopted, was a draft ofnurses.30 Still another measure was theincreased employment of ancillary per-sonnel to relieve nurses of nonprofessionalduties in the care of patients. During 1944and 1945 hospitals hired civilian nurses'aides and ward orderlies, sought the serv-ices of volunteer Red Cross nurses' aides,and used both enlisted men and Wacs, asthey were available, to assist nurses in thecare of patients.31

Greater Use of Limited Service Men

Along with measures affecting the allot-ment of officers and nurses to hospitals,there were changes in the type of enlistedmen employed during 1944 and 1945.32

The existing policy of reassigning generalservice men from zone of interior installa-tions to overseas units was made stricterand applied more widely during 1944than before. In January ASF headquar-ters began a drive to have all generalservice men, except those who were morethan thirty-five years old, those who hadalready served overseas, those who hadhad less than one year of Army service,and those who were considered to be incertain "key" categories, released from itsinstallations by June; later, October.33

This drive threatened to strip hospitals ofeven their trained technicians. In order toprevent this, the Surgeon General's Officegot the Military Personnel Division ofASF headquarters to consider such menas dental laboratory technicians, meatand dairy inspectors, pharmacists, X-raytechnicians, reconditioning instructors,medical technicians, surgical technicians,and laboratory technicians as being in"key" categories.34 In July 1944 ASFheadquarters announced that even "key"

technicians, if physically qualified foroverseas service, would be taken out ofzone of interior installations as soon as re-placements were available.35 Service com-mands interpreted these directives differ-ently, and some pulled "key" men out ofhospitals without thought of the availabil-ity of properly trained replacements.36 Torecover for the Medical Department someof the technicians improperly transferredas well as those misassigned initially to theGround Forces, the Surgeon General'sOffice succeeded in getting orders pub-lished during 1944 and 1945 requiringtheir retransfer to Medical Departmentunits and installations. These actionssaved enough technicians, so the EnlistedPersonnel Branch of the Surgeon Gen-eral's Office reported at the end of 1944,to man all hospitals properly,37 but not all

30 Blanchfield and Standlee, Organized Nursing,pp. 551-95.

31 An Rpts, 1944 and 45, 2d, 3d, and 9th SvC Surgs;An Rpts, 1944. Deshon, Halloran, O'Reilly, Baker,Fitzsimons, Baxter, Wakeman, Birmingham, andLovell Gen Hosps. HD.

32 For example, see An Rpts, 1944 and 45, FtsBragg and Knox, Cps Barkeley and Lee RegionalHosps, and Baxter, Beaumont, Halloran, Schick, andWakeman Gen Hosps. HD. See also McMinn andLevin, 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 MemoW615-44, 29 May 44, sub: Critically Needed Special-ists. HD. (3) Quarterly Rpt, 3d Qtr 1944, Enl PersBr Mil Pers Div SGO. HD. (4) Mins, Conf of PostSurgs 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 CivSituation in Sta and Gen Hosps during the Past FewMonths. HD: 230.-1 "Civ Pers (Gen)." (2) Quarter-ly Rpt, 4th Qtr 1944, Enl Pers Br Mil Pers Div SGO.HD. (3) An Rpts, Ft Bragg Regional Hosp and Beau-mont Gen Hosp. HD.

37 Quarterly Rpt, 3d and 4th Qtr 1944 and 2d Qtr1945, Enl Pers Br Mil Pers Div SGO, and An Rpts,1944, Baxter and Schick Gen Hosps. HD.


commanders were satisfied with savingtechnicians. Some complained loudlyabout the loss of certain clerical em-ployees, such as those occupying the posi-tion of sergeant major, whom they consid-ered also as "key" persons.38

One reason that hospital commanderscomplained about the loss of general serv-ice men was that they encountered per-sonnel-management problems in usingcivilians, Wacs, and limited service men toreplace them.39 As a rule, limited servicemen assigned to hospitals came eitherfrom nonmedical units in the UnitedStates or from organizations overseas.Many were not trained for work in hospi-tals and had to be oriented and trained onthe job, even in clerical positions. Somefelt that they had already contributedtheir share toward winning the war andwished to be discharged from the Army.Others were psychoneurotic and their job-assignments had to be made with caution.Still others had mental limitations whichmade it difficult for them to absorb job-training. Many were physically handi-capped and could not do heavy work.These restrictions on the use of limitedservice men complicated the problem ofstaffing hospitals.40 Furthermore, the as-signment of such men to hospitals oftencreated morale problems. Under the ASFpersonnel-control system, each hospitalwas authorized a specific number of non-commissioned officers. So long as it hadthat number it could make no promo-tions.41 Many limited service men as-signed to hospitals held noncommissioned-officer grades which they had earned innonmedical units. They were usually notqualified, either by experience or by train-ing, to hold such grades in hospitals.When required to do work which they

considered beneath the dignity of theirgrades, they became resentful. Moreover,their mere presence prevented the promo-tion of other men who, by reason of quali-fications and jobs held, deserved to benoncommissioned officers. Lack of oppor-tunities for promotion lowered the moraleof these men.42

Hospital commanders were powerlessto correct this situation, and the SurgeonGeneral's Office tackled it. Hoping tosolve the dual problem of having menwith proper job qualifications assigned asreplacements and of promoting men whodeserved noncommissioned-officer grades,that Office in 1944 prepared tables of or-ganization for zone of interior hospitals,showing job specifications and correspond-ing grades.43 These tables were not pub-lished in 1944. In January 1945, after theproblem of grades for enlisted men wasmade more acute by the proposal to as-sign WAC companies to hospitals,44 Sur-geon General Kirk appealed to the Secre-

38 For example, see remarks of hospital command-ers in the following: (1) Mins, Conf of Post Surgs andCOs of Gen Hosps, 2d SvC, 19-20 Jun 44, pp. 204and 209. HD: 337. (2) An Rpt, 1944, Ashford GenHosp. HD.

39 In the middle of 1943 the Army abolished theterm "limited service" but continued to classify menas qualified or not qualified for overseas service. Un-officially men not qualified for overseas service con-tinued to be called limited service men.

40 An Rpts, 1944, 2d, 4th, 5th, 7th, and 9th SvCSurgs; An Rpts, 1944, Halloran, Beaumont, Wake-man, Baxter, Baker, Ashford, and Birmingham GenHosps and Cps Barkeley, Lee, and Ft Knox RegionalHosps. 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 DivSGO. HD.



tary of War to approve the table-of-organ-ization method of manning hospitals inthe zone of interior.45 The Secretary ap-proved this proposal in principle, and theSurgeon General's Office revised thetables it had prepared in 1944.46 Duringthe following six months, the latter at-tempted to have them published. Forsome reason, perhaps simply red tape,this was not done and the problem of jobqualifications and grades remained un-solved in ASF hospitals.47

Replacement of Militaryby Civilian Employees

Although limited service men were au-thorized as replacements for men physi-cally qualified for overseas service, chiefemphasis of War Department policy re-garding nonprofessional personnel was onthe use of civilians to replace military em-ployees, whether general service men,limited service men, or enlisted women.Beginning in 1943 civilians were used ac-tually to replace enlisted men, rather thanto supplement them. Under the ASF per-sonnel-control system established in Juneof that year, hospitals had personnel ceil-ings which they could not exceed, and asthey employed additional civilians theyhad to release proportionate numbers ofenlisted men.48 The War Department'sgoal during 1944 and 1945 was to replacemilitary personnel with civilians up toabout half the total force.49 This goal —one to which Surgeon General Magee hadobjected vigorously in the fall of 194050—was approached, though not reached, dur-ing the later war years. In June 1944 ASFstation and regional hospitals employed33,023 enlisted men and women, but only19,469 civilians, exclusive of registered

nurses—a ratio of approximately 17 mili-tary to 10 civilian employees. Duringthe following year civilians replaced en-listed persons at such a rate that in June1945 such hospitals had 17,673 enlistedmen and women and 11,703 civilians—approximately 10 civilians for every 15enlisted men and women.51 General hos-pitals used civilian employees in greaterproportion. In March 1944 the ratio of en-listed to civilian workers in all generalhospitals was about 10 to 10.5, for therewere 28,060 enlisted men and women and29,546 civilians employed in those in-stallations. About a year later, when gen-eral hospitals employed 40,659 enlistedand 45,793 civilian workers, the ratio hadchanged to about 10 enlisted persons to 11civilians.52

In replacing military with civilian em-ployees, hospitals encountered difficulties,

45 Memo SPMDA 322.05, SG for SecWar, 10 Jan45, sub: Med Mission Reappraised. HRS: G-4 file,"Hosp, vol. II." It should be noted that this was areversal of The Surgeon General's traditional oppo-sition to staffing zone of interior hospitals accordingto tables of organization.

46 (1) DF WDGAP 321 Med, ACofS G-1 WDGSfor ACofS G-4 WDGS, 29 Jan 45, sub: Med MissionReappraised. 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 DivSGO. HD. (4) Unsigned Memo for Record, 22 Feb45. SG: 320.3 "(T/O) Jan-Mar 45."

47 (1) Memo, Dir Resources Anal Div SGO for GenBliss, 20 Jun 45, sub: Pers Guides. HD: ResourcesAnal Div file, "Hosp." (2) 2d ind, Dep SG to CGASF, 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; andMins, 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 DivSGO.

52 Tables on basic data and ratios for gen hosps. Offfile, Resources Anal Div SGO.


as they had earlier.53 They still had troublerecruiting civilians in sufficient numbers,maintaining stable civilian-personnelforces, and using women and elderly orpartially disabled men. They had to hirecivilians who were not qualified for jobsthey were to hold, and train them after-ward. For example, hospitals in theFourth Service Command trained civil-ians as apprentice dietitians, dental as-sistants, dental mechanics, laboratoryhelpers, X-ray technicians, guards, fire-fighters, telephone operators, steamfitters,refrigeration and air-conditioning me-chanics, laundry operators, ward attend-ants, mess attendants, orthopedic shoemechanics, cooks, and meatcutters. Fur-thermore, particularly in wards, hospitalcommanders confronted the difficulty ofreplacing enlisted men who worked twelvehours a day with civilians who workedonly eight. Hoping to solve this problem,The Surgeon General asked for replace-ments on a basis of three civilians for twoenlisted men. Some service commandsfollowed this practice, but the War De-partment Manpower Board disapprovedit and recommended allotments of civilianreplacements for enlisted men on a one-for-one basis.54 Hospitals then used splitshifts for civilian employees and madeother changes in work schedules, in orderto have sufficient numbers on duty dur-ing the hours when work was heavy.Other difficulties for hospital commandersresulted from their lack of control overcivilians, who often failed to show up forwork, refused to work on night shifts, and,because of civil service regulations, couldnot be moved from one job to another tomeet emergency needs. In such instancesit was necessary to assign enlisted per-sonnel to fill the vacancies. Finally, hos-

pitals began to employ a different type ofcivilian during the later war years—paidnurses' aides—who, although not numer-ous, often created morale problems amongenlisted Wacs by their mere presence.55

Use of Wacs in Army Hospitals

Although the Medical Department hadbegun to use Wacs56 in hospitals earlier,by the middle of 1943 their number wassmall in proportion to that of enlisted menand civilians. Apparently WAC headquar-ters could not supply more, for in January

53 See above, pp. 33, 135. This paragraph is basedin general upon the following: An Rpts, 1944, Surgs4th, 5th, 7th, and 9th SvCs, and 1945, 2d and 5thSvCs; and An Rpts, 1944 and 45, Brooke, Halloran,O'Reilly, Ashford, Baker, Birmingham, Wakeman,Baxter, Beaumont, Ashburn, and Battey Gen Hospsand Regional Hosps, Cps Shelby, Polk, Lee andCrowder, Scott and Keesler Flds, and Fts Bragg,Knox, and Meade, all in HD; and Ltr, Capt LutherF. Dunlop, QMC, Hosp Div SGO to HD SGO, 4 Jul44, sub: Summary of Civ Situation in Sta and GenHosps during Past Few Months, in HD: 230.-1 "CivPers (Gen)."

54 (1) Memo, WDMB for ACofS G-3 WDGS, 25Apr 44, sub: Anal of Proposed Strength Tables forMed Instls in ZI. (2) Memo, SG for DepCofSA thruCG ASF, 3 May 44, same sub. (3) Memo WDSMB323.3 (Hosp), WDMB for CofSA, n d, sub: WD Cir209, 1944. (4) Memo SPMDM 300.5, SG for ACofSG-1 WDGS, 17 Feb 45, same sub. (5) MemoWDCSA 200.3 (3 Mar 45), Asst DepCofSA for ACofSG-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 avail-able of the employment of civilian nurses' aides inArmy hospitals is in Blanchfield and Standlee, Or-ganized Nursing, pp. 487-89, 492-93, 568.

56 The Women's Army Corps (WAC) was author-ized by Congress to supersede the WAAC on 1 July1943. For a general discussion of the use of Wacs bythe Medical Department see McMinn and Levin,op. cit., and Mattie E. Treadwell, The Women's ArmyCorps (Washington, 1954), Chap XIX, in UNITEDSTATES ARMY IN WORLD WAR II.


1944 The Surgeon General's HospitalAdministration Division reported thatmany unfilled requisitions were on hand.57

As the withdrawal of general service menfrom zone of interior hospitals and the lackof sufficient nurses to fill authorized quotasincreased the need of hospitals for ancil-lary personnel, The Surgeon General ap-proved the use of Wacs and of both volun-tary and paid nurses' aides. During 1944and 1945 special recruiting campaignswere conducted both by WAC headquar-ters for additional Wacs and by the RedCross for civilian nurses' aides. By thespring of 1945 a surplus of Wacs had beenrecruited for the Medical Department.58

In order to use all of them, and at the sametime to offset the shorter hours which Wacswere by then authorized to work, TheSurgeon General requested their allotmentto replace enlisted men in a ratio of threeWacs for two men. The Staff refused thisrequest, and some of the Wacs recruitedfor the Medical Department had to betransferred to other assignments.59

As hospitals began to use more Wacs, acontroversy developed over policies gov-erning their employment. Basically, itsprang from the question of whether Wacswere to be considered primarily as womenor as enlisted personnel. The director ofthe Women's Army Corps placed moreemphasis on their sex than on their en-listed status. Interested in their welfareand in the success of recruiting programs,she wanted Wacs to work shorter hoursthan was customary for enlisted menassigned to ward duties, to be used only astechnicians and not as ward orderlies orkitchen workers, and to be given gradescommensurate with technical duties per-formed.60 Aware of difficulties which hos-pital commanders encountered in man-

ning installations in compliance with WarDepartment policies, The Surgeon Gen-eral wished to give them as much flexibil-ity as possible in the employment of mili-tary personnel. Therefore, he emphasizedthe enlisted status of Wacs and insistedthat they should not be given preferentialtreatment, just because they were women,in jobs, work-hours, or grades.61 This atti-tude, along with the kind of jobs to whichsome Wacs in hospitals were assigned, laidthe Medical Department open to the accu-sation in the fall of 1944 that it side-stepped recruiting promises.62

In the winter of 1944-45 The SurgeonGeneral almost lost out in the controversyover policies on Wac employment. InDecember 1944 G-1 ruled that Wacsshould work the same hours as nurses

57 (1) Tables on basic data and ratios of gen, re-gional, sta, and conv hosps. Off file, Resources AnalDiv SGO. (2) Diary, Hosp Admin Div, 25 Jan 44.HD: 024.7-3.

58 (1) Treadwell, op. cit., Ch. XIX, gives from theWAC viewpoint a full discussion of both the recruit-ing of Wacs for, and their use by, the Medical De-partment. (2) Blanchfield and Standlee, OrganizedNursing, pp. 489-93, have a discussion of the nurses'aide recruiting campaign.

59 (1) Ltr, SG to CG ASF attn Dir Mil Pers Div, 23May 45, sub: Asgmt of MD Enl Pers (WAC). SG:322.5-1 (WAC) 1945. (2) Ltr, SG to CG ASF attn DirMil Pers Div, 23 Jun 45, sub: Tng of Enl Pers (WAC).Same file. (3) Quarterly Rpts, 2d and 3d Qtrs (1 Junand 1 Oct) 1945, Enl Pers Br Mil Pers Div SGO. HD.

60 Ltr WD WAC 720 (29 Jun 44), Dir WAC to CGASF, 29 Jun 44, sub: WAC Duties on KP Detail andHosp 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 SGOfor Chief Prof Admin Serv SGO, 22 Nov 44. HD: 353"WAC Gen."

62 (1) T/S SPGAM/322.5 WAC(6 Sep 44)-97, CGASF to ACofS G-1 WDGS, 12 Sep 44, sub: WACDuties on KP Detail and Hosp Orderly Asgmts. AG:220.3 "WAC(29 Jun 44)(2)." (2) Blanchfield andStandlee, Organized Nursing, p. 494.


(normally less than those of enlisted menemployed in wards).63 The followingmonth the Chief of Staff, in approving arecruiting program for Wacs for the Medi-cal Department, directed that WAC table-of-organization or table-of-distributioncompanies should be organized for generalhospitals. The table of distribution thatwas adopted listed only technical jobs,except for company administrative work,and contained no grades lower than thatof technician fifth grade (the equivalent ofcorporal).64 If the wishes of the WAC direc-tor had been followed, all of the Wacsalready serving in hospitals under the bulk-allotment system would have been eitherassigned to these companies or transferredfrom hospitals. Either action would havedeprived hospitals of the use of Wacs asward orderlies, drivers, clerks, cooks, andbakers. The Surgeon General objected tosuch an arrangement and the GeneralStaff then agreed that general hospitalsmight retain some Wacs, without assigningthem to table-of-distribution companies,for use in nontechnical jobs.65 After V-JDay WAC companies were disbanded andthe Medical Department returned to theformer system of employing enlisted wom-en, along with enlisted men, as part of itsbulk allotment of military personnel.

As hospital commanders employedgreater numbers of Wacs, some reportedthat they could be used in all departmentson almost every type of job, but othersbelieved that Wacs could not replace en-listed men on a one-for-one basis in thewards and kitchens of hospitals, where thework was heavy and the hours long.66 Tokeep enough men in such places for heavywork, the General Staff approved TheSurgeon General's proposal that the num-ber of enlisted women assigned to wards

and diet kitchens should not exceed 40percent of the total enlisted staff.67

While some hospital commanders re-sented limitations upon their authority toselect the jobs and set the duty-hours ofWacs, the most common problem in em-ploying them was one of morale. Nursesrarely thought of enlisted women in termsof the nursing service and objected to theirassumption of many professional nursingduties.68 Because of misleading recruitingpublicity, Wacs came to expect more op-portunities in the nursing care of patientsthan was warranted, and many were dis-illusioned and disappointed when theyfound their actual jobs less glamorous thanhad been depicted.69 Enlisted men re-sented the preferential treatment whichWacs received in the matters of rank andworking conditions. Wacs in turn resented

63 DF WDGAP 220.3 WAC, ACofS G-1 WDGS toSG thru CG ASF, 26 Dec 44, sub: WAC Pers Asgd toHosp 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 Mar45. SG: 322.5-1 (WAC) 1945. (2) Memo, Act ChiefPers Serv SGO for SG, 14 Mar 45, sub: WAC Re-cruiting Program for T/D Co at Named Gen hosps.Same file. (3) Memo, Lt Col E. R. Whitehurst forDir Tng Div SGO, 18 Jul 45. Same file. (4) Quarter-ly Rpt, 1st and 2d Qtrs, 1945, Enl Pers Br Mil PersDiv 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 PersBr Mil Pers Div SGO. HD. (2) Weekly Summary ofDaily Diaries, Hosp and Dom Oprs SGO, 14 Jul 45.HD: 024.7-3.

67 (1) Memo SPMCQ 300.5(WD Cir), SG for DirPublication Div AGO thru CG ASF and ACofS G-1WDGS, 31 Jan 45, sub: Proposed WD Cir. . . . AG:220.3 "WAC (29 Jun 44)(2)." (2) WD Cir 71, 6 Mar45.

68 Blanchfield and Standlee, Organized Nursing,pp. 487, 594.

69 Treadwell, op. cit., Ch. XIX, and Blanchfieldand Standlee, Organized Nursing, p. 487.


preferential treatment accorded civiliannurses and nurses' aides.70 Despite thesedifficulties, Wacs became valuable andintegral parts of hospital staffs by the endof the war.71

Use of Prisoners of War in Army Hospitals

A final category of personnel whichproved advantageous in the operation ofhospitals in the United States was prisonersof war. Hospitals began to use them during1944 and by the end of the year some gen-eral hospitals employed as many as two orthree hundred each. They continued to beused until their repatriation in 1945. Nor-mally, prisoners of war were not used inwards in the care of patients. The mostcommon place for their employment wasin kitchens and messes and on buildingsand grounds. In some hospitals they servedalso in warehouses, motor pools, laun-dries, post exchanges, and orthopedicshops. Some prisoners had skilled tradesand others were skilled technicians. Hos-pital commanders used them, when desir-able, on jobs for which they had beentrained. Generally, prisoners of war seemto have been an industrious, easily man-aged lot, who did their work efficientlyand well so long as they were properlysupervised.72

The record of the Medical Department'sexperience in manning hospitals leads totwo conclusions. In the first place, duringthe earliest part of the war Army hospitalshad larger staffs than they actually neededto maintain a satisfactory standard of care,for the Surgeon General's Office itself wasagreeable to some reductions in 1944 whennecessity required them. It is a moot pointwhether or not the reductions required by

policies and practices of the War Depart-ment Manpower Board and ASF head-quarters were too great. In the secondplace, experience showed that hospitalscould be operated with a lower ratio ofdoctors and able-bodied enlisted men tototal hospital staffs than had been thoughtpossible. The Surgeon General's Officeresisted the substitution of Medical Ad-ministrative Corps officers for doctors inadministrative positions as well as the sub-stitution of civilians, limited service en-listed men, and Wacs for able-bodiedenlisted men; but when necessity or direc-tives from higher authority compelledthese steps to be taken experience provedthat they were not disastrous.

This is not to say that the practice ofreducing the staffs of hospitals and of sub-stituting personnel of various kinds forable-bodied enlisted men had no adverseeffect upon hospital operations. On thecontrary, as shown above, changes in per-sonnel created serious problems for hospi-tal commanders. Furthermore, opiniondiffered about the effect of those changesupon the quality of professional care.Many hospital commanders reported that

70 (1) Draft Ltr, SG to CG ASF, 23 Jul 45, sub: Dis-cipline and Morale of ASF Trps. (2) Memo, Con-sultant Women's Health and Welfare Unit SGO forChief Pers Serv SGO, 28 Jul 45, sub: Use of WAC inArmy Med Instls. Both in SG: 322.5-1 (WAC).

71 (1) Rpt, Subcmtee on Employment of Mil MedResources to the Exec Sec, Cmtee on Med and HospServ of the Armed Forces, 25 May 48, p. 542. HD. (2)Memo, Dep Dir Educ and Tng Div SGO for SpecPlanning Div SGO, 17 Apr 46, sub: Wacs in PostwarMil Estab. HD: 353 "WAC Gen."

72 (1) An Rpts, 1944, Percy Jones, Ashford, Baker,Letterman, and Halloran Gen Hosps, and Cp Barke-ley and Ft McClellan Regional Hosps; and An Rpts,1945, Birmingham, Lovell, Baker, Baxter, and Ash-ford Gen Hosps and Waltham and Cp Shelby Re-gional Hosps. HD. (2) Mins, 6th Conf of SvC Comdrs,Edgewater Park, Miss, 1-3 Feb 45, p. 192. HD: 337.


they continued to maintain high stand-ards; but some, as well as certain servicecommand surgeons and indeed the chiefof the Surgeon General's Hospital Divi-sion, believed that medical care sufferedas a result of changes in both the qualityand quantity of personnel assigned tohospital staffs.73

On the other hand, a group of non-medical officers who investigated com-plaints of the hospital commander at FortJackson (South Carolina) during thespring of 1944 believed that many hospitalcommanders became "panicky" whenfaced with changes in their staffs and thatmost of their problems were capable of

solution through "determined and efficientpersonnel management." 74 Certainly theproblems of hospital commanders wouldhave been fewer and the possibility of ad-verse effects upon professional care less ifchanges eventually made in hospital staffs,as well as measures to improve personnelmanagement in hospitals, had been initi-ated early in the war by the MedicalDepartment itself.

73 (1) See above, pp. 249-59. (2) Interv, MD His-torians with Brig Gen Albert H. Schwichtenberg, 29Apr 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 InternalOrganization and Administra-

tion of Hospitals in theUnited States

In the latter half of the war, reductionsin the staffs of hospitals and changes intheir make-up made more imperativethan formerly the improvement of hospi-tal organization and administration. Itwill be recalled that the Wadhams Com-mittee had recommended such action asearly as November 1942 and as a resultThe Surgeon General had brought intohis Office in the spring of 1943 an experi-enced hospital administrator, Lt. Col.Basil C. MacLean. In his opinion pre-liminary studies confirmed the need forimprovement.1 Moreover, as the Army'smanpower shortage became serious in thefall of 1943, ASF headquarters began ageneral program for the more efficient useof personnel. Extending to all technicaland supply services, including the MedicalDepartment, it comprehended the stand-ardization of organization, the eliminationof nonessential activities and records, thesimplification of work methods, and theimprovement of administrative proce-dures.2 As a part of this program and of

efforts to shorten periods of patient-stay inhospitals, the ASF Control Division andthe Surgeon General's Office began workin the fall of 1943 on the simplificationand standardization of the disability-dis-charge procedure, already discussed. Bythe following January, General Somervellinformed Surgeon General Kirk that heconsidered improvement of hospital ad-ministration one of the Medical Depart-ment's major problems. About a monthlater, at a service command conference inDallas, Tex., he directed the chief of theSurgeon General's Operations Service,Brig. Gen. Raymond W. Bliss, to "under-take to be the lead-off man in a study of

1 (1) Memo, Lt Col Basil C. MacLean, SGO, forBrig Gen Raymond W. Bliss thru Col A[lbert] H.Schwichtenberg, 6 Nov 43, sub: Observations Basedon Recent Visits . . . to Nine Gen Hosps. Off files,Gen Bliss' Off SGO, "Util of MCs in ZI" (19) #1. (2)Memo, MacLean for Bliss thru Schwichtenberg, 2Feb 44, sub: More Efficient Util of Army Hosp Fac.Off files, Gen Bliss' Off SGO, "Util of Army HospFac."

2 History of Control Division, ASF, 1942-45, pp.31-55, 160-66, 182-83. HD.


the simplification of this Medical Depart-ment paper-work." 3

Simplificationof Administrative Procedures

A basis for the study directed by Gen-eral Somervell was laid during the springof 1944. Work on the disability-dischargeprocedure had already demonstrated thevalue of simplification and standardiza-tion and about a week before the Dallasconference the Surgeon General's Hospi-tal Division had asked his Control Divi-sion to review hospital administrativeprocedures generally. The latter Divisioncalled for assistance upon the ASF Con-trol Division, which had had experienceand which had personnel qualified in suchmatters. In April 1944 these Divisions, as-sisted by service command control divi-sions, surveyed records and proceduresused at Schick, O'Reilly, and HalloranGeneral Hospitals and outlined a broadprogram for succeeding months. Studieswere to be made to simplify hospitalorganization, hospital admissions, wardadministration, fiscal procedures, messmanagement, hospital statistics, nursingadministration procedures, personnel of-fice procedures, information office proce-dures, and hospital dispositions. To pre-vent swamping hospitals with revised butimperfect procedures, the Hospital andControl Divisions of the Surgeon Gen-eral's Office insisted that each revisedprocedure should be approved by profes-sional consultants of that Office and testedin selected hospitals before general adop-tion. To avoid unnecessary delays in theiruse, procedures were to be studied sepa-rately and, when revised and tested, wereto be issued as parts of a loose-leaf manualon hospital administration.4

Several difficulties were encountered incarrying out this program. Short of per-sonnel because it had reduced its own staffas an example to others, the Surgeon Gen-eral's Control Division had only one officerwho could devote his full time to thatwork. The Division also lacked personnelqualified by training and experience tomake procedural studies and to draft pro-cedural manuals in the form desired byASF headquarters. Furthermore, its di-rector was absent on special overseas mis-sions during much of 1944 and work onthe program suffered from his absence. Toovercome some of these difficulties, theSurgeon General's Office temporarily bor-rowed personnel from the ASF ControlDivision, from Army hospitals, and fromother installations. Even so, the ASF Con-trol Division considered progress on theprogram unsatisfactory and threatened,early in 1945, to take over its completion.The Surgeon General prevented suchaction, but friction between his Office andthe ASF Control Division continued.5 Asa result of these difficulties, and of delays

3 (1) Memo, Lt Gen Brehon B. Somervell, CG ASFfor SG, 18 Jan 44. HRS: Hq ASF Somervell files, "SG1944." (2) Mins, ASF Conf of CGs of SvCs, Dallas,Tex., 17-19 Feb 44. HD: 337.

4 (1) Memo, Act Dir Control Div SGO for Dir Con-trol Div ASF, 10 Feb 44, sub: Proposed Study ofAdmin Procedures and Records Used in Gen Hosps.SG: 323.7-5 (Gen Hosp). (2) Memo, Dep SG for CGASF attn Dir Control Div ASF, 14 Mar 45, sub: Im-provement of Hosp Admin Procedures. SG: 300.7.(3) History of Control Division, ASF, 1942-45, App,pp. 357-59. HD.

5 (1) Memo, Maj J. B. Joynt, Control Div ASF forCol A. G. Erpf, Control Div ASF, 18 Dec 44, sub:Problems on Hosp Manual. (2) Memo, Col A. G.Erpf, Control Div ASF for Col O. A. Gottschalk, Con-trol Div ASF, 18 Dec 44, sub: Control Div SGO. (3)Memo SPMCQ 300.7, Dep SG for CG ASF attn DirControl Div ASF, 14 Mar 45, sub: Improvement inHosp Admin Procedures. (4) Memo, Col A. G. Erpffor Col O. A. Gottschalk, 17 Mar 45. All in HRS: HqASF Control Div file, "SGO." (5) Memo, Act DirControl Div ASF for Act CofS ASF, 5 Apr 45, sub:

INTERNAL ORGANIZATION AND ADMINISTRATION 263

inherent in testing revised procedures be-fore adopting them for general use, onlyone chapter of the projected manual—that on hospital admissions—was pub-lished before the peak patient load wasreached in the United States. Other re-vised procedures—those for linen control,disability discharges, and disability retire-ments—were published in separate man-uals or circulars before that date.

The hospital admissions procedure canbe used to illustrate both the manner inwhich new procedures were developedand the methods used to simplify hospitalpaper work. The Control Division of theSurgeon General's Office, in consultationwith the Hospital Division, developed atentative procedure for the admission ofpatients, and, along with it, the forms tobe used. Before these forms were pub-lished, they were approved by the ASFControl Division, the Air Surgeon's Office,the Surgeon General's Control, Profes-sional Services, Hospital, and MedicalStatistics Divisions, and the AdjutantGeneral's Methods Management Branch.6

The new procedure was then given a pre-liminary trial in three hospitals—two ofthe Service Forces and one of the AirForces.7 After they had commented on itsadvantages and disadvantages, it was re-vised and published in a tentative manualof hospital procedures.8 Soon afterward,the Surgeon General's Office called a con-ference in Washington to explain the new

procedure to representatives of varioushospitals.9 Selected hospitals, serving aspilot installations, then began to use theprocedure and to teach representativesfrom other hospitals how to employ it.10

Finally, early in 1945, the new procedurewas published in final form as a chapterof the new manual on hospital adminis-tration (TM 8-262), and by the middle ofthat year almost all hospitals with as manyas ten admissions a day had begun toadopt it.11

While the revised procedure covered insomewhat greater detail than did the oldone the various steps taken in the admis-sion of patients, its greatest significancelay in changes in hospital admission rec-ords and their preparation. Two basicforms were prepared for the admission ofpatients to hospitals: the clinical recordbrief and the medical report card. In ad-dition, other records such as deposit slipsfor patients' funds and locator cards foruse by interested groups in hospitals wereprepared 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. Samefile. (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 Rptof Control Div for FY 1945. HD: 319.1-2-(ControlDiv, SGO) FY 1945. The reason that Colonel Mac-Lean took little or no part in the development of sim-plified administrative procedures, and left the Sur-geon General's Office in the fall of 1944, is not clearto the writer.

6 (1) Diary, Hosp Div SGO, 12 and 14 Jun 44. HD:024.7-3. (2) Ltrs, SG to Chief Forms Design andStandardization Sec Methods Management Br Con-trol Div ASF, 13 Jul 44, sub: Revision of MD Form52 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 HospProcedures Simplification Project. SG: 323.7-5 (GenHosp).

8 Manual of Hosp Procedures (Tentative), pre-pared by SGO Control Div, 1 Sep 44. HD.

9 Ltr, CO Regional Hosp Cp Swift to CG 8th SvCattn SvC Surg, 1 Oct 44, sub: Rpt of Hosp AdminProcedure Conf Held in Washington, 25 Sep 44. SG:337.-1.

10 For example, see: An Rpts, 1944, Schick GenHosp, and Ft Jackson and Cp Swift Regional Hosps.HD.

11 (1) Memo SPMCQ 300.7, SG for CG ASF, 14Mar 45, sub: Improvement in Hosp Admission Pro-cedures. HRS: Hq ASF Control Div file, "SGO." (2)An Rpt, FY 1945, Control Div SGO. HD. (3) TM8-262, Admin of Fixed Hosps, ZI, Ch II, HospAdmissions, 1 Feb 45.


the old procedure the two basic forms hadto be typed in separate operations, foreven though much information was com-mon to them both, such as the patient'sname, rank, serial number, organization,age, race, length of service, etc., thoseforms were blocked off differently. Otherrecords had to be made up separately also,many by offices needing information foundeither on the clinical record briefer on thehospital's daily admission and dispositionsheet. Under the revised procedure, allforms containing common informationwere blocked off alike and a mimeographduplicator was used to transfer that in-formation to as many copies as neededthroughout the hospital. Thus one typingreplaced fifteen or twenty under the oldsystem. The chapter on the new admis-sions procedure illustrated each of theseforms and gave detailed instructions fortheir preparation and distribution. In theopinion of the Surgeon General's Office,the new procedure speeded up the ad-mission of patients, eliminated the du-plication of records, supplied operatingunits of hospitals with information theyhad not formerly received, and saved inthe hospitals where adopted a total ofabout 3,333 man-days of work per week.12

Hospital commanders encountered onlyminor difficulties in installing the newprocedure and, with few exceptions, con-sidered it an improvement over the oldone.13

As in the development of the admissionsprocedure which saved work for adminis-trative officers, the Surgeon General'sOffice was equally interested in proce-dures that would relieve ward officers ofadministrative details in order to permitthem to devote more time to professionalwork. One of the procedures developedduring 1944, that for the control and dis-

tribution of hospital linens, was designedfor this purpose. Developed in a mannersimilar to the hospital admissions proce-dure, the linen control procedure waspublished in December 1944 in an ASFcircular rather than as a chapter of thehospital-administration manual.14 Underthe old procedure physicians were chargedwith the linen used in wards and clinics.In order to avoid being "caught short,"they required ward personnel to countsoiled linen as it left the ward and cleanlinen as it was returned. Furthermore, theyrequired periodic inventories and sometended to hoard linen unnecessarily. Ad-ditional linen-counts were made at inter-mediate storage points and at hospitallaundries. Under the new procedure eachhospital had a linen officer who was re-sponsible for all linen used. All counts oflinen in wards and intermediate stationswere eliminated; and linen officers, ratherthan ward officers, made periodic inven-tories. According to some hospitals, a dis-advantage of this procedure was anexcessive loss of linens. This was com-pensated for, in the opinion of the Sur-geon General's Office and many hospitalcommanders, by the saving of about1,250 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 andDom Oprs SGO. HD.

13 For example see: An Rpts, 1944, Baxter andFitzsimons Gen Hosps; An Rpt, 1945, BirminghamGen Hosp; An Rpts, 1944, Cps Crowder and Swift,and Ft Jackson Regional Hosps; An Rpts, 1945, CpWolters 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 onLinen Control and Distribution Systems. Same file.(3) Rpt of Economies Effected through ProceduresStudies Made by or jointly with Control Div ASF, 13Apr 45. HRS: Hq ASF Control Div file, "Est AdminSavings Resulting from Procedural Revisions." (4)ASF Cir 395, 2 Dec 44.


the relief of doctors of administrative de-tails. It was also reported that the newprocedure decreased the hoarding of linenand speeded up its distribution to placeswhere needed.15

The use of dictaphones in hospitals wasnot called for by manuals or circulars, butnevertheless constituted an importantchange in the method of preparing clinicalrecords. Lack of enough medical stenog-raphers in hospitals, as a result of thecivilian labor shortage and of hospitalpersonnel ceilings, made it necessary dur-ing 1943 for doctors themselves to prepareclinical records, sometimes in longhand.To relieve them of such a time-consumingprocess, hospitals began early in 1944 toacquire dictaphones. At convenient timesdoctors recorded on these machines con-sultation reports, progress notes, case his-tories, and final summaries. Clerks or-ganized in central pools then transcribedthe information recorded. This system ofpreparing clinical records permitted doc-tors to keep more complete and morelegible records and to devote more atten-tion to care of patients. It also contributedto the more efficient use of clerical per-sonnel. Finally, by enabling doctors tokeep clinical records up to date it helpedto speed the disposition of patients and toshorten their period of hospitalization.16

The simplification of other administra-tive procedures was not completed beforethe peak patient load was reached, butwork on the program continued duringthe winter of 1944 and the spring of 1945.Beginning in July 1945 chapters in thehospital-administration manual were pub-lished on the following subjects: Patients'Funds and Valuables (1 July 1945); Hos-pital Organization (1 July 1945); WardAdministration (1 October 1945 and 15February 1946); Accounting Procedures

for Hospital Funds (1 October 1945);Mess Administration (15 November1945); Personnel Administration (28 De-cember 1945 and 15 February 1946);Clinical Procedures (15 February 1946);and Supply Procedures (1 March 1946).17

Work-Measurementand Work-Simplification Programs

Delay in completing the manual onhospital administration did not interferewith the simplification of administrativeprocedures and work methods by hospitalsthemselves. As part of its program forefficient personnel utilization, early in1943 ASF headquarters began to requiresubordinate installations to set up pro-grams of "work simplification" and "workmeasurement." Work simplification wasthe process of reducing the jobs of indi-vidual workers, or the operations of groupsof workers, to their simplest forms andeliminating from them all lost motion.Work measurement was the determina-tion by various standards of the numberof employees required for certain jobs oroperations.18 During 1944 and 1945 hos-

15 (1) An Rpt, FY 1945, Hosp and Dom Oprs SGO;An Rpts, 1944, Lawson, Thayer, Oliver, and Ash-burn Gen Hosps, and AAF Regional Hosp KeeslerFld; An Rpts, 1945, Birmingham and Lovell GenHosps, and Surg 7th SvC. HD. (2) Mins, HospComdrs Conf, 7th SvC, 22 Aug 45. HD: 337.

16 (1) Excerpts from rpts of various hosps on the useof dictaphones, Jun-Jul 44. SG: 413.51. (2) An Rpts,1944, Ashburn, Deshon, Beaumont, Baxter, and Bir-mingham Gen Hosps, and Regional Hosps at FtsMcClellan and Meade, Maxwell and Scott Fids, andCps Shelby, Barkeley, Swift, and Crowder. HD.

17 (1) TM 8-262, Admin of Fixed Hosps, ZI, dateslisted. (2) An Rpt, FY 1945, Hosp and Dom OprsSGO. 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 andAdmin Servs, CGs all SvCs, 1 Mar 43, sub: WorkSimplification. SG: 024.-1.


pital control officers appointed as a resultof ASF headquarters' emphasis uponmanagement techniques (or administra-tive engineering) conducted work-meas-urement and work-simplification studiesand proposed changes to save time andpersonnel in a multiplicity of functionsand activities.19 For example, a survey ofward attendants' duties at Walter ReedGeneral Hospital in the spring of 1944showed that attendants spent 20 percentof their time in off-the-ward errands. Tocorrect that situation a delivery servicestaffed with twenty people was set up, andforty ward attendants were released.20

Another hospital, Thayer General Hos-pital, made changes in its system of trashcollection that saved 200 man-hours permonth. At still another Ashford GeneralHospital, a reallocation of individualduties and a rearrangement of office anddesk space in the registrar's office per-mitted the completion in 1944 of 4,911more work-units in 9,600 fewer work-hours than in the year before. Seventeenwork-measurement and work-simplifica-tion studies made at Newton D. BakerGeneral Hospital during 1944 resulted inthe saving of 2,844 man-hours per month.Other hospitals reported similar sav-ings from local changes.21 In this way,hospitals adjusted their operations toperformance by reduced staffs and man-agement control became an establishedfunction in all large Army hospitals.22

Additional Activities and TheirPlace in the Organizational

Structure of Hospitals

In the latter half of the war new pro-fessional and administrative activitieswere added to Army hospitals. When con-valescent reconditioning was established

as an Army program, hospital command-ers placed that activity in a variety oflocations in their organizational struc-tures; but by February 1944 the SurgeonGeneral's Office concluded that recondi-tioning should be considered as a profes-sional service on a par with medical andsurgical services. The next month, withthe approval of ASF headquarters, thechief of The Surgeon General's Recondi-tioning Division announced this decisionas policy at a conference of reconditioningofficers at Schick General Hospital.23 Twoother changes occurred in the professionalservices during 1943 and 1944. Graduallyhospitals began to list nursing as a profes-sional rather than an administrative serv-ice and to show neuropsychiatry as anindependent service rather than as a sec-tion of the medical service.24

19 In an interview on 20 November 1951 GeneralKirk stated that he thought too much emphasis hadbeen placed upon the "workload business." In hisopinion workload studies were expensive and "didnot pay more than ten cents on the dollar." HD: 314(Correspondence MS)V.

20 Work Simplification Rpt, 8 Apr 44, sub: DeliveryServ, Walter Reed Gen Hosp. SG: 323.7-5 (WalterReed GH)K.

21 An Rpts, 1944, Thayer, Ashford, Newton D.Baker, O'Reilly, Kennedy, Baxter, Schick, and Bir-mingham Gen Hosps; An Rpts, 1945, Crile and Bat-tey Gen Hosps. HD.

22 (1) Memo, Dir Control Div SGO for Dir HDSGO, 23 Jun 45, sub: An Rpt of Control Div for FY1945. HD: 319.1-2 (Control Div, SGO) FY 1945. (2)SG Cir 119, 15 Sep 50, sub: Orgn of US Army HospsDesignated as Class II Instls or Activities, provided fora management office in each Army hospital desig-nated as a Class II installation or activity (that is, gen-eral hospitals operating in 1950 under the direct con-trol of SGO).

23 (1) An Rpts, 1944, Baxter, Finney, Crile, Law-son, Vaughan, and Fletcher Gen Hosps. HD. (2) Ltr,Act SG to CG ASF, 15 Mar 44, sub: Orgn Chart, Re-conditioning Program, with 1st ind, CG ASF to SG,17 Mar 44. Off file, Physical Med Consultants DivSGO, "Reconditioning, Gen (Policy)." (3) An Rpt,Reconditioning Conf, Schick Gen Hosp, 21-22 Mar44, p. 17. HD: 353.9 Schick Gen Hosp.

24 See annual reports of hospitals on file in HD.


Additional administrative activities inhospitals came largely as a result of theirintroduction generally in ASF installa-tions. Revision of the ASF organizationmanual in December 1943 caused addi-tion of control officers to serve as staff ad-visers on administrative, procedural, andmanagement problems.25 About the sametime authority was granted all ASF instal-lations having a strength of 2,000 or moreto appoint special services officers to con-duct athletics and recreation programsand orientation officers (later called infor-mation and education officers) to conductinformation and education programs.26 InFebruary 1944 ASF headquarters directedthe establishment on each of its posts of apersonal affairs division to assist soldiersin handling their personal affairs.27 In thefollowing December the War Departmentdirected separation centers and many hos-pitals (those separating from the serviceone hundred or more persons monthly) toset up classification and counseling unitsto assist soldiers in planning their returnto civilian life.28 General hospitals withfew exceptions and regional hospitals insome instances came within the purviewof these directives and acted accordingly.These new activities—special services, in-formation and education, personal affairs,and classification and counseling—were tobe known later as "welfare services" or as"individual services."

Effect on Hospitals of the ASF StandardPlan for Post Organization

The general program of ASF headquar-ters to standardize organization through-out the Service Forces continued, as it hadearlier, to influence the organization ofgeneral hospitals.29 In December 1943 thestandard plan for the organization of ASF

posts was revised. At that time a controlofficer and a post inspector general wereadded to form, along with the existingpublic relations officer, the commandingofficer's immediate staff. Furthermore, theseven functional divisions which previ-ously comprised all post activities werereplaced by seven administrative andseven technical staff units. To make thischange, the erstwhile Administrative Divi-sion, a functional division which had in-cluded the adjutant, judge advocate, andfiscal officer, was abolished and its officialswere listed among the seven administra-tive staff units. Certain technical services—quartermaster, ordnance, chemical war-fare, signal, and transportation—wererelieved from their former subordinationto the Supply Division and were estab-lished as independent technical staff units.Medical and engineer activities, consid-ered as functional divisions under the oldplan, now became technical staff units.All welfare activities continued, under thenew post plan, to be grouped under thePersonnel Division.30

General hospitals attempted to adjustthemselves to the new organizational planfor ASF posts as they had to its predeces-sor. In each hospital, professional servicesand some administrative units peculiar tohospitals, such as the registrar's office andthe dietetics division, had to be added tothe units included in the standard ASFplan. In the administrative field, hospitalsmade adjustments in various ways. Baxter

25 For example, see An Rpts, 1944, Baxter, Wood-row Wilson, Schick, and Mayo Gen Hosp. HD.

26 (1) ASF Cir 127, 20 Nov 43. (2) WD Cir 360, 5Sep 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.


General Hospital, for example, followedthe ASF plan carefully, at least in its or-ganization chart, and only added to thepost organization a reconditioning divi-sion, a medical supply office, a medicaldetachment, and a professional divisionthat included the professional services andsuch administrative units as the registrar'sand dietitian's offices. Mayo General Hos-pital adhered less strictly to the ASF plan.Although it had most of the officers whichthat plan called for, it placed many whowere supposed to be grouped under anintermediate supervisor, such as specialservices and personal affairs officers, in adirect relationship with the commandingofficer.31 (Chart 12) Hospitals that thusmultiplied the number of officers report-ing directly to the commander violatedone of the ASF principles of organization,namely, that the number of such officersshould be kept as small as possible.32 Sev-eral hospitals on the other hand followedthat principle (and incidentally a recom-mendation made by the Wadhams Com-mittee in the fall of 1942) by combiningtheir administrative services under a singledirector and their professional servicesunder another.33 In February 1945 thecommanding officer of Darnall GeneralHospital suggested that this grouping ofprofessional and administrative servicesunder separate directors, who in turn wereresponsible to the commanding officer,might be followed with advantage by allother hospitals.34

Two other changes were considered de-sirable to make the ASF post organizationapplicable to all hospitals. Officers in theThird Service Command headquartersand in the Surgeon General's Office, aswell as some hospital commanders, be-lieved that technical service officers withonly minor functions in hospitals, such as

those of the Chemical Warfare Service,Ordnance Department, and Transporta-tion Corps, should be either eliminated orsubordinated—as they had been underthe previous ASF post organization—to adirector of supply.35 Conversely, becauseofficers concerned with the individualwelfare of soldiers (special services, per-sonal affairs, information and education,and classification and counseling officers)assumed more importance in hospitalsthan in other installations, some hospitalcommanders and service command sur-geons felt that they should be groupedtogether under a director of individualservices rather than under the director ofpersonnel.36

Emergence of Standard Plansfor Hospitals

Early in May 1944 the Surgeon Gen-eral's Office announced that it was plan-ning to publish a standard plan for theorganization of general hospitals, but itsdevelopment was delayed because ofshortage of personnel in the Control Divi-

31 See annual reports of hospitals named. HD32 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 IslandArea Sta Hosp to CG 2d SvC attn SvC Surg, 3 Mar45, on Ltr, CG 2d SvC (Surg) to CO Staten IslandArea Sta Hosp, 24 Feb 45, sub: Orgn Chart. HD: 323"Hosp Orgn."'

34 Ltr, CO Darnall Gen Hosp to CG 5th SvC attnSvC Surg, 22 Feb 45, sub: Standard Orgn Charts ofGen, 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 Historianwith 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 ofDarnall, Nichols, O'Reilly, and Schick Gen Hosps.HD: 323 "Hosp Orgn."


sion and priority given to procedures fordisability discharges and hospital admis-sions.37 Meanwhile, the surgeon of theFourth Service Command worked out astandard plan for the organization of hos-pitals under his supervision.38 Then, inJune and July 1944 the surgeon and thecontrol officer of the Third Service Com-mand, with assistance from the SurgeonGeneral's Office, developed a standardplan for hospitals in that Command. Afterit had been tested for about six months,The Surgeon General submitted it forcomment in February 1945 to other serv-ice commands. On the basis of their sug-gestions, he made minor changes in theThird Service Command plan andadopted it as standard for general, re-gional, and station hospitals.39 It was pub-lished in July 1945 as a chapter of themanual on hospital administration.40 TheSurgeon General's Office also worked dur-ing this period on the organization of con-valescent hospitals and hospital centers.Tentative plans were published in 1944and 1945. The final plan for convalescenthospitals was published in December1945, but that for hospital centers re-mained unpublished because they beganto close before it was completed.41

During the movement to standardizehospital organization, the merits of such astep were freely discussed. Hospital com-manders generally and service commandsurgeons in some instances raised argu-ments against inflexible standardization.One feared that it would crystallize hospi-tal organization, increasing efficiency inthe operation of some installations butprohibiting imaginative and capable com-manders from making valuable innova-tions in others.42 Some felt that standard-ization would prevent hospital command-ers from adjusting to local conditions. For

example, hospitals giving little outpatientcare might not need to establish separateoutpatient services. Others believed thatcommanders needed freedom to fit theirorganizations to the personalities of offi-cers assigned to them. An eye, ear, nose,and throat specialist of intense individual-ism and higher rank than a chief of surgi-cal service, for instance, could hardly besuccessfully subordinated, in an EENTsection, to the latter.43 On the other hand,there was some feeling that men should befitted to jobs, not jobs to men, and that thestandardization of organization wouldhelp to solve problems raised by clashingpersonalities. The most telling argumentsin favor of standardization were that itwas the first step toward the simplificationand standardization of administrativeprocedures, that it facilitated the measure-ment of work and of personnel require-

37 (1) Rad, SG to CG 4th SvC attn SvC Surg, 3 Mar44. SG: 323.7-5(4th SvC)AA. (2) Edward J. Morganand Donald O. Wagner, The Organization of theMedical Department in the Zone of the Interior(1946), p. 145. HD. (3) Interv, MD Historian withDr. Press, 9 Oct 50. HD: 000.71.

38 (1) Rad, SG to CG 4th SvC attn SvC Surg, 3 Mar44. SG: 323.7-5(4th CA)AA. (2) 1st ind, CG 4th SvC(Surg) to SG, 9 Mar 45, on Ltr SPMCH 323.3 (4thSvC)AA, SG to CG 4th SvC attn SvC Surg, 16 Feb45. sub: Standard Orgn Charts of Gen, Regional, andSta Hosps. HD: 323 "Hosp Orgn."

39 (1) Ltr 323.3 (1st SvC)AA, SG to CG 1st SvCattn SvC Surg, 16 Feb 45, sub: Standard Orgn Chartsof Gen, Regional, and Sta Hosps. Identical letterswere sent to all service commands; these letters, withtheir 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, onLtr 323.3 (7th SvC)AA, SG to CG 7th SvC attn SvCSurg, 16 Feb 45, sub: Standard Orgn Charts of Gen,Regional, and Sta Hosps. HD: 323 "Hosp Orgn."

43 Letters from hospital commanders and servicecommand surgeons expressing these opinions are onfile, HD: 323 "Hosp Orgn."


ments, and that it promoted manpowereconomy.44 At any rate, both the SurgeonGeneral's Office and ASF headquarterswere committed to standardization of hos-pital organization by the winter of 1944.That they did not insist on inflexibilitywas demonstrated by a proviso that hospi-tal commanders might deviate from thestandard plan if their respective servicecommanders approved.45

Details of the Medical Department'sStandard Plans

The standard plan for the organizationof general hospitals, published in July1945, resembled the ASF plan for postorganization and reflected the experienceof hospitals in making adjustments to it.In both plans, the commander's immedi-ate staff included public relations officers,control officers, and inspectors (called in-spectors general on posts and medicalinspectors in hospitals). General hospitals,according to the standard plan, were tohave six of the seven administrative staffdivisions of posts. The seventh, training,was to be subordinated to the personneldivision. In addition, they were to havefour administrative staff units not calledfor in the post organization plan. Thesewere the station complement (medical de-tachment), the dietetics division, the vet-erinarian's office (for food inspection), andthe registrar's office. The plan for hospi-tals had no technical staff divisions assuch. Some, such as ordnance and chemi-cal warfare, were eliminated completely;others, such as quartermaster and trans-portation, were subordinated to the sup-ply division; and another, the engineer,was placed on the administrative staff.The welfare services, despite the wishes of

hospital commanders, were left subordi-nated to the personnel division. The planfor hospital organization naturally in-cluded professional services. There werenine in general hospitals, including thereconditioning service, the neuropsychi-atric service, and the nursing service. Inthis field hospital commanders were leftwith more latitude than in the adminis-trative because, the manual stated, theprofessional services "function solely in aprofessional manner and are subject toconstant variation by reason of changes intypes of patients treated." The standardplan for regional and station hospitals re-sembled that for general hospitals. Thechief differences were that administrativeand technical units which existed as partsof post and general hospital organizationswere eliminated and the neuropsychiatricservice was subordinated, as a section, tothe medical service.46 (Chart 13)

Publication of the standard plan for theorganization of general, regional, and sta-tion hospitals had little appreciable effectupon their organization.47 The chief rea-son, perhaps, was that the plan itselfreflected experiences of hospitals in con-forming with ASF directives on organiza-tion.48 Nevertheless it officially sanctionedtheir conformity and provided them witha detailed statement of the functions of allmajor units within hospitals. Undoubtedlyits value would have been greater if pub-

44 Ltr, SG to CG 1st SvC attn SvC Surg, 16 Feb 45,sub: Standard Orgn Charts of Gen, Regional, and StaHosps, 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 organ-ization given in the annual reports of 14 general and19 regional hospitals for 1944 and 1945.

48 Interv, MD Historian with Dr. Press, 9 Oct 50.HD: 000.71.


lished four years earlier, at a time whennew hospitals were beginning to open withstaccato rapidity.49

The development of standard organiza-tional plans for convalescent hospitals andhospital centers came even later than forgeneral hospitals and was therefore of lessvalue. Having only limited amounts ofpersonnel and no guides for organization,ASF convalescent hospitals were organ-ized by their commanding officers to fitindividual circumstances. Consequentlythey differed from one another in manyrespects. Convalescent hospitals that wereseparate installations attempted generallyto organize administrative activities ac-cording to the standard ASF post plan.50

Those that operated in conjunction withgeneral hospitals depended upon the lat-ter for some administrative services andorganized for the rest as the personnelassigned to them permitted.51 Graduallya common feature began to emerge. It wasthe establishment of a reconditioning sec-tion and the grouping of patients intocompanies, battalions, and/or regimentsfor administration and supervision.52 Inthe winter of 1944, when additional em-phasis was placed upon the convalescentprogram, the Surgeon General's Officedeveloped and published a guide53 whichleft the organization of administrativeactivities of convalescent hospitals almostentirely to the discretion of their com-manders. The result was that, as they re-ceived more patients and operating per-sonnel, some set up administrative officesthat duplicated, or at least paralleled,those of the general hospitals located nearby.54 The guide showed in more detail theorganization of convalescent activities.They were to be grouped in three divi-sions: a receiving division, an infirmary

division, and a reconditioning division.The infirmary division was not to be estab-lished in convalescent hospitals locatednear general hospitals. The reconditioningdivision was to have a twofold function: itwas to exercise command over patientswho were to be organized in three battal-ions (neuropsychiatric, primary recondi-tioning, and advanced reconditioning),and it was to conduct the convalescenttraining program. This program was toinclude occupational therapy, physical re-conditioning, educational reconditioning,and classification and counseling. Theplan served as a guide to convalescenthospitals that remained separate installa-tions during 1945, and it was used to someextent, particularly for the organization ofconvalescent activities, by those that be-came parts of hospital centers in the springof that year. That hospitals considered itas a guide only is indicated by differences

49 The plan of 1945 for general hospitals remainedin force for five years. The Surgeon General's Officethen published, on 15 September 1950, a new stand-ard plan for their organization. It is of interest thatthis plan called for fewer major units within a hos-pital and charged two officers, the executive officerand the deputy commanding officer, with the co-or-dination, if not the supervision, of the administrativeand professional services respectively. SG Cir 119, 15Sep 50, sub: Orgn of US Army Hosps Designated asGlass II Instls or Activities.

50 An Rpts, 1944, Mitchell Conv Hosp and Surg4th SvC. HD.

51 (1) An Rpts, 1944, Madigan and Percy JonesGen and Conv Hosps. HD. (2) An Rpts, 1945, Brookeand Wakeman Hosp Ctrs, have reference to 1944orgn. HD.

52 An Rpts. 1944, Wakeman and Lovell Gen andConv Hosps, and Cp Carson Conv Hosp. HD.

53 ASF Cir 419, 22 Dec 44, Pt II, Conv Hosp—Re-vised Program.

54 An Rpts. 1945, Percy Jones, Wakeman, and CpsButner and Carson Hosp Ctrs. HD. These reportshave discussions of organization of convalescent andgeneral hospitals before they were combined to formcenters.


that continued to exist in the organizationof different installations.55

At the end of 1945 a second plan for theorganization of convalescent hospitals wasdeveloped by the Surgeon General's Officeand published by ASF headquarters.56 Acombination of the old plan for convales-cent hospitals and the new standard planfor general hospitals, it showed the admin-istrative organization of convalescent hos-pitals in more detail than did the old one.The immediate staff of the commandingofficer and the administrative staff units ofconvalescent hospitals were to be essen-tially the same as those prescribed for gen-eral hospitals. The convalescent serviceswere to be similar to those called for bythe 1944 guide for convalescent hospitals.The most important change was the sepa-ration of the reconditioning, or convales-cent training, program from the adminis-tration of companies of patients. The chiefof the reconditioning service was to havecharge of the former, while the hospitalcommander was to supervise directly thecommanders of the 1st convalescent regi-ment (neuropsychiatric), 2d convalescentregiment (medical), and 3d convalescentregiment (surgical). Publication of thisplan after convalescent hospitals hadalready begun to close undoubtedly lim-ited its effect upon the organization ofsuch installations. (Chart 14)

The establishment of hospital centers inthe spring of 1945 was expected to elimi-nate duplication of administrative activi-ties involved in the operation at the samelocation of both convalescent and generalhospitals. The Surgeon General's Officeexpected that administrative functionscommon to both would be centralizedunder center headquarters, but a guidefor the organization of hospital centerspublished in April 1945 was sufficiently

general to leave to local commanders thedecision as to how much centralizationthere would be.57 For that reason, and be-cause of differences among hospital cen-ters—some being located on posts withother activities and some constituting postsin themselves—centers varied in organiza-tion from one to another.58 Two extremeswere represented by the Percy Jones Hos-pital Center and the Wakeman HospitalCenter. (Chart 15) The former, a post it-self, had operating as well as supervisoryfunctions, and administrative activitiescommon to both the general and conva-lescent hospitals assigned to it were per-formed by center headquarters.59 Wake-man, on the other hand, was located on apost with other Army activities that werenonmedical in character. Post headquar-ters furnished some administrative servicesfor both the general and convalescent hos-pitals; each hospital performed the othersitself; and center headquarters served in asupervisory, not an operational, capacity.60

In the hope of achieving a measure ofuniformity in the organization of hospitalcenters, the Surgeon General's Office inJuly 1945 sent out the Percy Jones plan forcomment by hospital center commanders

55 (1) An Rpts, 1945, Welch and Cp Upton ConvHosps. HD. (2) Orgn and Functional Charts, PercyJones Hosp Ctr, 24 Apr 45; Orgn and FunctionalCharts, Brooke Hosp Ctr, 16 Aug 45; Orgn and Func-tions, Cp Edwards, Mass, Embracing the Post andthe Hosp Ctr, 20 Aug 45; Orgn and Functional Man-ual, Cp Carson Hosp Ctr, 31 Jul 45. HD: 323 "HospOrgn."

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 Apr45. (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 SvCto SG, 9 Aug 45, on Ltr, SG to CG 5th SvC attn SvCSurg, 9 July 45, sub: Standard Orgn Charts for Hosps.SG: 323.3(5th SvC)AA.


and service command surgeons.61 Follow-ing receipt of their replies, that Office bythe beginning of 1946 developed a stand-ard plan for the organization of hospitalcenters. Although never published, it wassignificant because it represented TheSurgeon General's idea of what the organ-ization of a hospital center should be. Ofprime importance was the fact that centerheadquarters was to be operational andwas to perform for general and convales-cent hospitals the administrative servicesthat were common to both. Hence, thecenter commander's immediate staff andthe administrative staff divisions of hospi-tal centers were to be essentially the sameas those found in both general and con-valescent hospital organization charts. Toassist a center commander in supervisingand co-ordinating the professional activi-ties of hospitals under his control, hisimmediate staff was to contain a directorof dental services, a director of professionalservices, and a director of nursing services.General and convalescent hospitals, minusthe staff and administrative divisions ofcenter headquarters, were to be underseparate commanders, each of whom re-ported directly to the center commanderand had an administrative assistant toprovide the few administrative activities

that could not be concentrated undercenter headquarters.62 (See Charts 15, 16.)

A significant feature of the hospitalorganization plans just discussed was theirattempted conformity with the standardplan for the organization of ASF posts.While there were perhaps enough similar-ities between the functions of posts andthose of hospitals to warrant such con-formity, one may question whether it wasaltogether desirable or would have beenrequired if standard plans emphasizingthe peculiar functions of medical installa-tions had been issued earlier. Certainlythe Medical Department would havebenefited from having such plans avail-able when the hospital expansion programfirst began. Moreover, they would havemade easier the task of simplifying andstandardizing hospital administrative pro-cedures. While accomplishments in thisfield were substantial, it was unfortunatethat they came so late in the war. Offset-ting this delay, perhaps, was the fact thatmanagement control became an estab-lished function in all large Army hospitalsby the end of the war.

61 For example, see: Ltr, SG to CG 9th SvC attnSvC Surg, 9 Jul 45, sub: Standard Orgn Charts forHosps. SG: 323.3 (9th SvC)AA. Similar letters weresent to other service commands.

62 Morgan and Wagner, op. cit., pp, 156-64.

CHAPTER XVI

Changes in the Organizationand Equipment of Hospital

Units Prepared forOverseas Service

Since hospitals operating in overseastheaters were less subject to The SurgeonGeneral's authority than those in the zoneof interior, they were largely unaffectedby the movement, discussed in the fore-going chapter, to standardize organiza-tion and simplify administrative proce-dures. Nevertheless, certain changes intheir organization and equipment weremade before they left the United States.Changes in organization were primarilyof two types: the creation of units thatwould supply larger numbers of bedswithout corresponding increases in per-sonnel and the reduction of personnelauthorized for hospitals of different types.

Trend Toward Use of Larger Units

One method of supplying greater num-bers of beds to theaters without propor-tionately increasing the number of per-sonnel was to emphasize the use of largerhospital units.1 Tables of organization forvarious sizes of station hospitals, rangingin capacity to 900 beds, had been devel-oped during the early war years; but until

the middle of 1944 a general hospital ofonly one size (1,000-bed capacity) wasauthorized. During the winter of 1943-44the Technical Division of the SurgeonGeneral's Office developed tables of or-ganization, published in July 1944, for1,500- and 2,000-bed general hospitals.2

Another method of supplying more bedswith limited amounts of personnel—theuse of convalescent facilities to receive theconvalescent patients of general hospi-tals—was employed successfully in theUnited States and needed to be extended,in the opinion of the Surgeon General'sOffice, to theaters of operations. Tables oforganization for 1,000-bed convalescentcamps and 3,000-bed convalescent cen-ters were developed, but the General Staffwould not include such units in the troopbasis without requests from theaters. Thelatter were reluctant to requisition thembecause their capacities counted againstfixed-bed quotas while their staffs weremeager 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.


hospitals with equal numbers of beds.3 Asa result, such units were not used widely,only four of each being activated in thea-ters and none in the United States. In-stead, theaters requisitioned station andgeneral hospital units to meet authorizedquotas of beds and established convales-cent facilities with personnel availablefrom other sources.4

Cuts in Personnel of Hospital Units

As in zone of interior hospitals, reduc-tions were made in the staffs of numberedhospitals. In compliance with a G-1 di-rective, the Surgeon General's Office inMarch 1944 reduced the ratio of nursesin station and general hospital units from1 for every 9 or 10 beds to 1 for every 12.Thus the number authorized for a 1,000-bed general hospital was lowered from105 to 83 and for a 750-bed station hospi-tal from 75 to 63.5 Also in March, in con-sonance with the general policy of replac-ing physicians with administrative officerswherever possible, a War Department cir-cular directed that both the executive of-ficers and registrars of station and generalhospitals should be Medical Administra-tive Corps officers. The Surgeon Generalprotested that executive officers, whoserved as commanding officers in the ab-sence of their superiors, needed profes-sional training in medicine, and subse-quently the General Staff amended theannounced policy to permit MedicalCorps officers to continue serving as exec-utive officers of general hospitals.6 Mean-while, the Surgeon General's Office wasrevising the tables of organization of bothstation and general hospitals, in order toreduce the number of Medical Corps offi-cers and to increase the number of Med-ical Administrative Corps officers author-

ized for such units.7 In July 1944 the num-ber of physicians in a 1,000-bed generalhospital was reduced from 37 to 32. Threemonths later the number of MedicalCorps officers in station hospitals was alsoreduced, that for a 250-bed station hospi-tal, for example, dropping from 13 to 10and for a 750-bed station hospital from 23to 20. At the same time, the number ofMedical Administrative Corps officersassigned to these units was increased, thenumber in a 1,000-bed general hospitalrising from 7 to 10 and in a 750-bed sta-tion hospital from 10 to 12.8 No significant

3 (1) Memo, SG for Dir Mil Pers Div ASF, 4 Aug43, sub: Conv Cps. SG: 322.15-1. (2) T/O&E8-595, Conv Cps (1,000-bed), 12 Jun 44. (3) T/O&E8-591T, Conv Ctr (3,000-bed), 12 Jun 44. (4) IntervMD Historian with Col Arthur B. Welsh, 27 Dec 50.HD: 000.71. (5) Telewriter conv between Surg ETOand 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, 17Apr 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 ofT/O&E 8-560, Sta Hosp, and Revision of T/O&E8-550, Gen Hosp. SG: 320.3-1.

8 (1) T/O 8-550, Gen Hosp, 1 Apr 42; C-2, 5 Oct42; and T/O&E 8-550, Gen Hosp, 3 Jul 44. (2) T/O8-560, Sta Hosp. 22 Jul 42, and T/O&E 8-560, StaHosp, 28 Oct 44. In 1948 the wartime chief of theSurgeon General's Mobilization and Overseas Opera-tions Division stated that these cuts of Medical Corpsofficers had been too great. (Ltr, Col Arthur B.Welsh, MC. USA. 19 Apr 48, quoted in Rpt, Sub-cmtee on Employment of Med Resources, "Use ofMed Resources," Cmtee on Med and Hosp Serv ofArmed Forces, Off SecDef, 25 May 48. HD.) Severalyears later the number of Medical Corps officers in a1,000-bed general hospital unit was further reducedto 28. (T/O&E 8-551, Gen Hosp, 3 Jul 50.) Thisfinal cut in physicians in general hospital units afterthe war represented a reduction of over 50 percent inthe number of doctors authorized for a 1,000-bedgeneral hospital in 1940.

HOSPITAL UNITS PREPARED FOR OVERSEAS SERVICE 281

reductions were made in the latter half ofthe war in the number of Medical Corpsofficers or nurses authorized for evacua-tion hospitals.9

In the spring of 1944 the General Staffdirected reductions in the number of en-listed men in hospital units, as well as inthose of units of other technical services.10

The Technical Division of the SurgeonGeneral's Office complied with this direc-tive by reducing in the table of organiza-tion of general hospitals the number ofmen who performed housekeeping func-tions. It overcompensated for that reduc-tion by providing for the attachment tohospitals of personnel from other technicalservices.11 This meant that the number ofenlisted men authorized for assignment toa 1,000-bed general hospital was reducedfrom 500 to 450, but that additional mencould be supplied by attaching teams fromnonmedical services, such as a SignalCorps team to operate communicationssystems and a Military Police team to sup-ply interior and exterior guards.12 Subse-quently, in the fall of 1944 cuts were madealso in the number of enlisted men au-thorized for station hospital units but, asin the case of general hospitals, provisionwas made for the attachment of teams ofmen from other technical services.13 Whilethis change did not necessarily mean thatthe total number of men working in andaround a hospital plant was always re-duced, it actually had that effect in manyinstances because some theater com-manders did not approve the use of theteams authorized by the War Departmentand desired by theater surgeons. As a re-sult, the change was unpopular withmany Medical Department officers, espe-cially those in theaters who wished thepersonnel needed to perform station serv-ices for hospitals to be organic elements

of hospital units and not dependent upondecisions and actions of theater staff offi-cers. In this connection, it is significantthat the chief complaint which theaterMedical Department officers made aboutcuts in both enlisted and commissionedpersonnel in hospital units was not thatthey would endanger the care of patientsbut that they would reduce the ability ofhospitals to expand beyond table-of-or-ganization capacities.14

Another change designed to save per-sonnel was made in the organization ofthe hospital-center unit. This unit, in-tended to operate a 1,000-bed convales-cent camp and to perform certain admin-istrative services common to all hospitalsin a center, was authorized 29 officers, 4warrant officers, 1 nurse, and 255 enlisted

9 Compare T/O&E 8-581, Evac Hosp, Semimo-bile, dated 26 Jul 43 with that dated 25 Mar 44, andT/O 8-580, Evac Hosp, 23 Apr 43, with T/O&E8-580, Evac Hosp, 31 Jan 45.

10 Memo, Dir Tec Div SGO for Chief Oprs ServSGO, 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 OprsServ, 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 toT/O&E 8-550, Sta Hosp. SG: 320.3-1. CompareT/O&E 8-560, Sta Hosp, 28 Oct 44, with T/O8-560, Sta Hosp, 22 Jul 42.

14 (1) Memo, Off Chief Surg Hq ETO for SG, 14Jul 44, sub: Difficulties Presently Being Encounteredin the Med Serv, ETO. HD: MOOD "ETO." (2)Memo, Dep Chief Plans and Oprs SGO for Dir TecDiv 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 [MorrisonC.] Stayer, 25 Dec 44, sub: Memo for Dir Hosp DivSGO, 31 Oct 44, with incl. SG: 320.3 "T/Os Apr-Jun 45." (5) Memo, Dep Dir MOOD SGO for InspBr SGO, 14 Aug 45, sub: Comments on Rpt by Col[Floyd L.] Wergeland and Lt Col Moorhead ref theirvisit to SWPA and POA. HD: MOOD "Pacific." (6)Rpt, Gen Bd USFET, "Orgn and Equip of MedUnits," Study No 89. HD: 334 (ETO).


men until the early part of 1944.15 Duringthat year the belief developed that no sav-ing in personnel was gained by concen-trating hospitals and then providing themwith increased overhead personnel.16 Fur-thermore, separate tables of organizationhad been developed for convalescentcamps and convalescent centers. The oldtable of organization for hospital centers,in consequence, was superseded in April1944 and a hospital center headquarters,consisting of 7 officers, 1 warrant officer, 1nurse, and 23 enlisted men, was author-ized.17 This headquarters was not ex-pected to operate a convalescent campand it was to borrow any additional per-sonnel it needed for the performance of itsfunctions from general hospitals locatedin the center. Only two of the hospitalcenters activated under the old table oforganization were sent overseas. Theother eight were inactivated and theirpersonnel used in units of other types.18

Toward the end of the war, six hospitalcenter headquarters were activated underthe new table of organization in theSouthwest Pacific and sixteen in the Euro-pean theater.19

New Hospital Units

Although emphasis in the latter half ofthe war was less upon the development ofnew hospital units than upon the use —through improvisation, if necessary—ofMedical Department units already avail-able, two new hospital units were devel-oped and a third was proposed. Inresponse to a request from the chief sur-geon of the European theater for a hospi-tal that would specialize in the treatmentof neuropsychiatric cases, the SurgeonGeneral's Office developed a table of or-ganization in the latter half of 1943 for a

neuropsychiatric general hospital. It waspublished in October.20 The second hospi-tal developed was for use in forward areas.In the absence of small surgical hospitalsthat were highly mobile, the need to treatand hold near the front lines nontrans-portable casualties (those who could notbe moved immediately without danger totheir lives) was met throughout most of thewar by improvisation. During 1945 theGround Surgeon and surgeons of someforces in combat zones proposed publica-tion of a table of organization for a unit tomeet this need. The Surgeon General op-posed this development, believing that thereinforcement of available units—such asplatoons of field hospitals—with surgicalteams met the need adequately and at thesame time promoted flexibility in the useof scarce categories of officers. The formerview finally prevailed and on 23 August1945 a table of organization for a 60-bedmobile army surgical hospital was pub-lished.21 The third hospital, proposed butnot 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. AnRpts. 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, and820th Hosp Ctrs. HD.

20 (1) Telewriter conv, Surg ETO and SGO, 9 Augand 22 Oct 43. SG: 337.-1. (2) Memo, CG ASF forAG, 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 forACofS G-4 WDGS, 11 Aug 45, sub: Conf Rpt, Pro-posed Mobile Army Surg Hosp, T/O&E 8-571. HRS:G-4 files, "Hosp, vol. IV." (2) T/O&E 8-571, MobileArmy Surg Hosp, 23 Aug 45. Additional documentson this subject are on file in SG: 320.3.


in forward areas. Both in theaters of oper-ations and in the Surgeon General's Officethere was a belief that a small hospitalwas needed near the front lines to treatneuropsychiatric casualties who could besalvaged for further duty. A table oforganization for such a unit was neverpublished and theaters met this need byimprovisation.22

Changes in Supplies and Equipment

During the latter part of the warchanges occurred in both the medical andnonmedical equipment of hospitals. As aresult of changes and improvements inpharmaceuticals and biologicals and ofthe accumulation of experience in the op-eration of hospitals under various sets ofconditions in different parts of the world,the Surgeon General's Office made threecomplete revisions and several partial re-visions of Medical Department equipmentlists between the middle of 1943 and theend of 1945. Revision of these lists in-volved the selection of types and amountsof pharmaceuticals and biologicals, of sur-gical instruments and other operatingroom equipment, of X-ray and laboratoryequipment, of ward equipment, and ofother Medical Department items neededby hospitals of different types for the per-formance of their missions. These revi-sions, made by the Surgeon General'sOrganization and Equipment AllowanceBranch, were based on combat experienceas revealed by reports of essential tech-nical medical data (ETMD's), interviewswith officers who served overseas, and in-spections of theater medical services; onchanges in the size and personnel of units;and on the advice and recommendationsof the Professional and Preventive Med-icine Services of the Surgeon General's

Office, the Army Medical Center, and theNational Research Council. A significantadministrative feature of these revisionswas the consolidation and publicationduring 1944 and 1945 of equipment listsas parts of the medical section of the ASFsupply catalog and their distribution bythe Adjutant General's Office. Until thattime, such lists had been issued in mimeo-graph form by the Medical Departmentalone. Items added to them made avail-able to hospitals the newer drugs andbiologicals and improved items of equip-ment developed during the war.23

Changes in the nonmedical equipmentof hospital units revolved around theproblem of supplying items of equipmentnecessary for station services, or house-keeping functions. The chief question waswhether such equipment would be in-cluded in tables of equipment of hospitals,and therefore supplied automatically, orwhether it would not be included, andsupplied only when and if theater com-manders requested it. Types of nonmed-ical equipment which demanded theattention of the Surgeon General's Officewere those needed for such station servicesas laundries, electric lighting systems, andtelephone communications systems.

Inspections of theater medical servicesby Surgeon General Kirk and his chief ofProfessional Services in the middle of 1943revealed what they considered to be in-adequate laundry service for hospitals inboth the North African and Southwest

22 (1) Ltr, Surg Fifth Army to SG thru SurgMTOUSA, 22 Jun 45, sub: Mobile Med Hosp. SG:320.3. (2) An Rpt, NP Consultants Div SGO, FY1945. HD.

23 (1) History of Organization and EquipmentAllowance Branch [SGO], 1939-44. HD. (2) An Rpt,Sup Serv SGO, FY 1944. HD. (3) An Rpt, Orgn andEquip Allowance Br Oprs Serv SGO, FY 1944. (4)An Rpt, Tec Div Oprs Serv SGO, FY 1945. Copiesof the Equip Lists are on file, HD.


Pacific theaters. In their opinion this re-sulted from lack of sufficient numbers oflaundries and from the use of impropertypes of laundry equipment. On 5 June1943 The Surgeon General informed ASFheadquarters of the improvements he con-sidered necessary.24 As a result, the officesof The Quartermaster General and TheSurgeon General collaborated in chang-ing washing formulae and laundry equip-ment to improve the quality of servicewhich laundries afforded hospitals.25

The provision of adequate amounts oflaundry equipment and of sufficient num-bers of laundry operators was more com-plicated. On 1 July 1943 The Quarter-master General informed ASF headquar-ters that there was sufficient laundryequipment in this country to meet theneeds of theaters, provided the latter re-quested its shipment.26 Theater opinionsof what constituted an adequate laundryservice differed from The Surgeon Gen-eral's, for theaters accepted lower stand-ards of service than he considered desir-able.27 He wished, therefore, to find someway to assure that sufficient laundryequipment and personnel would beshipped with each hospital unit. The di-rector of the ASF Planning Division, onthe other hand, felt that theater command-ers, with the advice and help of their sur-geons, should determine the laundryservices needed and request the War De-partment to supply the necessary equip-ment and personnel.28 The ASF view pre-vailed and in August 1943 theater com-manders were reminded of the necessity ofplanning in advance for the laundry serv-ice of hospitals but were informed that theWar Department would not supply themwith laundry equipment and personnelunless such were requested.29 During thefollowing year, after the General Staff

authorized the attachment of technical-service teams to units of other technicalservices, revised tables of organization andequipment of hospital units carried astatement that Quartermaster Corpslaundry teams were authorized for attach-ment to hospitals when theater command-ers requested them.30 Although this servedas a reminder to theater staffs that theyhad to make specific provisions for hospi-tal laundry services, it left to theaters con-siderable discretion in the matter and theSurgeon General's Office continued itsunsuccessful attempt to have laundryequipment and personnel made integralparts of numbered hospitals.31

24 (1) Ltr. SG to CG ASF, 5 Jun 43, sub: LaundryFac in TofOpns. SG: 486.3. (2) Memo, Col R[obert]B. Skinner for the Record, 8 Jul 43, sub: Gen [CharlesC.] Hillman's Trip to SWPA. Ground Med files,Chronological file (Col Skinner). (3) Memo, SG forCG ASF. 10 Aug 43, sub: Interim Progress Rpt: StepsTaken During First Sixty Days Since Apmt as SG.SG: 024.-1.

25 Ltr, SG to CG ASF, 5 Jun 43, sub: Laundry Facin TofOpns, with 1st, 2d, and 4th inds. SG: 486.3.

26 Memo SPAOG 331.5, Dir Oprs ASF for DirPlanning Div ASF, 23 Jun 43, sub: Laundries andLaundry Equip, with 1st ind. HD: Wilson files, "DayFile, Jul 43."

27 (1) Memo, Col Arthur B. Welsh, MC for DepSG, 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 DepSG, 1 Jul 43, sub: Laundry for Overseas Hosps. SG:331.5. (2) Memo, Maj John S. Poe for Col [HowardT.] Wickert, 16 Jul 43. SG: 414.4-5. (3) HistoricalRecord. 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 Mar44. (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&E8-580, Evac Hosp (750-bed), 31 Jan 45.

31 Ltr, SG to CG ASF attn Dir Mob Div, 10 May45, sub: Tables of Orgn and Equip. SG: 320.3. Suc-cess came after the war. For example, see T/O&E8-566, Sta Hosp, 500-bed, ComZ, and T/O&E 8-551,Gen Hosp. 1,000-bed, ComZ. Reviewing the experi-


A similar problem arose in connectionwith electric lighting equipment. The Sur-geon General's Office recommended thatsuch equipment, including electric gen-erators, should be specifically listed intables of equipment of hospital units to in-sure its being provided for each.32 During1944 and 1945 this action was taken forfield and evacuation hospital units; butelectric lighting equipment was not in-cluded during the war in tables of equip-ment for general and station hospitals,convalescent hospitals, and convalescentcamps and centers. Instead, a War De-partment memorandum placed upon theChief of Engineers responsibility for fur-nishing electric lighting equipment, in-cluding generators, to such units whenthey received orders to move to theaters.33

At the beginning of the war the table ofbasic allowances for the Medical Depart-ment authorized telephone and switch-board equipment for the 750-bed evacua-tion hospital only. During the early partof the war, the tables for general and con-valescent hospitals were revised to include

that equipment. Similar action was takenfor station and 400-bed evacuation hospi-tals during the latter part of the war.34

Other significant changes in the equip-ment of hospital units were additions oftool chests of various sorts. Experienceshowed that hospital personnel in manyinstances had to perform much mainte-nance work and that the number of toolchests previously provided was insuffi-cient. Consequently, in successive revi-sions of tables of equipment of hospitalunits there were added tool chests forcarpenters, refrigeration mechanics, elec-tricians, plumbers, automobile mechanics,and the like.35

ences of World War II several years after its end, theformer chief of the Surgeon General's Mobilizationand Overseas Operations Division pointed out thefailure to solve this problem. (Extract from Ltr, ColArthur B. Welsh, MC, 19 Apr 48, quoted in "Use ofMed Resources," Rpt by Subcmtee on Employmentof 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 May44)(1).

34 (1) T/BA 8, MD, 1 Oct 41. (2) T/BA 8, MD, 15Jul 42; C 1, 29 Aug 42. (3) T/O&E 8-560, Sta Hosp,28 Oct 44. (4) An Rpt, Strategic and Logistic Plan-ning Sec MOOD SGO, 5 Jun 45 (HD), stated thatswitchboards and communications equipment hadbeen provided for 400-bed evacuation hospitals. How-ever, a search of the T/O&E for this hospital does notdisclose such authorization until publication ofT/O&E 8-581 on 11 January 1949.

35 For example, see (1) T/E 8-560, Sta Hosp, 28Dec 43. (2) T/O&E 8-581, Evac Hosp (400-bed), 25Mar 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&E8-560, Sta Hosp, 28 Oct 44. (6) T/O&E 8-580, EvacHosp (750-bed), 31 Jan 45.

CHAPTER XVII

Hospital Constructionand Maintenance

Emphasis in the Medical Departmentconstruction program in the United Statesin the latter part of the war was on ex-panding and improving existing hospitalplants rather than on the construction oracquisition of new ones. It will be recalledthat ASF headquarters considered thehospital construction program substan-tially complete by the middle of 1943. Atthat time forty general hospitals were inoperation and eighteen others were underconstruction. Afterwards, only eight addi-tional general hospitals were authorized,and they were located in buildings whichthe Army already had. Moreover, the clo-sure of station hospitals as troops movedoverseas made it unnecessary, except in afew instances, either to build or to acquirenew station hospital plants.1 Despite thisapparent completion of the hospital build-ing program, there was feverish construc-tion activity at many Medical Depart-ment installations. Mounting bed require-ments in the first half of 1945 made it nec-essary to provide housing in general andconvalescent hospitals for additional bedsequal in number to 80 percent of thoseaccumulated in general hospitals duringthe previous four years. Changes in con-cepts of patient treatment, patient welfare,and hospital administration created needsfor facilities not available in hospital

plants already built. Finally, The SurgeonGeneral took advantage of the passing ofthe initial phase of the Army's construc-tion program and of the increasing avail-ability of scarce materials to press for im-provements and refinements in existingplants in order to bring them up to thestandards of peacetime civilian hospitals.

In expanding and improving hospitalplants, The Surgeon General continued tohave only partial responsibility and au-thority. He was dependent upon ASFheadquarters for approval of all majorprojects and upon the Engineers for allconstruction work. They, in turn, contin-ued to be subject to decisions and policiesmade by the General Staff. The SurgeonGeneral's Hospital Construction Branchdeveloped general programs and standardcriteria for hospital expansions and im-provements, and insisted, as before, uponan opportunity to approve or disapproveconstruction which changed either thecapacities of hospital plants or the primaryprofessional functions of any of their build-ings. In general, that Branch tended torely more than before on service commandsurgeons and ASF hospital commanders

1 (1) Memo, Chief Cons Br SGO for HD SGO, 1Nov 46, sub: Record of Expansion and Contraction,Hosps, ZI, and Hosp Ships. HD: 632. (2) See Table14.

HOSPITAL CONSTRUCTION AND MAINTENANCE 287

for assistance in planning and initiatingprograms for expansions, additions, andimprovements. There were several rea-sons for this development. The expansionof existing hospital plants required in-dividual attention and planning in orderto make maximum use of available hous-ing and to fit additional facilities intoplants already constructed. Furthermore,many hospital commanders showed thatthey could secure additional facilities asgifts from civilian groups without assist-ance from the War Department. Finally,under prevailing War Department con-struction policies, requests for all butmajor construction projects had to beinitiated in the field and not in the officesof the chiefs of technical services in Wash-ington.2 Over Air Forces hospital con-struction the Surgeon General's Officeexercised less supervision than it had dur-ing the early part of the war. Complyingwith a request of the Air Surgeon and re-flecting perhaps the growing independ-ence of the Air Forces, The SurgeonGeneral on 22 January 1944 delegated tothe Air Surgeon authority to act as hisrepresentative in that field.3

Providing Housing for Additional Bedsin General and Convalescent Hospitals

in the United States

The primary method of obtaininghousing for additional beds was to useexisting buildings, whether for newlyestablished hospitals or the expansion ofthose already in operation. This methodwas adopted because of restrictions onnew construction imposed by ASF head-quarters under policies of the GeneralStaff.4 When ASF approved the estab-lishment of convalescent annexes for gen-eral hospitals in June 1943, it announced

that new construction, except for gymna-siums, was not authorized. Existing Armyhousing or leased civilian buildings wereto be used instead.5

During 1943, 1944, and 1945, on TheSurgeon General's recommendation theService Forces acquired through lease ortransfer eighteen pieces of real estate, in-cluding schools, hotels, and NationalYouth Administration buildings, withenough space to house beds for 9,322 con-valescent patients at a number of generalhospitals. Other general hospitals estab-lished annexes in vacant Army buildingslocated near by.6 After approving theestablishment of convalescent centers for25,000 patients early in 1944, ASF head-quarters turned over to the Medical De-partment vacant barracks on Army posts.Meanwhile, the Air Forces followed thesame procedure in setting up convalescenthospitals.7 In most instances existingbuildings were used during 1944 without

2 WD Cir 58, 19 Dec 43.

3 (1) Memo, Dep Air Surg for Chief Hosp AdminDiv SGO, 14 Oct 43, sub: Processing of Recomds forAAF 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, forOperational Control at AAF Hosp, with 1st ind, SGto 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: ConvFac. Off file, Gen Bliss' Off SGO, "Med Clarificationof 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 forSG, 29 Jun 44, sub: Housing Fac for Convs. Off file,Gen Bliss' Off SGO, "Med Clarification of Disposi-tion Policy." (2) AAF Memo 20-12, 18 Sep 43, sub:Orgn AAF Conv Ctrs. HD.


extensive alterations and with little addi-tional construction.8

The major hospital expansion programof the later war years came during thefirst six months of 1945, after G-4 ap-proved additional beds to meet the esti-mated peak load of patients. For this ex-pansion the War Department followedthe same method—the use of existingbuildings—but permitted more improve-ments and alterations than before. Bothgeneral and convalescent hospitals wereexpanded. Medical detachment barracksat general hospitals, which The SurgeonGeneral early in the war had successfullyinsisted should be parts of hospital plantsand of the same types and quality of con-struction, were converted into wards.Some convalescent annexes were madeinto wards and some nonhospital barrackswere converted into housing for ambula-tory patients. Four station hospital plantssupplemented by near-by barracks wereconverted into general hospitals. Severalstaging area hospitals were modified toserve as debarkation hospitals. And addi-tional barracks on posts where convales-cent hospitals were located were turnedover to them. These changes involvedchiefly improvements, already authorizedlate in 1944 for general and convalescenthospital plants, such as sealing insidewalls, painting and reflooring, installingsprinkler systems and fire escapes in con-verted wards, and inclosing the coveredwalkways connecting those wards withthe rest of the hospital plant. In general,the erection of new buildings was avoidedbut in some places no post housing wasavailable for medical enlisted men andWacs. In these instances theater-of-oper-ations-type barracks, along with buildingsfor detachment and company administra-tion, recreation, supply, and messing,

were constructed to house the men dis-placed from hospital barracks and theWacs sent to hospitals to help with in-creased patient loads.9

Initiation and completion of this pro-gram represented co-ordinated efforts ofthe Surgeon General's Hospital Con-struction Branch, the Chief of Engineers'Office, ASF headquarters, and their fieldofficers. Even before G-4 authorized theadditional beds, the Surgeon General'sConstruction Branch collaborated withservice command surgeons in making pre-liminary plans for hospital expansions,determining the number of additionalbeds that could be provided, and estab-lishing general criteria for conversionwork.10 Meanwhile, the Chief of Engi-neers' Office called upon division engi-neers, by telephone, for preliminarylayout plans and cost estimates. As a re-sult, within forty-eight hours after thatOffice received a directive to proceed withthe program, it authorized division engi-neers to begin work.11 To achieve speed inthe expansion, ASF headquarters per-

8 (1) Tynes, Construction Branch. (2) Interv, MDHistorian with Col Achilles L. Tynes, formerly ChiefHosp Cons Br SGO, 24 Apr 50. HD: 000.71.

9 (1) Ltr, SG to CofEngrs, 13 Jan 45, sub: Emer-gency Expansion of Gen Hosps. SG: 322 "Hosp." (2)Memo SPMOC 632, CG ASF for CofEngrs, 22 Jan45, sub: Prov of Add Hosp Fac for Gen Hosp Syst.CE: 683 Pt I. (3) Ltr, CofEngrs to Div Engrs, 2 Feb45, same sub. SG: 632. (4) Engr Cons Directives, ofvarious dates. Same file. (5) An Rpts, 1945, Birming-ham, Battey, and Cp Butner Gen Hosps, and CpCarson Hosp Ctr. HD.

10 (1) Memo, Dir Hosp Div for Chief Hosp ConsBr, 19 Dec 44. SG: 632. (2) Memo, same for same, 6Jan 45, sub: Ests of Cons Needs. Same file. (3) OffMemo, by Chief Hosp Cons Br, 12 Jan 45, sub: 6thSvC. Same file. (4) Ltr, SG to CofEngrs, sub: Emer-gency Expansion of Gen Hosps. SG: 322 "Hosp."

11 1st ind CE SPEMT 683, CofEngrs to CG ASFthru SG, 22 Feb 45, on Memo SPMOC 600.1, CGASF for CofEngrs and SG in turn, 7 Feb 45, sub:Conversion. New Cons, and Preferred Maintenanceat Gen and Conv Hosps. CE: 683 Pt I.


mitted The Surgeon General and theChief of Engineers to make minor changesin the approved program, particularly inthe number of beds for which housing wasto be provided at each hospital.12 In turn,they delegated similar authority to localengineer and medical officers, and theChief of Engineers directed division engi-neers to settle layout plans locally and tosecure The Surgeon General's approvalby telephone.13 Finally, both the Chief ofEngineers and ASF headquarters in-structed representatives in the field to co-operate fully with each other in pushingthe program to completion.14

None of these measures would havebeen sufficient to assure the expansion ofhospital housing capacity in time for thepeak load if a solid foundation for it hadnot already been established. The exist-ence at hospital plants of barracks similarin type to ward buildings made their con-version to wards relatively simple. Fur-thermore, establishment of convalescenthospitals during 1944, without G-4 ap-proval and in the face of attempts of theStaff to reduce the number of general andconvalescent beds, meant that a consider-able portion of the housing needed for theadditional beds authorized in November1944 and January 1945 had already beenprovided.15

Construction of Additional Facilitiesat Existing Hospital Plants

In the latter half of the war the MedicalDepartment also had to request addi-tional facilities that had not been plannedwhen hospitals were built because theneed for them had not been anticipated.The extension of specialization in generalhospitals during 1944 and 1945 requiredadditional clinical facilities. For example,

vascular centers needed constant-temper-ature rooms; orthopedic centers neededbrace shops, plaster and dressing rooms,and extra X-ray facilities; and centers forthe deaf, acoustic clinics.16 Since the con-struction of such buildings could not nor-mally be classified as "major" projects,local hospital commanders had to submitformal requests for each. As a rule, theprofessional consultants of the SurgeonGeneral's Office worked closely with theHospital Construction Branch and withhospital commanders, informing both ofwhat was needed. For example, an ortho-pedic consultant recommended the con-struction of an orthopedic clinic at FortGeorge G. Meade (Maryland) RegionalHospital in June 1944, and a few monthslater an ophthalmology consultant rec-ommended an acrylic eye laboratory andan eye clinic for Dibble General Hospi-tal.17 Generally, the Medical Departmentencountered little if any opposition in se-curing the approval of the Engineers andASF headquarters for the construction ofspecial clinical buildings. Perhaps this cir-cumstance was due to the fact that their

12 Memo SPMOC 632, CG ASF for CofEngrs, 22Jan 45, sub: Prov of Add Hosp Fac for the Gen HospSyst. CE: 683 Pt I.

13 Ltr, CofEngrs to Div Engrs, 2 Feb 45, sub: Provof Add Hosp Fac for Gen Hosp Syst. SG: 632.

14 (1) Ltr cited above. (2) Ltr SPMOC 632, CGASF to CGs SvCs, 3 Feb 45, sub: Prov of Add HospFac for Gen Hosp Syst. AG: 323.3 (4 Sep 44)(1).

15 (1) See above, p. 202. (2) An Rpt, FY 1945, HospCons Br SGO. HD.

16 (1) Memo, Capt A. W. Clark for Col A[lbert]H. Schwichtenberg, 1 Feb 45, sub: Constant-Tem-perature Rooms. SG: 632. (2) Memo, Col LeonardT. Peterson, Chief Orthopedic Br SGO for Dir HospDiv SGO, 26 Mar 45, sub: Orthopedic Clinic. Samefile. (3) Diary, Hosp Cons Br SGO, 29 Feb and 6Mar 44. HD: 024.7-3.

17 (1) Ltr, Col Leonard T. Peterson to SG, 24 Jun44, sub: Rpt of Visit to Ft George G. Meade Re-gional Hosp. HD: 333.-3. (2) Memo, Maj MiddletonE. Randolph for SG, 27 Nov 44, sub: Rpt of Trip toDibble Gen Hosp. HD: 333.-2.


use was so obviously a part of the profes-sional care of patients. In the case of otherspecial buildings less evidently needed forprofessional care but appropriate to al-most all general hospitals, the SurgeonGeneral's Office had to request ASF head-quarters to establish a general policy per-mitting their construction. This occurredin the case of occupational therapy clinics,which were needed after The SurgeonGeneral began to emphasize occupationaltherapy in all general hospitals, and in thecase of neuropsychiatric social therapyclinics, which were needed after neuro-psychiatric centers were established inmany general hospitals. In October 1943ASF headquarters approved the construc-tion of occupational therapy clinics; abouta year later, of neuropsychiatric socialtherapy clinics.18 The provision of specialclinical facilities continued even after theMedical Department began to contractthe general-convalescent hospital system.As late as September 1945, for example,when specialized centers were being re-located because some hospitals were beingclosed, the Surgeon General's Office re-quested the construction of special build-ings for centers for rheumatic fever, deaf,paraplegic, neuropsychiatric, and plasticsurgery patients in hospitals that were ex-pected to remain open for long periods oftime.19

Development of the convalescent re-conditioning program called for additionsto hospital plants which were generallyauthorized less readily than special clin-ical buildings. Among them were recre-ational facilities, such as theaters, gymna-siums, swimming pools, ball fields, andbowling alleys; instructional facilities,such as classrooms and prevocationaltraining shops; and others that could beused for both recreational and education-

al purposes, such as libraries and radiosystems.

In the second half of 1943, with the in-auguration of the reconditioning programand the growing belief that patients re-cuperated more rapidly if kept occupiedphysically and mentally to the maximumextent consistent with their degree of re-covery, hospital commanders began to re-quest appropriate facilities.20 At that timeThe Surgeon General was reluctant tosupport requests for "elaborate and costly"additions, such as swimming pools; but heurged the construction at general hospi-tals of buildings normally erected onArmy posts, such as gymnasiums, librar-ies, and theaters.21 ASF headquarters ap-proved the construction of gymnasiumsand theaters in June and December 1943,respectively.22

As materials became more plentifuland the prospective load of battle casual-

18 (1) Ltr, SG to CG ASF, 22 Oct 43, sub: Occupa-tional Therapy Instls, with 1st ind SPRMC 632 (22Oct 43), CG ASF to CofEngrs thru SG, 26 Oct 43.SG: 632.1 (2) Memo, Dir Hosp Div SGO for ChiefHosp Cons Br SGO, 28 Nov 44, sub: Rooms forVisiting with Relatives at NP Ctrs, with 1st ind, ChiefHosp Cons Br SGO to Dir Hosp Div SGO, 30 Nov44. SG: 632. (3) Ltr. SG to CofEngrs, 13 Dec 44, sub:NP Social and Occupational Therapy Bldg, with 4inds. Same file.

19 Memo, Dep SG for CofEngrs, 11 Sep 45, sub:Engr Serv, Army — Project No 200 (Cons) RevisedEstimates, FY 1946. SG: 632.

20 For example: (1) Diary, Hosp Cons Br SGO, 17Feb and 28 Mar 44. HD: 024.7-3. (2) An Rpts, 1943,Baxter, Billings, Bushnell, Hoff, and Kennedy GenHosps. HD. (3) Memo, Chief Hosp Cons Br SGOfor 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 ASFto SG, 22 Jun 43, sub: Conv Ctrs, on unknown basicltr. SG: 632.-1. (2) 1st ind, CG ASF to SG, 8 Dec43, on Memo, SG for CG ASF, 22 Nov 43, sub:Theaters for Gen Hosps. SG: 631.


ties more imminent during 1944, TheSurgeon General broadened his pro-gram.23 In that year the construction atgeneral hospitals of libraries, swimmingpools, and athletic fields was approved byASF headquarters.24 Early in 1945, afterthe Reconditioning Consultant's Divisionpublished an elaborate convalescent-re-conditioning program and the Presidentgave it his blessing, The Surgeon Generalpressed for buildings and equipment of alltypes for use in that program. In Febru-ary 1945 ASF headquarters approved theinstallation of four-channel, program-dis-tribution (or radio) systems in generalhospitals.25 Two months later the GeneralStaff approved a construction program forconvalescent hospitals which includedshops for machine work, welding, auto-mobile repairs, woodwork, photography,electrical work, and the like; classroomsfor general academic courses, business ad-ministration, and music appreciation;athletic facilities such as bowling alleys,stables, tennis courts, baseball and softballdiamonds, archery ranges, golf courses,skeet ranges, and football fields; and thea-ters, libraries, clubhouses, and otherrecreational buildings.26

In securing eventual approval for suchfacilities, The Surgeon General encoun-tered difficulties and delays. ASF head-quarters would authorize only thosewhich appeared necessary for the treat-ment and recovery of patients, and TheSurgeon General therefore had to justifyeach request by explaining the therapeu-tic benefits additional facilities wouldafford.27 Furthermore, ASF tended tolimit programs which it approved to gen-eral hospitals that were expected to re-main in operation during the postwaryears.28 The Surgeon General agreed thatextra facilities should be provided first for

general hospitals in which overseas pa-tients were treated; but he wanted themlater for regional and station hospitalsalso. He resisted attempts to limit recon-ditioning facilities to hospitals that wouldbe used for the postwar period, arguingthat they were needed for all patients ofWorld War II, whether in hospitals thatwould be closed or in others that would bekept open after the war.29 ASF headquar-ters sometimes encountered difficulties ingetting money appropriated for the extraconstruction which The Surgeon Generalwanted. For example, the opposition ofthe Bureau of the Budget to the appro-

23 For example, see: (1) Ltr, SG to CG ASF, 8 May44, sub: Cons of Swimming Pools. SG: 631. (2) Memo,SPMC 631.-1, SG for Dir Spec Serv Div ASF, 10May 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: BudgetDef for Nurses Call Systs and Libraries for ArmyHosps. SG: 632.-1.

24 (1) 1st ind SPMOC 632 (9 Sep 44), CG ASF toCofEngrs, 23 Sep 44, on DF G-4 2623, ACofS G-4WDGS to CG ASF, 8 Sep 44, sub: Libraries for ArmyGen Hosps. (2) 1st ind SPRMC 631 (8 May 44), CGASF to SG, 16 May 44, on Ltr SPMCH, SG to CGASF, 8 May 44, sub: Cons of Swimming Pools. (3)Memo, SPMOC 600.1 (21 Sep 44), CG ASF forCofEngrs, n d, sub: Outdoor Recreational Fac forConv Soldiers at Gen and Conv Hosps. All in SG: 631.

25 3d ind SPRLR 413.45 (3 Feb 45), CG ASF toChief Sig Off, 16 Feb 45, on Ltr, Dep SG to CG ASF,3 Feb 45, sub: Funds for Instl of PA Systs in GenHosps. SG: 413.47.

26 Memo SPMOC 632 (29 Apr 45), CG ASF forCofEngrs, sub: Conv Hosps, with incl, Criteria forProviding and Maintaining Fac at AAF and ASFConv Hosps. SG: 322 (Conv Hosp).

27 (1) Diary. Hosp Cons Br SGO, 8 Mar, 22 Apr,and 4 Sep 44. HD: 024.7-3. (2) Ltr, SG to CG ASF,8 May 44, sub: Cons of Swimming Pools. SG: 631.(3) Memo SPMCH 632, SG for CG ASF, 8 Dec 44.Same file.

28 For example, see: 4th ind, CG ASF to SG, n d,on Ltr, SG to CG ASF, 8 May 44, sub: Cons of Swim-ming Pools. SG: 631.

29 Memo, SG for CG ASF, 18 Oct 44, sub: Cons ofSwimming Pools at Gen Hosps, with 2d ind, Dep SGto CG ASF, 9 Nov 44. SG: 631.


priation of money for the building oflibraries delayed that program for severalmonths during 1944.30 In instances wherelack of appropriated funds prevented ASFheadquarters from approving additionalconstruction or where those funds weresufficient to provide facilities for only alimited number of hospitals, ASF head-quarters and the Surgeon General's Officeapproved, as a rule, the use of nonappro-priated funds to construct them.31 As a re-sult of that policy and of generous gifts bycivilians, some hospitals got such addi-tions as swimming pools, bowling alleys,and radio systems before the use of WarDepartment funds for such purposes wasapproved.32 Others were not so fortunate.Furthermore, because of delays in gettingASF and G-4 approval, some hospitalsnever got to use the extra facilities author-ized, for the war ended and their con-struction had to be canceled.33

Concurrently with the addition to hos-pitals of clinical and reconditioning facil-ities, the increase in administrative activ-ities and the development of newoperational procedures created needs foradditional or enlarged administrativebuildings. During the early war yearsseveral hospitals had begun to operatecentral service systems similar to thosefound in large civilian hospitals.34 Suchsystems permitted the centralized mainte-nance, storage, preparation (includingsterilization), and issuance of supplies andequipment which were used for certaindiagnostic and therapeutic procedures inall wards but which were not needed inwards at all times. Among such itemswere those used for transfusion and intra-venous medication, wound dressing,spinal puncture, thoracentesis, catheter-ization, gastric lavage and gastroduodenal

suction, and oxygen administration.35 Inthe last half of 1943 the Surgeon General'sOffice developed standard operating pro-cedures for central service systems andprepared typical layouts for buildings tohouse them.36 By January 1944 it decidedthat all hospitals with capacities of 750 ormore beds should have such systems.37

Their use would save both personnel andequipment, would achieve uniformity insterilization techniques, and would insurethe ready availability of all items needed

30 (1) Memo, WD Budget Off for ACofS G-4WDGS. 18 Jul 44, sub: Libraries for Army GenHosps. 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 forCofEngrs, 13 Jun 44, sub: Libraries at Gen Hosps.SG: 631.

32 (1) Memo. SG for CG ASF, 18 Oct 44, sub: Consof Swimming Pools at Gen Hosps. SG: 631. (2) Com-ments by Col A. L. Tynes, Chief Hosp Cons Br SGOat 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 ofPA Systs in Gen Hosps. SG: 413.47.

33 (1) Memo, Chief Hosp Cons Br SGO for ChiefOprs Serv SGO, 22 Aug 45, sub: Reduction of ConsReqmts and Concurrent Changes in Budget. SG: 632.(2) Ltr SPMCH 632, SG to CG ASF, 17 Sep 45, sub:Cancellation and Reinstatement of Comd Cons Proj-ects, ZI Gen Hosps. CE: 632 (Hosp). (3) Memo,CofEngrs for CG ASF, 9 Oct 45. Same file.

34 An Rpt. 1941. Sta Hosp, Ft Bragg; and An Rpts,1942. Percy Jones Gen Hosp and Sta Hosp Cp Butner.HD.

35 WD Memo W 40-44, 12 Apr 44, sub: CentralServ Syst in Army Hosps. SG: 300.6.

36 (1) Memo. Maj Michael E. DeBakey for BrigGen C. C. Hillman, 20 Jul 43, sub: Central Serv. SG:632.-1. (2) Memo, Chief Hosp Cons Br SGO for DirSurg 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.


by doctors in wards.38 ASF headquarterstherefore authorized the Engineers to pro-vide buildings for such services, either bynew construction or by the alteration ofexisting buildings, wherever they were re-quested and justified by hospital com-manders.39 Thereafter, during 1944 and1945 central service buildings were pro-vided for all general and regional hospi-tals.40

In getting other administrative build-ings, the Surgeon General's Office was lesssuccessful. One fault with hospital plantsalready constructed was that they lackedrooms for clinical conferences.41 More-over, the addition to general hospitals offunctions and activities not common inpeacetime increased the need for moreadministrative space. Special services of-ficers, reconditioning officers, personalaffairs officers, Veterans Administrationrepresentatives, and United States Em-ployment Service representatives oftenhad to set up offices in wards, barracks,and storerooms. Consequently, on 28 July1944 The Surgeon General requested theenlargement of hospital administrativebuildings. Before granting approval, ASFheadquarters required him to collaboratewith the Chief of Engineers in a detailedstudy of office-space requirements.4 2 Bythe time it was completed in February1945 the general-convalescent hospital ex-pansion program had increased evenmore the need for administrative space.43

On 3 April 1945 The Surgeon Generalagain urged that it be authorized, andfinally, on 25 April 1945, ASF headquar-ters instructed the Engineers and TheSurgeon General to collaborate in plan-ning whatever construction was needed tobring existing hospital plants up to thestandards set by their joint study.44 Sur-

veys by service command surgeons ofexisting administrative space and of theadditional amount required delayed thebeginning of work on this program untilhospitals began to close. It was thenlargely abandoned.45

Improvements in Existing Hospital Plants

At the same time hospital plants werebeing expanded and improved to meetneeds that had developed during the war,the Surgeon General's Office was attempt-ing to correct constructional defects andto bring the Army's hurriedly erected hos-pital buildings up to the standards offinish, appearance, and equipment ofcivilian institutions. During 1944 the re-flooring program was continued,46 anddefects in hospital construction revealedby inspections made by the War Projects

38 Ltr, SG to CofEngrs, 21 Jan 44, sub: CentralServ Bldg at Cushing Gen Hosp. SG: 632 (CushingGH)K.

39 Memo, CofEngrs for SG, 2 Feb 44, sub: CentralServ Bldgs at Gen Hosps. SG: 632.-1.

40 (1) An Rpt, FY 1944 and 1945, Hosp Cons BrSGO. HD. (2) Memo, SG for CofEngrs, 10 Mar 45.SG: 632.

41 1st ind, SG to CofEngrs, 7 Mar 44, on Ltr, COMcGuire Gen Hosp to SG, 10 Feb 44, sub: Cons ofAdd Clinic-Type Bldg. SG: 632.-1 (McGuire GH)K.

42 1st ind SPMOC 632 (31 Jul 44), CG ASF toCofEngrs, 3 Aug 44, and 2d ind, CofEngrs to SG, 7Aug 44, on Ltr SPMCH 632, Dep SG to CG ASF, 28Jul 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 RegionalHosps, 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 toCofEngrs thru SG, 25 Apr 45, on Ltr SPMCH 632,SG to CG ASF thru CofEngrs, 8 Jan 45, sub: AdminSpace 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 BrSGO, 9 and 20 Jun 44. HD: 024.7-3.


Unit of the Bureau of the Budget werecorrected by the Engineers.47 In theopinion of the Surgeon General's HospitalConstruction Branch a broader programof more general application was needed.Therefore, late in the summer of 1944,when ASF headquarters began to plan forthe improvement of Army installationsthat would be selected for postwar use,48

Surgeon General Kirk secured the per-sonal backing of General Somervell for arelaxation of the War Department's policyof "Spartan simplicity" in order to permithigher maintenance standards for hos-pitals.49 About the same time, Congres-sional criticism of Army hospital construc-tion and maintenance apparently spurredASF headquarters to more "aggressive ac-tion in increasing the maintenance pro-gram for hospitals." 50 At any rate, duringSeptember and October 1944 the ASFCommand Installation Branch and officesof The Surgeon General and the Chief ofEngineers agreed upon a program for im-proving ASF hospitals. It included cover-ing floors in corridors and administrativebuildings, as well as in wards and clinics,with linoleum over plywood; sealing ex-posed framing in corridors and nurses'quarters; inclosing all corridors used bypatients; painting both exteriors and in-teriors to conform to peacetime standards,including the use of pastel colors for in-teriors; replacement of "victory-grade"with standard hardware and fittings; andthe planting and proper maintenance oflawns and grounds.51 In approving thisprogram G-4 stipulated that it should becarried out only partially in hospitals thatthe Army would not retain after the war.52

ASF headquarters decided therefore tolimit the program to general and con-valescent hospitals that would be retained

in the postwar period and to delay its ex-tension to regional and station hospitalsuntil a later time.53 The Surgeon Generalrepeatedly protested against both the G-4and ASF limitations, but was unsuccessfulin getting them removed during the war.54

47 For example, see: (1) Ltr SPMCH 632, SG toCofEngrs, 19 Aug 44, sub: Transmittal of Commentson 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 GenHosp Cons. Same file. (3) Ltr SPMCH 632, SG toCofEngrs, 25 Nov 44, sub: Transmittal of Commentson Army Hosp Cons Rptd to SG by War ProjectsUnit, Bu of Budget. Same file. (4) Ltr SPEMY 632,CofEngrs to SG, 18 Apr 45, sub: Comments on ArmyHosp Cons. SG: 632.

48 1st ind SPMOC 600.1 (18 Aug 44), CG ASF toCofEngrs, 25 Aug 44, on unknown basic ltr. CE: 632.

49 Comments by Col A. L. Tynes, Chief Hosp ConsBr SGO at Conf of SvC Surgs, 12 Dec 44. SG: 632.

50 (1) Memo, Dir Plans and Oprs ASF for Dir MobDiv 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 Repre-sentatives, 78th Cong, 2d sess, pursuant to H. Res. 30(Washington, 1944).

51 (1) Memo, SG for CG ASF, 6 Sep 44, sub: Sug-gested Remedial Measures, Hosp Cons, ZI, in Tynes,Construction Branch. (2) Memo, CofEngrs for CGASF, 18 Sep 44, sub: Preferred Maintenance for PostWar Use Instls. CE: 632 (Hosp). (3) Memo, CofEngrsfor CG ASF, 30 Sep 44, sub: Suggested RemedialMeasures, Hosp Cons in ZI. CE: 600.18. (4) Memo,CofEngrs for CG ASF, 14 Oct 44, sub: PreferredMaintenance 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 CGASF, 27 Oct 44, sub: Increased Maintenance at Genand Conv Hosps. HRS: G-4 file, 600.3 (I).

53 Memo SPMOC 632, CG ASF for CofEngrs, 31Oct 44, sub: Increased Maintenance at Gen and ConvHosps, 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 toSG, 16 Nov 44, in Tynes, Construction Branch. (2)Memo, SG for CofEngrs, 11 Jul 45, sub: IncreasedStandards of Maintenance at Regional Hosps, with3d ind SPMOC 423.3 (1 Aug 45), CG ASF toCofEngrs, 10 Aug 45. SG: 323.3 (Hosp).


Finally, in June 1946, the General Staffsanctioned the program, within the limitsof funds available, for regional and stationhospitals to be kept for the postwarArmy.55 Meanwhile, in March 1945, afterrepresentatives of G-4 suggested that thestaging area hospitals being convertedinto debarkation hospitals should be"dressed-up" for the reception of return-ing war casualties, ASF headquartersauthorized the application of the high-er standards of maintenance to thosehospitals.56

Although improvement of general andASF convalescent hospitals was author-ized in October 1944, it did not get starteduntil early in 1945. Causes for delay dur-ing that period and later were numerous:the controversy over whether to limit theprogram to postwar hospitals; the tardi-ness of service commands, which underexisting procedures had to initiate the re-quests for improvements; the time spentby the offices of The Surgeon General andthe Chief of Engineers in deciding oncolors of interior paint; the confusion inthe field that arose from carrying on twoprojects at once—the improvements pro-gram and the hospital expansion pro-gram; the extension of the project to coverbarracks and other buildings newly con-verted to hospital use; the effort to inter-fere as little as possible with the normaloperation of the hospitals; and the hin-drance of winter weather to the plantingof lawns and the painting of exteriors. Inview of such factors the Engineers esti-mated in February 1945 that the main-tenance program would not be entirelycompleted until the end of 1945, but thatthe greater portion of it would be finishedby the end of July.57

Another aspect of the general move-

ment to raise the standards of Army hos-pital plants was extension of the programof installing air-conditioning or ventilat-ing equipment and inauguration of a pro-gram of installing nurses' call systems.The Surgeon General's Office wanted theexisting air-cooling program expanded.During the last six months of 1943 andthe early part of 1944 the Hospital Con-struction Branch sought approval for theinstallation of air-conditioning equipmentin the operating rooms of all general hos-pitals, whether they were located in areaswith July temperatures above 75 degreesFahrenheit or not, and in dental clinics incertain areas that had hot summers. Italso requested that either mechanical-ventilating or evaporative-cooling equip-ment be permitted in some storeroomsand in patients' recreation buildings.58 Arevision of policy by ASF headquarters inApril 1944 permitted the installation ofair-conditioning equipment in dentalclinics in the South and of either mechani-cal-ventilating or evaporative-cooling

55 Ltr SPMCH 600.3, SG to CG ASF thruCofEngrs, 4 Jun 46, sub: Increased Maintenance atRegional and Sta Hosps, with 1st ind, CofEngrs toDir SS&P WDGS, 19 Jun 46, and 2d ind, Dir SS&PWDGS to SG thru CofEngrs, 26 Jun 46. SG: 600.3.

56 (1) Memo SPMOC 632 (9 Mar 45), CG ASF forCofEngrs, 9 Mar 45, sub: Improvement of Debarka-tion Hosps. SG: 632. (2) Memo, Col L[loyd] E. Fel-lenz, GSC, G-4 Div for ACofS G-4 WDGS, 14 Mar45, sub: Improvements at Debarkation Hosps. HRS:G-4 file, "Hosp and Evac Policy."

57 Memo SPMOC 600.1, CG ASF for CofEngrs andSG in turn, 7 Feb 45, sub: Conversion, New Cons, andPreferred Maintenance at Gen and Conv Hosps, with1st ind, CofEngrs to CG ASF thru SG, 22 Feb 45. CE:683 Pt. I.

58 (1) Memo, SG to CG ASF, 28 Jul 43, sub: Venti-lative Treatment for Hosp Storehouses. (2) Memo,SG for CG ASF, 28 Aug 43, sub: Air Conditioning,Surgeries. (3) Memo, SG for CG ASF, 12 Oct 43, sub:Proposed Changes in WD Policy Governing Air Con-ditioning, Ventilation, and Cooling in ZI Hosps. (4)Memo, SG for CG ASF, 12 Feb 44, sub: Air Condi-tioning for Dental Clinics. All in SG: 673.-4.


equipment in patients' recreation build-ings, but not in storehouses, in areas wherethe July temperatures exceeded 75 degreesFahrenheit.59 Soon afterward, as theclosure of station hospitals began to makeequipment in those plants available forother uses, The Surgeon General againrequested an extension of the program,and on 13 July 1944 ASF headquartersapproved the installation of air-condition-ing equipment in operating rooms and ofeither air-conditioning or ventilatingequipment in X-ray clinics and recoverywards of general and regional hospitalsanywhere in the United States, regardlessof average July temperatures. The in-stallation of such equipment in stationhospitals was still limited to those locatedin southern areas of the country.60

As in the case earlier of air-coolingequipment, a shortage of critical materialsdelayed initiation of a nurses' call-systemprogram. During the winter of 1943-44some hospitals nevertheless succeeded inprocuring equipment and in having suchsystems installed with nonappropriatedfunds.61 When equipment became moreplentiful in the spring of 1944, ASF head-quarters authorized the use of appropri-ated funds to install nurses' call-systems inall general hospitals and to some extent inothers.62 Because the amount of money setaside for this purpose was limited, TheSurgeon General decided that, in general,only wards used for nonambulatory pa-tients would get the equipment and gen-eral hospitals would get it before regionalhospitals.63 By March 1945 all generalhospitals and all but thirty-one regionalhospitals had had nurses' call systems in-stalled. At that time ASF headquartersapproved the Engineers' request for suffi-cient additional funds to complete the in-

stallation of such systems in all regionalhospitals.64

Housing for Hospitalsin Theaters of Operations

In the middle of 1943 Surgeon GeneralKirk and his chief of Professional Serviceshad the problem of housing for hospitalsin theaters called forcibly to their atten-tion during visits to North Africa and theSouthwest Pacific. According to plans atthe beginning of the war, hospitals in the-aters of operations were to be housed intents, in existing buildings wherever theywere available, or in buildings erected bythe Engineers with either native or im-ported building materials according tostandard plans for theater-of-operations-type construction. None of these means ofhousing had proved universally satisfac-tory. In some areas, such as North Africa,tentage was too hot. In others, such as thePacific, it not only was too hot but it mil-dewed, rotted, and disintegrated within

59 (1) Memo, CG ASF for SG, 14 Mar 44, sub: Pro-posed Revision of WD Memo W 100-4-43, withincl, draft of memo. SG: 300.6. (2) WD Cir 148, 14Apr 44.

60 (1) Ltr. SG to CG ASF, 19 Jun 44, sub: Air Con-ditioning in Gen and Regional Hosps, with 2d ind,CG ASF to CofEngrs, 13 Jul 44. (2) OCE Cir Ltr 3457(Repairs and Utilities No 10), 19 Dec 44, sub: Refrig-eration and Ventilation—Revision of Policy for Air-conditioning in Gen, Regional and Sta Hosps. Bothin CE: 673.

61 Ltr, SG to CofEngrs, 16 Mar 44, sub: MD ConsReqmts for FY 1945. SG: 632.-1.

62 Memo, CG ASF for SG, 1 Apr 44, referred to in1st ind SPMCH 676, SG to CofEngrs, 26 Aug 44, onMemo, CofEngrs for SG, 23 Aug 44, sub: Nurses' Sig-naling Fac. SG: 413.45.

63 1st ind SPMCH 676, SG to CofEngrs, 26 Aug 44,on Memo, CofEngrs for SG, 23 Aug 44, sub: Nurses'Signaling Fac. SG: 413.45.

64 Memo, CofEngrs for CG ASF, 25 Mar 45, sub:Nurses' Call Systs, with 1st ind SPMOC 676.1 (25Mar 45), CG ASF to CofEngrs, 2 Apr 45. SG: 413.45.


about six months. In addition, the use oftentage made more difficult the control ofmosquitoes in malarious areas. In some ofthe places where tentage was unsuitablefor housing hospitals, there were no avail-able existing buildings. Moreover, theMedical Department often encountereddifficulties in getting theater-of-operations-type housing constructed because of short-ages of lumber in theaters and of competi-tion for Engineer services with such high-priority projects as the construction ofharbors, docks, piers, airstrips, and essen-tial roads. Beginning in the latter half of1943 the Surgeon General's Office turnedits attention to these problems.65

The problem of modifying tentage sothat interior temperatures were loweredwas relatively simple to solve. Late inJuly 1943 representatives of The SurgeonGeneral and The Quartermaster Generalfound that the British used a fly with theirtents.66 Suspended on poles above a tent,it provided shade for the tent roof andalso retained an insulating layer of air,thereby reducing the temperature insideby about 20 degrees in the summer sun.After suitable tests, the QuartermasterTechnical Committee in the summer of1943 approved the use of flies with hospi-tal tents. Plans were then made to procure30,000, and subsequently tent flies wereincluded in revised tables of equipment forhospital units. Thus a large existing stockof hospital ward tentage was adapted touse in tropical climates of low humidity.67

Meanwhile the Quartermaster Corpshad begun a more extensive project—thedevelopment of a new type of hospitaltent. Called a sectional hospital tent, ithad two distinguishing characteristics. Awhite liner made of cotton sheeting cov-ered the entire inside of the tent, lowering

temperatures and promoting cleanliness.This tent was so constructed that a com-plete end section could be detached fromthe main body and additional center sec-tions added to extend its length as desired.It was standardized in July 1944 and, astables of organization and equipment ofhospital units were subsequently revised,was included as a replacement for wardtents with flies. Some were issued for over-seas use before the end of the war.68

The problem of providing housing inhot humid areas that had little lumberand no buildings was more difficult. Dur-ing the early part of the war the Southwest

65 (1) Memo, SG for CG ASF, 10 Aug 43, sub: In-terim Progress Rpt. SG: 024.-1. (2) An Rpt, ChiefSurg SWPA, 1942. HD. (3) Ltr, Hq USASOS SWPAto CG ASF thru CG SWPA, 16 Sep 44, sub: Rpt ofTrip to SWPA. . . . SG: 333.1-1 (Aust)F. (4) Ltr,SG to CG ASF, 28 Nov 44, Hosp Fac in TofOpns.HD: 632.-1 (Hosp Fac in POA). (5) Memo SPMCP632 (Aust)F, SG for CG ASF, 29 Dec 44, sub: HospCons, SWPA. HRS: ASF Hq Somervell files, "SG,1944."

66 The United States Army used flies with smalltents but had made no provision for their use withthe much larger hospital ward tents. Informationsupplied by Dr. Irving G. Cheslaw, Historian,OQMG.

67 (1) Memo SPOPI 424.1, Col Robert C. McDon-ald, MC, Chief Hosp and Evac Sec Planning DivOprs ASF for Gen Lutes, 21 Jul 43, sub: Improve-ment in Tentage and Laundries for the MD. HD:Wilson files, "Day File, Jul 43." (2) Inf note, W. D.Styer to Col Smith, ca. 17 Aug 43. HRS: ASF ControlDiv, 319.1 "SGs Interim Rpt, G-56." (3) Memo, Col[Robert C.] McDonald for Col F. M. Smith, 17 Aug43, 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. Samefile. (5) T/O&E 8-550, Gen Hosp, C 2, 16 May 44.(6) T/O&E 8-581, Evac Hosp SM (400-bed), 25Mar 44.

68 (1) Erna Risch, The Quartermaster Corps: Organi-zation, Supply, and Services (Washington, 1953), p. 171,in UNITED STATES ARMY IN WORLD WARII. (2) T/O&E 8-560, Sta Hosp, 28 Oct 44. (3)T/O&E 8-580, Evac Hosp, 31 Jan 45. (4) Informa-tion supplied informally by Dr. Risch on 30 Novem-ber 1953.


Pacific theater had developed plans forpartially prefabricated buildings and hadarranged with the Australians for theirmanufacture. Constructed of corrugatedsheets of iron, floored with wood or con-crete, screened, and provided with wideoverhanging eaves for protection againsttropical rains, buildings of this type—called "Australian cowsheds"—had beensatisfactory. By the middle of 1943, thedemand for them threatened to exceed theAustralian supply and the theater calledupon the zone of interior to furnish prefab-ricated buildings to house 22,000 beds in44 hospitals.69 As a result, the offices ofThe Surgeon General and the Chief ofEngineers worked on improvements inplans for overseas hospitals and on theprovision of prefabricated buildings.70 Theterm "prefabricated" was used loosely byboth offices and apparently meant differ-ent things to different people, for in Sep-tember 1943 the Surgeon General's Con-struction Division was surprised when itdiscovered that the Engineers were plan-ning precut but not prefabricated build-ings.71 The Surgeon General protestedagainst the adoption of precut construc-tion, but because of the urgent need forhospital buildings in the Pacific, ASFheadquarters, the Engineers reported, di-rected them to fill the theater's requisi-tion.72 In conferences with representativesof the Surgeon General, the Chief of Engi-neers agreed that truly prefabricated steelbuildings would be preferable to those ofprecut wood, but pointed to restrictionsupon the use of steel as the major reasonfor not planning its use in hospital build-ings. The Surgeon General's Office thenprepared an urgent request to ASF head-quarters for steel, and the ASF Matérieland Production Division decided that, as

a result of the cancellation of drum platecommitments, it could be supplied forbuildings for twenty of the forty-four hos-pitals requested by the Pacific.73 Subse-quently, the Surgeon General's Office andthe Engineers engaged in a revision ofplans for the types, sizes, and internalarrangements of hospital buildings, to cor-rect defects that had been revealed byexperience in using theater-of-operations-type construction in the Desert TrainingCenter in the United States.74

The plans for precut hospital buildingsdeveloped by the Office of the Chief ofEngineers failed to meet the approval oftheater headquarters. In the first place,the Southwest Pacific theater believedthat they would not solve the engineeringproblem, for to erect them would requiremore construction personnel than would

69 Office of the Chief Engineer, General Headquar-ters Army Forces. Pacific, Engineers in Theater Opera-tions, in ENGINEERS OF THE SOUTHWESTPACIFIC 1941-45, vol. I (1947), pp. 127-28. Refer-ence to a requisition dated 19 July 1943, which hadnot been located, is made in Ltr, CG USASOS SWPAto CG ASF thru CG USAFFE, 28 Apr 44, sub: Pre-fabricated Hosps. CE: 632 "Vol. 4."

70 Memo, CofEngrs for SG, 19 Aug 43, sub: Pro-posed Plans for . . . Tropical Hosps . . . Prefabri-cated All Wood Bldgs, with 3 inds. SG: 632.-1 (Gen).

71 Memo, CofEngrs for SG, 23 Sep 43, sub: Prefab-ricated Tropical Hosps, with 1 ind and 3 incls. CE:632 "Vol. 4."

72 (1) Memo, CofEngrs for SG, 13 Oct 43, sub:Structures for Tropical Hosps. SG: 632.-1 (Gen). (2)Memo, Maj Edwin M. Loye, SGO for Lt Col A. L.Tynes, SGO, 15 Oct 43, sub: Mtg . . . RegardingPrefabricated Steel and Stock Precut Wood HospBldgs. 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 toCofEngrs. 23 Oct 43, sub: Steel Hosp Bldgs, on unlo-cated basic Ltr. SG: MOOD "Pacific."

74 (1) Memo, Chief Hosp Cons Br SGO for SG, 21Feb 44, sub: Insp of TofOpns Type Hosp Facs in theC-AMA. SG: 632.-1. (2) Ltr, SG to CofEngrs, 24 Apr44, sub: Modifications of TofOpns Specifications forHosp Cons. Same file. (3) Rpt of Conf, CofEngrs toSG, 19 May 44. HD: 632.-1.


be available. In the second place, hospi-tals planned for precut construction weremore elaborate than the theater thoughtnecessary. For example, floor space perbed in wards was greater than in Austra-lian prefabricated buildings, services andutilities were considered excessive, andcertain buildings such as fire stations,guardhouses, and quarters for officers andenlisted men were considered unnecessary.War experience in the Pacific had dic-tated austerity in hospital housing whichthe Surgeon General's Office was unwill-ing to approve. The Southwest Pacificagreed to accept the hospital buildingsbeing prepared for shipment from theUnited States "on the score of expedien-cy," but requested that they be held untilcalled for.75 Meanwhile, the SouthwestPacific continued to use "Australian cow-sheds" and the Central Pacific to useQuonset huts supplied by the Navy.76

When precut hospital buildings did arrivein the Pacific, theater headquarters foundthem, for the reasons expected, unsatisfac-

tory.77 During the rest of 1944 and theearly part of 1945 the Offices of The Sur-geon General and the Chief of Engineerscontinued attempts to provide prefabri-cated hospitals that would meet the needsof the Pacific, but the war ended beforethey could achieve success.

75 (1) Ltr, CG USASOS (SWPA) to CG ASF thruCG USAFFE, 28 Apr 44, sub: Prefabricated Hosps,with 7 inds. CE: 632 "Vol. 4." (2) Ltr, SG toCofEngrs, 29 May 44, sub: Prefabricated Hosps. SG:632.-1. (3) Memo, Chief Theater Br SGO for ColWelsh, 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 forHosps in SWPA. SG: MOOD "Pacific." (2) RadCM-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 DirHosp Div SGO, 2 Sep 44. (2) Memo, Lt Col [DouglasB.] Kendrick, [Jr.] MC for SG, 2 Sep 44, sub: Rpt ofTrip 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 Bldgsfor Pacific Theater. All in SG: MOOD "Pacific." (4)Ltr, CG Hq Island Comd Saipan to CG POA, 17 Jan45, sub: Deficiencies of Bks—Precut Ptbl Wood, forHosp Usage, with 2 inds. CE: 632 (USAFPOA).

CHAPTER XVIII

Return to a Peacetime BasisWith the war's end, first in Europe and

then in the Pacific, pressure to return toa peacetime basis was so great that hos-pital resources built up over a period ofmore than five years were liquidated inlittle over a year. This process was firstcompleted in overseas theaters.

Redeployment and Demobilizationof Numbered Hospital Units

The peak of hospital beds in overseastheaters was reached in May 1945, whenthere were in all theaters 343,975 fixedhospital beds and 85,975 mobile hospitalbeds. Of these, the greatest number werein the European theater, which at thattime had 200,350 fixed beds and 58,200mobile beds.1 With the approach of V-EDay, the War Department placed em-phasis upon evacuating as many patientsas possible from both the European andMediterranean theaters, in order to makefull use of shipping space that would laterbe diverted to the Pacific and to free asmany hospital units as possible for rede-ployment after the defeat of Germany.2

In April 1945 the 60-day evacuation pol-icy which Europe had been following on ade facto basis for several months was madeofficial for both the European and Medi-terranean theaters.3 After V-E Day, asboth troops and patients were moved outof these theaters, plans were made to shipsome of their hospital units direct to thePacific, some to the United States for latershipment to the Pacific, and some to the

United States for inactivation.4 As a re-sult, by August 1945 the number of fixedbeds in the European theater decreasedto 141,850 and of mobile beds to 50,775.5

In that month it was possible to placeboth the European and Mediterraneantheaters on an inactive basis—that is, toreduce their establishments to the require-ments of occupation forces. Their evacu-ation policies were therefore set at 120days and their fixed-bed ratios at 4 per-cent.6

1 Statistics Branch, Control Division, Hq. ASF, Sta-tistical Review, World War II: A Summary of ASF Activi-ties (n d), App R, p. 243 (cited hereafter as StatisticalReview, World War II).

2 (1) Ltr WDGDS 10303, Dep ACofS G-4 WDGSto CofSA, 17 Mar 45, sub: Evac of Pnts from ETO,with 3 incls. HRS: G-4 files, "Hosp, vol. III." (2) Ca-blegram CM-OUT-65962, WD to Hq ComZ ETO,10 Apr 45. Same file. (3) Memo, SG for ACofS G-4WDGS, 11 Apr 45, sub: Evac Policy with Spec Refto ETO. SG: 705.

3 S/S WDGDS 11921, ACofS OPD WDGS toCofSA, 18 Apr 45. sub: Proposed Change in EvacPolicy for ETO and MTO. HRS: G-4 files, "Hosp,vol. III."

4 (1) ASF Monthly Progress Rpt, Sec 7. Health, 30Jun 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 ColE[dward] C. Spaulding, GSC for ACofS G-4 WDGS,27 Jul 45, sub: Reduction of Fixed Hosp Bed Basis inETO. HRS: G-4 files, "Hosp, vol. IV." (3) Memo,SG for ACofS G-4 WDGS, 10 Sep 45, sub: Recom-mended Reduction in Fixed Beds in ETO and MTOto 4 percent. SG: 632.2. (4) Rad CM-OUT-63182,WAR to CG ETO and MTO, 12 Sep 45. HRS: G-4files, "Hosp, vol. IV." (5) Memo SPOPP 370.05, ActDir Plans and Oprs ASF for SG and CofT, 24 Jul 45,sub: Evac Policy ETO. SG: MOOD "ETO." (6) RadCM-OUT-46451 (Aug 45), COMGENSERV to CGUSAF MTO, 8 Aug 45. SG: 705.

RETURN TO A PEACETIME BASIS 301

With redeployment, the number offixed and mobile beds in the SouthwestPacific increased from 67,250 in May1945 to 82,700 in August 1945. Mean-while, the number of beds in other areasof the Pacific declined from 37,600 to 32,-700.7 The surrender of Japan in Augustheralded a cancellation of the shipment offurther hospital units to the Pacific8 anda repetition of the process that had beenfollowed in Europe of clearing hospitalsof patients by evacuating them to theUnited States. Early in August, the WarDepartment directed the Pacific—whichin April had been placed under a singlecommand—to use all evacuation facilitiesavailable, reducing the evacuation policyto 60 days if necessary.9 The next monthit was possible to plan to place that areaon an inactive basis. The War Depart-ment therefore directed it to return to a120-day policy effective 1 December 1945and to comment on a proposed reductionof its bed ratios to 4.8 percent.10 Beforethis reduction was actually made, the Sur-geon General's Office and the GeneralStaff turned to re-examining the needs ofall theaters.

By the end of October 1945 the num-ber of beds in fixed hospitals in theatersof operations had been reduced, throughthe inactivation of some units in theatersand the return of others to the UnitedStates, from a peak of 343,975 in May1945 to 236,050.11 This reduction was notgreat enough to return physicians, den-tists, and nurses to civilian life as rapidlyas the public and the Congress desired,and in November 1945 both the Secretaryof War and the Chief of Staff of the Armytook personal interest in speeding thatprocess. Consequently, G-1 called a con-ference of representatives of other GeneralStaff divisions, of AAF, AGF, and ASF

headquarters, and of the Surgeon Gen-eral's Office. At this conference it wasagreed that the Surgeon General's Officewould make studies of the requirements ofvarious theaters for beds during demobi-lization and would submit recommenda-tions for changes in authorized ratios.12

During November and December 1945such studies were completed and the Gen-eral Staff requested theaters to commenton the proposals of The Surgeon General.Aside from a recommendation that theauthorized bed ratio of each theater be re-duced, his most important proposal wasthe application of that ratio to beds notonly in fixed hospitals but also in mobilehospital units that retained professionalstaffs of physicians, dentists, and nurses.The reason that The Surgeon Generalnow proposed what he had protestedagainst in August 1943—that is, the useof a single ratio for authorizing beds inboth fixed and mobile hospitals—was thatthe need for mobile hospitals to supporttroops in combat had vanished with thecessation of hostilities. The only possibleexcuse for a theater's keeping professionalstaffs in the mobile units left there was touse these units as fixed hospitals. The Sur-geon General's proposals were approvedand 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-4files, "Hosp, vol. IV."

10 (1) Memo, Dir MOOD SGO for Record, 24 Sep45. SG: MOOD "Pacific." (2) Rad CM-OUT-70899(Sep 45), WARGFOUR to CINCAFPAC, 27 Sep 45.SG: 705. (3) Rad CM-IN-2145, CINCAFPAC toWD, 4 Oct 45. HRS: G-4 files, "Hosp, vol. IV."

11 Statistical Health Rpts. Off file, Health Rpts BrMed Statistics Div, SGO.

12 Memo, Lt Col Johnnie R. Dyer, GSC for ACofSG-4 WDGS, 26 Nov 45, sub: Delays in Discharge ofDoctors and Dentists. HRS: G-4 files, "Hosp, vol. IV."


of comments by theaters, the GeneralStaff in December 1945 authorized a bedratio of 4 percent for all theaters exceptthe American, which was to continue on a3 percent basis.13 In consequence, thenumber of beds in fixed hospitals and pro-fessionally staffed mobile hospitals de-creased rapidly until by the end of May1946 there were only 42,100 such beds inall theaters.14

Contraction of the Zone of InteriorHospital System

Soon after V-E Day G-4 began to putconsiderable pressure upon ASF, and thatheadquarters in turn upon the SurgeonGeneral's Office, to estimate general andconvalescent hospital requirements in theUnited States through the first quarter of1946 and to make plans to reduce thenumber of beds accordingly.15 Emphasiswas placed upon planning for the con-traction of the general-convalescent hos-pital system because the reduction andclosure of station and regional hospitals,dependent primarily upon the reductionand closure of posts where they were lo-cated, had already begun and would con-tinue under established procedures. AfterV-E Day, G-4 called for revised estimatesof requirements and The Surgeon Gen-eral projected forward to the end of 1946his plans for shrinking the general-con-valescent hospital system.16

In estimating bed requirements at thistime, there still were uncertainties to con-tend with. Before V-J Day the number ofbattle casualties that would occur and thenumber of patients to be evacuatedmonthly from the Pacific were of courseunknown. In addition, there was uncer-tainty about the amount and rate of rede-ployment of troops to the Pacific through

the United States and the speed withwhich German prisoners of war would berepatriated.17 After V-J Day some of thesedifficulties vanished but additional factorsappeared. Among them were the rate atwhich the Army would be demobilized;the time required to treat patients for sec-ondary diagnoses; the number of soldiersthat would be found at separation centersto need hospitalization, especially for tu-berculosis and deafness, before their dis-charge from the Army; and delays thatthe shortage of specialists might occasionin the disposition of patients alreadyunder treatment, particularly plastic sur-gery and amputation cases.18

In view of these uncertainties and diffi-culties, the Resources Analysis Division ofthe Surgeon General's Office presented toG-4 "conservative" estimates of the num-ber of beds that could be eliminated eachquarter, in order to protect the MedicalDepartment against the possibility of hav-ing too few beds for any reason. For ex-ample, the number of patients who would

13 ASF Monthly Progress Rpt, Sec 7, Health, 31Dec 45, p. 17, HD. The studies made by the SurgeonGeneral's Office, the comments of theaters, and thedocuments in which the Staff authorized new bedratios are filed in HRS: G-4 files, "Hosp, vol. V."

14 ASF Monthly Progress Rpt, Sec 7, Health, 31May 46, p. 22. HD.

15 (1) Diary, Resources Anal Div SGO, 16 Jun 45.HD: 024.7-3. (2) DF WDGDS 15204, ACofS G-4WDGS to CG ASF, 23 Jun 45, sub: ZI Hosps. HRS:Hq ASF Planning Div file, 700 "ZI Hosp." (3) T/SSPOPP 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 CGASF attn SG, 18 Aug 45, sub: ZI Hosps. SG: 322"Hosp." (2) Memo, SG for ACofS G-4 WDGS thruCG ASF, 14 Sep 45, sub: Cut-back in Gen and ConvHosp 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 MemoSPOPP 705, CG ASF for SG, 9 Nov 45, sub: Cut-backin Gen and Conv Hosp Fac, ZI. SG: 323.3 (GenHosp).


need beds in November was used as thenumber who would need them in Decem-ber, and to this number were added addi-tional beds that would be vacant eitherbecause of dispersion or because some pa-tients were absent from hospitals on leaveand furlough.19 On 14 September 1945The Surgeon General informed G-4 thatthe capacities of general hospitals couldbe reduced by 40,000, 38,000, and 39,000beds and of convalescent hospitals by21,000, 14,000, and 8,000 beds duringthe last quarter of 1945 and the first twoquarters of 1946, and that 16,000 addi-tional general hospital beds could beeliminated during the last half of 1946. InDecember this program was revised,chiefly to speed the liquidation of the con-valescent hospital system.20

Soon after V-E Day the ResourcesAnalysis Division had established a pro-cedure for reducing the number of bedsin general and convalescent hospitals. Itinvolved closing entire hospitals ratherthan parts of all of them, in order to freemore physicians for return to civilianlife—a matter that was to assume increas-ing importance as the press, the public,and the Congress continued to clamor fortheir release. For example, a reduction ofthe capacities of five 2,500-bed hospitalsby 500 beds each would release only 25physicians while the closure of one 2,500-bed hospital would release 60.21 This de-cision having been made, the Divisionestablished certain broad principles togovern the selection of particular hospi-tals for closure during successive quarters.They were as follows: leased buildingsshould be returned to their owners, andhospitals needed by other governmentagencies, such as the Veterans Adminis-tration, should be transferred to theseagencies as soon as possible; hospitals in

heavily populated areas should be re-tained to permit the hospitalization of pa-tients near their homes; hospitals thatwere less desirable because of climate andconstruction should be closed beforeothers; hospitals needed for the postwarArmy and for station hospital purposesshould be retained; and hospitals desig-nated as specialized centers for long-termcases, such as amputation and neurosur-gery cases, should be retained as long aspossible in order to keep to a minimumthe transfer of those patients to other hos-pitals.

In some instances, these principles con-flicted with one another. For example,Halloran and Mason General Hospitalswere located in leased buildings and Mc-Guire and Vaughan were desired by theVeterans Administration, but they werealso situated in areas of dense populationwhere many beds were needed. Lovelland Tilton General Hospitals were ofpoor construction, being among the firstof the cantonment-type general hospitalsconstructed during World War II, butwere located on Army posts and might beneeded for station hospital use. These con-

19 (1) Statement by Eli Ginzberg, Dir ResourcesAnal Div SGO, in Notes on Morning Sess of SvCSurgs Conf, 27 Sep 45. HD: Resources Anal Div files,"Hosp." (2) Memo, Dir Resources Anal Div SGO forChief Oprs Serv SGO, 7 Jun 45, sub: Criteria for Re-duction in Hosp Fac. SG: 323.3 (Hosp).

20 (1) Memo, SG for ACofS G-4 WDGS thru CGASF, 14 Sep 45, sub: Cut-back in Gen and ConvHosp Fac. SG: 322 "Hosp." (2) Memo, SG for ACofSG-4 WDGS thru CG ASF, 21 Dec 45, same sub. SG:323.3 (Hosp).

21 (1) Memo, Dir Resources Anal Div SGO forChief Oprs Serv SGO, 7 Jun 45, sub: Criteria for Re-duction in Hosp Fac. SG: 323.3 (Hosp). (2) Statementby Eli Ginzberg, Dir Resources Anal Div SGO, inNotes on Morning Sess of SvC Surgs Conf, 27 Sep 45.HD: Resources Anal Div file, "Hosp." (3) Ltr, SG toCGs SvCs attn Surg, 20 Dec 45, sub: ComparativeStudies of Gen-Conv and Sta-Regional Hosp Systs.SG: 323.3 (Hosp).


flicts complicated the selection of hospi-tals to be closed.22

In addition, the needs of both the Vet-erans Administration and the postwarArmy had not been fully determined.23

Finally, local citizens sometimes protestedthe closure of hospitals, and service com-mand surgeons, because of local condi-tions, disagreed with some of the decisionsmade in the Surgeon General's Office.24

Despite these difficulties, the program forclosures drawn up in the fall of 1945 wasfollowed with comparatively few changes.

The actual process of closing hospitalswas a responsibility of service commandofficials until April 1946, when generalhospitals were placed again, as they hadbeen before the war, under the direct com-mand of The Surgeon General. ASF head-quarters informed service commanders ofthe hospitals that would be closed eachquarter; the Surgeon General's Officedecided the particular dates on which theywould be closed; and several months priorto those dates the Medical RegulatingOfficer "blocked" those hospitals—that is,permitted no more patients to be sent tothem. After hospitals were blocked, serv-ice commanders were required to reviseauthorized bed capacities twice monthlyand to reduce personnel in accordancewith these revisions. Hospital command-ers submitted information which higherauthorities needed in order to declare assurplus the property no longer required bythe Army. They also disposed of hospitalpersonnel, supplies, and equipment underprocedures established by ASF headquar-ters. After hospital buildings were de-clared surplus, the Medical Departmentlost all control over them and they weredisposed of by other government agen-cies.25 In order to assure the reduction

and closure of hospitals according toschedule, the Surgeon General's ResourcesAnalysis Division each month analyzedhospitalization reports from service com-mands and called the attention of localArmy authorities to any failures in mak-ing reductions.26 Beginning in July 1945,in compliance with instructions from G-4,The Surgeon General reported monthlyto that Division the progress made in con-tracting the hospital system.27

Under these procedures the MedicalDepartment moved from a wartime to apeacetime basis for hospitalization in theUnited States in approximately a year'stime. By July 1946 all of the convalescenthospitals but one, the Old Farms Conva-lescent Hospital for the blind, had beenclosed.28 By December of that year all re-gional hospitals either had been closed or

22 Memo, Dir Resources Anal Div SGO for ChiefOprs Serv SGO, 4 Sep 45, sub: Plan for Post V-J DayReduction 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 WDGSthru CG ASF, 5 Sep 45, sub: Comd Instls for Reten-tion in Post-War Mil Estabs. SG: 370.01.

24 (1) Ltr, SG to Hon Francis J. Meyers, 28 Jan 46.SG: 323.3 (Hosp). (2) Ltr, SG to Mrs Dorothy Finn,Stockton, Calif, 15 Jan 46. Same file. (3) Statementsby SvC Surgs in Notes on Morning Sess of SvC SurgsConf, 27 Sep 45. HD: Resources Anal Div file,"Hosp."

25 (1) Memo, SG for Dir Mob Div ASF, 24 Sep 45,sub: Closure of ZI Gen Hosps. SG: 322 "Hosp." (2)Ltr SPMOC 632, CG ASF to Serv Comdrs, 2 Oct 45,sub: Closure of Gen Hosps. Same file. (3) Diary, Re-sources Anal Div SGO, 13 Dec 45. HD: 024.7-3. (4)Notes on Morning Sess of SvC Surgs Conf, 27 Sep 45.HD: Resources Anal Div file, "Hosp."

26 Ltr, SG to CGs SvCs attn Surg, 7 Nov 45, sub:Comparative Studies of Gen-Conv and Sta-RegionalHosp Systs. SG: 323.3 (Hosp). Similar letters for othermonths 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. Similarletters for other months are found in this same file andin SG: 322 (Hosp).

28 Weekly Hosp Rpt, vol. II, No 27, for week end-ing 5 Jul 46. Off file, Med Statistics Div SGO.


had reverted to station hospitals.29 By thebeginning of 1947 the Army (includingthe Air Forces) had only 54 station hospi-tals with 15,715 beds, only 14 general hos-pitals with 34,846 beds, and only 1 con-valescent hospital (Old Farms) with 100beds.30 A comparison of bed authoriza-tions for general and convalescent hospi-tals during successive quarters of 1945 and1946 with the program for bed reductionsprepared by the Surgeon General's Officein the fall of 1945 shows that the programwas followed closely. The chief deviationoccurred in a more rapid liquidation ofconvalescent hospitals than had been an-ticipated. A comparison of "patientsremaining" in general and convalescenthospitals with authorized beds shows aclose correlation between reductions inthe patient-load and in hospital beds. Asin earlier months, the number of beds oc-

cupied continued to be considerablysmaller than either the number of bedsauthorized or the number of patients re-maining.31 (See Table 15; also Chart 10.)

29 (1) Weekly Hosp Rpt, vol. III, No 49, for weekending 6 Dec 46. Off file, Med Statistics Div SGO.(2) WD GO 148, 11 Dec 46.

30 Information furnished by Resources AnalysisDivision, SGO, 4 Dec 50. The fourteen general hos-pitals were Army and Navy, William Beaumont, Fitz-simons, Letterman, Walter Reed, Brooke, Madigan,Oliver, Percy Jones, Tilton, Valley Forge, McCor-nack, Murphy, and Pratt. The last three had beendesignated general hospitals in May 1946 by WD GO45, 15 May 46.

31 (1) Memo, SG for ACofS G-4 WDGS thru CGASF, 14 Sep 45, sub: Cut-Back in Gen and ConvHosp Fac. SG: 322 "Hosp." (2) Memo, SG for ACofSG-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 weekending 29 Mar 46; vol. III, No 26, for week ending 28Jun 46; and vol. III, No 52, for week ending 27 Dec46. Off file, Med Statistics Div SGO.

PART FOUR

EVACUATION

TO AND IN THE ZONE OF INTERIOR

IntroductionThe evacuation of patients from thea-

ters of operations to the zone of interiorand from one point to another in theUnited States was an intricate operation,involving not only the transportation butalso the care en route of patients sufferingfrom all kinds of diseases and injuries. Itwas complicated by many factors, amongthem the means employed. Various typesof transportation facilities were used—motor vehicles, trains, ships, and air-planes. Each of these had subtypes. Forexample, both hospital and transportships returned patients from theaters.Various kinds of personnel, civilian andmilitary, were employed to operate trans-portation facilities and care for patientsaboard them—doctors, nurses, techni-cians, pilots, and many others. Moreover,equipment and supplies needed to carefor patients in transit were extensive andsundry, ranging from aspirins to operat-ing tables. To some degree personnel andequipment required were governed bytransportation facilities employed, be-cause hospital ships, for instance, neededmore elaborate equipment and largerstaffs than did airplanes.

Evacuation was further complicated byits interrelationship with plans, policies,and procedures for hospitalization. Forexample, the division of general hospitalbeds between the theaters and the zone ofinterior was determined by—among otherfactors—the evacuation facilities expectedto be available. On the other hand, thenumber of beds supplied to theaters in-fluenced the number of patients to betransferred to the zone of interior, and

hence the transportation facilities thatwould be required. Successful operationof the specialized hospital system in theUnited States and observance of a policyof hospitalizing patients as near theirhomes as possible depended upon theevacuation system.1

To co-ordinate evacuation with hospi-talization and to use all available means—transportation facilities, personnel, andequipment—in such a way that largenumbers of patients would be moved assafely and expeditiously as possible re-quired a highly organized operationalsystem. Its development and conduct werecomplicated not only by the divers meansemployed but also by the distances trav-ersed and the agencies involved. Patientstraveling by land, air, and sea from hospi-tals in theaters of operations to those inthe zone of interior were the responsibilityof successive military agencies. Amongthem were the bases and headquarters oftheaters of operations; the Air TransportCommand with its overseas wings; theTransportation Corps with its ports of em-barkation and debarkation in the UnitedStates; the Offices of the Chief of Trans-portation, The Surgeon General, and theAir Surgeon; service and air commandsin the United States; and the headquar-ters of both the Air and Service Forces.

Involvement of so many agencies madeit important to define their respectiveareas of responsibility—particularly after

1 Interrelationships between hospitalization and thepolicies and processes of evacuation have been dis-cussed at various points in preceding chapters andwill be referred to again from time to time.


the War Department reorganization inMarch 1942. On recommendation of SOSheadquarters, this was done for majoragencies the following June. The com-manding general, Army Air Forces, wascharged with development and operationof air evacuation. Commanders of theatersof operations and of major commands inthe United States were declared responsi-ble for the movement of patients withintheir own commands. The commandinggeneral, Services of Supply, was chargedwith evacuating patients from all majorcommands—those overseas as well as inthe United States—and of co-ordinatingall plans of such commands for the evacu-ation of sick and wounded to be deliveredto his control.2 To assist him in this func-tion, various responsibilities (which willbe discussed later) were assigned to theChief of Transportation, The SurgeonGeneral, and port and corps area com-manders. In the early part of the war theiractivities were closely supervised and co-ordinated by the SOS Hospitalization andEvacuation Branch.

Beginning in 1943 a series of eventstransferred that Branch's responsibilityand authority for evacuation to The Sur-geon General and the Chief of Transporta-tion. Early that year, it will be recalled,ASF (formerly SOS) headquarters beganto return to The Surgeon General some ofthe functions it had assumed earlier inhospitalization and evacuation opera-tions. Some of the officers of its Hospi-talization and Evacuation Branch weretransferred to the Surgeon General'sOffice after the Branch was reduced instatus to a section of another branch inASF headquarters. One of them was Lt.Col. John C. Fitzpatrick, who had beenactive in sea evacuation operations whilein ASF headquarters. Soon afterward,

The Surgeon General and the Chief ofTransportation decided that the latterwould need constant technical advicefrom the Medical Department on mattersof evacuation that concerned him andthat the former would need a means ofexercising technical supervision over evac-uation operations. Accordingly The Sur-geon General in June 1943 assigned Colo-nel Fitzpatrick as his liaison officer withthe Chief of Transportation, who gave himoffice space for a Transportation LiaisonUnit. In this capacity Colonel Fitzpatrickassisted the Chief of Transportation inestimating evacuation requirements andin planning and supervising the transpor-tation of patients by water and rail.

In the spring of 1944, in anticipation ofthe patient load expected as a result ofaggressive combat operations, the unitheaded by Colonel Fitzpatrick was in-creased in size and given additional au-thority and responsibilities. In May, it willbe recalled, The Surgeon General re-moved the Evacuation Branch from hisHospital Division and merged it with theTransportation Liaison Unit to form aMedical Regulating Unit. This step com-bined the function of regulating the flowof patients from ports to hospitals of defin-itive treatment with that of providing fortheir transportation. Thus one office, rep-resenting The Surgeon General andbelonging to his Operations Service butlocated in and working as a part of theMovements Division of the Office of theChief of Transportation, assumed respon-sibility in the latter half of the war forsupervising all evacuation operations ex-

2 (1) Ltr AG 704 (6-17-42) MB-D-TS-M, TAGto CGs AGF, AAF, SOS, et al., 18 Jun 42, sub: WDHosp and Evac Policy. (2) Ltr SPOPM 322.15, CGSOS to CGs and COs of CAs, PEs, Gen Hosps, andSG, 18 Jun 42, sub: Opr Plans for Mil Hosp andEvac. Both in AG: 704(6-17-42).

INTRODUCTION 321

cept the movement of patients by air. TheAir Forces Medical Regulating Service inthe Air Surgeon's Office controlled thetransfer of patients between AAF hospi-tals and supervised air evacuation opera-tions. Collaborating closely with the ASFMedical Regulating Unit, the Air Regu-lating Office followed the pattern of theASF office both in its development and inits procedures.3

In contrast with wartime operations,evacuation of patients from overseas areasand within the United States in peacetimehad been a small-scale affair. The fewtroops who were in overseas areas werenot engaged in combat activities; andtherefore the number of patients whoneeded to be returned to the UnitedStates for hospital care was not large.General hospitals in this country werelocated in relation to troop density andserved on a regional basis to treat com-plicated cases of all types rather than ona specialized basis to treat few types ofcases from wide areas; and therefore themovement of patients from station to gen-eral hospitals was also a relatively simpleprocedure.

The primary means of transporting pa-tients from overseas areas was by trooptransports. No hospital ships were avail-able, and the movement of patients by airwas still in the experimental stage. Trans-ports delivering troops and supplies atoverseas ports took aboard patients for re-turn trips and transport surgeons caredfor them in ships' hospitals or in ships'quarters.4 Before arrival in the UnitedStates, transport surgeons radioed to portsof debarkation lists of patients aboard,with their diagnoses and proposed disposi-tions. Ports receiving such information ar-ranged with the corps area (later called

service command) in which they were lo-cated for the transportation of patientsbeing evacuated. Upon arrival of trans-ports, port commanders issued orderstransferring patients to general hospitalsin which ports had bed credits and theninformed The Surgeon General of thenumber received and of the hospitals towhich they had been transferred. TheNew York Port, for example, had bedcredits in both Tilton and Lovell GeneralHospitals and transferred patients withinthe limit of its allotments to these hos-pitals. Because the nearest meant anambulance trip of more than two hours,the port occasionally kept in its stationhospital for short periods of time patientswho needed rest before further travel.Personnel both for transports and for thedebarkation of patients was supplied byports from their bulk personnel allotmentsor was borrowed from corps areas.5

Within the United States patients weremoved from ports to hospitals, or from onehospital to another, by ambulance, bytrains, and by airplanes. Ambulancesavailable to all hospitals were used, ashospital commanders directed, for shorttrips. Accommodations for patients aboardregularly 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: Wilsonfiles, "Book IV, 16 Mar 43-17 Jun 43." (2) ASF Cir147, 19 May 44. (3) WD Cir 140, 11 Apr 44. (4) AAFReg 25-17, 7 Feb and 6 Jun 44. (5) An Rpt, FY 1944and 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 partof each voyage report by AR 30-1150, 19 Septem-ber 1941, were submitted through port surgeons toArmy Transport Service. For surgeon's reports seefiles SG: 721.5, QM or TC: 569.1 under name ofArmy transport.

5 (1) AR 40-1025, 12 Oct 40. (2) WD Cir 120, 21Jun 41. (3) An Rpt, NYPE, 1943, contains an accountof activities before 1943. HD.


arranged by corps area officers with localagents of carriers involved. Normally,transfers were made without reference tosuch higher authority as the Surgeon Gen-eral's Office, because station hospitals,corps area surgeons, and port com-manders had general hospital beds setaside for their use by the bed-credit sys-tem.6 Some airfields and air trainingcenters converted airplanes available tothem into airplane ambulances and usedthem to transfer patients from scenes ofcrashes to near-by hospitals or, in someinstances, from one hospital to another.When airplane ambulances were notavailable, medical personnel on duty withthe Air Corps made local and informalarrangements with Air Corps operationsofficers for the transportation of patients

in operational planes.7 Such an informalsystem worked well enough as long as thenumber of patients to be evacuated wassmall and the distances they were to bemoved were short, but it was not easilyadaptable to the movement of large num-bers of patients over long distances. Theway this system was transformed will bediscussed later. It will be helpful, though,to consider first the magnitude of oper-ations that made necessary such a trans-formation.

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 ACTGto CofAC, 15 Aug 41, sub: Air Amb, with inds. AAF:452.-1B (Amb Planes).

CHAPTER XIX

Estimated and ActualRequirements for Evacuationfrom Theaters of Operations

Estimating future evacuation require-ments was primarily a matter of calculat-ing the probable patient-load of theatersand of determining the part that wouldbe transferred to the zone of interior underprevailing policies. Early in the war esti-mates of this kind were practically unnec-essary because the number of patients tobe evacuated was still comparativelysmall, combat operations were limited,and there was plenty of space for evacueesaboard returning transports. Meetingevacuation requirements amounted sim-ply to insuring that transports had ade-quate hospital space, attendant personnel,and medical supplies, and that they wererouted on return trips to places where pa-tients had accumulated. In the latter halfof the war this situation changed. Thenumber of patients evacuated, which hadbeen less than 1,000 a month before No-vember 1942 and an average of about3,300 from then until the middle of 1943,mounted steadily until it reached a peakof more than 57,000 in May 1945. (Table16) Moreover, as the build-up of troops intheaters ceased, the number of returningtransports declined. Under these circum-stances estimates of the evacuation loadhad to be made so that enough transpor-

tation could be assembled to handle it;and estimates had to be made far enoughin advance so that the use of transporta-tion facilities—which came to include air-planes and hospital ships as well as trooptransports—could be properly co-ordi-nated.

A study which the Surgeon General'sOffice made in the winter of 1943-44 ofthe patient load that would develop dur-ing 1944 evoked a critical appraisal earlythat year not only of plans for supplyingthe Army with hospitalization but also ofplans for evacuating patients from theatersof operations.1

Whether plans for evacuation would beadequate depended upon the size of theevacuation load and upon the use to bemade of transportation facilities. The Sur-geon General's estimate of the potentialload was questioned by ASF headquartersand the Chief of Transportation. Subse-quently, as a result of additional informa-tion supplied by the European and Medi-

1 See above, pp. 201-02. The following three para-graphs are based upon "Hospitalization and Evacua-tion: A Re-estimate of the Patient Load and Facili-ties," February 1944, and "Hospitalization andEvacuation, An Analysis," March 1944, togetherwith memorandums and letters in ASF Planning DivProgram Br files 370.05 and "Hosp and Evac, vol. 3."


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 ofAllied 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 reports of

patients debarked, now located in SG: 705 "Evac Reqmts, Books I and II."

REQUIREMENTS FOR EVACUATION 325

terranean theaters, the Chief of Transpor-tation decided to use lower figures. Forexample, The Surgeon General first esti-mated that 44,300 patients would be evac-uated to the United States during Septem-ber 1944, but the Chief of Transportationin March 1944 believed that the figurewould be nearer 27,000. Neither consid-ered that airplanes would supply any sig-nificant capacity for evacuation. Pastperformance indicated that few patientswould be transported from theaters by air,and air travel—being subject to weatherconditions—was considered uncertain atbest. Both officers concentrated their at-tention, therefore, on surface vessels.

In determining patient capacities oftransports and hospital ships expected tobe available, two factors had to be consid-ered. The use of hospital ships for intra-theater evacuation, a matter which hadnot entered into considerations leading totheir authorization, would reduce thenumber and therefore the total capacityof hospital ships for transporting patientsfrom theaters to the United States. Also,capacities of transports would vary accord-ing to the standards set for lifeboats andother lifesaving equipment for patients.Under "desirable" standards, which werethe highest in terms of lifesaving equip-ment, capacities would be least. If stand-ards were lowered, capacities would beincreased. Under "adequate" standards atransport was permitted to load more pa-tients than it had spaces for in lifeboats,provided the latter could accommodateall litter and hospital ambulant patients.For others—mental and troop class pa-tients—only flotation equipment was nec-essary. Under "acceptable" standardseven litter and hospital ambulant patientscould exceed accommodations for patientsin lifeboats, though flotation equipment

had to be provided for the excess in thesecategories as well as for all other patientsaboard. Hence, greatest capacities couldbe achieved by evacuating patients under"acceptable" conditions.

Because of variations in standards oflifesaving equipment and in estimates ofthe evacuee load, opinions about the ade-quacy of planned shipping facilities dif-fered. Both the Chief of Transportationand The Surgeon General agreed thathospital ships already authorized wouldbe sufficient to evacuate to the UnitedStates only a portion of the "helpless frac-tion" (estimated to be about 60 percent ofthe total number) of patients. They dis-agreed about the adequacy of transportsfor the remainder of the load, includinghelpless patients who could not be accom-modated aboard hospital ships. On thebasis of his estimate The Surgeon Generalconcluded that sufficient shipping wouldbe available for evacuation from the Pa-cific but that, even under "acceptable"conditions, there would be barely enoughspace for patients from the European the-ater in hospital ships already authorizedand in transports expected to be available.Nor would there be enough for patientsfrom the Mediterranean. Using a lowerestimate the Chief of Transportation de-cided that the space available under"acceptable" standards would be sufficientfor the patients from all theaters. In viewof this decision and the constant need formore troop ships, he advised against theprocurement of additional hospital ships.By the end of March ASF headquartersadopted a middle-of-the-road course, ac-cepting recommendations of the Transpor-tation Corps but directing that plans forseven additional hospital ships be drawnto be used if needed, that provision bemade for additional medical personnel for


sea evacuation, and that more extensiveuse of air evacuation be arranged in orderto reduce the number of patients carriedby water and thus enable higher standardsto be observed on ships.2

Events in 1944 justified the courseadopted by ASF headquarters. As a resultof co-operative efforts of the Army ServiceForces, the Army Air Forces, the War De-partment General Staff, and overseaswings of the Air Transport Command, airevacuation increased. In the spring of1944 the Air Forces estimated that 800 to1,910 patients from the European theaterand 300 to 1,350 from the Mediterraneancould be evacuated monthly in transportplanes without altering their accommoda-tions and without interfering with normalhigh priority traffic. The installation ofspecial equipment to support tiers of littersin aircraft cabins, it was anticipated,would raise these figures 50 percent. InMay 1944 the Air Forces made plans forplacing webbing-strap litter supports insixty-five of the C-54A planes already inuse and in all transport planes to be builtsubsequently, and the Air Transport Com-mand directed its overseas wings to pre-pare for the evacuation of the number ofpatients planned.3 In consequence, theproportion of the total monthly patientload evacuated by air increased from 11.8percent in April to a peak of 34.9 percentin July 1944, and of the total annual loadfrom 4.5 percent in 1943 to 18.2 percent in1944. (See Table 16.)

Additional hospital ships became avail-able during 1944—a cumulative total of 9by the end of June, 16 by the end of July,and 22 by the end of September.4 Thisnumber was insufficient to meet the de-mands of all theaters, because the shipshad to be deployed in terms of world-wideshipping needs rather than according tothe desires of theaters for accommodations

for patients. Some were required for in-tra-theater evacuation; others for thetransportation of patients to the UnitedStates.5 As troop shipping to the Mediter-ranean declined during 1944, space forpatients aboard transports returning tothe United States became insufficient forthe evacuee load and hospital ships had tobe used to a greater extent for that theaterthan for others. Consequently, betweenMarch and December 1944 more patientswere returned from the Mediterranean byhospital ship than by transport. The Euro-pean theater, generously supplied withtroop shipping because of its combat oper-ations, received fewer hospital ships pro-portionately than did the Mediterraneanand hence had enough for only a third ofthe patients evacuated by water from thattheater between April and December1944. Because of the need for hospitalships in the Atlantic and Mediterranean,only one of those built by the Army wassent to the Pacific before 1945, and notuntil the latter half of 1944 did the threeships built and operated by the Navy forthe Army—the Hope, Comfort, and Mercy—go into service there. Evacuation by hospi-tal ship from the Pacific during 1943 and

2 See last note above.3 (1) Memo, SG for CG ASF (Plans and Oprs), 27

Feb 44, sub: Potentialities of Air Evac of Pnts forOverseas to US. SG: 580. (2) Rpt of Conf on AirEvac, 13 Apr 44. SG: 337.1. (3) Memo, CG ASF forACofS OPD WDGS, 26 Apr 44, sub: Air Evac fromEur 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 PlanningDiv 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, 28Jan 44; ETO to AGWAR, 5 Feb 44; WD (init byMvmt 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: HospShips, with inds. SG: 560.2.


1944 was limited therefore to the return ofthree shiploads of patients—one by aNavy ship from the Central Pacific inNovember 1943, another by a Navy shipfrom the South Pacific in October 1944,and the third by the Comfort from theSouthwest Pacific in December 1944.Despite the lack of enough hospital shipsto meet the desires of all theaters, the pro-portion of patients evacuated from the-aters to the United States aboard hospitalships increased, as those authorized be-came available, from 2.7 percent of thetotal in 1943 to 20.4 percent in 1944.6 (SeeTable 16.)

Increased transportation of patients byairplane and hospital ship reduced the pro-portion of the total patient load evacuatedby transports from 92.8 percent in 1943to 61.4 percent in 1944. This reductionmight have been smaller if theaters hadevacuated as many patients by transportas zone of interior authorities consideredproper. Failure to do so resulted in partfrom the lower estimates of capacity thattheater officials used in figuring accommo-dations for patients aboard transports. Toraise these estimates the Chief of Trans-portation in January 1944 began a surveyof all transports to establish their officialcapacities under "adequate" standards.7

Even after these capacities were set not alltheaters used transports to the extent pre-scribed. Thus the European theater untilthe end of 1944 adhered rather closely tothe recommendation of its chief surgeon,Maj. Gen. Paul R. Hawley, that helplesspatients should be evacuated only by hos-pital ships, even though the War Depart-ment had stated early that year that help-less patients would have to be evacuatedby transports as well. Although forced bycircumstances—increases in the patientload resulting from the invasion of thecontinent, the need to vacate some of the

beds in hospitals in the theater, and thelack of sufficient numbers of hospitalships—to return some helpless patients tothe United States in transports during1944, the European theater steadfastly re-fused to make full use of officially an-nounced capacities.8 As a result, patientsaccumulated in its hospitals while beds ingeneral hospitals in the United States re-mained empty. Theaters in the Pacificcomplied more readily with War Depart-ment policy on the use of transports andtherefore did not develop similar backlogs,but in the fall of 1944 a problem devel-oped in the Southwest Pacific when thenumber of mental patients to be evacuatedexceeded the capacities of returning trans-ports for patients of that type. It was solvedby evacuating mental patients by air (apractice formerly considered undesirable)and by increasing and improving accom-modations aboard transports for mentalpatients.9

Toward the end of 1944 attention wasfocused upon estimates of the evacuationload for 1945 and upon an evaluation of

6 (1) Study of Pnt Evac. HD: 705 (Evac). Thisstudy consists of work sheets on which the ASFMedical Regulating Unit listed monthly, by theaterof operations, the transports and hospital ships evac-uating patients and the number of patients, by trans-portation classification, on each. (2) Roland W.Charles, Troopships of World War II (Washington,1947), pp. 327-51.

7 (1) TC Cir 80-12, 22 Jan 44 and Misc Ltr 28,14 Jul 44, sub: Capacity of Pers Trans. TC: 569.6.(2) Ltr, SG to South Pacific Base Comd attn ChiefSurg, 25 Sep 44, sub: Pers Capacity of Trans. SG:560. Similar letters were sent to the other theatercommands.

8 (1) Memo for Record, on draft Rad, WD to HqComZ ETO, 19 Sep 44. HD: 705 (MRO, FitzpatrickStayback, 1484). (2) Interv, MD Historian with GenHawley, 18 Apr 50. HD: 000.71.

9 (1) Memo for Record, on draft Rad, WD (pre-pared by Mvmt Div OCT) for CinC SWPA, 9 Oct44. 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 DisturbedMental Pnts from SWPA. HD: MOOD "Pacific."


the means available or required to handleit. There were several reasons for the in-quiry: first, the war was lasting longerthan had been anticipated; second, thepatient load in the European theater wasbecoming heavy because of a high inci-dence of trench foot, a larger number ofcasualties resulting from intensified com-bat activity, and failure to use fully theevacuation space available aboard trans-ports; and third, the possibility of victoryin Europe during 1945 made it necessaryto plan for evacuation in terms of theredeployment of ships to the Pacific.

In a study prepared by the ASF Medi-cal Regulating Unit, adopted by the JointLogistics and Joint Military Transporta-tion Committees, and submitted on 16December 1944 to the Joint Chiefs ofStaff, the number of patients who wouldneed evacuation was estimated by class,by month, and by theater, for the periodfrom December 1944 through December1945. From these estimates were sub-tracted the numbers of patients of allclasses who could be evacuated eachmonth, from each theater, by troop trans-ports and by airplanes. The remainderrepresented the number of patients whowould have to be evacuated by hospitalships. Conclusions drawn from these cal-culations were that a peak load of morethan 54,000 patients would require evac-uation in August 1945, that hospital shipsalready authorized would not be able totransport all who could not be accommo-dated in transports and airplanes, andthat an additional number of hospitalships ranging from two in January 1945 totwenty-eight in April would therefore beneeded.10

This study led the Joint Chiefs of Staffon 21 December 1944 to approve the con-version of troop transports to ambulance-type hospital ships in sufficient numbers

(later determined by the Joint MilitaryTransportation Committee to be six) toprovide additional carrying capacity for5,500 patients.11 While neither the JointCommittee nor the Joint Chiefs expectedthis action to eliminate entirely the short-age of space for evacuation, they antici-pated that it would reduce the shortage tomanageable proportions.

Steps taken to "manage" the shortageapplied primarily, though not altogether,to the European theater, which was ex-pected to have almost as many patients toevacuate early in 1945 as the Pacific andMediterranean theaters combined. It al-ready had a backlog of patients awaitingevacuation and therefore a shortage ofhospital beds. Furthermore, the patientswho had accumulated would need to beevacuated from Europe early in 1945 be-cause redeployment of transports fromEurope to the Pacific would reduce capac-ities for evacuation from the Europeantheater later in the year.12 Therefore, on3 December 1944 the Chief of Staff, on therecommendation of the Medical Regulat-ing Officer and the Office of the Chief ofTransportation, overruled General Haw-ley's objections and ordered the Europeantheater to exploit fully the normal patientcapacity of transports, even though it

10 (1) Memo, Joint Logistics Plans Cmtee for LtCol J[ohn] C. Fitzpatrick, 15 Nov 44, sub: Hosp ShipProgram. (2) Joint Logistics Cmtee (JLC 221/1), 7Dec 44, Hosp Ship Program. (3) JCS/1199, 16 Dec44, 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 Dec44, Hosp Ship Program. SG: 560.2 JMTC selectedthe Saturnia, Republic, President Tyler, Athos II,Columbie, and the USS Antaeus (ex St. John) for con-version. All but the last were to be converted,manned, and operated by the Army.

12 Following series of files (1945) deal with evacua-tion requirements, adequacy of hospitalization bothin theaters and zone of interior, and use of evacua-tion facilities: HRS: G-4 file, "Hosp, vol. II"; HRS:ASF Planning Div Program Br files, "Hosp andEvac"; and SG: 705.


might have to reduce its evacuation policyto 90 days to supply enough patients forthis purpose.13 Meanwhile, American andBritish officers, both in the zone of interiorand in the theater of operations, were dis-cussing more extensive use of some of thelarger and faster British vessels for evacu-ation. Subsequently they agreed to ar-rangements for enlarging the capacities ofthe Queen Mary and Queen Elizabeth forlitter and hospital ambulatory patients to2,000 and 2,500 respectively and for troopclass patients to 1,000 each. This agree-ment was approved by the CombinedMilitary Transportation Committee on16 January 1945.14 A third step was to in-crease the evacuation of patients by air, forit had fallen from a peak of 2,846 patientsreturned from Europe in July 1944 to 987in November. Again on the recommenda-tion of the ASF Medical Regulation Offi-cer, the Chief of Staff directed the Euro-pean theater on 25 December 1944 toarrange to use air evacuation to "the full-est practical extent". Soon afterward, thetheater Air Priorities Board agreed to allo-cate spaces on planes for the evacuation of3,000 patients per month.15 A fourth stepwas taken in March 1945 after a re-evalu-ation of the evacuation load indicatedthat estimates made in December for theSouthwest Pacific and European theaterswere perhaps too low. With the concur-rence of The Surgeon General, the Chiefof Transportation directed that restrictionsimposed by lifeboat standards upon pa-tient capacities should be waived, as theyhad been for the Queens, for seventeenArmy transports and three Navy trans-ports, and that those vessels should be pre-pared to carry "maximum" loads ofpatients.16

By these measures sufficient facilitieswere provided to meet evacuation require-ments during the first half of 1945 and to

carry a peak load of 57,030 patients inMay, just after V-E Day. During this pe-riod the major portion of patients camefrom the European theater, which wasmost affected by the measures adopted. Incompliance with the Chief of Staff's orderof 3 December 1944, it began to use spaceaboard transports more fully, sending tothe United States in transports duringthat month 15,682 patients as comparedwith 4,665 in November, and increasingthe number steadily during the early partof 1945. The number of patients evacu-ated by air from the European theateralso grew, rising from 987 in November1944 to more than 2,500 in February 1945.By March, arrangements for enlargingthe capacities of the Queens had been com-pleted and each of those vessels returnedas many as 2,000 to 3,000 patients pertrip. Gradually, also, greater numbers ofpatients were evacuated aboard transportsfor which maximum loading was author-

13 (1) Diary, ASF Planning Div, 2 Dec 44. HD: 705(MRO, Fitzpatrick Stayback, 1584). (2) Interv, MDHistorian 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-4file, "Hosp, vol. III."

14 (1) Tel Conv WD-TC-1367, Washington andLondon (OCT officials), 27 Nov 44. SG: 337. (2)Rad CM-OUT-76241 (12 Dec 44), WD (init byMvmt Div OCT) to ETO ComZ. SG: 560.2. (3) RadCM-IN-16292 (17 Dec 44), UK Base Sec to WD.SG: 705. (4) Memo CMT 67, 16 Jan 45, sub: Com-bined Mil Trans Cmtee, Return of Pnts and otherPers Westbound on the Queen Elizabeth and QueenMary. 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 Plansand Oprs, 6 Feb 45, sub: Air Evac to ZI. SG: 580.(4) Rad CM-OUT-82083 (25 Dec 44), WD to HqComZ 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 Feb45, sub: Pnt Capacity, Mount Vernon, Wakefield, andWest Point. TC: 569.5. (3) Rads, CofT to PEs andETO, 16 and 22 Mar 45. Same file.


ized, some carrying 2,000 or more patientsper trip in May. In addition, some of thehospital ships which had been used in theMediterranean were sent to the Europeantheater, as were the last two of the twenty-four authorized in July 1943 and the firstof 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 tofour trips each from Europe to the UnitedStates. The patient load from the Medi-terranean theater, which was considerablysmaller by the early part of 1945 than be-fore, was carried in the hospital ships stillassigned to that theater, and in transportsand airplanes.17 By April 1945, enoughevacuation facilities were available for theWar Department to decide, with the ap-proach of V-E Day, to speed the flow ofpatients from both the European andMediterranean theaters. Accordingly, inMay it placed these theaters on 60-dayevacuation policies.18

Evacuation from the Pacific continuedto be primarily by transport. Althoughplans were made as early as April 1945 totransfer hospital ships from the Atlantic tothe Pacific, only one Army hospital ship—sent to the Pacific in the latter half of1944—made a trip carrying patients fromthat area to the United States in the firsthalf of 1945. The number of patients evac-uated by air from the Pacific rose from2,763 in April 1945 to 4,665 the followingJune. From all theaters, 262,524 patientswere evacuated to the United States dur-ing the first half of 1945. Of these, 19 per-cent were returned by air, 14.5 percent byhospital ship, and 66.5 percent by trooptransport. (See Table 16.)

Evacuation requirements fell off duringthe last half of 1945 with the cessation ofhostilities. By September the patient loadof the European and Mediterranean the-

aters had been so reduced that it was pos-sible for them to return to a normal 120-day evacuation policy and to send patientsto the United States thereafter almostexclusively by either hospital ship or air-plane. Since the Pacific had no great back-log of patients, evacuation from that areain 1945 caused no problem. In the latterhalf of 1945, Navy hospital ships, Armyand Navy transports, airplanes, and thethree hospital ships operated by the Navyfor the Army evacuated large numbers ofpatients to the United States. To thesewere added ten Army hospital ships trans-ferred from the Atlantic. Just before V-JDay space for evacuation from the Pa-cific was so ample that the War Depart-ment ordered a reduction in its evacuationpolicy to 60 days to provide enough pa-tients to make full use of available trans-portation. After V-J Day the Pacific wasordered to return all of its patients asquickly as possible. The patient load wasin consequence reduced by October to apoint that it was possible for the theater tolower its ratio of beds to troop strengthand to return to a 120-day evacuationpolicy.19 (See Table 14.) During the latterhalf of 1945, of the 123,448 patients evac-uated from all theaters, 29.9 percent re-turned to the United States by air, 31.9percent by hospital ship, and 38.2 percentby transport. This represented a reversalof the situation during the first half of theyear, when approximately two thirds ofall patients were evacuated by transport.During the entire year, 385,792 patientswere evacuated from all theaters: 22.5percent by air, 20.1 percent by hospitalship, and 57.4 percent by transport. (SeeTable 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 Proceduresfor Evacuation from Theaters to

the Zone of Interior

Before the patient load (described inthe last chapter) could be transferred fromtheaters to general hospitals in the UnitedStates, policies and procedures to governthe entire operation had to be developed.Those established early in the war re-mained effective with minor modificationsto its end.

Procedures for Sea Evacuation

SOS directives charged ports of em-barkation, operating directly under theChief of Transportation, with responsibil-ity for the evacuation of patients fromoverseas areas to which they supplied warmateriel. A basic prerequisite to the dis-charge of this responsibility was informa-tion about the kind and number of pa-tients to be evacuated. Accordingly, inAugust 1942 SOS headquarters an-nounced that patients would be classifiedfor transportation purposes as mental,hospital, or troop class.1 The next monththese classes were increased to four bysplitting the hospital class in two: hospitallitter and hospital ambulant. Mental, orClass I, patients were those who requiredsecurity accommodations aboard ships or

trains to prevent them from injuring ordestroying themselves. Hospital litter, orClass II, patients were those whose phys-ical condition required them to remain inbed and be cared for entirely by others.Hospital ambulant, or Class III, patientswere those who required medical care andservice, even though they did not have toremain in bed at all times. Troop class,or Class IV, patients were those whoneeded little medical care en route andwere able to care for themselves even inemergencies.2

In 1944 subdivisions were establishedfor Class I, or mental patients. They wereactually of three groups: those who wereseriously disturbed and needed locked-ward accommodations in hospitals as wellas on ships; those who were borderlinecases and might or might not requirelocked-ward care on land but did requireit aboard ships; and those who were onlymildly disturbed and did not need to be

1 Memo, CG SOS (init by Lt Col J[ohn] C. Fitz-patrick) for SG, 21 Aug 42, sub: Est of Reqmt for SeaEvac. SG: 560.-2.

2 Ltr SPOPH 322.15, CG SOS to CGs and COs ofSvCs and PEs and to SG, 15 Sep 42, sub: Mil Hospand Evac Oprs. AG: 370.05.


placed under restraint in any event. Pa-tients of the last type suffered from beingquartered with the more serious mentalcases and, if placed in locked wards, tookup space needed for the latter. Yet, underexisting regulations and classifications,transport surgeons and medical officers incharge of patients on hospital ships oftentreated all mental patients alike, regard-less of the degree of their disability. Toremedy this situation the War Depart-ment in June 1944 broke the classificationfor mental patients (Class I) into threeparts—Class I A, Class I B, and Class IC—to conform with the three groupingsjust stated.3 The Chief of Transportationthen ordered hospital ship commandersand transport surgeons not to place ClassI C patients in restrictive quarters but toevacuate them instead in accommoda-tions used for troop class (Class IV)patients.4

To furnish ports in the United Stateswith information about the number of pa-tients of each type to be returned to thezone of interior, SOS headquarters inSeptember 1942 devised a system of re-ports of "essential information concerningevacuation of sick and wounded fromoverseas." Offices of both The SurgeonGeneral and the Chief of Transportationconcurred in its establishment. Each over-seas commander was required to reportmonthly to the port commander servinghis area the following information: (1) thetotal number of patients awaiting evacu-ation, (2) the number in each of the fourclasses listed above who were awaitingevacuation at each port within the thea-ter, and (3) the number in each class whowere expected to require evacuation atthe beginning of the following month.Upon embarkation of patients for theUnited States, each theater commander

was required to report by air mail to portcommanders in the United States thename of the ship upon which patients em-barked, the number of patients of eachclass aboard the ship, and the expecteddate and port of arrival in the UnitedStates. Receipt of such information wouldsupply a basis for the TransportationCorps to use in providing transportationand for the Medical Department to use inassuring the availability of sufficient num-bers of vacant beds for patients beingevacuated.5

Early in 1943 this system was slightlymodified. In some instances embarkationreports failed to reach ports in the UnitedStates before the arrival of ships carryingpatients. In others, theaters failed to sub-mit such reports. In still others, theysubmitted incorrect reports. For example,on 9 December 1942, 788 patients arrivedfrom the European theater at the port ofHalifax in Canada. Although the theaterhad reported them all as ambulatory, itwas discovered upon arrival that sevenwere litter and 104 mental patients whorequired attendants. Because of the erro-neous report, insufficient medical person-nel had been sent to Halifax to care forthe patients received and their debarka-

3 Ltr AG 704.11 (3 Jun 44) OB-S-E-SPMOT-M,TAG to CGs AAF, AGF, ASF, Base Comds, andTofOpns, 8 Jun 44, sub: Procedure for Evac of Pntsby 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, 28Jul 44. SG: 560.2. (3) Telg, CofT (Mvmt Div) to CGsPEs, 2 Sep 44. SG: 705. (4) Ltr, CofT (Mvmt Div) toPEs, 21 Sep 44, sub: Sea Evac of Mental Pnts. SG:560.2.

5 (1) Memo, CG SOS for ACofS OPD WDGS, 3Sep 42, sub: Essential Inf Conc Evac of Sick andWounded from Overseas. OPD: 370.05. (2) Ltr AG370.05 (9-15-42) MS-SPOPH-M, TAG to CGs DefComds, TofOpns, and Base Comds. 16 Sep 42, samesub. SG: 705.-1.

PROCEDURES FOR EVACUATION 333

tion was delayed.6 To prevent similar oc-currences, as well as the arrival of patientswithout prior arrangements for their re-ception, theaters were directed in January1943 to exercise more care in making re-ports of embarkation and to transmit themby radio rather than by air mail.7

Another modification in the reportingsystem occurred as a result of increasingparticipation during 1942 of agenciesother than the Army TransportationCorps in the evacuation of patients. Somewere returned on British ships; others, bythe Air Transport Command and the U. S.Navy. For example, by the end of 1942most patients evacuated from the SouthPacific area were returned by the Navy;and from Central Africa, by the AirTransport Command. Commanders ofthose areas considered it unnecessary tosubmit reports of patients awaiting evacu-ation, since they did not normally useArmy ships. While failure to receive suchreports did not interfere with the Chief ofTransportation's efforts to supply suffi-cient transport lift for patients awaitingevacuation by sea, it did hamper planningfor the reception of patients in the UnitedStates and for their further transporta-tion, usually by rail, to hospitals of defin-itive treatment. Therefore, on 13 January1943 the War Department directed thea-ter commanders to report monthly, in ad-dition to information already required,the number of patients awaiting evacu-ation by air, by Navy ships, and by anyother means, as well as the number ineach category who were expected to needevacuation at the end of the following 30days.8

Further changes were made later in thewar. Toward the end of 1944 the returnof able-bodied men and officers on "rota-tion" complicated the problem of evalu-

ating the adequacy of patient lift becausesuch persons sometimes took up space ontransports which the Medical RegulatingUnit had considered available for pa-tients. In August 1944, therefore, the WarDepartment directed theater command-ers to add to reports of patients all othermilitary personnel awaiting transporta-tion to the zone of interior.9 Early in 1945,as the patient load mounted toward itspeak, the Surgeon General's ResourcesAnalysis Division requested additional in-formation for planning purposes. As aresult, the War Department directed the-aters in March 1945 to report not only thepatients awaiting evacuation and thoseexpected to need evacuation at the end ofthe following month but also those thatwere expected to need evacuation at theend of the second and third months afterthe date of the report.10

To assure proper use of the informationsubmitted by theaters, the SOS Hospital-ization and Evacuation Branch prepareda directive in October 1942 for the Chief

6 (1) Memo, Lt Col J. C. Fitzpatrick for Chief Hospand Evac Br Plans Div Oprs SOS, 21 Dec 42, sub:Rpt on Temp Duty, Hq 2d SvC and Hq NYPE. HD:705 (MRO, Fitzpatrick Daybook, Aug 42-Jun 43).(2) Memo, CG SOS for CofT, 3 Jan 43, sub: Recep-tion of Pnts Evac by Sea from Overseas Comds. Samefile.

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 Jan43, HD: Wilson files. "Book III, 1 Jan 43-15 Mar43."

8 Ltr, TAG to CGs Def Comds, Depts, and BaseComds, 13 Jan 43, sub: Essential Info Conc Evac ofSick and Wounded from Overseas. AG: 370.05.

9 OCM form, with message prepared by OCT fordispatch to CGs Def Comds, TofOpns, and PEs, 30Aug 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 forOverseas Theaters. SG: 705. (2) Rad CM-OUT-55158, WD to all Overseas Comds, 17 Mar 45. TC:370.05 (Monthly Rpt of Reqmts).


of Transportation to issue to port com-manders.11 It required them to transmitinformation received from theaters to theOffice of the Chief of Transportation, toother interested port commanders, and tothe commanding generals of service com-mands in which ports were located. Also,port commanders were to compare thenumber and types of patients to be evac-uated during the following month withaccommodations aboard transports sched-uled to call at theater ports. If it appearedthat there would be insufficient "lift" —that is, too few ships returning from thea-ters or unsuitable accommodations onavailable ships for different classes of pa-tients—port commanders were to reportthis fact to the Chief of Transportation inorder that additional lift might be pro-vided. Finally, port commanders were touse information received in embarkationreports to plan transportation from portsin the United States to hospitals of defin-itive treatment.12

In the final months of 1942 transportsarriving at overseas ports sometimes foundmore patients ready for evacuation thantheaters had reported and hence had in-sufficient accommodations for all of them.This situation resulted from the tempo-rary and sudden accumulation of patients,particularly of Class I (mental), after re-ports had been sent in, and from the pre-emption of all space on a transport by itsfirst port of call to the detriment of portsof later call. Measures were taken to avoidsuch occurrences. Port commanders wererequired to submit their comparisons ofevacuation requirements with scheduledsailings of transports to the Office of theChief of Transportation for review. Whenthat Office found that accommodationson transports scheduled for return tripsfrom theaters were insufficient for patients

needing to be evacuated, it directed portcommanders to determine through directcommunication with theater commanderswhat additional evacuation space wasreally necessary. The Chief of Transporta-tion was then responsible for complyinginsofar as possible with desires of the the-ater commander. In addition, when trans-ports sailed for a theater with several portsof call, port commanders in the UnitedStates were required to inform theatercommanders of their capacities and thea-ter commanders in turn were required tosuballocate reported space among theseveral ports under their jurisdiction.13

Later in the war, the Medical Regulat-ing Unit used information submitted inreports of patients being embarked andawaiting evacuation to plan the most ef-fective use of all available evacuationfacilities. Its Water Evacuation Sectionmaintained at all times current records ofpatients needing transportation from dif-ferent ports in the several theaters. Com-parisons of such records with space forpatients aboard scheduled transports re-vealed whether or not anticipated lift fora particular port or theater would be ade-quate. If not, the Medical RegulatingOfficer recommended steps to supply therequired lift such as changes in the sched-ules of transports, increases in the number

11 Memo. CG SOS (Hosp and Evac Br) for CofT,10 Oct 42, sub: Sea and Port Evac Oprs. SG: 705.-1.

12 Ltr SPTSM 370.05, CofT (Mvt Div) to CGs PEs,23 Oct 42, sub: Sea and Port Evac Oprs, with incl.SG: 704.-1.

13 (1) Ltr. Surg NOPE to CG SOS (Plans Div), 10Feb 43, sub: Overseas Evac Plan Ships' Hosp SpaceAlmt, with 5 inds. HD: 705 (MRO, Fitzpatrick Day-book, Aug 42-Jun 43). (2) Memo, Chief Hosp andEvac Sec Plans Div ASF for Col [Frank A.] Heile-man, 22 Apr 43, sub: Sea Evac Oprs. HD: Wilsonfiles, "Day File." (3) Memos, ACofS for Oprs ASF forSG and CofT, 9 May 43, sub: Hosp and Evac Oprs.Same file.


of patients to be evacuated by air, or theredeployment of hospital ships.14

While directives issued during 1942charged the Chief of Transportation andport commanders under his control withevacuation from theaters of operations,they contained no demarcation of areasof responsibility of overseas commandersand the Chief of Transportation for trans-fer of patients from control of the formerto the latter. To insure co-ordination be-tween a theater and the zone of interior,such demarcation was necessary. Hence,early in 1943 the SOS Hospitalizationand Evacuation Branch prepared a direc-tive on "sea evacuation operations" whichthe War Department issued on 25 Jan-uary 1943.15 This directive detailed spe-cifically for the first time the respectiveresponsibilities of the Chief of Transporta-tion, port commanders, and theater com-manders.

The Chief of Transportation wascharged with the care, treatment, andsafety of patients after their ships had leftoverseas ports. Up to that point theatercommanders were responsible. These com-manders were charged with selecting pa-tients to be evacuated, with concentratingthem at or near ports of embarkation,and, in co-ordination with overseas portofficials, with placing them on ships boundfor the United States. They were responsi-ble for insuring that patients were notplaced on ships lacking suitable accom-modations. For example, a theater com-mander was not to permit mental (ClassI) patients to be embarked in excess of aship's capacity for patients of that type.Furthermore, he was to prevent the load-ing of ships with more patients than couldbe "reasonably expected to be evacuatedto lifeboats should it become necessary toabandon ship." This left the decision as to

suitability of accommodations up to the-aters. Eventually, though, they wereforced to substitute the War Department'sopinion of suitable accommodations fortheir own. As transportation and medicalofficials of ports in the zone of interiorcompleted surveys of transports during1944, theaters were expected to use offi-cially announced capacities for patientsof all classes.16

Theater commanders were also re-sponsible for providing adequate medicalpersonnel for patients embarked and forfurnishing any additional medical sup-plies requested by transport surgeons.Personnel whom they placed on ships nor-mally belonged to the Chief of Trans-portation and were supplied to theaterson an "attached" basis. Medical hospitalship platoons of various sizes were at-tached to United States ports by the Chiefof Transportation. Port commanders thenordered them to temporary duty in the-aters of operations. Only when such pla-toons were not available were theatercommanders required to supply medicaltroops of their own. As with personnel,theater commanders were expected tofurnish additional medical supplies totransports only in unusual or emergencycircumstances. Normally port command-ers in the United States placed aboardeach transport enough medical supplies tocare for all troops on its outbound voyageand 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—MonthlyRpt," Books 1 and 2, Nov 43-May 46. SG: 705. Alsosee 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 TaskForces, and COs Base Comds and Task Forces, 25Jan 43, sub: Sea Evac Oprs. AG: 704 (1-19-43).

16 See above, p. 327.


equal in number to one fourth of thetransport's troop capacity.

Theater commanders were given addi-tional responsibilities in connection withsea evacuation operations in the latterpart of the war. To reduce the medicalpersonnel who would be needed for as-signment to regularly organized medicalhospital ship platoons, they were requiredafter 8 June 1944 to form Medical Depart-ment officers, nurses, and enlisted menbeing returned to the United States on"rotation," into provisional medical hos-pital ship platoons. Regularly organizedplatoons were saved for use only whenprovisional platoons could not be formed.In the same month, theater commanderswere directed to furnish transport sur-geons and hospital ship commanders notonly with evacuation orders but also withlists of patients showing diagnosis, trans-portation classification, and type of ac-commodation needed for each. Similarlists had formerly been prepared by trans-port surgeons and hospital ship command-ers for submission to zone of interior portofficials for use in debarkation activities.Now, their preparation by theaters savedtime for medical officers aboard ships andassisted them in placing patients in suit-able accommodations. Theater officialswere expected, in addition, to assemblecomplete sets of records for each patientand to deliver them, along with patients'baggage and valuables, to ships uponwhich patients were embarked. Whenrecords were missing, theater commanderseither had new ones prepared or sub-mitted to ships' officers certified state-ments of those missing and of the reasonsfor their absence.17 Near the end of thewar an additional duty was placed ontheater personnel. Up to that time debar-kation tags containing information similarto that found on embarkation lists were

prepared and attached to patients aboardship.18 In July 1945 a War Departmentcircular required theater hospitals to pre-pare and attach identification tags to eachpatient before his embarkation. Thesetags were made of four perforated sections.The first three could be detached to servetheater ports, ships, and United Statesports as records of patients handled. Thelast section, containing information abouta patient's diagnosis, could be used bydebarkation hospitals in assigning patientstowards.19

The directives just discussed served as abasis for co-ordination of activities of the-aters and the zone of interior in the evacu-ation of patients by sea. A further step—the co-ordination of activities of transportsurgeons with those of the ports of debar-kation in the United States—was taken in1943. In the spring the New York Portissued instructions for transport surgeons.In addition to describing the manifoldduties and responsibilities of transportsurgeons for sanitation aboard transports,for the care of outbound troops, and forthe care and treatment of inbound pa-tients, these instructions covered theduties of transport surgeons in the trans-fer of patients from ships to ports. Uponarrival at a zone of interior port, eachtransport surgeon was required to submitto a port surgeon's representative a list ofall Army patients, showing for each a

17 (1) Ltr AG 704.11 (3 Jun 44) OB-S-E-SPMOT-M, TAG to CGs AAF, AGF, ASF, Base Comds, andTofOpns, 8 Jun 44, sub: Procedure for Evac of Pntsby 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, FitzpatrickStayback, 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 Debarka-tion Tag (Manual for Trans Surg); (Revised 17 Jul44). TC: 710.

19 WD Cir 218, 20 Jul 45.


brief diagnosis, a classification (neuro-psychiatric, medical, or surgical), andwhether litter or ambulatory, along withrecords accompanying each patient. Eachtransport surgeon was required to submita list of the baggage of patients and a listof patients' money and valuables in thesurgeon's possession. Finally, he was tocomplete all entries on a debarkation tagfor each patient and was to insure the at-tachment of such tags to the clothing of allexcept those who were neuropsychiatric.Tags for the latter were to be delivered todebarkation officers. These actions weredesigned to assist ports in planning thetransfer of patients to general hospitalsand to assist these hospitals in assigningthem to proper wards.20

As experience accumulated and theevacuation load grew heavier, the Trans-portation Corps, assisted by the MedicalRegulating Officer, supplied transportsurgeons and hospital ship commanderswith more specific instructions than for-merly. Toward the end of 1943 the guidefor transport surgeons which the New YorkPort had issued earlier was sent to otherports for transmission to the surgeons oftransports which called at them.21 Aboutthe same time, general regulations cover-ing the sailing of hospital ships were pub-lished. Later, as the number of hospitalships in service increased, the CharlestonPort, which had been designated as thehome port for Army hospital ships servingthe European and Mediterranean the-aters, issued a sixty-one page manual ofinstructions for their commanders. Itcovered such subjects as reports andrecords, procedures in case of death, reg-ulations for sanitation and hygiene, quar-antine procedures, suggestions for the careof patients at sea, supplies and equipment,and the like.22 Instructions issued to trans-port surgeons and hospital ship com-

manders also included procedures to befollowed in preparing for debarkations atports in the United States, but graduallymany of their duties in this connectionwere transferred, as already described, totheater officials. As that happened medi-cal officers on ships became responsible forchecking for accuracy and completenessthe embarkation lists and identificationtags prepared in theaters.

Procedures for Air Evacuation

Though few patients were transportedby air from theaters to the United Statesin the first year and a half of the war, suchdemands for air evacuation as were maderesulted in the establishment during 1942of a basic system of air evacuation.

Earliest requests for the evacuation ofpatients by air from outlying areas cameparticularly from the Alaska DefenseCommand. Before the war that Com-mand had asked for airplane-ambulanceservice to the United States; in the firsthalf of 1942 it renewed its requests, point-ing out then and later that evacuation bysea was uncertain, delaying the move-ment of patients in some cases from two tofour weeks and subject at all times tointerruption by enemy activities.23 To thedemands of Alaska were added in July

20 (1) Instructions for Transport Surgeons, Off PortSurg, NYPE, 26 May 43. HD: 560 (NYPE), (2) ARs55-350, 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, Fitz-patrick 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 ShipGuide. HD: 560.

23 (1) Gordon H. McNeil, History of the MedicalDepartment in Alaska in World War II (1946), pp.167-192. HD. (2) Ltrs, CG Alaska Def Comd to CGWestern Def Comd and Fourth Army, 14 Jul and 6Oct 42, sub: Aircraft Amb for Alaska. AG: 452. The14 July 1942 letter cites earlier letters on the samesubject dated 10 November 1941 and 6 April 1942.


1942 a request of the Newfoundland BaseCommand for air evacuation to New York.The Surgeon General's Office and SOSheadquarters approved this request andpassed it on to the Army Air Forces, whichin June had been charged with responsi-bility for the development and operationof air evacuation.24

The Air Surgeon saw in these demandsan opportunity to develop an air evacua-tion system,25 but basic decisions had to bemade first as to (1) who within the ArmyAir Forces would be responsible for plan-ning and operating this system, (2)whether or not special airplane ambu-lances would be provided, and (3) the ex-tent to which air evacuation would be en-couraged or permitted. On 25 August1942 the Air Surgeon foreshadowed theanswer to the second question when hestated that "airplanes have not been pro-duced in sufficient quantity to allot planessolely for ambulance use. . . ,"26 On thesame day he recommended that the AirTransport Command be charged withplanning, developing, and operating asystem of air evacuation from outlyingbases to the United States.27

Three days later the Air Staff an-nounced its decisions. Special planeswould not be provided for the evacuationof patients from overseas bases and the-aters; but air evacuation would be carriedout in connection with the routine opera-tion of air transports. Since the Air Trans-port Command operated such transports,it would operate the air evacuation sys-tem. The Air Surgeon—not the Air Trans-port Command—would be responsible forplanning and establishing policies for thissystem.28 To discharge this responsibility,the Air Surgeon expanded his Office, as-signing to it in September and Octobertwo officers—Maj. (later Col.) Richard L.Meiling and Col. Wood S. Woolford—

who had already demonstrated an interestin air evacuation.29

Meanwhile the Air Surgeon had drafteda policy governing the extent of air evacu-ation. After approval by the Air and Gen-eral Staffs it was announced to theaters bythe Chief of Staff of the Army on 25 Sep-tember 1942. Air evacuation would be ac-complished "upon call" on the Air Trans-port Command, but such calls would bekept "to [a] minimum." Theater com-manders would classify patients for airevacuation according to the followingorder of precedence: first, emergency casesfor whom essential medical treatment wasnot available locally; second, cases forwhom air evacuation was a "militarynecessity"; and third, cases—except psy-chotics—who required prolonged hospi-talization and rehabilitation.30

24 (1) Ltr, CG Eastern Def Comd and First Army toCG AAF, 31 Jul 42. sub: Air Amb Evac of Pnts fromNewfoundland Base Comd, with 3 inds. SG: 705.-1(Newfoundland)F.

25 The chief of the SOS Hospitalization and Evac-uation Branch gained this impression after confer-ring with representatives of the Air Surgeon. Diary,Hosp and Evac Br SOS, 12 Nov 42. HD: Wilson files,"Diary."

26 4th ind, CG AAF (Air Surg) to SG, 25 Aug 42,on Ltr, CG Eastern Def Comd and First Armyto CG AAF, 31 Jul 42, sub: Air Amb Evac of Pntsfrom Newfoundland Base Comd. SG: 705.-1 (New-foundland)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) forCG ATC, 28 Aug 42, sub: Evac of Casualties by Air.(2) 1st ind, Same to Air Surg, 28 Aug 42, on Ltr AirSurg to ACofAir Staff A-4. 25 Aug 42, same sub. Bothin AAF: 370.05.

29 (1) An Rpt, FY 1943, Oprs Div ASO. USAF:SGO Hist Br. (2) Medical History, I Troop CarrierCommand From 30 April 1942 to 31 December 1944,pp. 49-50. Same file. (3) Ltr, Dr. Richard L. Meilingto Col Calvin H. Goddard, 30 Jun 52. HD: 314 (Cor-respondence on MS) XI.

30 (1) Rad CM-OUT-8628 thru 8637, Marshall toCGs 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.


After basic decisions were made aboutair evacuation from theaters, representa-tives of the Air Surgeon's Office, the SOSHospitalization and Evacuation Branch,and the Air Transport Command collabo-rated in establishing operational proce-dures and delineating responsibilities ofvarious participating commands. Where-as the Air Transport Command was re-sponsible for equipment attached toplanes, such as litter brackets, the Medi-cal Department was to furnish all medicalsupplies and equipment used in the careof patients en route. Supplies such aslitters and blankets were to be furnishedby theaters, but were to be returned bythe Services of Supply after patients ar-rived in the United States. Medical airevacuation transport squadrons, consistingof nurses and enlisted technicians, were tobe assigned to the Air Transport Com-mand to furnish attendants for patientsaboard transport planes. Theater com-manders were to transfer patients to pointsalong regular ATC routes. They were alsoto co-ordinate plans for air evacuation tothe United States with the commanders ofATC wings serving their respective areas,reporting to the latter daily the locationand number of litter, hospital ambulant,and troop class patients who should bepicked up. Flight surgeons alone woulddetermine the suitability for flight of pa-tients selected by theater commanders.Finally, the Air Transport Commandwould be responsible for the care andtreatment of patients from the time it ac-cepted them in theaters until it deliveredthem to SOS or AAF control in the UnitedStates.31

Although ATC medical officers alonecould determine the final suitability of pa-tients for flight, after the first half of 1944theater medical authorities were responsi-ble for establishing the general groups of

patients to be transported by air. Theyagreed that litter patients should takeprecedence over the less serious cases. Thechief surgeons of both the European andMediterranean theaters considered pa-tients requiring neurosurgery, maxillo-facial surgery, and plastic surgery, as wellas those who were blind, to be amongthose who should have priorities in airevacuation. Both believed that seriousmental disturbances were a contraindica-tion to transportation by air.32 On theother hand, in the fall of 1944 the South-west Pacific theater included mental pa-tients among the groups to be evacuatedby air as a regular procedure. Success inthis practice resulted in the preparation inAugust 1945 of a standing operating pro-cedure for the air evacuation of psychiatricpatients.33

Early in 1943 the Air Priorities Divisionof the Air Transport Command deter-mined the priority of patients designatedfor air transportation as against prioritiesalready established for passengers and

31 (1) Rpt, Mins of Mtg, ATC, 13 Oct 43, Air Evacof Wounded. AAF: 370.05. (2) Memo, CG SOS forCG AAF, 9 Nov 42, sub: Evac Oprs. AG: 704 (17Jun 42)(1). (3) Memo, CG SOS for CG AAF, 12 Nov42, sub: Status of Hosp Cons and Evac Fac for AlaskaSta. AG: 632. (4) 2d ind, CofSA to CG Alaska DefComd, 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: Wil-son files, "Diary."

32 (1) Logistical History of NATOUSA-MTOUSA, 30November 1945 (Naples. Italy, 1945), pp. 328-29, HD:MTO, 314. (2) Off Chief Surg Hq ETO, AdminMemo 147, 2 Nov 44; Admin Memo 16, 23 Mar 45,and other correspondence dealing with selection ofpatients for air evacuation. HD: ETO, 370.05 (EvacBr Corresp 1944-45).

33 History of the Medical Department. Air Trans-port Command, 1 January 1945-31 March 1946. HD:TAS. For a discussion of medical considerations in-volved in air evacuation, see Sidney Leibowitz, "AirEvacuation of Sick and Wounded," The Military Sur-geon, vol. 99, No. 1 (July 1946), pp. 7-10.


cargo in general. Three degrees of preced-ence for the latter two were announced inJanuary. Persons whose movement wasrequired by an emergency so acute thatany delay would seriously and directlyimpair the war effort were given a Class 1priority. Passengers and cargo whosetransportation by air was absolutely nec-essary for the accomplishment of a missionessential to the prosecution of the warwere given a Class 2 priority. Class 3priorities were given to passengers andcargo whose transportation by air wasvital to the war effort but not of an ex-tremely urgent nature.34 In February 1943ATC headquarters announced that pa-tients would normally have Class 3 priori-ties but could not be displaced, or"bounced," once they were en route, ex-cept at the discretion of ATC flight sur-geons at stopover points. In effect, thisgave patients a Class 3 priority for loadingbut a Class 1 priority for the duration offlight. In emergencies, ATC announced,patients might be given initially thehighest priority at a theater commander'sdisposal. Medical attendants were totravel under the same priorities as patientsduring flights to the United States; to in-sure their prompt return to theaters whichsupplied them, they were then to be givena Class 2 priority.35

An important change in the system ofdetermining priorities was made in 1944.Beginning in April the Air TransportCommand allocated transport space on atonnage basis to each theater commander,and theater priorities boards then deter-mined the amount of space that would beset aside for patients, for other personnel,and for cargo.36 Among the obvious ad-vantages of this system was the increasedcertainty with which both theater sur-geons and Medical Regulating Officers in

the United States could plan air evacua-tion.

The use of air evacuation necessitated asystem by which airports in the UnitedStates and air bases along Air TransportCommand routes could be informed of thearrival of patients by plane. In October1943 the Air Transport Command issueda regulation making ATC officers respon-sible for the necessary reports. It requireda base embarking patients for another toinform it by the fastest means of com-munication available. It also required thepilot of a plane carrying patients to reporthis cargo to the operations officer of thenext stopping point thirty minutes beforearrival. After planes landed in the UnitedStates, ports of aerial debarkation—usinga code devised by the ASF Medical Regu-lating Unit—reported patients received tothe Air Forces Regulating Officer.37

Procedures for Debarkation

Patients transported from theaters tothe zone of interior by the TransportationCorps and the Air Transport Commandhad to be transferred soon after arrival toservice commands for definitive treatment.It was necessary, therefore, to determinethe point where responsibility for theirtransportation and care devolved uponservice commands, and to establish pro-cedures for their debarkation, their move-ment from ships and planes to near-by

34 Air Priorities Div, ATC, Directive No 5, Prior-ities for Air Trans, 9 Jan 43. AAF: 580 "Air Trans."

35 (1) Ltr AFATC 580.1, CG ATC to CGs OverseasComds, Wing Comdrs, 26 Feb 43, sub: Air PrioritiesInstruction 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, 4Oct 44, sub: Rpt of Pnts for Trf. (3) Comments byBrig Gen Richard L. Meiling USAF, 30 Jun 52. HD:314 (Correspondence on MS) XI.


hospitals, and their reception and prep-aration for further transportation to hos-pitals of definitive treatment. Problems inthis connection were not as great for airbases as for port commands because pa-tients arrived by plane in smaller groupsand fewer numbers than by ship.

In the early period of the war ports ofembarkation were responsible for sendingpatients who arrived from theaters to gen-eral hospitals for further treatment.38 Thisresponsibility conflicted with a basic prin-ciple of Army evacuation, namely, thatsupport was always from rear to front.According to it, responsibilities of ports forthe movement of patients should haveended at their normal rear boundaries.Failure to observe this principle is perhapsaccounted for by the lingering influence ofpeacetime practices. In peacetime themost common movement of patients in theUnited States was from station to generalhospitals and in such instances stationcommanders were responsible for issuingorders and arranging transportation. Solong as the number of evacuees arriving atports was small, it was perhaps logicalthat port commanders should perform thisservice for them as well as for patientsfrom port complements.

The practice of considering command-ers of ports of embarkation responsible fortransferring evacuees to general hospitalshad to be partially modified after patientsbegan to return to the United States byair. Under current regulations theatercommanders issued orders directing themto report to commanders of seaports re-sponsible for the supply and evacuation ofrespective theaters. As a result patientswho traveled by air from the Caribbean,for example, landed in Florida with ordersto report to the commander of the NewOrleans Port of Embarkation. In such in-

stances they had to be sent by rail fromMiami to New Orleans for subsequenttransfer to a general hospital, rather thandirectly to the general hospital which wasnearest Miami (Lawson General Hospital,Atlanta, Ga.). This not only caused incon-venience to patients and delayed theirtreatment, but also added unnecessaryburdens to transportation facilities thatwere already overtaxed. In February 1943SOS Headquarters referred this problemto the Air Surgeon's Office. On the recom-mendation of the latter the War Depart-ment in May directed overseas command-ers not to designate, in orders transferringpatients to the United States, specificcommanders to whom they were to report.At the same time air bases in the UnitedStates were granted authority to issueorders transferring patients to generalhospitals for definitive treatment.39

Unlike port commanders, commandersof air bases serving as debarkation pointsoperated debarkation hospitals or at leastused station hospitals located on suchbases for debarkation processing of pa-tients. They were responsible for remov-ing patients from airplanes and transport-ing them and their baggage to such hos-pitals. To discharge this responsibility theywere required by ATC regulations to sup-ply a team of at least one medical officerand four enlisted men to meet each planebringing in patients. They did not assumethe additional responsibility and authorityof arranging for the transportation of pa-tients from air debarkation hospitals to

38 (1) AR 40-1025, 12 Oct 40; C 1, 21 Aug 42; C4, 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 toCG NOPE, 27 Jan 43, sub. Designation of SpecificHosp in Evac Orders with 5 inds. AAF: 370.05(Evac). (2) WD Cirs 119, 11 May 43, and 137, 16Jun 43.


general hospitals. Instead they normallycalled upon service commands to performthis function, but in extreme emergenciesmight arrange locally, or apply to the AirSurgeon, for air transport.40

Early in the war commanders of portsof embarkation were responsible for re-moving patients from ships and also fortransporting them to debarkation hospitalsoperated by service commands. By themiddle of 1943 several developed "SOP"(Standing Operating Procedures) for thisoperation. The SOP for the New YorkPort, for example, explained proceduresfor the transfer of patients from transportsto near-by hospitals. Upon arrival of aship, a party from the port went aboard toverify the reported number and classifica-tion of patients and to receive from thetransport surgeon his list of patients classi-fied according to diagnosis (medical, sur-gical, or neuropsychiatric). This list wassent immediately to Halloran GeneralHospital, so that room in appropriatewards could be prepared. Ambulatorypatients, the first to be debarked, weredispatched to Halloran in commercialbuses in groups of ten, with two enlistedmen as medical attendants for each group.Litter patients were placed in ambulances,each carrying four patients and one at-tendant. Finally, mental patients wereconsigned to ambulances, with necessaryattendants. After patients were removedfrom a ship, their valuables were turnedover to the boarding officer for transmis-sion to the receiving hospital. Baggage ofsmall groups was sent by the port direct tothe hospital, while that of large groups washandled by the baggagemaster's section ofthe Army Transport Service or, later, theport's water division. Patients' recordswere put in proper order and transmittedto Halloran General Hospital. The port

surgeon's office then sent reports of de-barkation to the Chief of Transportation,The Surgeon General, the commander ofthe New York Port of Embarkation, andthe surgeon of the Second Service Com-mand.41

For debarking patients from ships andtransporting them to general hospitalsport commanders normally used person-nel and vehicles belonging to installationsunder their control. For example, theCharleston Port trained as litter bearersenlisted men belonging to its own medicaldetachment and to port and service bat-talions in training or on duty in the area.It also used its own ambulances, trucks,and passenger cars to carry patients toStark General Hospital, which was locatednear by.42 This procedure sufficed whenthe number of patients received was small.When large-scale operations were ex-pected, other arrangements had to bemade. In the fall of 1942, for instance, toassist in the reception of casualties fromthe North African invasion the New YorkPort called upon the Second Service Com-mand for both personnel and vehicles andused, in addition, an ambulance section ofa Ground Forces medical regiment.43 In

40 (1) Memo, Air Surg for ACofAir Staff A-4, 24Feb 43, sub: Air Evac Casualties, with draft of direc-tive to all air commands in the United States. AAF:370.05. (2) ATC Reg 25-6, 15 Oct 43 and 29 Apr 44;AAF Reg 25-17, 6 June 44; AAF Ltr 25-10, 11 Jul 44and 9 Dec 44.

41 Ltr, Surgs Br NYPE to Port Surg NYPE, 12 Jul43, 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, onunknown basic Ltr. HD: 705 (MRO, Fitzpatrick Day-book, Aug 42-Jun 43).


such instances ports actually controlledthe movement to hospitals of only smallnumbers of patients, while they continuedto be responsible for the larger groupsmoved in service command vehicles byservice command personnel.

Early in 1944 this procedure waschanged. To provide a clear-cut line ofdemarcation between responsibilities ofports and service commands and to sim-plify operations by having only oneagency furnish vehicles and personnel fortransportation from ports to hospitals, theSecond Service Command proposed, andthe commanding general of the ServiceForces approved, a change in the transferpoint.44 After 11 April 1944 it was nor-mally at shipside rather than in trains orhospitals.45 In the case of New York thisproved advantageous. The Second ServiceCommand controlled a number of near-by medical installations upon which itcould call for ambulances and personnelto move large shipments of patients toHalloran and Mason General Hospitals.In other instances this change introducedthe very situation it was designed to cor-rect. The Ninth Service Command, forexample, had to call upon the San Fran-cisco Port for twenty buses each capable ofcarrying thirty-seven ambulatory patientsto assist in transporting patients fromdocks to the Letterman General Hospital.In any event the removal of patients fromships to debarkation hospitals requiredclose co-operation between port and serv-ice command officials.46

For the transportation of patients fromdocks to hospitals, service commands usedambulances, buses, and trains, dependingupon the physical condition of patientsand the distances to be traveled. The Sec-ond Service Command, for example,transferred patients from piers located in

Brooklyn, Staten Island, New Jersey, andthe North River to service command de-barkation hospitals by ambulance, gov-ernment bus, commercial bus, and hospitaltrain. During 1944 this Command calledupon as many as twenty of its installationsto supply vehicles and personnel for suchmovements. In a single day, it reported,more than 200 ambulances and 55 buseswere used to move 3,000 patients receivedin one convoy. The First Service Com-mand normally used trains to move pa-tients from ships in the Boston harbor toCamp Edwards and Camp Myles Stand-ish hospitals. The Fourth Service Com-mand used motor vehicles almost exclu-sively to transport patients from theCharleston port to Stark General Hospital.In the Ninth Service Command patientswere transported from the San Franciscoport to Letterman General Hospital inbuses and ambulances, but they weremoved from the Seattle port to MadiganGeneral Hospital in small groups by am-bulance and in large groups by rail.47

Ports continued to be responsible fordebarking patients from ships. Normallythey used their own men, including spe-cially trained port and sanitary companies,as litter bearers, but in some instances they

44 (1) Rpt, Conf CGs of SvCs, Dallas, Tex, 17-19Feb 44. HD: 337. (2) Memo, CG ASF (Control Div)for CofSA thru SG and CofT, 26 Feb 44, sub: Controlof Med Serv at PE, with 3 inds. SG: 705. (3) Rpt,Conf to Discuss Proposed Changes in AR 170-10 andCir 316, 6 Mar 44. SG: 337.-1. (4) Memo, Opns DivASF for Planning Div ASF, 10 Mar 44, sub: Evac ofReturning Casualties from Ports. TC: 370.05 (Evacof 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 (Hal-

loran, Hammond, LaGarde, Letterman, Lovell,Madigan, McGuire, Stark) and Sta Hosps (Cp Ed-wards, Cp Myles Standish) for 1944 and 1945 ex-plain debarkation procedures and reception ofpatients by hospitals. HD.


still borrowed enlisted men from servicecommand hospitals. To save personnel andspeed operations the Boston Port usedwheeled litters to move patients on itspiers. Ports differed in the order in whichthey unloaded patients. Some unloadedmental patients first, and then ambulatorypatients. Others reversed this order. Usu-ally litter patients were debarked last be-cause such preparations as transferringthem to litters could be made while otherpatients were being debarked. As portsgained experience in operations and im-proved procedures, the time required tounload ships decreased. For example, theCharleston Port cut the time from fivehours at the beginning of 1944 to twohours by the end of 1944 and then to onehour for a 600-patient hospital ship dur-ing 1945. The Boston Port reported thaton one occasion in 1945 as many as 1,958patients, among them 287 litter cases,were moved from a transport to near-bytrains in two hours and twenty minutes.48

The manner in which general hospitalsreceived evacuees differed from one toanother. In May 1943 The Surgeon Gen-eral directed hospitals receiving largenumbers of patients from either ships ortrains to admit them directly to wards,without "processing" them through hospi-tal receiving offices. The reason was toavoid delays in giving patients neededfood, rest, and treatment. Halloran Gen-eral Hospital had developed a differentsystem, and on request of the hospital andthe Second Service Command, The Sur-geon General approved its continued use.There, a receiving ward had been estab-lished to care for a large number of pa-tients. It contained a mess hall for theprompt feeding of patients, space for themedical inspection of patients and for thecare of those needing immediate medical

treatment, bathing facilities, and a cloth-ing room in which patients received freshhospital clothes and stored their ownclothing. There was also space for a bat-tery of typists brought in to complete all ofthe paper work required for the admis-sion of patients. The average length oftime patients stayed in this building, be-fore being admitted to wards, was reportedto be 61 minutes.49

With the growth of the evacuee load in1944 and 1945 debarkation hospitals hadto transfer evacuees to other hospitals asrapidly as possible—normally within sev-enty-two hours—so as to keep enoughbeds vacant for large groups of new pa-tients arriving in quick succession. Withsuch a short period of time the medicaland surgical care afforded evacuees had tobe limited. They were given necessarymedications and their dressings werechanged, while a brief examination servedto check the accuracy of the diagnosis car-ried in medical records and to determinetheir ability to undertake further travel.Primary emphasis was upon administra-tive matters. Records required for use indebarkation hospitals had to be prepared;reports of patients received had to bemade to Washington; orders for theirtransfer to other hospitals had to be issued;patients had to be outfitted with complete

48 (1) Files SG: 705 (ports or debarkation hospitals)contain correspondence dealing with debarkation dif-ficulties and operational procedures; for example,Memo, CG 4th SvC for CG ASF, 13 Jun 44, sub:Evac of Overseas Casualties at Stark Gen Hosp. SG:705 (Stark GH). (2) History of Stark General Hospi-tal, Charleston, S.C., 1941-45. HD. (3) An Rpts,Boston, Charleston, Hampton Roads, New Orleans,New York, San Francisco, and Seattle PEs, 1944,1945. HD.

49 Ltr, Halloran Gen Hosp to SG, 19 May 43, sub:Admission of Pnts when Arriving in Convoy. SG:705.1 (Halloran GH). (2) An Rpt, Halloran GenHosp, 1943. HD.


uniforms and given partial payments;5 0

and arrangements had to be made fortheir transportation. The paper work thusrequired was voluminous. Beginning inthe latter part of 1944 attempts were madeto simplify it. Concurrently, it will be re-called, the Surgeon General's Office wasengaged in a more general project tostandardize and simplify administrativeprocedures in all hospitals. Changes thatwere made in debarkation procedureswere of two types. In June 1944 the Con-trol Divisions of Stark General Hospitaland the Fourth Service Command pro-posed the elimination of records requiredfor patients admitted to hospitals for defin-itive treatment but not needed for those intransit and the simplification of entries inother records. As a result, evacuees werenot admitted to the registers of debarka-tion hospitals and their names were notentered on admission and dispositionsheets. In addition, standard rubber stampentries were authorized for use in patients'service and field medical records.51 Dur-ing the winter of 1944-45 another meas-ure toward simplifying the work of debar-kation hospitals was adopted: the installa-tion of addressograph equipment. Withthis equipment hospitals prepared plates

for use in making rosters and in issuingorders and thus eliminated the necessity oftyping each separately.52 Though seem-ingly small when considered individually,the significance of such measures can bejudged more accurately if the total evacu-ation load of different hospitals is takeninto account. Stark General Hospital, forexample, admitted 44,003 patients in thenine-month period from 1 January 1945to 30 September 1945, while Halloran ad-mitted about 69,500 and Letterman about73,000 during the entire year.53

50 That is, partial payments of the pay and allow-ances due service men, made by the Army pendingfull 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 (ControlDiv), 13 Jun 44, sub: Evac of Overseas Casualties atStark Gen Hosp, with inds. SG: 705 (Stark GH).

52 (1) Memo, SG (Control Div) for QMG, 30 Aug44, sub: Use of Addressograph and Embossing Equipin Debarkation Hosps. SG: 413.51. (2) Ltr, SG to CG2d SvC, 20 Dec 44, sub: Admitting Off Procedure forPnts 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, 14May 45, sub: Procedure of Pnts Recd from Overseasthru Stark Gen Hosp. SG: 705 (Stark GH).

53 An Rpts, Stark, Halloran, and Letterman GenHosps, 1945. HD.

CHAPTER XXI

Movement of Patientsin the United States

The movement of patients in the UnitedStates, although fairly simple early in thewar when it involved only the transfer ofindividuals or small groups from station togeneral hospitals, began to assume differ-ent characteristics about the middle of1943. A steady increase in the number ofevacuees received from theaters—fromabout 3,000 per month early in 1943 to apeak of more than 57,000 in May 1945—focused attention on the transportation ofpatients from debarkation to general hos-pitals. Meanwhile declining troop strengthin the United States, along with establish-ment of regional hospitals to serve in lieuof general hospitals for patients fromcamps in surrounding areas, reduced to atrickle the transfer of zone of interior pa-tients to general hospitals. Growth of theArmy's fleet of hospital cars from 24 earlyin 1943 to 380 by the end of the war, alongwith a shortage of commercial sleepers anddiners, meant that emphasis shifted fromthe transportation of patients on regularpassenger trains to their movement onArmy hospital trains. A change in AirForce policy in the spring of 1944, permit-ting certain planes to be assigned pri-marily to evacuation operations in theUnited States, resulted in a transition fromsporadic to regular movement of patients

by air. Finally, compliance with the policyestablished early in 1943 of transferringpatients from debarkation hospitals tohospitals designated as specialized centersand located as near as possible to patients'homes complicated the problem of plan-ning their transportation.

Regulating the Flow of Patients

Although The Surgeon General wasdesignated by Army directives as the chiefmedical "regulator," in the early part ofthe war he exercised only a general influ-ence over the distribution of patientsamong Army hospitals. His office grantedports unlimited bed credits in general hos-pitals located nearest them. Port com-manders then transferred patients to suchhospitals, reporting later to the SurgeonGeneral's Office the number received fromtheaters, the date of their arrival, and thename of the hospital to which they hadbeen transferred.1 Station hospitals trans-ferred patients to general hospitals inwhich they held bed credits. General hos-

1 (1) WD Cir 120, 21 Jun 41. (2) An Rpt, 1943,NYPE. HD. (3) Ltr, SG to CG HRPE, 14 Aug 42,sub: Rpt of Pnts Arriving from Overseas. SG: 705.-1(HRPE).

MOVEMENT OF PATIENTS IN THE UNITED STATES 347

pitals normally did not hold bed credits inother general hospitals and hence had torequest the Surgeon General's Office toauthorize transfers and to designate re-ceiving hospitals. In order to know whichhad vacant beds, The Surgeon Generalbegan in April 1943 to require all generalhospitals to submit daily bed status reportsto his Office.2 When general hospitals re-quested the transfer of patients to othersuch hospitals in order to free beds forsubsequent arrivals from near-by ports, hisOffice authorized the transfer of groups,sometimes as large as 250. Decisions as toparticular patients to be transferred wereleft to hospital commanders. Normally,then, in the first part of the war the Sur-geon General's Office authorized thetransfer of patients in bulk and dependedupon local commanders to request indi-vidual transfers to comply with the policyof hospitalizing patients near their homesand in specialized centers.3

Later in the war, as the movement ofpatients in the United States increasedand grew more complex, a new procedurewas developed to give the Surgeon Gen-eral's Office greater control over the trans-fer of individual patients. It involved re-ports to the Medical Regulating Unit ofpatients received at debarkation hospitalsand of vacant beds in general and con-valescent hospitals. In May 1944 theMedical Regulating Officer established asystem for debarkation hospitals to use inrequesting the transfer of patients to otherhospitals. Instead of asking for authorityto transfer a certain number of patientswithout regard to disabilities or home lo-cations, debarkation hospitals reported incoded teletype messages the geographicaldestination (home), diagnosis or specialdisability, sex and military status, andgeneral physical condition (litter or am-

bulatory) of each patient received. For ex-ample, one male enlisted neurosurgicalpatient whose home was in Florida wasreported as "6NCY"; ten such patients,as "6NCY10." In August 1944 this systemwas revised, and additional medical clas-sifications or diagnoses were listed, alongwith more exact definitions of each. Aboutthe same time, the system of daily bedstatus reports was changed. In the fall of1943 a code had been established for hos-pitals to use in reporting vacant beds. InAugust 1944 this code was modified sothat hospitals reported vacant beds not insuch general categories as medicine, sur-gery, and neuropsychiatry but in terms ofthe particular diseases or injuries forwhich they had been designated as spe-cialized centers. For example, hospitalswith vacant beds for male neurosurgicalpatients reported them under code"12TVKN." Early in 1945 both debarka-tion and bed status reports were furtherrevised to reflect changes in specialtydesignations of hospitals and thereby topermit a greater degree of accuracy insending patients to proper hospitals. Usingboth reports together, the Medical Regu-lating Unit was able to direct debarkationhospitals to transfer patients, in smallgroups or as individuals if necessary, togeneral hospitals that specialized in thediseases or injuries with which they suf-

2 (1) AR 40-600, 6 Oct 42. (2) Ltr, SG to COBillings Gen Hosp, 26 Apr 43, sub: Daily Bed Rpt.SG: 632.2 (Billings GH). By July 1943 the Hospitali-zation and Evacuation Division, SGO, was receivingdaily reports from 28 hospitals, giving number ofpatients, number of medical, surgical, and neuro-psychiatric beds, and number of patients transferredto and received from other general hospitals.

3 Telegrams in which the Surgeon General's Officeauthorized the transfer of patients are filed in SG:704.-1 and 705.-1. See also weekly diaries of the Hos-pital Administration Division. HD.


fered and that were located as near aspractical to their home addresses.4

At first this system applied only to pa-tients being transferred from debarkationhospitals to general hospitals of definitivetreatment, but gradually it was extendedto cover even the transfer of patients fromstation and regional hospitals to generalhospitals. Because of crowded conditionsof general hospitals in the populous north-eastern part of the United States, in July1944 The Surgeon General directed thatno patients should be transferred to cer-tain hospitals in that area without priorapproval of the ASF Medical RegulatingOfficer. In effect, this directive canceledall bed credits which station or regionalhospitals held in the hospitals listed.About two months later additional hospi-tals were placed in this category, raisingthe number thus restricted from thirteento thirty-one. Ultimately, early in 1945the system that originated as a means ofauthorizing the transfer of evacuees fromdebarkation to general and convalescenthospitals was formally extended to includeall transfers to such hospitals.5 The degreeof control which the Medical RegulatingOfficer thus achieved over the use of bedsin general and convalescent hospitals en-abled him to authorize transfers of pa-tients promptly and to use beds effectivelywhen they were at a premium in the firsthalf of 1945.

Centralized control over the transfer ofpatients to general and convalescent hos-pitals did not assure that policies on thehospitalization of patients near theirhomes and in specialized centers would bewholly complied with. Hospital beds inthe United States were not distributed inproportion to density of population.Hence, early in 1945 when the patientload became great enough to fill general

and convalescent hospitals, it was impos-sible for the Medical Regulating Officerto send all patients to hospitals locatednear their homes. Furthermore, the neces-sity of sending patients to specialized cen-ters sometimes conflicted with and out-weighed the desirability of sending themto hospitals near their homes. Finally, de-barkation hospitals had time for littlemore than superficial examinations of pa-tients before requesting their transfer toother hospitals. As a result, the medicalclassifications reported by debarkationhospitals were sometimes incorrect andpatients were sent to general hospitalswhen they should have been sent to con-valescent hospitals.6

Some idea of the complexity of theprocess of authorizing patient-transfersmay be gained from the work load of theASF Medical Regulating Unit. In theearly part of 1945 it received bed statusreports from 64 general, 12 convalescent,and 7 temporary debarkation hospitals.Information from these reports was posteddaily to show at all times the ability ofhospitals to accept patients. Each day theUnit received approximately 100 tele-grams, 10 letters, and 25 telephone callsrequesting the transfer of patients in smallgroups or as individuals. Every month itreceived 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 BedRpt. SG: 632.-2 (Billings GH)K. Identical letterswere sent to other general hospitals. Telegrams andcorrespondence on bed capacities and patient trans-fers are filed in HD: 705 (MRO Staybacks), 705(MRO Chart on Pnt Capacities in Hosps), and 705(MRO Daily Diaries, Daily Bed Status).

5 Telg SPMDD-DR, SG (MRO) to all SvCs, 3 Jul44, 17 Sep 44, 21 May 45, 6 Sep 45. HD: 705 (MedReg Unit book).

6 See above, pp. 211-12, 240-41.


telegrams from debarkation hospitals re-questing the transfer of patients to generalhospitals; the typical request covered 500patients who had to be transferred be-cause of their diagnoses, home addresses,sex, and military status to an average offorty-five different hospitals.7

Procedures for Rail Evacuation

The principal method of moving pa-tients in the United States—other than byambulance—was by train—either regularpassenger trains or hospital trains madeup of Army hospital cars supplementedby commercial equipment. During mostof 1942 patients were moved almost ex-clusively in Pullman cars of passengertrains, because the necessity of transport-ing large groups was practically nonex-istent and the Army had only six hospitalcars. For groups of patients and attendantsnumbering fewer than fifty, local trans-portation officers arranged with railroadsfor cars and routings. For larger groups,the Office of the Chief of Transportationmade necessary arrangements, upon re-quest of local transportation officers.8

Toward the end of the summer of 1942,SOS headquarters, the Chief of Trans-portation, and The Surgeon General be-gan to plan for the operation of hospitaltrains. By that time the delivery of addi-tional hospital cars—enough to serve asthe nuclei of eight hospital trains—wasexpected, and an increase in the numberof evacuees was impending. Since severalagencies were involved, delineation oftheir responsibilities for the control andoperation of hospital cars was compli-cated. Although hospital cars were pro-cured by the Transportation Corps andused by the Medical Department, SOS

headquarters decided with the approvalof both The Surgeon General and theChief of Transportation that they shouldbe "attached" to (i.e., placed under thejurisdiction of) service commands. A serv-ice command hospital was being con-structed near each port which lacked one,and it was anticipated that patients de-barked at ports would be transported bymotor vehicles to such hospitals and thereturned over to service command control.Hence, ports would have no need for hos-pital cars. In addition, it was thought thatservice commands could furnish personneland medical supplies for hospital trainsmore easily than could ports. Experiencehad already shown that service commandswhere ports were located would need hos-pital cars most, because general hospitalsin such commands would receive largenumbers of patients for transfer to hospi-tals further inland. Plans were thereforemade to attach six hospital cars each tothe Second, Fourth, and Ninth ServiceCommands, four to the Eighth, and twoto the Sixth (for use in evacuating patientsfrom areas in Canada), and service com-mands were directed to furnish suppliesand medical attendants for hospital trains.Any of the hospital cars could be attachedto or detached from service commands bythe Chief of Transportation. Either oneunit car and two ward cars, or one warddressing car and two ward cars, were toform the nucleus of a hospital train. Sup-plemental Pullmans, diners, and other

7 Memo, Dirs Hosp and Resources Anal Divs SGOfor Dir HD SGO, 18 Jun 45, sub: Add Mat for AnRpt for FY 1945. HD: 319.1 -2.

8 (1) Memo, CofT for SG, 28 Mar 42, sub: BasicPlan for Evac of Sick and Wounded. HD: 705. (2) AR30-925, C 2, 22 Aug 42. (3) WD Cir 192, 16 Jun 42.(4) Ltr SPOPH 322.15, CG SOS to CGs and COs ofSvCs and PEs, and to SG, 15 Sep 42, sub: Mil Hospand Evac Oprs, with incl. HD: 705.


rail equipment were to be used to com-plete it.9

After the decision to attach hospitalcars to service commands was made, SOSheadquarters issued directives establish-ing procedures for their use. The directivesconflicted with one another and withArmy regulations governing the trans-portation of personnel in general. As al-ready noted, War Department regulationspermitted local transportation officers toarrange with railroads for the transporta-tion of groups of persons numbering lessthan fifty (after June 1943 less than forty),but provided that the Chief of Transporta-tion would arrange for the transportationof all larger groups. This meant arrangingwith railroads for carrier-owned equip-ment and for routes and schedules.10 Onthe other hand, SOS directives providedthat local transportation officers could ar-range for all routings of hospital cars with-in the boundaries of service commands towhich they were attached. Another statedin contradiction that except in emergen-cies service commands would ask theChief of Transportation for routing in-structions to cover the movement of eachhospital car. Two SOS directives statedthat service command transportation of-ficers would arrange with railroads for allsupplemental rail equipment, while an-other limited them to arrangements forsupplemental equipment needed whenhospital cars were moved within servicecommand boundaries. None of the SOSdirectives took account of Army regula-tions requiring the Chief of Transporta-tion to arrange for equipment and rout-ings for the movement of large groups.11

Such conflicting instructions caused con-fusion about which both the Office of theChief of Transportation and service com-mands complained.12

The feasibility of attaching cars to serv-ice commands and then attempting todivide authority for controlling their usewas questioned in the winter of 1942 andagain in the spring of 1943. The com-manding general of the Eighth ServiceCommand believed that hospital carswould be used most in the transportationof patients arriving from theaters of oper-ations and proposed, therefore, that theyshould be controlled exclusively by theTransportation Corps and operated byports.13 The Chief of Transportation con-sidered this possibility, but agreed withthe SOS Hospitalization and EvacuationBranch to follow plans already made.Nevertheless, in preparation for the recep-tion of casualties from the North Africaninvasion, all hospital cars were temporar-ily transferred to the New York andHampton Roads Ports and placed undertheir jurisdiction.14 In December 1942both the Chief of Transportation and theHospitalization and Evacuation Branchagreed that they should be returned to

9 (1) Memos, CG SOS for CGs 2d, 4th, 6th, 8th,and 9th SvCs. CofT, and SG, 18 and 26 Aug 42, sub:Location and Control of Hosp Tns. AG: 531.4. (2)Ltr, CofT to CGs PEs and SvCs, 9 Sep 42, sub: Con-trol of Hosp Tns. TC: 531.4. For a discussion of dif-ferent types of Army-owned hospital cars, see below,pp. 372-75, 381-83.

10 (1) WD Cir 192, 16 Jun 42. (2) AR 55-130, 28Dec 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 SFPEthru CG 9th SvC, 3 Nov 42, on telg (n d) from CG 9thSvC. AG: 322.38. (3) Memo, Tank Car Br OCT forCol 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., 17Dec 42. HD: 337.

14 (1) Ltr, CG SOS to TAG, 31 Oct 42, sub: Hospand Evac for Special Opr. TC: 531.4. (2) Memo, CGSOS for SG and CofT, 1 Nov 42, same sub. HRS:ASF Planning Div file, "Hosp and Evac No 15."


service commands.15 In the spring of 1943,when plans were being made to receiveninety-six hospital cars ordered earlier, arepresentative of The Surgeon Generalsuggested that it would be advantageouseventually, when large numbers of pa-tients began to arrive from theaters of op-erations, to have service commands sup-ply personnel for hospital trains but toplace all hospital cars in pools under theexclusive control of the Chief of Transpor-tation. Presumably such an arrangementwould have promoted the more efficientuse of cars, but the Transportation Corpspreferred to continue the system of attach-ing cars to service commands in whichports were located, and The Surgeon Gen-eral's representative concurred in plansfor the allocations of 45 cars to the Second,24 to the Third, and 27 to the Ninth Serv-ice Commands.16

Later in the war, when a shortage ofcarrier-owned equipment combined witha steadily increasing evacuation load torequire the greatest possible use of Armyhospital cars, centralized control wasadopted, along with other measures, toachieve that goal. By the winter of 1943-44 it was widely recognized that maxi-mum use was not being made of hospitalcars. In many instances they returnedempty to home stations after deliveringpatients to general hospitals. In others,service commands permitted hospital carsto stand idle while they arranged for car-rier-owned equipment to transport pa-tients. In February 1944 the SurgeonGeneral's Office pointed to this situationand suggested again that better use couldbe achieved by centralizing control of hos-pital cars in the Office of the Chief ofTransportation.17

Before this step was finally taken, amovement already begun to achieve closer

co-operation between the TransportationCorps and the Medical Department hadto be completed. Late in 1943 the Evac-uation Branch of the Surgeon General'sOffice had agreed to supply the Office ofthe Chief of Transportation with copies ofall messages authorizing general and de-barkation hospitals to transfer patients toother hospitals, enabling the latter to an-ticipate requests from service commandsfor rail equipment. A short time later theChief of Transportation established anevacuation unit in his Traffic ControlDivision. It collaborated with the SurgeonGeneral's Office and service commands inplanning rail movements, and for this pur-pose kept a current record of the locationand use of each hospital car. In May 1944the transfer (already mentioned) of theSurgeon General's Evacuation Branch tothe Medical Regulating Unit, which wasphysically located in the Office of theChief of Transportation, enabled medicalofficers who authorized the transfer of pa-tients from debarkation to other hospitalsto consult at all times with transportationofficers as to the availability of Army hos-pital cars and carrier-owned equipment.Conversely, transportation officers hadreadily available information as to the lo-

15 (1) Ltr, CofT to CGs NYPE and HRPE, 10 Dec42, sub: Hosp Cars. TC: 531.4. (2) Diary, Hosp andEvac 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, 22Apr and 18 May 43. SG: 453.-1. (2) Ltr, CG ASF toCGs 2d, 3d, and 9th SvCs, 22 May 43, sub: Locationof Add Hosp Cars. TC: 531.4. (3) Memo, Mvmt DivOCT for ACofT, 2 Jul 43, sub: Mtg of SvC Comdrs.Same file.

17 (1) Memo for Record, on 3d ind, CG ASF toCofT, 10 Sep 43, on unknown basic ltr. HD: Wilsonfiles, "Day File." (2) Ltr, Dir Hosp Admin Div SGOto Surg 9th SvC, 4 Dec 43. SG: 705.-1 (9th SvC)AA.(3) Hosp and Evac: Re-estimate of Pnt Load andFacs, pp. 25-26. HD: 705.-1. (4) Rpt, Conf CGs ofSvCs, Dallas, Tex, 17-19 Feb 44. HD: 337.


cation, destination, number, and types ofpatients to be moved by rail.18

As the offices of The Surgeon Generaland the Chief of Transportation developedcloser co-operation in planning the move-ment of patients by rail, measures wereadopted to centralize the control of hospi-tal cars. At the end of 1943, SOS direc-tives that had caused confusion byattempting to divide responsibility fortheir use between service commands andthe Office of the Chief of Transportationwere superseded by a War Departmentcircular which agreed in its provisionswith general transportation regulations.The routing, including scheduling fortrain connections, of all hospital cars—whether empty or loaded and whethermoving within or beyond service com-mand boundaries—was centralized in theOffice of the Chief of Transportation.Moreover, local transportation officerswere specifically limited in the arrange-ments which they could make for supple-mental rail equipment to instances whenfewer than forty persons were to be car-ried on hospital trains. When largergroups were moved the Office of the Chiefof Transportation alone could make all ar-rangements. For several months this Of-fice was indulgent, accepting generallythe recommendations of service com-mands as to dates of hospital train move-ments and the make-up (that is, the com-bination of Army-owned with carrier-owned cars) of hospital trains. Later, inthe spring of 1944, it began to exercise itsauthority to arrange without consultationwith service commands for the rail trans-portation of groups of patients numberingforty or more. Informed by the MedicalRegulating Unit of the patients to bemoved and of their destinations, the Traf-fic Control Division determined the make-

up of hospital trains and set the dates oftheir departure. Upon the recommenda-tion of the Medical Regulating Officer itdiverted hospital cars to places where theywere needed, informing service commandsto which they were attached only if thisaction delayed their return to home sta-tions for more than ten (later five) days.This meant, for example, that a car at-tached to the Second Service Command,carrying patients to a hospital in the FifthService Command, might be loaded withother patients at the latter place anddiverted to a destination in the FourthService Command before being returnedto its home station.19

Further centralization in rail evac-uation operations and more extensive useof hospital cars was achieved during 1945when the size of groups for which servicecommands might independently arrangecommercial transportation was reducedfrom a maximum of thirty-nine to four-teen. As long as service commands couldarrange for the movement of groups of pa-tients that were large enough to warrantthe addition of a special tourist or sleep-ing car to a regularly scheduled train(that is, any group of fifteen or more per-sons), it was possible for such a car to beprocured to move patients along a route

18 (1) Memo, CofT for SG, 23 Oct 43, sub: Opr ofHosp Tn Cars. SG: 453.-1. (2) Memo, Maj SamuelN. Farley, TC, for Lt Col I. Sewell Morris, TC, 27Oct 43, sub: Conf in SGO re Better Util of Govt-Owned Hosp Cars. Off file, Hosp Evac Unit, OCT.(3) Memo, Same for Same, 17 Jan 44, sub: Functionsof 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, FitzpatrickStayback, 1334). (5) Memo, SG for Fiscal Dir ASF, 26Jul 44. SG: 322 (Hosp Tns). (6) ASF Cir 328, 30 Sep44. (7) Transcript of Proceedings, Hosp Tn Conf,15-16 Feb 45. HD: 531.4.


over which an Army hospital car—underorders of the Office of the Chief of Trans-portation—was traveling empty at ap-proximately the same time. The Chief ofTransportation therefore recommended inMay 1945 that arrangements for themovement of all groups of patients andattendants numbering fifteen or more per-sons should be centralized in his Office.This recommendation was approved andin June 1945 local transportation officerswere limited to making arrangements forthe movement of individuals and ofgroups of patients and attendants num-bering fourteen or less. Knowing the lo-cations and routes of all Army hospitalcars, the Chief of Transportation couldthen arrange to use them in moving someof the groups which service commandshad formerly dispatched in extra sleepingand tourist cars of regularly scheduledpassenger trains.20

Despite the fact that centralized controlof hospital cars and hospital train move-ments was not wholly approved by servicecommands, the Surgeon General's Officeconsidered such control essential. Oneservice command surgeon felt that his lackof control over the personnel on hospitalcars from other commands jeopardizedthe loading and care en route of patientswhom he was transferring. A local trans-portation officer in another service com-mand believed that he could expedite themovement of patients from the debarka-tion hospital which he served if he werepermitted to arrange rail movements in-dependently. Still another service com-mand complained of the use elsewhere ofpersonnel which it supplied to care for pa-tients being transported from its own de-barkation hospital. Other objections arosefrom the difficulty service commands en-countered in property and mess manage-

ment on hospital cars attached to thembut diverted elsewhere for use. In reply tosuch complaints, The Surgeon General re-peatedly explained that centralized con-trol of the movement of hospital cars andhospital trains was necessary to insure themaximum use of all available rail equip-ment, both Army- and carrier-owned, inthe orderly transportation of large num-bers of patients.21

Measures other than centralization ofcontrol were adopted to achieve better useof hospital cars, conserve medical person-nel, and relieve railroads of furnishingmore sleeping cars. In June 1944 theTransportation Corps requested carriersto return hospital cars in passenger ratherthan in freight service. In this way hospi-tal cars that had to be moved without pa-tients spent less time idle than they mighthave otherwise.22 By the early part of 1945the Transportation Corps itself began toarrange hospital-car routes and schedules,without reference to railroad representa-tives. Though this procedure was a de-parture from the Army's agreement withthe railroads, the latter apparently inter-

20 (1) Memo, CofT for ACofS G-4 WDGS, 16 May45, sub: Routing Control and Carriers' Equip forMvmt of Pnts and/or Med Attendants in Groups of15 or More. . . . TC: 511 (AR 55-130). (2) WD Cir177, 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 LtCol 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, 21Nov 44. SG: 705.1 (Letterman GH). (6) Ltr, DepChief for Hosp and Domestic Oprs, Oprs Serv SGOto Surg 2d SvC, ca. 28 Dec 44. SG: 531.2 (2dSvC)AA. (7) Memo, Maj Frederick H. Gibbs, MAC,for Surg 4th SvC, 29 Jan 45, sub: Hosp Tn Serv, StarkGen 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 Jun44. TC: 531.4.


posed no objection. Its chief advantagewas that hospital cars could be sent alongunauthorized routes (those not normallyused by railroad companies) to reducemileage and to deliver groups of patientsat different hospitals. The higher costwhich railroads charged for such move-ments was considered by the SurgeonGeneral's Office to be fully justified by theends achieved.23

In addition to the larger problem ofusing hospital cars to the best advantage,others were encountered in the operationof hospital trains. One of them, feedingpatients on hospital trains, was partiallysolved by the procurement of Army hos-pital kitchen cars and the installation ofbuffet-kitchens in other hospital cars.24 Togovern the procurement of food for thesecars, along with the bookkeeping proce-dures involved, the ASF Control Division,the Surgeon General's Office, and the Of-fice of The Quartermaster General col-laborated in the preparation of a standardsubsistence procedure for hospital trainsin the last part of 1944.25 Other problemsarose in accounting for hospital cars andtheir equipment, and in their mainte-nance. In September 1944 a circular gov-erning accounting procedures was pub-lished by ASF headquarters, while somemonths earlier the Transportation Corpsprepared technical bulletins on the main-tenance of hospital cars.26 Another prob-lem involved the position of hospital carsin trains. In the winter of 1943-44 theTransportation Corps requested carriersto place hospital cars on regular passengertrains in such a position that the publicwould not have to use them as passage-ways. Carriers agreed to place them eitherdirectly ahead of or directly behind otherpassenger cars in the same train. Further-more the carriers agreed, upon the request

of the Chief of Transportation and the rec-ommendation of The Surgeon General, toplace "buffer" cars (cars in which no pa-tients were carried) between hospital carsand locomotives when special hospitaltrains were made up.27 The carriers alsoco-operated in observing a request of TheSurgeon General that patients be trans-ported only in air-conditioned cars. ByArmy regulations and an agreement withrailroads, patients were authorized "sleep-ing car accommodations in tourist sleep-ing cars if available, otherwise standardsleeping cars." Of the entire fleet of Pull-man tourist cars, only four hundred wereair-conditioned, and it was therefore im-possible for carriers always to supply air-conditioned tourist cars when they wererequested. For a time during 1944 theysupplied higher-priced air-conditionedstandard sleeping cars without any in-crease in cost, but in December of thatyear 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 MilCmtee, 9 Mar 45. TC: 531.4. After the war ended, inNovember and December 1945, the Army and Navyagreed upon a procedure for the joint use of Armyhospital cars in the United States. This agreementcontributed to the conservation of carrier-ownedequipment and still greater use of Army-owned hos-pital cars. ASF Cir 441, 11 Dec 45.

24 See below, pp, 381-86.25 WD Cir 480, 22 Dec 44. Also see WD Cir 184,

21 Jun 45.26 (1) ASF Cirs 286, 1 Sep 44; 401, 9 Dec 44. (2) TB

55-285-1, 24 Jul 44; TB 55-285-2, 24 Aug 44, onEchelon Maintenance for Hosp and Kitchen Cars. Acomplete manual for operation of the new unit cars(TM 55-1254, 15 Dec 45, Car, Railway, HospitalUnit) was issued after the end of the war.

27 (1) Ltr, Hosp Tn Comdr to CG 2d SvC, 21 Oct43, sub: Trans Rpt of Hosp Tn Mvmt HT-69, Main57616. 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, SGto SvCs, 2 Dec 44, sub: Use of Buffer Cars in Connec-tion with Mvmt of Pnts by Rail. SG: 453 (SvCs).


with the Army to provide special rates forstandard sleeping car equipment.28

The problems just reviewed are repre-sentative only, in no way intended to bean exhaustive listing, of those encounteredby authorities on a higher level than hos-pital train commanders. These command-ers were faced with other problems whichwere perhaps even more varied and com-plex. Solutions for most of them had to befound locally, for there was no War De-partment manual on hospital train oper-ations. During 1945 a series of conferencesof hospital train commanders, attendedby representatives of The Surgeon Gen-eral and the Chief of Transportation, wereheld to discuss such common questions aslinen exchange procedures, feeding diffi-culties, the handling of baggage, entrain-ing and detraining plans, personnel andequipment requirements, means of pro-viding recreation aboard trains, and prob-lems of hospital car maintenance and op-eration.29

Some idea of the scope of hospital trainoperations may be gained from the follow-ing figures. During 1944, 172 hospitaltrains carrying 37,371 patients were dis-patched from the Second Service Com-mand to general and convalescent hospi-tals scattered throughout the UnitedStates. During the period from 26 June1944 to 15 October 1945, 205 hospitaltrains evacuated 35,697 ambulatory pa-tients and 17,320 litter patients from StarkGeneral Hospital. From January to Au-gust 1945, inclusive, the hospital train de-tachment of the First Service Commandmade 232 trips to 1,334 destinations, cov-ering 48,888 miles and moving 67,608 pa-tients. Between July 1944 and December1945, the Ninth Service Command moved56,061 patients in hospital cars and 29,439in Pullmans.30

Despite the widespread use of centrallycontrolled hospital trains, service com-mands retained throughout the war theauthority to arrange with common car-riers for the movement of patients as in-dividuals or in small groups. The maindifficulty they encountered was in secur-ing accommodations for them in sleepingor parlor cars occupied also by civilians.In November 1943 the ASF Control Divi-sion investigated complaints of hospitalsabout delays in getting reservations for pa-tients and found that they were justified.The average period that elapsed betweenthe time transportation was requested andwas made available for 27,265 patientswas 3.8 days. In some instances it rangedas high as 15.3 days. Continuation of thissituation would mean not only that thetreatment of patients would be delayedbut also that some hospitals in time wouldbecome hopelessly overcrowded. In Feb-ruary 1944, therefore, ASF headquartersdirected The Surgeon General, with theassistance of the Chief of Transportationand service commands, to arrange withrailroads for securing promptly rail ac-commodations for Army patients.31

28 (1) AR 55-125, 9 Jan 43; C 1, 4 Jun 43; C 2, 4Aug 43. (2) Memo, CofT for SG, 22 Aug 44, sub: Ac-commodations 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, MillerFld, NY; Hosp Tn Unit Comdrs Conf, 10-13 Jul 45,Presidio of San Francisco. HD: 531.4 (Conf). (2) AnRpts, 1st, 2d, 4th, and 9th SvCs, 1944 and 45. HD.(3) Ltr, 9956 TSU Letterman Gen Hosp to SG, 22Mar 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) His-tory of Control Division, ASF, 1942-45, App, Project95-2. HD.


In conferences held in Chicago andWashington during April and May 1944,representatives of The Surgeon General,the Chief of Transportation, and the Rail-road Interterritorial Military Committeeagreed upon procedures for obtainingreservations for individuals and for groupsof fewer than fifteen persons. For this pur-pose, patients were divided into fiveclasses. Class I patients were those whowere acutely sick or injured and whoseimmediate movement to hospitals staffedand equipped to care for them was "amatter of extreme urgency." Class II pa-tients were similar cases whose movementmight be delayed safely for forty-eighthours. Class III patients were those whoneeded to be moved for medical reasonsbut whose transfer could be delayed ap-proximately seventy-two hours; this groupincluded patients received from theatersof operations at debarkation hospitals.Class IV patients were those being moved,not for medical reasons, but for their ownconvenience; their transfer might be de-layed for approximately six days. Class Vpatients were those being discharged fromthe service, being returned to duty, orbeing sent on sick leave; their movementcould be delayed about ninety-six hours.The carriers agreed to appoint specialrepresentatives for each individual rail-road to assist hospital commanders in ob-taining accommodations for patients of allclasses within the time limits establishedfor each. Hospital commanders were en-joined to co-operate with such representa-tives and, when requesting transportationfor patients in either of the first two classes,were required to submit certificates attest-ing that transportation for Class I patientswas necessary immediately and for ClassII patients within forty-eight hours.32

The question of priorities for patients

over civilians came up when this agree-ment was reached. Army authoritiesagreed with railroad representatives thatestablishment of such priorities wouldcarry the unintentional implication thatrailroads were not "doing the job." There-fore they decided against it. In the follow-ing June, representatives of The SurgeonGeneral, the Chief of Transportation, andrailroad companies maintained a likeposition when the Office of Defense Trans-portation proposed a system of priorities.Soon afterward, however, the InterstateCommerce Commission, on the recom-mendation of the Office of Defense Trans-portation, issued an order which providedfor the dispossession of passengers to ob-tain accommodations for patients. Whilethis action protected railroads against un-warranted lawsuits by civilians who weredisplaced, the Surgeon General's Officefeared that it might create unjustifiedhysteria on the part of the public insteadof dissuading it from unnecessary traveland, at the same time, might endangerthe Army's good relations with the rail-roads. To avoid the latter contingency,and particularly the unwarranted use ofpriorities by general hospitals, the Armyin October 1944 revised the circular de-scribing the voluntary agreement workedout in May. Restating that agreement, therevised version of the circular requiredhospital commanders to submit to rail-roads, along with each request for reserva-tions, certificates attesting the classifica-

32 (1) Memo, SG for CG ASF thru CofT, 20 Mar44, sub: Delays in Trans of Pnts to Hosps, with inds.SG: 531.2. (2) Memo, CofT (Mvmt Br) for SG, 16May 44, sub: Delays in Trans of Pnts to Hosps. Samefile. (3) Ltr, CofT to SG, 29 Apr 44, sub: Apmt of RRRep at US Army Gen Hosps in Arranging Accom-modations for Litter and Ambulatory Cases. SG: 705.(4) Ltr, Western Mil Bu to Member RR Assn, 9 May44, sub: Accommodations for Litter and AmbulatoryCases. SG: 531.2. (5) WD Cir 234, 12 Jun 44.


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 withinwhich accommodations should be pro-vided. In addition it provided that theInterstate Commerce Commission ordershould be invoked only in accordancewith the provisions of this circular. It alsoforbade the use of priorities to dispossesspassengers to secure accommodations formedical attendants returning to homestations.33 Presumably, so long as railroadslived up to terms of the May agreement,the Army would not dispossess passengersto secure accommodations for patients.

Procedures for Air Evacuation

Air evacuation in the United States inthe early part of the war was limited tothe movement of individuals or groups ofthree to four patients from scenes ofcrashes to hospitals or from one hospitalto another. In 1942, for instance, MaxwellField transported a few patients by planeto Lawson General Hospital, and MacDillField sent others to both Lawson andWalter Reed General Hospitals. At thetime of the North African invasion, theHampton Roads Port arranged for theflight of a patient suffering from a braininjury to Walter Reed General Hospital.34

Such flights were exceptional and the firstsizable air evacuation of patients in theUnited States did not occur until the be-ginning of 1944. For sporadic flights priorto that time, the Air Forces normally setaside no single group of planes, and it wastherefore imperative that air evacuationbe carried out normally in administrative,training, or transport planes.35 Moreover,until the latter part of 1942, no personnelwas trained especially for air evacuationoperations. Air station surgeons either ar-

ranged with local operations officers forthe transportation of patients by planesbelonging to their stations or called uponthe surgeons of training centers to supplythe necessary accommodations. Theyeither accompanied patients themselvesor sent nurses or doctors from air stationhospitals as attendants. AAF headquar-ters authorized SOS installations to sub-mit requests for the air transportation ofpatients to near-by Air Forces installa-tions, the Air Transport Command, troopcarrier commands, and the Air Surgeon'sOffice.36

During the winter of 1943-44 therewere widespread demands, for a variety ofreasons, for air transportation of patientsin the United States. On 16 November1943, for example, the commander of Ash-ford General Hospital requested air evac-uation to relieve congestion on railroads inthat area. A few weeks later the com-mandant of the School of Air Evacuationsuggested it to provide training for airevacuation personnel and to increase thecomfort of patients.37 Early the next Janu-

33 (1) ICC, Order 213, Title 49, Transportation andRailroads, 27 Jun 44. HD: 531.4. (2) Memo, ColA[lbert] H. Schwichtenberg for SG, 26 Jun 44, sub:Rail Trans of Pnts. SG: 531.2. (3) WD Cir 405, 14Oct 44. See also WD Cirs 61, 26 Feb 45, and 471, 15Dec 44.

34 (1) Ltr, Base Surg AAB MacDill Fld to CG AAF(Air Surg), 17 Nov 42. AAF: 370.05 (Evac Book No1). (2) Ltr, Surg HRPE to CO Langley Fld, 16 Dec42. sub: Air Trans for Overseas Sick and WoundedArriving 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 Arrivingat HRPE. AAF: 452.1 (Amb Planes). (2) Ltr, 6th SvCto AAF (Air Surg), 16 Apr 43, sub: SOP, with ind.AAF: 370.05 (Evac).

37 Ltrs, CO Ashford Gen Hosp to CO AAB, Rich-mond, Va., 16 Nov 43; AAF School of Air Evac, Bow-man Fld, Ky., 6 Dec 43, sub: Trans of Pnts by Air.AAF: 370.05 (Evac, Book 1).


ary the director of the Surgeon General'sHospital Administration Division con-ferred with the Deputy Chief of Air Staffon the "feasibility of moving patients byair from port hospitals." 38 The followingmonth, at a conference of service com-manders, the commanding general of theSecond Service Command stated that airtransportation for patients was "mostdesirable," and suggested its use particu-larly for small groups who needed to bemoved without delay.39 In April the flightsurgeon assigned to Brooke General Hos-pital propounded still another reason: theevacuation of patients by air would beeconomical, saving the Government, ac-cording to his estimate, at least fifty dollarsper patient.40 A combination of suchreasons, along with increases in aircraftproduction, a shortage of Pullman cars,and the absolute necessity of moving largenumbers of patients who arrived in theUnited States from theaters of operations,were responsible for the extensive use ofair evacuation in this country during thelatter half of the war.

The first large-scale movement of pa-tients by air in the United States wasmade in January 1944. At that time threetroop carrier command planes, with per-sonnel from the School of Air Evacuation,were sent to Stark General Hospital tomove patients being debarked from twohospital ships. In a period of ten flyingdays, between 7 and 19 January, theseplanes flew 661 patients in 29 loads to 5general hospitals. No cases of air sicknessoccurred and only twelve patients re-quired medication, such as the admin-istration of aspirin or morphine, duringflight. The success of this mission promptedthe commanding general of the ServiceForces to congratulate the Air Forces andto 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 weremade to convert that hope into a reality.In April the Air Transport Command wasmade responsible for the movement of pa-tients by air in the United States (as it hadbeen made responsible earlier for air evac-uation from theaters of operations). Soonafterward it assigned to its Ferrying Divi-sion as a special mission the movement ofabout 700 patients from coastal medicalinstallations to various hospitals through-out the United States. The next monththe Transport Command delegated its re-sponsibility for domestic air evacuation tothe Ferrying Division, and began to ear-mark transport planes for evacuationonly.42 In June representatives of AAF andATC headquarters, the Ferrying Division,the Air Surgeon, and The Surgeon Gen-eral agreed upon procedures for domesticair evacuation operations. When the ASFMedical Regulating Officer desired tomove patients by air, he informed theAAF Medical Regulating Officer, request-ing necessary arrangements. The lattertelephoned the Ferrying Division in Cin-cinnati, Ohio, to determine availability

38 Diary, Hosp Admin Div (SGO), 8 Jan 44. SG:314.8.

39 Rpt. Conf CGs of SvCs. Dallas, Tex., 17-19 Feb44. HD: 337.

40 Ltr, Off Flt Surg Brooke Gen Hosp to CG AAFthru Central Flying Tng Comd, 28 Apr 44, sub: Trfby Air of AAF Pnts from Brooke Gen Hosp to AAFConv 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 CGAAF, 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 to30 June 1944), Headquarters Ferrying Division, AirTransport Command. HD: TAS. (2) Memo, Lt ColRichard L. Meiling for Air Surg, 27 Apr 44, sub: AirEvac 19-25 Apr 44. AAF: 370.05. (3) See below, pp.436-37.


and location of planes and then informedthe ASF Medical Regulating Officer if themission could be accomplished within thetime limits desired. If so, the ASF MedicalRegulating Officer directed hospitals toprepare patients for the movementplanned and the AAF Medical Regulat-ing Officer informed the Ferrying Divi-sion of the mission to be accomplished.43

The Ferrying Division co-ordinatedplans for each flight with the hospital fromwhich patients were being transferred atleast 24 hours in advance of the plane'sdeparture. Flight attendants supplied bythis Division to care for patients en routealso arranged to have them properlytagged for identification and to have theirrecords and valuables carried along withthem. To permit hospitals receiving pa-tients to prepare for their reception, flightattendants notified them in advance bytelephone of the expected time of arrival.44

During the period from April 1944 toAugust 1945 the Ferrying Division trans-ported about 100,000 patients from de-barkation hospitals to general and con-

valescent hospitals throughout the UnitedStates. Each patient was flown an averageof 1,388 miles.45 The procedure by whichthis was accomplished made it possible,after control of hospital train movementswas also centralized in Washington, forthe ASF Medical Regulating Officer toco-ordinate the use of planes and trains indomestic evacuation, thereby relievingrailroads of a tremendous burden. It alsoenabled the Regulating Officer to observemore closely than might have been other-wise possible the policy of transferring pa-tients promptly and directly from debar-kation hospitals to installations where theywould receive final treatment.

43 (1) Rpt, Conf on Air Evac, 7 Jun 44. SG: 580. (2)Memo, SG for CG AAF attn Reg Off, 7 Jul 44. SG:580.-1.

44 (1) Organizational History of the Ferrying Divi-sion, June 20, 1942 to August 1, 1944. ATC: Hist Div.(2) 1st ind, CG Ferrying Div ATC (Surg) to CG ATCattn Surg, 24 Sep 44, on Ltr, CG 2d SvC to CG ASFattn SG, 29 Aug 44, sub: Air Evac. SG: 580.

45 Andres G. Oliver and Hampton C. Robinson,Jr., "Domestic Air Transportation of Patients," TheAir Surgeon's Bulletin, Vol. II, No. 11 (1945), p. 400.

CHAPTER XXII

Providing the Meansfor Evacuation by Land

Supplying enough ambulances and railcars of suitable types for the transportationof patients in the United States and inoverseas areas was a continuing problem.Plans for improved types were being madebefore the war started, and when it endednew ones were still being developed andordered. Numerous difficulties were en-countered in this process, as well as inmanning and equipping hospital trains.

Motor Ambulances

Of all conveyances the motor ambu-lance was the most widely used and trans-ported the largest number of patients. Thetype in greatest use was the general-serviceambulance. Capable of serving in trainingcamps in the United States as well as incommunications and combat zones of the-aters of operations, it was called at differ-ent times the field ambulance, the stationambulance, and the cross-country ambu-lance. Others of more specialized—andtherefore more limited—use were the met-ropolitan and multipatient ambulances.

General-Service Ambulances

Because general-service ambulanceswere basic conveyances for patients inboth peace and war, experiments to im-

prove them were made between WorldWars I and II. In 1932 a field ambulanceon a (4 x 2)1 chassis of 1½-ton capacitywas developed by the Medical Depart-ment Equipment Laboratory and by 1939it had replaced ambulances of World WarI type. Although this ambulance was de-signed for use at Army posts and camps inthe United States as well as for field serv-ice with tactical units, it was not entirelysatisfactory for either. It rode too roughlyand was too poorly heated and ventilatedfor the comfort of patients in the UnitedStates, and it got stuck in the mud tooeasily for satisfactory service in the field orin forward areas of theaters of operation.2

The Surgeon General's Office concludedthat heavier ambulances, perhaps of themetropolitan type normally used by civil-ian hospitals, should be used not only atArmy hospitals in the United States butalso in communications zones of theaters,and that a light ambulance, able to oper-

1 That is, having four wheels, two of which wereattached to the engine drive-shaft.

2 (1) Ltr, SG to TAG, 21 Feb 34, sub: Repl of War-time Ambs. HRS: G-4/29094. (2) Ltr, QMG toTAG, 15 Apr 35, sub: Mil Characteristics for Ambs,Light Fld Type. QMG: 451.8. For letters on motorvehicular requirements and assignment of ambu-lances see files HRS: G-4/29714 and QMG: 451.8;for changes in specifications and rear spring improve-ments see files SG: 451.8-1 and 451.8-1 (Carlisle Bks).

PROVIDING THE MEANS FOR EVACUATION BY LAND 361

ate over bad terrain, should be developedfor use in combat zones.3

Beginning in 1937 the Medical Depart-ment and the Quartermaster Corps hadexperimented with development of suchan ambulance. Meanwhile the GeneralStaff reaffirmed its policy of limiting thetypes of chassis used by the Army in orderboth to assure the mass production of ve-hicles and to simplify the procurement anddistribution of spare parts as well as themaintenance and repair of vehicles. It an-nounced in August 1939 that all tacticalvehicles (that is, those used by table-of-organization units) would be all-wheel-drive types, and that only five chassiswould be considered standard for theArmy: ½-ton, 1½-ton, 2½-ton, 4-ton, and7½-ton.4 The Medical Department Equip-ment Laboratory and Holabird Quarter-master Depot then concentrated on exper-iments with a ½-ton (4 x 4) chassis, andin June 1940 The Surgeon General an-nounced that the ambulance built on itwould be "accepted as the new cross-country motor ambulance for use in alldivisional and corps units in the combatzone."5 This ambulance, like the one itwas to replace, could carry four litter pa-tients. When the first of this type was de-livered for testing early in January 1941,the Surgeon General's Office and theLaboratory found that the ambulancewhich had been developed primarily foruse in combat zones rode so comfortablyand was so well heated and ventilatedthat it would serve satisfactorily for hos-pitals in the zone of interior as well.6 Inshort, the new cross-country ambulancewas a better general-service ambulancethan the 1½-ton (4 x 2) field ambulance.

A change in standard chassis requireda change in the new ambulance during1942. In 1941 two new chassis—¼-ton (4

x 4) and ¾-ton (4 x 4)—were introduced,and the ½-ton (4 x 4) was dropped fromthe Army's standard list. As early as Feb-ruary 1942 the Quartermaster Corps wasanticipating issuing ¾-ton ambulances inplace of ½-ton vehicles.7 About fourmonths later plans for the change hadbeen completed, and ¾-ton ambulanceswere ordered along with other ¾-ton ve-hicles. Although similar in appearance tothe ½-ton ambulance, the new ¾-ton am-bulance had a shorter wheelbase, largertires, and more clearance under the axle.8

The Medical Department EquipmentLaboratory thought that these differencesmade it more comfortable for patients andless apt to get stuck in mud and sand.

While the cross-country ambulance wasdesigned mainly for use in theaters of op-erations, it was used widely in the zone ofinterior as well. The stoppage of passen-ger-car production early in the war cur-tailed the procurement and use ofmetropolitan ambulances built on pas-

3 2d ind, SG to TAG, 3 Jan 40, on Ltr, SG to TAG,25 Nov 39, sub: Fld Ambs, Motor. SG: 451.8-1. Alsosee 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, 12Aug 39, sub: Standardization of Motor Vehs. AG: 451(8-12-39).

5 (1) For letters on these experiments see filesQMG: 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: CriticalMeasurement Data on Cross-Country Amb. HD:McKinney files, Jun 40.

6 Memo, Col G[arfield] L. McKinney (PlanningSubdiv) for SG, 14 Jan 41, sub: New Cross-CountryAmb; Insp at Carlisle Bks, 13 Jan 41. Off file, Re-search and Dev Bd SGO, "Cross-Country Amb."

7 (1) Ltr QM 451 M-ES, QMG to SG, 14 Feb 42,sub: Reclassification of Amb, Fld, with 3 inds. QMG:451.8. (2) Memo, TAG for CGs AGF and AAF, C ofArms and Servs, 6 Apr 42, sub: Standardization ofWheeled Motor Veh Chassis and Trailers. AG: 451(4-4-42).

8 (1) TM 9-2800, 1 Sep 43, Standard Military Mo-tor Vehicles.


PLACING THE FOURTH LITTER PATIENT IN A FIELD AMBULANCE

senger-car frames.9 The Medical Depart-ment therefore used what was available.As ambulances of the cross-country typewere delivered to the Army, they werefirst distributed to table-of-organizationunits. Those of the older type (1½-ton fieldambulance) that were no longer neededby such units were divided among posts,camps, and stations in the United States.10

As ambulances of the old type wore out oras requirements exceeded supply, ambu-lances of the new types were issued to zoneof interior installations. In addition, 356chassis for 1½-ton (4 x 4) trucks weretaken from a civilian pool of motor vehi-cles in 1943 and were used to build modi-fied field ambulances for service in lieu ofunavailable metropolitan ambulances.11

Thus, in addition to the metropolitan am-bulances either on hand or procured fromavailable stocks at the beginning of thewar, hospitals in the United States usedfour types of ambulances: the 1½-ton (4 x2) field ambulance; the 1½-ton (4 x 4)modified field ambulance; the ½-ton (4 x

9 For letters on efforts to secure additional metro-politan ambulances and their procurement and dis-tribution see file SG: 451.8-1 (1939-43). Also see His-tory of the Automotive Division, War ProductionBoard, 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 fieldambulances from tactical units to zone of interior hos-pitals see files: SG: 451.8-1, AG: 451.8, and HRS:G-4/29714 for 1940-43.

11 Memo, ACofS for Oprs ASF for CofOrd, 6 May43, sub: Reqmts for Fld Ambs. AG: 451.8 (5-6-43).


FIELD AND METROPOLITAN AMBULANCES USED IN 1942

4) cross-country ambulance; and the ¾-ton (4 x 4) ambulance.

By the winter of 1942-43 it appearedthat the ¾-ton ambulance was not entire-ly satisfactory for overseas use. SOS head-quarters thought it took up too muchshipping space, and some theaters ex-pressed dissatisfaction with its perform-ance. The Southwest Pacific, for instance,stated that lighter vehicles with greatertraction were needed for the rough muddytrails over which patients had to be trans-ported, while reports from North Africaindicated that the ¾-ton ambulance wasdifficult to land from lighters, lacked thetraction and drive needed in that theater,and had insufficient angles of approachand departure to allow it to operate easily

over ditches and hills of rough terrain.12

The SOS Requirements Division in Jan-uary 1943 proposed several methods ofovercoming these difficulties: shipment ofthe standard ambulance in a two-unitpack for reassembly in theaters of oper-ations, replacement of its metal body withbows and a tarpaulin top, and provisionof "litter kits" for use in adapting stand-

12 (1) Diary, SOS Hosp and Evac Br, 13, 16, 22,and 28 Jan 43. HD: Wilson files, "Diary." (2) Ltr,CinC SWPA to CG SOS, 21 Nov 42, sub: Improve-ment of Equip and Orgn, US Army, with 3 inds. SG:322.15-1. (3) Memo, Col Robert C. McDonald, Hospand 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 Cmteeto Col Calvin H. Goddard, 7 Jul 52. HD: 314 (Corre-spondence on MS) XI.


MOTOR AMBULANCES. Left to right, ½-ton (4x4), ¾-ton (4x4), and ¾-ton (6x6),the last being an experimental vehicle which was never standardized.

ard vehicles to the transportation ofpatients.13

The Surgeon General's Office coun-tered with a different proposal. The Med-ical Department Equipment Laboratoryhad already begun to evaluate experi-ments of medical units in replacing litterbearers with motor vehicles—particularly¼-ton (4 x 4) trucks, or jeeps—to trans-port patients from battalion aid stations tocollecting stations. By the middle of 1942it had decided that none of the standardvehicles of the Army were satisfactory forthis purpose. Some were too rough; somehad silhouettes that were too high; andothers—notably the unprotected and un-covered jeep—were so small that littersprotruded over their sides or ends. Conse-quently the Medical Department Tech-nical Committee and the Surgeon Gen-eral's Office had proposed in August 1942

the development of a light forward-areaambulance on a nonstandard chassis—a¼-ton (4 x 4) chassis to which an extraaxle and two wheels were added, makingit a ¾-ton (6 x 6) chassis. SOS headquar-ters had disapproved this proposal be-cause it conflicted with the War Depart-ment's policy of using only standardchassis.14 The Surgeon General's Officestill believed that this vehicle was a prac-tical solution to the dual problem of sav-ing space on ships and furnishing theaterswith ambulances that could be used farforward 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 SGOfor Chief Fld Equip Br Research and Dev Div SGO,3 Sep 42, sub: Forward Area Amb. All in Off file, Re-search and Dev Bd SGO, "Amb, Forward Area."


1943 recommended again that this typeshould be developed at once. The SOSRequirements Division referred this rec-ommendation to the Army GroundForces, principal user of front-line ambu-lances. Rather than introduce a new typeof chassis, AGF headquarters recom-mended the modification of the ¾-ton(4 x 4) ambulance and the issuance of"litter kits" for use with standard fieldtrucks.15 The Surgeon General's Officeconsented, and during the early part of1943 the Ordnance Department and theMedical Department Equipment Labora-tory collaborated in the development ofan ambulance on a ¾-ton (4 x 4) chassisthat incorporated improvements desiredfor field use and had a body that could be"knocked down" for shipment. By July1943 two experimental vehicles had beentested, and in August the Surgeon Gen-eral's Office recommended that one withplywood and steel paneling be adopted asstandard.16 As the 1944 ambulance pro-curement program was nearing comple-tion (April 1944), the new "knock down"ambulance was standardized, and theolder ¾-ton vehicle, which had been is-sued widely to units in all areas, was re-classified as a limited standard item.17

Metropolitan Ambulances

The possibility of procuring metropoli-tan ambulances in addition to those onhand or acquired at the beginning of thewar was raised in the middle of 1944.Early in June the War Production Boardcalled the attention of ASF headquartersto an opinion of the Ambulance BodyManufacturers Industry Advisory Com-mittee that "The Army may not haveconsidered the need for street ambulances

to be used in connection with [Army] hos-pitals in this country." 18 Referring thematter to the Surgeon General's Office on21 June 1944, ASF headquarters routinelycalled for recommendations as to possibleArmy requirements for "street" ambu-lances. When The Surgeon General tookthis opportunity to insist upon the pro-curement of 200 metropolitan ambu-lances, ASF headquarters disapproved,stating that no suitable commercial chassiswere in production, that the conversion ofpassenger cars frozen in the civilian poolwould be too expensive, and that require-ments for metropolitan ambulances couldcontinue to be met by using field (or gen-eral-service) ambulances.19 The SurgeonGeneral's Office then surveyed servicecommand needs and in January 1945 re-ported its findings. The 149 metropolitanambulances already in use were so badlyworn as to require replacement, and 151additional vehicles of that type wereneeded by ASF and AAF hospitals. Ac-cordingly The Surgeon General requested

15 1st ind, SG to CG SOS, 5 Feb 43, 2d ind, CGSOS (Reqmts Div) to CG AGF, 18 Feb 43, and 3dind, CG AGF to CG ASF, 10 Apr 43, on Memo, CGSOS 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, MDEquip 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, ¾-ton, 4 x 4 , Amb KD-Stand-ardization and Rev of Mil Characteristics, with 2inds. AG: 451.2. (2) Ord Tec Cmtee, Item 23100, 9Mar 44. HD: 451.8. Limited standard vehicles wereusable substitutes for standard vehicles and wereissued 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 ASFfor SG, 20 Jul 44, sub: Amb, Metropolitan, 24-ton,4 x 2 , with 2 inds. Both in SG: 451.8-1.


ASF headquarters to authorize the devel-opment of "substitute standard" metro-politan ambulances by the conversion oflight sedans which the War Departmenthad on hand. The Ordnance Departmentbegan such a project, but the war endedbefore it was completed.20

Multipatient Ambulances

Toward the end of the war the MedicalDepartment succeeded in getting a multi-patient ambulance and thus achieved, inpart at least, a goal toward which it hadworked in the early war years. From 1939until the middle of 1943 the Surgeon Gen-eral's Office and the Medical DepartmentEquipment Laboratory had conductedalmost continuous experiments to developa single large vehicle that could serve notonly as a multipatient ambulance both inthe zone of interior and in combat areasbut also as housing for mobile laboratories,operating rooms, and wards and as ameans of transporting surgical, shock, andother specialized teams to areas wherethey were critically needed.21 They hadexperimented with 2½-ton (4 x 2) front-wheel-drive bus-type vehicles, van-typesemitrailers pulled by 1¾-ton and 2½-tontractors, and 2½-ton (6 x 6) trucks.22

These experiments failed mainly becausean attempt was being made to use a singlevehicle for several purposes, and nonepossessed all of the characteristics re-quired. For example, the front-wheel-drive bus was a nonstandard vehicle andlacked sufficient traction for cross-countryuse, while the semitrailer lacked maneu-verability in combat areas and was toorough for patients. The 2½-ton (6 x 6)truck, on the Army's standard list, was

successfully used in the development of asurgical truck for armored divisions, butthe Quartermaster Corps thought that itwould be unsatisfactory as an ambulancebecause full loads of ambulatory patientswould overload its front axles and wheels.Thus the Medical Department reachedthe middle of 1943 without having devel-oped a standard multipatient ambulance.Meanwhile its Equipment Laboratoryconverted eight experimental, nonstand-ard, front-wheel-drive bus-type vehicles,which had been procured in 1940 and1941 and had been found unsatisfactoryfor field use, into multipatient ambulancesfor service at ports in the United States.In June four apiece were issued to Letter-man and Halloran General Hospitals inplace of the passenger buses requested byLetterman, and instead of the additionalstandard general-service ambulances re-quested for Halloran by the second ServiceCommand.23 The next month the Labo-ratory recommended that the project forthe development of a multipatient ambu-lance be continued, but Surgeon General

20 (1) Ltr, SG to all SvCs, 26 Sep 44, sub: Amb,Metropolitan, ¾-ton, 4 x 2 , 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 Mar45, sub: Amb, ¾-ton, 4 x 2 , Light Metropolitan. HD:451.8.

21 Ltr, MD Equip Lab to SG, 27 Dec 45, sub: Histof Amb, Bus-Type, Experimental, MD Equip LabProj F 2. HD: 451.8.

22 For documents on these experiments see files for1940-43 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 Mar43, sub: Req for Passenger Buses, with 2 inds. SG:451.8-1 (9th SvC). (2) Memo, 2d SvC Ord Br forDepCofOrd 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 SurgHosp Vehs to Bus-Type Ambs. SG: 451.2-1 (CarlisleBks).


Kirk directed that it be dropped.24 Duringthe following year his Office and theLaboratory concentrated on the develop-ment of such special purpose vehicles asmobile medical and dental laboratories,optical repair units, and dental and sur-gical operating trucks.25

In the second half of 1944 the questionof furnishing multipatient ambulanceswas reopened. In July Letterman GeneralHospital asked for the replacement of thefour worn-out multipatient ambulanceswhich it had received in mid-1943. To thisrequest Ninth Service Command head-quarters added four more for other de-barkation hospitals on the west coast (twofor Birmingham General Hospital andtwo for Fort Lewis). By October the num-ber requested for the Ninth Service Com-mand was doubled.26 Meanwhile, duringJuly and early August, Mitchel Field,which served as a debarkation point forair evacuees, converted four Ordnancemaintenance trucks into special multipa-tient ambulances for the transportation ofpatients from planes to the Mitchel FieldHospital and from that installation toHalloran General Hospital.

To meet the need thus demonstrated,the Surgeon General's Office proposed on11 September 1944 the development of aspecial ambulance to be used only in theUnited States and to carry twelve to six-teen litter patients. This limitation wasexpected to eliminate difficulties encoun-tered earlier in attempts to develop multi-patient ambulances that could carryeither litter or ambulatory patients inboth the zone of interior and combatzones. At first ASF headquarters was re-luctant to approve a developmental proj-ect for a vehicle in small demand. It pro-posed, instead, that The Surgeon General

submit a list of standard military vehiclesthat would be satisfactory, when modified,for the use intended. Believing that nostandard military vehicle was suitable, theOrdnance and Medical Departments de-cided that front-wheel-drive bus-type ve-hicles of the kind procured for experi-mental purposes in 1940 and 1941 shouldbe used. An important factor in this deci-sion was the statement by the companymaking such vehicles that it had "openproduction facilities" and could therefore"offer favorable delivery," if standard en-gines, transmissions, and axles were madeavailable to them.27 In addition, The Sur-geon General pointed out, a pilot modelhad already been developed in 1940. Herequested, therefore, that the Chief ofOrdnance be authorized to procuretwenty-four such vehicles for Medical De-partment use. This request was approvedby ASF headquarters on 4 November1944.28

24 (1) Ltr, SG to MD Equip Lab, 6 Jul 43, sub:Dropping and/or Suspension of Dev Projects, withind. SG: 451.8-1. (2) Ltr, SG to CG ASF (ReqmtsDiv), 22 Jul 43, sub: Bus-Type Amb (Project F-2 andMobile Hosp Ward (F 15.01)). Same file. (3) Memo,Chief Fld Equip Dev Br SGO for Chief ResearchCoord Br SGO, 27 Jul 43, sub: Experimental ¾-tonAmb. Off file, Research and Dev Bd SGO, "Bus-Type Amb, F-2."

25 For full discussions of these projects, see John B.Johnson, Jr, and Graves H. Wilson, A History ofWartime Research and Development of MedicalField Equipment (1946), pp. 295-730. HD.

26 (1) Memo, CG Letterman Gen Hosp for CG 9thSvC, 20 Jul 44, sub: Repl of Ambs, Bus-type, with 3inds. SG: 451.8 (9th SvC). (2) Ltr, SG to CG Letter-man Gen Hosp, 26 Sep 44, sub: Multi-litter Ambs(Bus-Type), with 2 inds. Same file.

27 Having "open production facilities" meant thatthe company's plant could begin production immedi-ately without having to await the completion of otherorders.

28 Ltr, CG ASF (Dir of Sup) to CG 2d SvC, 21 Jun44, sub: Trucks, 1½-ton, (4 x 4) Ord Maintenance, forMitchel Fld, with 12 inds. SG: 451.8.


EXTERIOR VIEW OF MULTIPATIENT METROPOLITAN AMBULANCE, 1945

Production of the new 12-litter ambu-lances began almost immediately after thecontract was awarded late in December1944. Preliminary work on blueprints andspecifications had already been com-pleted, and on 8 January 1945 construc-tion of the first model began. At the end ofFebruary it was road-tested by Ordnanceand Medical Department representatives.By late March the first two were deliveredto the Army, and during May—themonth when the greatest number of pa-tients arrived from theaters of opera-tions—other multipatient ambulanceswere ready for delivery to hospitals.29

Meanwhile, the Surgeon General's Officehad surveyed requirements and foundthat additional ambulances of this typewould be needed—forty-seven for servicecommands and fifty-one for the AirForces. In June 1945 ASF headquartersapproved their procurement. The nextmonth the Ordnance Department beganthe process of standardizing the newambulance. Before this was done in Sep-

29 (1) Ltr, SG to CGs SvCs, 26 Feb 45, sub: Amb,1-ton, 4 x 2 , 12 litter, Metropolitan Front Drive, withreplies. SG: 451.8 (SvCs). (2) See letters on develop-ment and inspections, modifications in litter supports,and changes in rear springs in Off file, Research andDev Bd SGO, "Amb, Bus-Type, Experimental, F-2."


INTERIOR OF THE MULTIPATIENT METROPOLITAN AMBULANCE

tember 1945, V-J Day occurred and thecontract for ninety-eight additional multi-patient ambulances was canceled.30

Hospital Trains

At the beginning of 1939 the MedicalDepartment had no hospital trains onhand and only indefinite plans for procur-ing them in the event of war. The Armyhad disposed of its World War I hospitalcars because it was cheaper to transportthe few patients who required movementin peacetime in Pullman cars and touristsleepers of regularly scheduled trains.

Thereafter the Medical Department hadassumed that three types of trains wouldbe used in the event of another war: (1)trains made up entirely of government-owned cars; (2) "semipermanent" trainscomposed of one government-owned ad-ministrative car, called a unit car, and anappropriate number of commercial bag-gage cars, Pullman cars, tourist sleepers,and chair cars; and (3) improvised trains

30 (1) Ord Tec Cmtee, Items: 28530, 26 Jul 45;29055, 13 Sep 45; 29740, 8 Oct 45, sub: Amb, 1½-ton,4 x 2 , 12-litter Metropolitan. HD: 451.8. (2) Memo,SG for CG ASF (Reqmts and Stock Control Div), 6Sep 45, sub: Ambs. SG: 451.8.


consisting of any available commercialrolling stock. Trains of the last type wereconsidered undesirable because theylacked accommodations for the emergencytreatment of patients and for train admin-istration. There were doubts that those ofthe first type could be constructed in suf-ficient numbers during wartime. Hence,emphasis was placed upon planning forthe conversion of commercial cars intounit cars. Such plans were drawn duringthe twenties and approved by the GeneralStaff in 1931.31

Development of the "Ideal" Unit Car

During 1939 more specific planning forhospital trains was inspired by planningfor rail transportation undertaken by theArmy Engineers, urged on by the deteri-orating international situation. As a partof a more general project to furnish light-weight trains for use on damaged or poor-ly laid tracks in theaters of operations, theEngineers in January 1939 proposed agovernment-owned hospital train builtfrom standard military cars (20-ton, 28-foot-long, four-wheeled box cars). It wasto consist of a personnel car, a dressing (oroperating) car, nineteen ward cars, and akitchen car, and was to be used, accord-ing to the Engineers, to transport patients"from the front line to any point in theCommunications Zone or Zone of In-terior." The Surgeon General's Office andthe Medical Department Board agreed toadopt this train "for planning purposes,"believing that they were not thereby elim-inating the possibility of using other typesof trains in communications zones. On 4August 1939 the Engineers announcedthat they were basing plans for all trainsin theaters of operations on the use of 20-ton railway cars. Shortly afterward, before

committing itself further, the SurgeonGeneral's Office turned to a study of trainsused during World War I both in theatersof operations and in the zone of interior.32

This study showed that trains made upentirely of government-owned cars hadbeen used effectively in Europe but thatthe semipermanent, or unit-car, type oftrain had been more successful in theUnited States. The unit car had had a kit-chen large enough to feed 250 people,space for transporting 28 litter patients,and quarters for 1 officer, 2 noncommis-sioned officers, and 2 cooks. Among its ad-vantages had been its flexibility, its econ-omy of procurement and operation, and itsprovisions for feeding patients. As a singlecar attached to a regularly scheduledtrain, it had been used to transporttwenty-eight or fewer patients; with oneor two Pullman cars, it had been attachedto regularly scheduled trains to carrymore patients; and it had been used, alongwith Pullman cars, tourist sleepers, chaircars, and baggage cars, to make up a spe-cial hospital train with accommodationsfor over 200 patients. Conversion of aPullman car into a unit car was thoughtto have been cheaper than the construc-tion of cars for an entire train. Moreover,since other cars used in connection with ithad been owned either by railroads or bythe Pullman Company, only the unit car

31 (1) Ltr, QMG to SG, 29 Dec 21, sub: Dispositionof 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, 15Feb 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 MotivePower and Rolling Stock on Standard Gauge Rys(Rpt 559, Prelim Rpt on Hosp Tns, Engr Bd, 23 Dec38), with 9 inds. SG: 453.-1. (2) Rpt, MD Bd MFSSCarlisle Bks, Pa, 30 Mar 39. Same file.


had had to be "deadheaded" (returnedempty) to the trains' point of origin. Fur-thermore, the unit car's kitchen facilitieshad helped to solve one of the major prob-lems of World War I—the feeding of pa-tients. Because of these advantages, andsince the Engineers were already workingon plans for cars for completely govern-ment-owned trains, the Surgeon General'sOffice 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 thatdiffered considerably from the unit car ofWorld War I and to some extent from onethat had been planned in 1931. The latterpresumably represented an improvementover the World War I car. It was to haveside doors for loading patients and, in ad-dition to the kitchen, an operating ordressing room and more space for attend-ants, but its capacity for patients had beenreduced from twenty-eight to ten. In thefall of 1939 the Surgeon General's Plansand Training Division decided to elimi-nate all spaces for patients, in order to in-crease the feeding capacity of the kitchento 500, enlarge the operating room andmake an aisle around it, provide roomierquarters for more medical attendants, andfurnish storage space for foods and med-ical supplies. These changes were intendedto produce a car which would have mostof the facilities planned by the Engineersfor the several administrative cars (dress-ing, kitchen, and personnel) of the pro-posed overseas train and would be "ideal"for use in mass evacuation in the UnitedStates.34

After preliminary plans for the unit carhad been drawn, the Medical Depart-ment Board and the Surgeon General'sOffice studied "in a new light" the Engi-neers' proposal to use only lightweight

trains in theaters of operations. Theyfound that the General Staff had "notspecifically approved" the 20-ton car fora hospital train, but that it had approved(in 1931) the unit car. Moreover, theyconsidered the train proposed by theEngineers to be "unsatisfactory" and "areversion to that [type] used prior to1863." Finally, they had an alternative tooffer: the unit car "included all the neces-sary facilities for the care of the sick andwounded" and could be used with com-mercial cars to make a complete hospitaltrain either in the zone of interior or intheaters of operations. The Surgeon Gen-eral and the Engineers then reached acompromise on 8 May 1940. The latteragreed with The Surgeon General that, asa first choice, hospital trains in theaters ofoperations should consist of the unit carand other heavy cars appropriate to it.The Surgeon General agreed that hospitaltrains of lightweight cars could be used inareas where the construction of roadbedsmade the use of heavier equipment im-practical.35 Thereafter, the Surgeon Gen-eral's Office and the Medical DepartmentBoard collaborated with the Quartermas-ter General's Office and the PullmanCompany in completing specifications forthe 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 MedicalDepartment . . . in the World War (1923), vol. I, pp.334-35; (1923), vol. V, pp. 180-86; (1925), vol. VIII,pp. 37-41.

34 (1) Memo, SG (Capt Joe A. Bain) for QMG, 4Oct 39, sub: Hosp Unit Car. SG: 453.-1. (2) Memo,SG (Col James E. Baylis, Exec Off) for MD Bd, 6 Feb40. 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, 8Jun 40, on Memo, Engr Bd for CofEngrs, 12 Jan 39,sub: SP 70, Type Plans and Specifications for Mo-tive Power and Rolling Stock on Standard GaugeRys. SG: 453.-1. (2) Notes on Conf on Hosp Tns,TofOpns, by Capt Bain, 8 May 40. Same file.


STATIONARY BEDS IN HOSPITAL WARD CAR, 1941

making preliminary designs for cars forthe lightweight train.36

In the fall of 1940, when the establish-ment of Army bases in the Atlantic andthe prospective passage of selective serv-ice legislation created a potential need forhospital trains, the Surgeon General's Of-fice requested that two Pullman cars beconverted into unit cars. This request wasapproved. Furthermore, in December1940 the Engineers ordered, along withother railway equipment, enough 20-toncars to test some for use in hospital trains.37

Need for Ward Cars and Their Development

About the time the first unit cars weredelivered, the Surgeon General's Office

found, contrary to its expectations, thatgovernment-owned hospital cars of an-other type would be needed. When thedecision was made to eliminate spaces forpatients in the unit car, the Planning andTraining Division had expected that litterpatients would be carried in tourist sleep-ers. About a year later, in February 1941,it discovered that tourist sleepers, like

36 (1) Memo, SG for TAG, 6 May 40, sub: HospUnit Car. TC: 531.4. (2) Rpts, MD Bd No 190, 27Aug 40, Hosp Unit Car; No 174, 27 Aug 40, HospTn, Combat Area; No 174, 9 Sep 40, Berth for HospTn. 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, pt6. (3) Extract from History of the Development ofRailroad Equipment, prep by Hist Staff, Engr Bd, FtBelvoir, Va. HD: 531.4.


Pullman cars, had washrooms at eitherend, instead of straight through-and-through aisles, and that patients on litterscould therefore not be carried from sleep-ers to unit-car operating rooms.38 For thelatter to be of any use, it was necessary todevelop a special ward car. During thespring of 1941 the Pullman Company, fol-lowing recommendations of the MedicalDepartment, prepared plans for convert-ing standard Pullman cars into ward cars.This was to be done by removing existingwashrooms and installing other toilet andwashing facilities in such a way as to leavea straight aisle; by adding wide side doorsto permit easy loading and unloading oflitter patients; and by replacing the Pull-man berths with sixteen two-tiered sta-tionary beds made by the Simmons Com-pany. Such beds were chosen, instead ofGlennan adjustable beds used duringWorld War I, because they were thoughtto be more comfortable and cheaper toprocure. In July 1941 the General Staffapproved a request from The SurgeonGeneral for four cars of this type, and con-tracts were let with the Pullman Com-pany in September. It was then antic-ipated that a hospital train would consistof one government-owned unit car, twogovernment-owned ward cars, a baggagecar, and a variable number of standardPullman or chair cars. The four ward carswere delivered in November and Decem-ber 1941.39 (Table 17)

When the Japanese attacked PearlHarbor, the Army had two unit cars andfour ward cars—enough government-owned equipment to serve as the nuclei oftwo hospital trains. The unit cars had notbeen used during 1941 because they werenot air-conditioned and no ward carswere available for use with them. Theward cars just delivered had not been

used either, but they had been favorablyreceived by Medical Department officerswho had seen them. Enough rail equip-ment for six additional hospital trains wasneeded, according to previous plans, fora full mobilization of the Army.40

Ward Dressing Cars Replace Unit Cars

Early in January 1942 the SurgeonGeneral's Office began to plan for addi-tional hospital cars. In the course of a fewmonths the concept of the types of carsneeded changed radically. Despite lack ofexperience with the new unit cars, theSurgeon General's Planning and TrainingDivision decided to abandon them as atype. In view of earlier statements andsubsequent experience it is probable thatthe following factors accounted for this de-cision. The unit car developed in 1940had no space for patients. Capable of feed-ing up to 500 persons, its kitchen could beused to capacity only with trains consist-ing of about eighteen cars. On such trains,serving food from a unit car to patients inother cars was a real problem. Moreover,since patients transported in the UnitedStates did not normally require surgeryen 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, Researchand Dev Bd SGO, "Unit Car." (2) Memo, Capt Bainfor Brig Gen Albert G. Love, 6 Feb 41, sub: HospUnit Car. Same file.

39 (1) Ltrs, SG to Pullman Co, Chicago, 4 Mar, 20Mar, 2 May, and 9 May 41; Pullman Goto SG, 14Mar, 22 Apr, 24 Apr, 5 May, and 27 May 41. SG:453.-1. (2) Ltr, SG to CofEngrs, 31 May 41, sub:Hosp Ward Cars. CE: 453, pt 6. (3) Ltr, SG to TAG,31 May 41, same sub, with 4 inds. SG: 453. (4)Memo, CofEngrs for QMG, 25 Nov 41, same sub. CE:453, pt 6.

40 (1) Rpt, Observer, Second and Third Army Ma-neuvers, Sabine-Red River-Louisiana-Area, 15-26Sep 41. SG: 354.2-1 (Maneuvers, Gen). (2) Memo,SG for TAG, 6 May 40, sub: Hosp Unit Car. SG:453.-1.


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 AGTechnical Records: SG 453.1 and 531.4; TC, same file numbers.

car was larger and more elaborate thanwas needed.41

To replace the unit car the SurgeonGeneral's Office and the Pullman Com-pany developed a ward dressing car in theearly months of 1942. It contained a smallsurgical dressing room and space for thirtylitter patients, but it lacked kitchen facil-ities. It differed from the ward car only inthe replacement of a toilet and berths fortwo patients with an operating or dress-ing room. This room, which could also beused as a loading room, was equippedwith an operating or dressing table, a

washstand, a sterilizer, and a locker forsurgical instruments. The dressing tablecould be used in the center of the room,moved down the aisle of the car to a pa-tient's berth, or stored at the side of thecar. Food would come from commercialdining cars. Thus the Medical Depart-

41 (1) Rpt of MD Bd to consider MD Bd Project No190, Hosp Unit Car, 8 Jul 41. SG: 453.-1. (2) Ltr, SG(Maj Thomas N. Page) to Pullman Go, 13 Jan 42. Offfile, Research and Dev Bd SGO, "Hosp Ward Car."(3) Ltr, SG (Lt Col H[oward] T. Wickert) to PullmanCo, 13 Feb 42. SG: 453.-1. (4) Ltr, Lt Col ThomasN. Page to Modern Hosp Pub Co, Chicago, 1 Dec 42.Same file.


DRESSING ROOM IN HOSPITALWARD DRESSING CAR, 1942

ment placed its reliance early in WorldWar II, as it had in World War I beforethe unit car was developed, upon railroadand Pullman companies for feeding pa-tients. Instead of stationary Simmonsbeds, two-tiered Glennan adjustableberths were to be used in both ward andward dressing cars. Chief advantage of thelatter was that upper berths could bepulled down to form backs for lowerberths and thus make places for patientsto sit. To provide enough government-owned equipment for six hospital trains,in addition to that already available fortwo, the Engineers ordered six warddressing cars and twelve ward cars inMarch 1942. They were delivered tothe Charleston, New Orleans, San Fran-cisco, and New York Ports in July andAugust.42 (See Table 17.)

Air-Conditioning Hospital Cars

About a month before the new carswere delivered, the Surgeon General's Of-fice initiated action to get them air-condi-tioned. In response to a hospital traincommander's request, that Office askedSOS headquarters in June 1942 to haveair-conditioning equipment installed inall hospital cars. Action on this requestwas delayed because of differences ofopinion about the more desirable kind ofequipment between the Surgeon Gen-eral's Office on the one hand and the En-gineers and the Transportation Corps onthe other. Both the Engineers and theTransportation Corps favored the use ofice-activated air-conditioning equipment,apparently because it was simpler to in-stall and because it was commonly usedon Pullman cars at the time. The SurgeonGeneral's Office preferred a type of me-

chanical air-conditioning equipmentwhich was thought to insure more eventemperatures and was not dependentupon batteries for operation when hospi-tal cars were standing.43 A mechanicalsystem of this type, produced by Moun-tain Aire Products, Incorporated, was in-stalled in one hospital car for testing in thefall of 1942. Subsequently, as a result ofthese tests, differences of opinion arose

42 (1) Ltrs, Pullman Co to SG, 13 Jan, 26 Jan, 10Feb 42, with blueprints, Plan 4103-A, 4103-B. SG:453.-1. (2) Specifications for Remodeling 18 PullmanParlor Cars to Hosp Ward Cars for WD, from Pull-man Co, 30 Jan 42. Off file, Research and Dev BdSGO, "Hosp Ward Cars."

43 (1) Ltr, Med Sec 1927 CASU, Hosp Tn No 1(San Francisco) to Surg 9th CA, 22 May 42, sub: Air-Conditioning for Hosp Tn No 1, with 5 inds. SG:453.-1. (2) Memo SPOPM 673, ACofS for Oprs SOSfor CofEngrs, 18 Jun 42, sub: Mechanical Air Condi-tioning for Unit Cars. Same file.


even within the Transportation Corps asto whether this or an ice-activated systemwas desirable but officially the Transpor-tation Corps in December 1942 recom-mended installation of ice-activated sys-tems and "declined to accept responsibil-ity" for the performance of Mountain Airesystems. Despite this "veiled threat," theSurgeon General's Office requested thatMountain Aire equipment be installedin all ward and ward dressing cars. SOSheadquarters resolved this deadlock bydirecting the Chief of Transportation toinstall air-conditioning equipment in allcars and by allowing him to determinethe type of equipment that would meetperformance requirements recommendedby The Surgeon General.44 After theTransportation Corps and the MedicalDepartment agreed upon desirable per-formance standards, the former in thespring of 1943 had ice-activated air-con-ditioning equipment installed in the wardand ward dressing cars which had beendelivered during 1941 and 1942. The in-stallation of such equipment in hospitalcars ordered after the fall of 1942 raisedno problem, because they were procuredwith the air-conditioning systems nor-mally used by companies supplying thecars—some mechanical and some ice-ac-tivated.45 Later, during 1945, the Moun-tain Aire system was removed from thecar in which it had been installed and wasreplaced with an ice-activated system.46

Toward the end of the war the Transpor-tation Corps as well as the Surgeon Gen-eral's Office came to prefer mechanicalair-conditioning systems, because of thedifficulty of icing cars en route and thefear of ice shortages, but they considered achange undesirable at that time lest itdelay completion of additional cars beingordered.47

Disagreement About the Typeand Number of Cars

Soon after the Surgeon General's Officefirst requested air-conditioning for hospi-tal cars, SOS headquarters raised thequestion of whether those being procuredwere of the proper type and number. Atthat time neither the Surgeon General'sOffice nor SOS headquarters had had ex-perience in the operation of hospital trainsduring World War II. Moreover, with themajority of troops still in training in theUnited States, the ultimate strength oftheaters of operations and the number ofcasualties to be returned to the zone of in-terior were not yet fully envisioned. Norwas the strain which the war was to puton commercial transportation entirelycomprehended. Nevertheless, officers con-cerned with secret planning for the NorthAfrican invasion were anticipating thereception of casualties from that opera-tion, and those intimately involved intransportation problems were beginningto 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, with2 inds. SG: 453.-1. (2) Memo, CofT (Rail Div) forSGO (Lt Col J. B. Klopp), 12 Dec 42, sub: MountainAire 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 BdSGO, "Hosp Tns, Air Conditioning."

45 (1) Memo, CofT (Rail Div) for SG (Col J. B.Klopp), 4 Feb 43, sub: Air Conditioning for HospCars, with incl "Mil Characteristics of Air Condition-ing for Hosp Cars." SG: 453.-1. (2) Ltr, CofT forCGs 1st, 2d, 3d, 4th, 8th, and 9th SvCs, 10 Feb 43,sub: Air Conditioning of Hosp Cars. TC: 531.4 (HospCars).

46 (1) Memo, CofT for SG, 21 Nov 44, sub: AirConditioning on Ward Dressing Car 89002. SG:453.1. (2) Memo, CofT (Rail Div) for Procmt DivOCT, Cincinnati, 13 Mar 45, sub: Cooling Syst onHosp Car 89002. TC: 531.4.

47 Memo, Sup Div OCT to Rail Div OCT, 19 Jan45. TC: 531.4.


railroads would encounter in meetingtransportation needs of both the civilianpopulation and the armed forces. In thisatmosphere the Assistant Chief of Staff forOperations of SOS headquarters, to whoseHospitalization and Evacuation Branch aMedical Corps officer, Lt. Col. William C.Keller, had recently been assigned for thepurpose of advising on rail evacuation,issued a directive on 23 July 1942 that pro-voked a re-examination of the hospitaltrain program. It called upon the Engi-neers to develop a new type of hospitalcar, called a rail ambulance car, and sug-gested that twenty-seven of them—threefor 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 wereof an unsatisfactory type because they hadto be supplemented with commercial Pull-mans, sleepers, diners, and baggage cars,and second, that available railway facili-ties would be inadequate when patientsbegan to arrive from theaters in largenumbers. The proposed car was to havespaces for twenty to thirty-three patients,depending upon whether berths were two-or three-tiered; quarters for medical at-tendants, including one officer, one nurse,and four enlisted men; kitchen facilitiescapable of feeding both patients and at-tendants; and a dressing room and phar-macy. Because of a developing shortage ofPullman cars and tourist sleepers, loungecars were to be used for conversion. Eachlounge car thus converted would decreasedemands of the Medical Department forcommercial sleepers and would, at thesame time, relieve the railway dining serv-ice of some of its load. From seven toeighteen cars of this type could make upcomplete hospital trains; or single cars, at-

tached to regularly scheduled trains, couldmove patients in small groups.48

The Surgeon General objected both tothe proposed type of car and to the sug-gestion that additional hospital cars wereneeded. He pointed out that small num-bers of patients could still be moved inPullman cars of regularly scheduled trains.For the mass movement of patients he pre-ferred a complete train made up of gov-ernment-owned ward and ward dressingcars and commercial baggage, sleeping,and dining cars to one consisting entirelyof government-owned rail ambulancecars. A train of the latter type, he con-tended, was wasteful of both personneland equipment. One having 10 cars wouldhave 10 dressing rooms and 10 kitchensand would require 10 officers, 10 nurses,and 40 enlisted men. The Surgeon Gen-eral stated that patients were not put ontrains until doctors felt reasonably surethat they would need little treatment intransit. Hence so many dressing roomswere not needed. Moreover, he believedthat regular dining car service could beused for feeding patients either in Pull-man cars of regularly scheduled trains orin the cars of complete hospital trains. Inhis opinion the transportation of sick andwounded would rate so high a prioritythat the Medical Department wouldalways be able to get sufficient com-mercial cars for its use. Furthermore, theSurgeon General's Office opposed the useof three-tiered berths because it was diffi-cult to get litter patients into the top one.49

48 (1) Memo SPOPM 370.05, ACofS for Oprs SOSfor CofEngrs thru SG, 23 Jul 42, sub: Proposed RailAmb Car. SG: 322.2-5.

49 1st ind. SG to CofEngrs, 1 Aug 42, on MemoSPOPM 370.05, ACofS for Oprs SOS for CofEngrsthru SG, 23 Jul 42, sub: Proposed Rail Amb Car; also2d ind, CofEngrs to CG SOS thru SG, 24 Aug 42; and3d ind, SG to CG SOS, 29 Aug 42 (init Col H. T.Wickert). SG: 322.2-5.


After first stating that the eight hospi-tal trains which his Office had plannedwould be sufficient, The Surgeon Generalreviewed requirements about a monthand a half later and concluded in Octo-ber 1942 that additional trains would beneeded. On the basis of four litter patientsper 1,000 troops per month from a totaloverseas strength of 2,500,000, he esti-mated that 10,000 litter patients wouldhave to be moved from ports to hospitalseach month. The eight trains (twenty-fourcars) already planned, making three1,000-mile trips per month, could move2,160 litter patients per month. For theremainder, The Surgeon General esti-mated that thirty-two additional hospitaltrains would be needed. He recom-mended, therefore, that instead of railambulance cars thirty-two ward dressingcars and sixty-four ward cars be pro-cured.50 This recommendation, as well astypes of hospital cars in general, was dis-cussed on 9 October 1942 in a conferenceof representatives of the Surgeon General'sOffice, the Engineers, the TransportationCorps, and the SOS Hospitalization andEvacuation Branch.51 The Surgeon Gen-eral later expressed the belief that thisconference had settled the issue in favor ofward and ward dressing cars.

Before giving The Surgeon General'srecommendations formal approval, SOSheadquarters asked the TransportationCorps about the prospective availabilityof commercial diners and sleepers. In thisconnection it called attention to WorldWar I experience, especially to difficultiesin feeding patients.52 In reply the Trans-portation Corps emphasized the burdenalready placed upon commercial diningcar service by wartime travel and troopmovements and, in addition, raised a newpoint. Instead of using one ward dressing

and two ward cars as the nucleus of acomplete hospital train, the Transporta-tion Corps proposed that one rail ambu-lance car be used for that purpose. If thisshould be done only 32 hospital carswould be needed, instead of 96, and theremaining 64 cars could be used for regu-lar troop movements.53 It seems that theTransportation Corps believed that com-mercial dining cars would not be availablein sufficient numbers but that Pullmanand tourist sleepers would. SOS head-quarters therefore decided not to approveThe Surgeon General's recommendation,but directed the Engineers instead to pro-cure thirty-two self-contained rail ambu-lance cars.54

The Surgeon General's Office, which"considered the controversial matter [ofthe types and numbers of hospital cars re-quired] finally settled" by the 9 October1942 conference, was displeased with thisaction and on 18 November asked foranother conference "to arrive at a com-plete and final decision." 55 During thatmeeting The Surgeon General's repre-sentative stated that he preferred ward

50 4th ind SPOPH 322.15, ACofS for Oprs SOS toSG, 25 Sep 42; 5th ind SPMCP 322.2-5, SG to CGSOS, 10 Oct 42, on Memo SPOPM 370.05, ACofSfor 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 TnEquip. SG: 453.-1.

52 Memo SPOPH 322.15, CG SOS for CofT, 22Oct 42, sub: Rail Amb Cars. TC: 531.4.

53 (1) Memo, Mvmts Div OCT for Maj GenC[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 AmbCars. Same file.

54 6th ind SPOPH 370.05, ACofS for Oprs SOS toCofEngrs thru SG, 6 Nov 42, on Memo SPOPM370.05, 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), 16Nov 42. HD: Wilson files, "Diary." (2) Memo, SGfor CG SOS, 18 Nov 42. HRS: Hq ASF Control Divfile, "Evac."


and ward dressing cars, regardless of thenumber procured, to rail ambulance cars.In addition the Surgeon General's Officewent on record as preferring to feed pa-tients from kitchens improvised in railwaybaggage cars, if diners should not be avail-able, rather than to agree to the procure-ment of rail ambulance cars. After thisconference SOS headquarters reversed itsdecision and on 24 November directed theTransportation Corps to procure not lessthan forty and, if practical, as many asninety-six ward and ward dressing cars.Contracts for the higher number were letin January 1943.56 (See Table 17.)

Development of a Hospital Trainfor Overseas Use

In the course of discussions about thenumbers and types of hospital cars neededfor the zone of interior, the question oftrains for theaters of operations came up.Before mid-1942 the Engineers hadswitched from a 20- to a 40-ton car as thestandard for overseas military trains. Afterstudying blueprints and proposals for 40-ton cars, the Surgeon General's Office andthe SOS Hospitalization and EvacuationBranch agreed in August 1942 to use themin hospital trains built for theaters of oper-ations.57 Following Medical Departmentrecommendations, the Engineers com-pleted preliminary drawings and specifi-cations for a combat-zone hospital train oftwenty-one 40-ton cars (operating, per-sonnel, kitchen, and ward cars) by the endof November 1942. The Surgeon General'sOffice then suggested changes in the pro-posed specifications and in January 1943recommended to the Chief of Transporta-tion that one train of 40-ton cars shouldbe constructed immediately for servicetesting and that all trains included in theArmy supply program should be procured

as soon as possible after completion of suchtests.58

In February 1943 the Army supply pro-gram included forty overseas hospitaltrains of twenty-one cars each for procure-ment in 1943 and 1944, but none hadbeen ordered and SOS headquartersdoubted that these figures actually repre-sented requirements. The SOS Hospi-talization and Evacuation Branch there-fore conferred on 18 February 1943 withrepresentatives of the SOS RequirementsDivision, the Surgeon General's Office,and the Transportation Corps. The Sur-geon General's representative informedSOS headquarters that only fifteen over-seas trains would be needed in 1943 andfive more in 1944. On 23 February 1943SOS headquarters directed TransportationCorps to procure that number, plus oneadditional train of ten cars for experi-mental and training purposes. Soon after-ward the War Department learned thatthe European theater was procuringtwenty-three hospital trains in the UnitedKingdom and on 8 April 1943 the Sur-geon General's Office requested the Trans-portation Corps to have only the experi-mental train constructed.59

56 (1) Memo SPAOG 370.05, ACofS for Oprs SOSfor CofT, 24 Nov 42, sub: Ward Cars (Med). TC:531.4. (2) Memo SPMC 322.2-5, SG for CG SOS, 25Nov 42. Same file.

57 (1) Diary, SOS Hosp and Evac Br (Keller), 6-7Aug 42. HD: Wilson files, "Diary." (2) Memo, ACofSfor Oprs SOS for CofT, 10 Aug 42, sub: Conf on RailEvac. HD: Wilson files, "Book I, 26 Mar 42-26 Sep42."

58 2d ind. SG to CofT (Rail Div), 8 Jan 43, onMemo, Engr Bd for CofT (Rail Div), 30 Nov 42, sub:Lightweight, Combat Zone, Hosp Tn, with 10 draw-ings and 10 specifications. SG: 453.-1.

59 (1) Memo, SOS Reqmts Div for SOS Plans DivHosp and Evac Br, 11 Feb 43, sub: Hosp Cars, withMemo 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 forTng Purposes, with 2 inds. SG: 453.-1.


During the latter half of 1943 this trainwas completed and exhibited to the publicon a cross-country trip. It was then usedfor the evacuation of patients from theCalifornia-Arizona Maneuver Area, re-turned to Hampton Roads for two testruns, sent to Camp Ellis (Illinois) for use intraining hospital train units, returned tothe manufacturer for the correction ofdeficiencies, and displayed as a part of theFifth War Bond Drive in New York City.Complaints about the mechanical aspectsof the train were numerous, but the mostimportant from the viewpoint of patientevacuation were that the ward cars werepoorly ventilated, crowded even whenthey carried a normal load of patients (six-teen in each car), and uncomfortablyrough even at speeds of less than thirty-five miles per hour.60 Finding no furtherneed for this train in the United States, theTechnical Division of the Surgeon Gen-eral's Office in July 1944 drafted messagesin which the War Department queried theEuropean and North African theaters asto whether or not they could use it. Thelatter agreed to accept the train and inSeptember 1944 it was taken to HamptonRoads for shipment to southern France.61

Improvement of Existing Carsand Procurement of Kitchen Cars

In late 1942 and the first half of 1943,while the types and numbers of hospitalcars needed for the zone of interior werebeing discussed and the program for trainsfor theaters was being re-examined, ex-perience made it possible to evaluate thehospital unit, ward, and ward dressingcars. The unit cars had proved to be oflittle use, for reasons already explained.Ward and ward dressing cars appeared tofulfill their purposes and required only

minor modification, such as the installa-tion of storage lockers, floor lights, bulle-tin boards, and bedside holders for pa-tients' food trays. These changes wereincorporated in specifications for new cars.They were also made in the ward andward dressing cars already delivered.62

Two major problems in the operation ofhospital trains appeared: safeguardingneuropsychiatric patients during transitand feeding patients and medical at-tendants from commercial diners. Hospitaltrain commanders found that in trans-porting mentally disturbed patients eitherrestraints and sedation had to be used oradditional attendants had to be assigned.As a partial solution to this problem, theyrecommended the use of wire screens insidecar windows.63 Throughout late 1943 andearly 1944, the Medical Department col-laborated with the Transportation Corpsand the Pullman Company in developinga standard screen to meet this need. It wasmade of heavy mesh wire and was de-signed to fit inside the windows of stand-ard tourist and Pullman cars. It was re-

60 (1) Memo, Col I. Sewell Morris, OCT for MvmtDiv OCT, 4 Nov 43, sub: Hosp Tn for Calif-Ariz Ma-neuver Area. HD: 453.1 (10-Car Hosp Tn, Overseas).(2) Ltr, CO 3d Hosp Tn to SG, 15 Dec 43. TC: 531.4.(3) Memo, CofT for SG, 20 Apr 44, sub: Ten-CarHosp Tn. . . . SG: 453.-1. (4) Ltr, CofT to SG, 4Apr 44, sub: Hosp Tn, Contract W-2789-tc-1201.TC: 531.4.

61 (1) Draft rad prepared by Tec Div SGO for dis-patch to ETO, 1 Jul 44. SG: 322 (Hosp Tn)H. (2)Weekly Diary, Tec Div SGO, 29 Jul-4 Aug 44. HD:453.1 (10-Car Hosp Tn, Overseas). (3) RoutingForms, AAR, 13 Sep 44. TC: 511 "Main 39595."

62 (1) Memo, SG for CofT, 4 Mar 43, sub: HospCar Changes. SG: 453.-1. (2) Memo SPTSY 453,CofT for SG, 8 Mar 43, sub: Hosp Cars, with Rpt ofInsp of Cars being Air-Conditioned. Off file, Researchand Dev Bd SGO, "Hosp Tns, Air Conditioning."

63 (1) Ltr, Hq 2d SvC to Hosp Tn No 2, Ft Mon-mouth, N.J., and Hosp Tn No 1, Tilton Gen Hosp, FtDix, N.J., 3 Apr 43, with 4 inds. SG: 322.2-5. (2) Seeother train reports, SG: 322.2-5 and TC: 531.4 (HospTn Mvmts).


movable and could be locked in place bymeans of the standard bunk key carriedby all Pullman porters. Issued on the basisof a set of thirty-two (enough for one car)for each hospital train, these guards werehelpful in preventing patients from hurt-ing themselves on car windows and fromattempting to escape.64

The feeding problem was more com-plicated. Train commanders were almostunanimous in complaints about difficul-ties of feeding patients from commercialdiners. These diners often failed to meetArmy standards of sanitation, carried nofoods for special diets, served meals thatbecame monotonous, provided midmorn-ing or midafternoon nourishment for pa-tients only at excessive costs, were not openfor meals for attendants on night duty, andwere often uncoupled at junction points,leaving both patients and attendantswithout meals for the remainder of theirjourneys.65 Moreover, the fear that diningcars would be unavailable for all needs—expressed by SOS headquarters and theTransportation Corps in the fall of 1942—was becoming a reality. The entire prob-lem was discussed in February 1943 in aseries of conferences on railway rates be-tween railroad officials and representa-tives of the Surgeon General's Office, theTransportation Corps, and the SOS Hos-pitalization and Evacuation Branch. Atthat time the railroads agreed to supplyhospital trains with dining cars or, if dinerswere not available, with baggage cars thatcould be used as kitchen cars.66 Soon after-ward the Transportation Corps asked theGeneral Staff for authority to converttwenty-one idle Coast Artillery kitchencars into hospital kitchen cars. Afterspending several months modifying andtesting one, the Medical Department andthe Transportation Corps decided that

they were too small and lightweight tooperate with fast passenger trains. In July1943, therefore, they agreed to seekauthority to procure forty kitchen cars ofthe type being built for use with trooptrains. Since cars in that number wouldprovide one kitchen car for each group ofthree ward and ward dressing cars—thesame ratio by which kitchen cars wereprovided for troop cars—ASF headquar-ters approved the request on 16 August1943. By December one hospital kitchencar was delivered for service testing, andthe remainder, incorporating minorchanges made as a result of this test, weredelivered during 1944.67 (See Table 17.)

Development of a "New-Type" Unit Car

Within two months after ASF head-quarters approved the procurement ofhospital kitchen cars and before all ward

64 (1) Ltr, SG (Tec Cmtee) to CG ASF (ReqmtsDiv), 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 WardCars. Same file. (3) Ltr, SG for CGs all SvCs, 26 Apr44, sub: Window Guards for Hosp Tns. SG: 453.1(SvCs).

65 Reports of hospital train movements are repletewith 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 Carriersto CofT (Tfc Control Div), 25 Jan 43, with incls. TC:531.4. (2) Diary, SOS Hosp and Evac Br (Keller),24-26 Feb 43. HD: Wilson files, "Diary." (3) Ltr, In-terterritorial Mil Cmtee Rail Carriers to SG, 6 Apr43. 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 ACofSOPD 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, samesub. SG: 453.1. (4) Memo, Dep Dir of Oprs ASF forCofT, 16 Aug 43, same sub. HD: Wilson files, "DayFile, Aug 43." (5) Rpt, 1247 SCSU for CG 2d SvC, 23Dec 43, sub: Rpt of USA Kitchen Car, 8731. Samefile.


and ward dressing cars already orderedhad been delivered, the Surgeon Gen-eral's Office in October 1943 requestedthat additional cars of still another typebe provided. The reason was that a changewas gradually being made in the distribu-tion of patients among general hospitals.Establishment of a policy of caring forpatients from theaters of operations in hos-pitals near their homes and designation ofparticular hospitals for the specializedtreatment of certain disabilities meantthat patients arriving on a single shipwould be distributed among many differ-ent general hospitals. For a time the prac-tice of sending a complete trainload ofpatients (from 200 to 300) to one generalhospital continued, and it was often neces-sary to retransfer patients to other hospi-tals. During the latter half of 1943, how-ever, the Second Service Command beganto try to send patients directly from thedebarkation hospital in New York to thegeneral hospitals in which they would re-ceive treatment. This was done by makingup trains in sections which could be cut offat intermediate points for routing to dif-ferent general hospitals. Each section con-sisted of a combination of ward cars, warddressing cars, and commercial sleepingcars. The chief difficulty encountered inthis practice was in feeding patients. Un-til kitchen cars were delivered, the entiretrain had to depend upon uncertain com-mercial dining car service. Even if kitchencars had been available, each section sep-arated from the main train would havestill been dependent upon commercialdining service.68 On 15 October 1943,therefore, the Surgeon General's Officerequested the Transportation Corps toprovide fifty "new type unit cars" by May1944. These cars, for which a sketch hadbeen drawn by the Hospital Construction

Branch, were to be similar to the rail am-bulance car designed by the Engineers inthe fall of 1942.69 They were to be used asparts of complete hospital trains; for sec-ondary movements from the main, or pri-mary routes of hospital trains; and for thetransportation of small groups of patientson nonhospital trains. Although ASFheadquarters had formerly advocated theuse of such cars, it replied in November1943 that no new developmental projectshould be started unless it was essential towinning the war and directed, as a prelim-inary step to further action on The Sur-geon General's request, an evaluation ofthe passenger traffic problem with partic-ular reference to the transportation ofpatients. The next month this headquar-ters modified its position by authorizingthe conversion of the two unit cars thathad been delivered to the Army in 1941into pilot models for the new type.70

Reappraisal of the Hospital Train Program

Before the pilot models were completedfor service testing, the Surgeon General'sOffice re-examined the entire hospitaltrain program. Early in 1944, it will berecalled, a group in this Office had com-pleted a detailed study of the anticipatedpatient load.71 It was estimated that30,000 patients per month would have tobe moved by train by October 1944 andthat at least 75 percent of them wouldhave 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. Seeabove, pp. 377-80.

70 Memo, SG for CofT, 18 Sep 43 (corrected 18 Oct43), sub: Unit Car, New Type, with 5 inds. TC: 531.4.

71 See above, pp. 323-25.


cars. Assuming that each car could carrytwenty-five patients per trip and couldmake four trips per month, 225 cars wouldbe needed. Since 120 were already avail-able or authorized, The Surgeon Generalrequested 105 additional hospital cars ofthe new unit type. At the same time heasked that buffet kitchens be installed inall ward and ward dressing cars. TheTransportation Corps agreed with TheSurgeon General as to the type of cars de-sired but believed, on the basis of a studyjust made, that as many as 200 additionalhospital cars would be needed. On 11April 1944 representatives of ASF head-quarters, the Surgeon General's Office,and the Transportation Corps agreed thatit would be quicker and more economicalto construct new cars than to try to leasecommercial cars for conversion. Two weekslater ASF headquarters approved boththe alteration of ward and ward dressingcars and the procurement of 100 new cars.Additional ones would not be authorized,it was stated, until military requirementsbecame "firmer." 72 Contracts for alteringold cars and building new ones were letwith the American Car and FoundryCompany in May 1944, and by late fall ofthat year cars of both types were ready fortrial runs.73

The new unit car was similar to the unitcar of World War I and to the rail ambu-lance car proposed in 1942 in that it hadspace for both patients and attendants aswell as facilities for caring for patients andfor feeding all passengers. It was differentin that it was built specifically as a hospi-tal car, instead of being converted fromexisting rolling stock, and was equipped"with every travel luxury." Ten feet longerthan Pullman cars, its body was of steeland was mounted on easy-riding six-wheeltrucks. At one end was a stainless steel

kitchen, with a refrigerator, an ice creamcabinet, a coal range, sinks, a steam table,and a coffee urn. Both the press and theArmy called this the "principal innovationin the new car." Next to the kitchen was apharmacy and receiving room, with widedoors on each side for loading litter pa-tients. This room could be used also as anemergency operating or dressing room.Adjoining it were two sets of three-tieredberths that could be used for seriously illpatients, for mental patients, or for medi-cal attendants. This section was separatedfrom the main ward by a sterilizer roomon one side of the car and a toilet andwashroom on the other. The main wardsection had a row of five three-tieredGlennan-type berths on each side. Theycould be adjusted to provide seating space,or the two lower berths could be used forlitter patients and the upper berth for am-bulatory patients or attendants. Betweenthe main ward and the vestibule werestorage lockers and a shower bath on oneside of the car, and a roomette each for anofficer and a nurse on the other. Each carwas carpeted, equipped with special light-ing fixtures, and air-conditioned.74 Al-though less luxurious and lacking specificaccommodations for doctors and nurses,hospital ward and ward dressing cars,after the installation of the kitchenettes inspace made available by removal of berthsfor four patients, could be used in much

72 Memo, SG for CG ASF, 30 Mar 44, sub: HospCars, 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 (ReqmtsDiv) for CG ASF (Dir of Mat), 14 Jun 44, sub: HospCars, 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) Fordetails of development see files SG: 453.1, TC: 531.4,and Off file, Research and Dev Bd SGO, "Hosp UnitCar."


WARD IN NEW HOSPITAL UNIT CAR, 1944 (note adjustable berths).

the same way as the new unit cars. Thusby the end of the war, the Medical De-partment had what were in effect only twotypes of hospital cars: unit cars andkitchen cars.

With development of the new unit carand modification of ward and ward dress-ing cars, a change occurred in hospitaltrain movements. Gradually the practicedeveloped of making up hospital trains fora number of destinations and of includingin them variable numbers of hospital carsin different combinations. Ordinarily, re-gardless of the inclusion of hospital carswith kitchen facilities, hospital kitchencars were used for feeding all patients solong as a number of hospital cars remainedattached to the train. This practice wasfollowed because it was more efficient to

prepare food in one place than in manydifferent places. All cars of a hospital traindid not proceed to the same destination.At "gateways" (railway junctions) sepa-rate cars were cut away from the mainroute and were attached to commercialtrains to carry loads of patients to differentdestinations. After delivering initial loads,cars were often diverted to transport addi-tional groups of patients from one generalhospital to another before being usedagain as parts of a complete hospital train.Whenever cars were separated from hos-pital trains, their buffet kitchens were usedto feed patients.75 Thus the hospital cars

75 (1) Rpts, Hosp Tn Conf, 15-16 Feb 45, MillerFld, SI, N.Y.; 10-13 Jul 45, Presidio of San Francisco.HD: 531.4 (Conf). (2) Records of hospital train move-ments, filed in OCT, Tfc Control Div, form OCT 145.


RECEIVING ROOM IN NEW HOSPITAL UNIT CAR, 1944

finally in use in World War II possessed anadaptability which permitted them to beused along with other cars to make up acomplete hospital train or singly to trans-port small groups of patients on commer-cial trains.

Procurement of Additional Hospital Cars

In the winter of 1944-45 the SurgeonGeneral's Office reviewed the anticipatedpatient load and re-estimated the hospitaland evacuation facilities that would berequired. On the assumption that V-EDay would occur in June 1945, it was esti-mated in December 1944 that the numberof patients returned to the United Stateseach month from January through August1945 would range from 32,000 to 36,000

and would decrease thereafter.76 A dropin the patient load would result in no lessneed for hospital cars, for after V-E Daythe major portion of patients would arriveat Pacific ports and a car operating fromone of them could make fewer round tripsand carry fewer patients per month, be-cause of the greater distance to generalhospitals, than could one from an Atlanticport. At the same time, railroads werefinding it increasingly difficult to supplythe Army with enough commercial cars ofthe desired type. To assure adequate num-bers of hospital cars, the Surgeon General'sOffice on 19 December 1944 asked for 100additional unit cars as soon as possible.ASF headquarters approved this request,

76 See above, pp. 327-28.


and contracts were let with the AmericanCar and Foundry Company in January1945.77 Meanwhile, it became apparentthat more kitchen cars would be neededbecause the increasing number andchanged type of hospital cars permittedthe operation of more than forty trains atone time. On 22 January 1945, The Sur-geon General requested the Transporta-tion Corps to procure twenty troop kitchencars from the Defense Plant Corporationfor use with hospital trains. This requestwas approved, and the twenty cars weredelivered within the next few months andput into use immediately, without signifi-cant alterations.78 (See Table 17.)

The peak of the patient load arrivingfrom theaters of operations came beforethe second group of 100 unit cars was de-livered. In May 1945, when the greatestnumber of patients in any single montharrived, the Army was using 120 old carsand 100 new unit cars, plus almost 60kitchen cars. During that month, 47,044patients were moved by train. This re-quired the use of 1,200 Pullman cars tosupplement government-owned cars.79

Thereafter, the number of patients de-clined rapidly and by late August 1945,when the last of the cars ordered in Janu-ary had been delivered, the Medical De-partment declared surplus thirty-six modi-fied ward and ward dressing cars. AfterV-J Day the decline in the patient loadpermitted the disposal of additional carsand by the middle of 1946 the MedicalDepartment retained only 100 unit cars.80

(See Table 17.)

Problems in Manning Hospital Trains

At the beginning of the war the MedicalDepartment had a table of organizationfor a hospital train unit. Revised early in

1942, it was reissued in April as Table ofOrganization 8-520. It provided for aself-sustaining unit to operate a completehospital train with a capacity of 360 pa-tients. To perform its own administrative,mess, and supply functions as well as tocare for patients, each unit was authorized4 Medical Corps officers, 6 nurses, and 33enlisted men.81 Eight such units were or-ganized between June 1942 and June1943, and for a short time there was con-fusion about their purpose both in SOSheadquarters and among service com-mands. In September 1942, on recom-mendation of the Surgeon General'sOffice, SOS headquarters made it clearthat such units were intended for servicein theaters of operations and were to beemployed in the United States on trainingtrips only.82

About the same time, there was concernabout attendants for patients being trans-ported by train in the United States. Afterthe North African invasion, casualties be-gan to arrive in increasing numbers. Fur-thermore, hospital cars which the Armyhad ordered early in 1942 were delivered

77 (1) History . . . Medical Regulating Service. . . , Tab 5, Hospital Trains. (2) Memo, SG for CGASF (Planning Div) thru CofT, 19 Dec 44, sub: HospCars, ZI, with ind. SG: 322.2-5. (3) Memo, ASFPlanning Div for ASF Reqmts and Stock Control Div,21 Dec 44, same sub. HRS: ASF Planning Div Pro-gram Br file, "Hosp and Evac."

78 (1) Memo, SG for CofT (Rail Div), 22 Jan 45,sub: MD Kitchen Cars. SG: 453.1. (2) Memo, MajR. 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 andRecords Section, Traffic Control Branch, PassengerDivision. OCT.

80 (1) Memos, SG for CofT (Mil Ry Serv), 27 Sep45, 27 Feb 46, and 2 Apr 46, sub: Release of SurplusHosp 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 Memofor Record, on Memo, CG 4th SvC for CG SOS, 29Aug 42, sub: Hosp Tn. AG: 322.38.


and in August the entire fleet of twenty-four were assigned to service commands.83

In discharging responsibility for manningthem, service commands encountereddifficulty in determining how many doc-tors, nurses, and enlisted men were needed.SOS directives instructed them to use as aguide Table of Organization 8-520, but itapplied to an entirely different situation.In the zone of interior hospital trains wereto be composed of three hospital cars sup-plemented with such common-carrierequipment as Pullmans, diners, and bag-gage cars. They carried varying numbersof patients and depended upon the rail-roads in the early part of the war for messservice. To supply service command sur-geons with a more appropriate guide, SOSheadquarters on 24 December 1942 di-rected The Surgeon General to prepare amanning table for zone of interior hospitaltrains. Submitted six days later, this tableindicated that 2 doctors, 1 nurse, and 14enlisted men were needed for 100 patients;2 doctors, 1 nurse, and 16 enlisted men for200 patients; 3 doctors, 1 nurse, and 19enlisted men for 300 patients; and 3 doc-tors, 1 nurse, and 21 enlisted men for 400patients. Soon afterward SOS headquar-ters directed the Second Service Com-mand—and presumably others—to usethis guide in requisitioning personnel foruse aboard hospital trains.84

As experience accumulated in transport-ing increasingly large numbers of patients,ASF headquarters in August 1943 issued anew guide—Table of Distribution 8-1520—which differed from the one pre-pared by the Surgeon General's Office inDecember 1942. Whereas the old guidehad covered groups of patients ranging byhundreds from 100 to 400, the new onecovered groups increasing by twenty-foursfrom 118 to 358. This change reflected the

growing tendency to send small groups ofpatients to different hospitals instead ofmaking mass movements from a port toone or two hospitals only. The old guidehad called for 2 doctors, 1 nurse, and 16enlisted men for 200 patients; the new onecalled for 3 doctors, 1 administrative offi-cer, 3 nurses, and 11 to 16 enlisted men for190.85 Despite a moderate increase in per-sonnel in the new guide, it proved inade-quate, at least in one service command,and was not followed. During the periodfrom 15 March 1944 through 12 May1944, seventeen hospital trains evacuatedpatients from Stark General Hospital inthe Fourth Service Command. Each car-ried an average of 190 patients and hadassigned as attendants an average of 6doctors, 3 administrative officers, 5 nurses,and 57 enlisted men.86 Presumably otherservice commands also were free to usemore attendants than the guide called for.

Another problem which service com-mands encountered was the manner inwhich train personnel should be handledadministratively. Until the middle of 1943all commands assigned such personnel tostation or general hospitals. Difficultiescaused by this procedure were illustratedby 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 Hospand Evac Oprs, with incl. AG: 704. (2) 2d ind, CGSOS to SG, 24 Dec 42, with Memo for Record; 3dind, SG to CG SOS, 30 Dec 42, with incl; and 4th ind,CG SOS to CG 2d SvC, 5 Jan 43, with Memo forRecord, on Memo, CG SOS for CG 2d SvC, 21 Nov42, 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 [4thSvC] for Maj Maxwell, 5 Jun 44, sub: Pers Reqmtsfor Hosp Tn. HD: 531.4 (Pers Reqmts). There is noindication in the document cited as to the organiza-tion to which Major Maxwell was assigned.


Command. For example, officers, nurses,and enlisted men used to operate one ofits trains were assigned to Halloran Gen-eral Hospital. This hospital assigned themto ward duties, maintained their records,paid them, and considered them adminis-tratively a part of the hospital staff. Inconsequence, nurses and enlisted menoften worked on wards until the departuretime of trains, without opportunities torest and prepare themselves for trips. Toget enlisted men released from ward dutiesfor train trips, the train commander hadto request the permission of the command-ing officer of the hospital medical detach-ment who, in turn, had to request permis-sion of the chief of the section for whomthese men worked in the hospital. Officerswho were assigned to wards lost contactwith patients they left behind while awayon train trips. Working part of the time inthe hospital and part on hospital trains,officers and enlisted men found it difficultto demonstrate to hospital authorities theirfitness for promotion and were oftenpassed over when promotions were made.Enlisted men who were absent from thehospital on paydays failed to receive theirpay and, unless paid on a supplementalpayroll, had to await the next regular pay-day a month later. The hospital consid-ered this situation just as unsatisfactory asdid the train commander because it hadofficers, nurses, and enlisted men uponwhom it could not always depend for hos-pital service. Nevertheless this system keptall personnel fully occupied in the inter-vals between train movements, and per-haps some of the problems connected withit could have been solved by minor admin-istrative changes. The Second ServiceCommand however adopted a differentsolution by requisitioning additional per-sonnel for train operations and assigning

it, along with that already available, to aseparate unit, the 1247th Service Com-mand Service Unit.87

During 1944 other service commandsfollowed this example. The organizationof train units that were separate from hos-pital detachments was discussed at a serv-ice commanders' conference in February1944 and was indorsed by the command-ing general of the Service Forces. After-ward, in July 1944, the First, Third, andNinth Service Commands organized sepa-rate train units. At least one of them, theFirst, placed its train unit under the directcontrol of the service command surgeon inthe spring of 1945. The Fourth ServiceCommand followed a different procedure.In September 1944 a receiving and evacu-ation detachment, consisting of litterbearers and clerks as well as train person-nel, was organized at Stark General Hos-pital.88 The organization of separate units,if their members were kept fully occupied,was superior to the use of hospital person-nel for train service, since it simplifiedadministration in all respects.

Service command surgeons encountereddifficulty in getting adequate personnelallotments for train operations. Havingestimates of the potential patient load, theSurgeon General's Office attempted earlyin 1944 to forestall this difficulty. In Aprilit submitted to ASF headquarters an esti-mate of medical attendants needed byeach service command during 1944 fortrain operations. ASF headquarters took

87 (1) Rpt, Hosp Tn 1, Halloran Gen Hosp to CG2d SvC ASF (Med Br Sup Div), 5 May 43, sub: Rptof Hosp Tn Mvmt, HT 16-21-1-11, Main 24025,27-28 Apr 43, with Supp. SG: 531.4. (2) An Rpt, 2dSvC, 1943. HD.

88 (1) Rpt, Conf CGs of SvCs, Dallas, Tex, 17-19Feb 44. HD: 337. (2) An Rpts, 1st and 9th SvCs, Mc-Guire and Stark Gen Hosps, 1944, HD. (3) GO 49,14 Apr 45, Hq ASF, 1st SvC, Boston. HD: 531.4.


the position that service commands shoulddetermine their own needs and shouldsubmit requisitions accordingly.89 Underthis system, service command surgeonsapparently failed to get the strength actu-ally needed for train operations. For ex-ample, at the end of 1944 the surgeon ofthe Second Service Command had anallotment of 589 for assignment to hospitaltrains, but used 1,175. To make up the dif-ference, he attached to trains 586 personsfrom other medical installations in thecommand. The Surgeon General discussedthis problem with the Chief of Staff at theend of 1944. As a result service commandsgot additional personnel. For example, thenumber assigned to train service in theSecond Service Command increased byMay 1945 to 1,322—58 physicians, 1 den-tist, 75 other officers, 91 nurses, 1,053enlisted men, and 44 civilians.90

Supplies and Equipmentfor Hospital Trains

Equipment for the care and comfort ofpatients on hospital trains had to beplanned for each hospital car developed,and consideration had to be given to bal-ancing the necessity of items for medicaluse against the limited amount of spaceavailable. Hence, large items of equipmentthat were fixed parts of hospital cars, suchas berths, instrument cabinets, storagelockers, instrument sterilizers, bedpanwashers and sterilizers, cooking ranges,refrigerators, coffee urns, and the like,were planned along with cars in whichthey were to be installed and became apart of the specifications for their construc-tion. Builders of hospital cars normallyprocured and installed such items, but insome instances the Medical Departmentprocured certain special ones, such as in-

strument sterilizers and operating tables,for installation by builders.91

Supplies and items of equipment thatwere not fixed parts of hospital cars werelisted in tables of allowances and in Medi-cal Department equipment lists. The lat-ter were the more important, becausehospital cars carried few items supplied byservices other than the Medical Depart-ment. By the fall of 1940, when procure-ment of the first two unit cars was ap-proved, the Surgeon General's Office haddeveloped an equipment list for cars ofthat type. Like other Medical Departmentequipment lists, it included such items asdrugs and biologicals, gauzes and band-ages, surgical instruments, linens, officesupplies, and mess equipment.92 Later, in1942, when ward and ward dressing cars

89 (1) Memo, Dep Dir Plans and Oprs ASF for DirPers ASF, 26 Apr 44, sub: Reqmts for Med Pers toCover Rail Mvmts . . . , with incl. HRS: ASF Plan-ning Div Program Br file, "Hosp and Evac, vol. 3."(2) Memo, Dep Dir Plans and Oprs ASF for DepCofSfor SvCs ASF, 8 May 44, sub: Est of Numbers of Sickand Wounded Arriving from Overseas, with incl.Same file.

90 (1) History, Office of the Surgeon, Second CorpsArea and Second Service Command From 9 Septem-ber 1940 to 2 September 1945. HD. (2) Notes for GenKirk on Conf with Gen Marshall, Summary: 25 Dec44. HD: 024 (Resources Anal Div, Jul-Dec 44).

91 (1) Gen Specifications for Hosp Unit Cars forWD, 4 Jun 40. TC: 453. (2) Rpt of MD Bd, Med FldServ Sch, 27 Aug 40. SG: 453.-1. (3) 1st ind, SG toMSO Carlisle Barracks, Pa., 10 Apr 41, on Ltr, MSOCarlisle Barracks, Pa., to SG, 7 Apr 41, sub: Car,Railroad, Hosp Unit, Unit Car No 2. Off file, Re-search and Dev Bd, SGO, "Hosp Unit Cars." (4)Specifications for Remodeling 18 Pullman ParlorCars to Hosp Ward Cars for the WD, 30 Jan 42. Offfile, Research and Dev Bd, SGO, "Hosp Ward Car."(5) TC US Army Specification No TC-3066, 8 May44, Construction of Car, Hospital. Off file, Researchand Dev Bd, SGO, "Unit Car, New Type." (6) Ltr,SG to CO Hosp Tn SCSU 1247, 27 Jun 45, sub: Steri-lizers 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.


were developed, equipment lists were pre-pared for them also, and when their de-livery was expected in the spring of thatyear the Surgeon General's Office re-quested SOS headquarters to approve theinclusion of assemblages, packed accord-ing to these lists, as authorized items intables of allowances for hospital cars.Approval was given, and these lists be-came the official basis for the issuance ofequipment and supplies to ward and warddressing cars when they were first deliv-ered to the Army in the late summer of1942.93

These early equipment lists were neces-sarily theoretical in nature, because theMedical Department had had no experi-ence, when they were prepared, in oper-ating hospital cars of the types developedduring World War II. In 1943 they wererevised. Subsequently, as experience ac-cumulated, hospital train commandersproposed further revisions. Their recom-mendations were at variance with one an-other, and the Surgeon General's Officehad difficulty in deciding which toaccept.94 Hence, at a hospital train com-manders' conference in February 1945, arepresentative of the Surgeon General'sTechnical Division distributed a tentativeequipment list, based upon recommenda-tions already submitted, for considerationby officers who were responsible for thecare of patients aboard hospital trains.After discussing the items listed, traincommanders and The Surgeon General'srepresentative agreed upon which shouldbe retained, deleted, or added.95 Newequipment lists for ward, ward dressing,unit, and kitchen cars were then pub-lished in March 1945.96 Several monthslater it appeared that train commanderswere dissatisfied with the supplies andequipment agreed upon and at a confer-

ence in July 1945 they proposed changes.Some, such as in the substitution of twelvebath towels for twelve hand towels, theSurgeon General's Office approved.Others it refused to authorize because TheSurgeon General insisted upon retainingin all hospital cars enough equipment ofcertain types, such as surgical instruments,to provide for emergencies or accidentsthat might occur as well as for the routinecare of patients en route.97

In addition to revising equipment lists,the Surgeon General's Office either devel-oped new items or permitted hospital traincommanders to do so. For example, upona recommendation of the Fourth ServiceCommand, the Surgeon General's Officein 1944 developed a better mattress of adifferent size for use on hospital trains.98

Accepting a suggestion from the SecondService Command, it soon afterward de-veloped an adjustable back rest. This itemcontributed to the comfort of patients byenabling them to change positions while

93 (1) Memo, Lt Col Thomas N. Page for Lt ColGriffin and Lt Col Hays, 20 Apr 42. Off file, Researchand Dev Bd, SGO, "Hosp Ward Cars." (2) Ltr, SG toReqmts Div SOS, 10 May 42, sub: Med Equip forHosp Tn, with ind. SG: 453.-1. (3) Memo, CG SOSfor 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 toSG, 2 Oct 43, sub: Changes to Med Equip, Ward andUnit Cars. SG: 453.-1. (2) Diary, Tec Div SGO, 25Nov-1 Dec 44. HD. (3) Memo, Post Sup Off [StarkGen Hosp] to SG, 21 Jan 45, sub: Mess Equip onHosp 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, 27Mar 45.

97 (1) Transcribed Mins of Hosp Tn Unit Comdrs'Conf, 10-13 Jul 45. HD. (2) Memo, Capt George R.Allen for Dir Tec Div SGO, 30 Jul 45. Off file, Re-search and Dev Bd SGO, "Unit Car, New Type."

98 (1) Diary, Tec Div SGO, 3-9 Jun 44, 25 Aug-1Sep 44. HD. (2) Transcript of Proceedings, Hosp TnConf, 15-16 Feb 45. HD.


in train berths.99 Another example of newequipment was the bath tray. Fitting onthe sides of hospital berths, this tray sim-plified the work of nurses in bathing pa-tients in bed. It was first put in use by theSecond Service Command in the latterpart of 1944. The Surgeon General's Of-fice adopted the idea and began a devel-opment project for such a tray but the warended before it was standardized.100

Items included in the equipment lists ofhospital cars were considered to be theminimum in type and quantity that shouldbe kept aboard at all times. Hence, hospi-tal car commanders were authorized todraw equipment and supplies, to replacethose used, from any medical supply of-ficer in the United States. Normally, how-ever, home stations made replacements.101

To avoid bookkeeping, linen was ex-changed on an item-for-item basis. Regu-lations early in the war required hospitalsto exchange linen with hospital trainswhen patients were transferred to theircontrol. It happened frequently that suchexchange either delayed train schedules

or was not made at all. At the train com-manders' conference in February 1945,therefore, it was decided that the exchangeof soiled for clean linen would normally bedeferred until the end of a trip or untilpoints were reached at which trainsstopped for lengthy periods. In cases wheresoiled linen was not replaced by one of thehospitals to which patients were delivered,that hospital furnished a receipt for thelinen it received so that train commanderscould draw clean linen from general hos-pitals at the ends of trips.102

99 (1) Ltr, SG to CO 2d SvC Hosp Tns 1247thSCSU, 11 Sep 44, sub: Back Rests. SG: 442.7 (2dSvC)AA. (2) Diary, Tec Div SGO, 28 Apr-4 May45. HD.

100 (1) Ltr, Chief Hosp and Evac Br 2d SvC to CGASF attn SG, 14 Oct 44, sub: Hosp Tns, with incl.SG: 700.7-2. (2) Ltr, SG to CO 2d SvC Hosp Tns1247th 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 andMemo for Record. HRS: Hq ASF Planning Div Pro-gram Br file, 370.05 "Hosp and Evac." (2) Transcriptof Proceedings, Hosp Tn Conf, 15-16 Feb 45. HD.

CHAPTER XXIII

Providing the Means forEvacuation by Sea

Most of the patients evacuated fromtheaters of operations to the zone of in-terior were transported in surface vessels.It is therefore important to consider in thefollowing discussion the types of vesselsused, reasons for their employment, andproblems encountered in suiting them tothe transportation of patients, along withdifficulties in furnishing such vessels withthe supplies, equipment, and attendantsrequired for the care of patients en route.

Ships' Hospitals and Hospital Ships

At the beginning of 1939 the Army hadfour transports in which to return patientsfrom overseas bases, such as Hawaii andthe Philippines. With the expansion of ex-isting bases and the establishment of newones in the Atlantic during 1939 and 1940,additional transports were added to theArmy's fleet, and efforts were made to en-large and improve their hospital facilities.These efforts were only partially success-ful, because funds for such work werelimited. Furthermore, the ships themselveswere too old to warrant extensive altera-tions, and the speed with which some wereput into transport service left no time formajor changes.1 In view of this situation aswell as the probability that large numbersof patients would be evacuated in subse-

quent months, the New York Port of Em-barkation proposed in the fall of 1940 thatthe U.S. Army Transport Chateau Thierryshould be converted into a part-time hos-pital ship, to carry freight and troops onoutbound voyages and return with fullloads of patients.2 On recommendation ofthe chief of his Hospital Construction Sub-division, The Surgeon General disap-proved, stating that the proposed trans-port was not suitable for conversion, thatits use would violate the terms of the

1 The United States Army Transports U. S. Grant,St. Mihiel, Chateau Thierry, and Republic had been inalmost continuous service since World War I. TheHunter Liggett, Leonard Wood, and American Legion wereadded in 1939. Others added to meet Army expan-sion needs were the Irwin, Kent, Munargo, Orizaba, andPresident Roosevelt (Joseph T. Dickman.) For their his-tories, see Roland W. Charles, Troopships of World WarII (Washington, 1947), pp. 1-68. Information onproblems of providing hospital facilities on these shipsmay 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' reportsattached to voyage reports filed in TC: 721.1 . Also seeChester Wardlow, The Transportation Corps: Responsi-bilities, Organization, and Operations (Washington,1951), pp. 136-44. in UNITED STATES ARMY INWORLD WAR II.

2 (1) Ltr, Supt ATS NYPE to QMG thru CONYPE, 27 Sep 40, with 1st ind. TC: 632 (ChateauThierry). (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 Nov40, 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 andthat its employment in the evacuation ofsmall numbers of patients from scatteredareas would be uneconomical. He recom-mended instead that "the idea of develop-ing a hospital ship be given further study,"and that the Army continue to use trans-ports for the evacuation of its sick andwounded from overseas areas.4

During 1941 the question of whether ornot hospital ships would be provided re-mained unanswered. The question alsoarose of whether the Army or the Navywould be responsible for the evacuation ofArmy patients. Existing plans called forthe control of all water transportation bythe Navy beginning on M-Day (Mobili-zation Day), and during the early part of1941, under policies announced by thePresident, the Navy began to take overArmy transports on which hospital areashad been enlarged and improved. Dis-turbed by this loss to the Navy of evacua-tion space and fearing a repetition ofWorld War I experiences, when the Navyfailed to evacuate patients to the satisfac-tion of the Army, the surgeon of the NewYork Port in October 1941 proposed thata hospital ship should be provided for theArmy.5 Reaction in Washington wasmixed. Some officers in the G-4 Divisionof the General Staff, in the Office of TheQuartermaster General, and in the Sur-geon General's Office were favorably im-pressed; but the chief of the Surgeon Gen-eral's Hospital Construction Subdivisiondoubted "the wisdom and productivity ofthis proposal." 6 In transmitting it to theGeneral Staff, The Surgeon General askedfor decisions as to the policy on evacuationand as to whether the Army or the Navywould be responsible for transporting theArmy's patients.7 The Japanese attack onPearl Harbor occurred before further ac-

tion was taken on the New York Port'sproposal.

Basic Decisionson Water Evacuation in 1942

Entry of the United States into the warmade necessary both immediate and long-range plans for facilities for the evacuationof patients from theaters of operations. Anagreement between the Army and Navysoon after Pearl Harbor for the Army tocontinue to operate transports despite pre-war plans to the contrary partially solvedthis problem,8 for the Army could con-tinue to evacuate patients aboard them.Other questions remained to be answered:(1) whether or not hospital ships would be

3 The Geneva Conventions of 1864, 1906, and1929 established principles for belligerents to followin the care, treatment, and transportation of the sickand wounded of land warfare; the Hague Conven-tions of 1899, 1904, and 1907 adapted to maritimewarfare the provisions of the Geneva Conventions.The Hague Convention of 1907 was signed by therepresentatives of forty-three countries, among themthe United States, China, France, Great Britain, Ger-many, Italy, and Japan. In 1942 the Medical Depart-ment published an article on the Conventions, alongwith copies of their texts. Albert G. Love, "TheGeneva Red Cross Movement: European and Amer-ican Influence on its Development," Army MedicalBulletin, No. 62 (1942).

4 (1) Memo, Lt Col John R. Hall, SGO, for Plan-ning and Tng Div SGO, 10 Dec 40, sub: Conv ofUSAT Chateau Thierry into a Hosp Trans Ship. (2)2d ind, SG to QMG, 28 Dec 40, on Ltr, CG NYPEto QMG, 26 Nov 40, sub: Inadequate Hosp Fac onTrans. Both in SG: 632.-1 (Chateau Thierry)BB.

5 (1) Ltr, Surg NYPE to SG thru CG NYPE, 29Oct 41, sub: Hosp Ships, with 4 incls. HRS: G-4/29717-100. (2) Memo, ACofS G-4 WDGS for ACofSWPD WDGS, 19 Nov 41, sub: Trf of ATS to Navy.HRS: G-4/29717-51.

6 Memos, Col A[rthur] B. Welsh for Col [HowardT.] Wickert, undated; Col Wickert for Cols [HarryD.] Offutt and [John R.] Hall, 7 Nov 41, sub: HospShips. 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.


used, and (2) if so, the extent to whichthey would be used and whether or notthe Army or Navy would control them.

Opinions on these points differed dur-ing the first half of 1942. General Head-quarters approved the use of both trans-ports and hospital ships for evacuation,but believing that the enemy would notrespect the terms of the Hague Conven-tion granting hospital ships immunityfrom attack, GHQ recommended that allplans for evacuation should be preparedwith that probability in mind. GHQ alsorecommended that a decision be soughton whether the Army or Navy wouldoperate hospital ships.9 Taking the posi-tion that transports could be used forevacuation from areas with ample ship-ping, as demonstrated in World War I,The Surgeon General recommended acontinuation of that method for all largetheaters; but because of disruption by thewar of peacetime transport schedules, henow proposed that two hospital ships (onefor the Atlantic and one for the Pacific)should be provided for the evacuation ofpatients from small scattered bases. Hemade the latter recommendation contin-gent upon respect by the Axis Powers forthe terms of the Hague Convention—theprimary consideration, in his opinion, inany decision to use hospital ships. TheSurgeon General also announced that hepreferred to evacuate Army patients inships operated solely under Army control.In any case, he wanted no division of re-sponsibility. The agency responsible foroperating ships for evacuation should beresponsible also, in his opinion, for themedical care and administrative controlof patients aboard them.10 The Quarter-master General recommended the con-version of two Army transports into vesselsthat could be used either as hospital ships

or as ambulance transports. If employedin the latter capacity they could be oper-ated by the Army Transport Service andwould sail under convoy, carrying troopson outbound voyages and returning fullloads of patients to the United States.11 Agroup of officers in G-4, most of whomwere later transferred to SOS headquar-ters and among whom was a MedicalCorps officer (Maj. William L. Wilson),maintained that Convention-protectedhospital ships—at least six—should beused in addition to transports to evacuateArmy patients from major theaters despiteuncertainty about the attitude of the AxisPowers toward the Convention. Further-more, having ascertained that the Navyhad no plans for providing hospital shipsfor the Army and being convinced byWorld War I history of the futility of de-pending upon the Navy for evacuation,this group wanted the Army both to ownand to operate the vessels procured for useas hospital ships.12

In the first half of 1942 the G-4 grouppressed for approval of its plans. After theBureau of the Budget disapproved sup-plemental estimates for funds for six hos-pital ships submitted in January 1942,because the Maritime Commission stated

9 (1) Memo, Chief Surg GHQ. for CofS GHQ, 9 Jan42, sub: Return of Sick and Wounded from ForeignTheaters. HD: 541 (Trans). (2) Memo, GHQ forACofS 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 Spaceon Army Trans. TC: 632 (Army Trans).

12 (1) Memo, ACofS G-4 WDGS for TAG, 24 Jan42, sub: Hosp Space on Army Trans. HRS: G-4/29717-100. (2) Memo, CG SOS for CofSA, 28 Apr42, sub: Hosp Ships, with 9 incls. HD: Wilson files,"Book IV, 16 Mar 43-17 Jun 43." (3) The Medical De-partment . . . in the World War (1923), vol. I, pp. 357-71.


that it would procure ships required bythe Army, G-4 requested the Commissionon 12 February 1942 to procure six hos-pital ships, along with several vessels ofother types, for the Army's use. When theCommission replied that hospital ships fell"properly under the cognizance of theNavy Department," G-4's TransportationBranch disagreed and asked the Commis-sion to reconsider its opinion. Receivingno reply to this request by late April 1942,SOS headquarters (recently establishedand containing many officers formerly inG-4) pursued the matter further. In lettersprepared for the signature of the Secre-tary of War, it urged the Maritime Com-mission to procure six hospital ships forthe Army, whether to be operated by theArmy or Navy, and called upon the Sec-retary of the Navy to settle with the Armythis question of jurisdiction. The adminis-trator of the recently established WarShipping Administration, who was alsochairman of the Maritime Commission,replied that he could not allocate vesselsfor use as hospital ships until the Armyand Navy had agreed upon "strategic re-quirements." Because of its close relationto other shipping problems, the Secretaryof the Navy proposed that the whole ques-tion be referred to the Joint Staff Planners,a group working under the Joint Chiefs ofStaff.13

The investigation conducted by theJoint Staff Planners and the Joint Chiefsof Staff covered not only the strategic ship-ping situation but also other matters: theprobability of enemy respect for theGeneva and Hague Conventions, the Brit-ish practice of evacuating patients by sea,and the estimated evacuation require-ments for operations in the Pacific and forBOLERO (the build-up of American troopsin the United Kingdom for an invasion

of the European continent). The views ofthe Chief of the Bureau of Medicine andSurgery of the Navy and of The SurgeonGeneral of the Army were also sought.The latter restated the position which hehad taken earlier. The former believedthat both Army and Navy patients shouldbe evacuated by transports that weremanned and operated by the Navy butwere supplied with enough Army officersand enlisted men to care for Army medi-cal records. If hospital ships should beused, he disapproved painting and mark-ing them as international conventionsstipulated. Rather he proposed that theybe painted like transports for travel inconvoy and reveal their identity as hospi-tal ships only under "desirable" circum-stances. In view of agreement between thetwo medical services on the use of trans-ports for evacuation and in the interest ofeconomy in shipping, the Joint Chiefs ofStaff announced on 25 May 1942 that thenormal means of evacuating patients fromareas with "more or less continuous trans-portation service" would be by returningtroop transports. Since the Army andNavy disagreed on the question of hospitalships, the Joint Chiefs announced a com-promise decision in June 1942. Three ves-sels would be procured and operated ashospital ships under the Hague Conven-tion. They would be built according toplans supplied by the Army, would beoperated under the "general direction" ofthe Army, and would be provided withArmy medical complements, but wouldbe converted under supervision of the

13 (1) Memo, ACofS G-4 WDGS for CofSA, 8 Feb42, sub: Supp Ests "D," FY 1942. AG: 111 (1-31-42).(2) Ltrs, CofSA for US Mar Comm, 12 Feb, 7 Mar, 1May 42; US Mar Comm to CofSA, 24 Feb, 4 May42. SG: 560.-2. (3) Ltr, SecNav to SecWar, 6 May 42,sub: Basis of Responsibility for Procurement and Oprof Hosp Ships. AG: 573.27 (5-6-42).


Navy and would be operated by Navycrews.14 Although authorized in the mid-dle of 1942, the first of these ships was notplaced in service until June 1944.

In the course of these protracted nego-tiations, the Army—believing that thegeneral problem of evacuating patientsfrom ground operations in overseas the-aters was one for solution within the WarDepartment—partially took matters intoits own hands.15 In March 1942 the earlierproposal of The Quartermaster General toconvert transports into vessels that couldbe used either as hospital ships or as am-bulance transports was revived by theTransportation Corps. The Surgeon Gen-eral reversed his prewar position in oppo-sition to the use of ambulance transportsand in April supported this proposal as ameans of caring for immediate needs.Even if hospital ships should be author-ized, he pointed out, their constructionwould require at least eighteen months.16

SOS headquarters approved, and late inMay 1942 the Acadia was withdrawn fromregular transport service. From June toOctober it underwent conversion at theBoston Port of Embarkation, emergingwith a capacity of approximately 1,100troops outbound and 530 patients in-bound. Making its first trip as an ambu-lance transport in December 1942, theAcadia continued to sail as such untilplaced under the protection of the HagueConvention as a hospital ship in May1943.17

Providing Facilities for Evacuationby Transports Early in the War

In view of shipping shortages, uncer-tainty about the use of hospital ships, andthe decision for the Army to continue tooperate troop transports, the most obvious

method of meeting immediate evacuationneeds was the use of transports. Existingregulations required each to have a hospi-tal with beds equal in number to 1 per-cent of its passenger capacity for cases ofsickness en route.18 Before the war thenumber of hospital beds on most trans-ports had been increased to provide addi-tional space for patients being evacuatedfrom overseas areas. In March 1942 theOffice of the Chief of Transportation pro-posed that the larger bed capacities beofficially authorized for all transports—those to be procured as well as those al-ready in service. Both the Surgeon Gen-eral's Office and SOS headquartersapproved, and in June 1942 the higherratios were authorized. Changes weremade in the fall of that year in the pro-portion of beds for different types of pa-tients, but not in the total numberauthorized. The first eight months of theyear had shown that 75 percent of thepatients evacuated to the United Stateswere mental cases. To provide more ac-commodations for them SOS headquar-ters on 8 September 1942 directed the

14 (1) JMTC 4/M, 9 May 42, Evac of Sick andWounded from Overseas. SG: 704.-1. (2) JCS 52, 21May 42; JCS 52/1, 29 Jun 42. Records and AdminBr, Off ACofS G-3 WDGS. (3) Ltr, Bu of Med andSurg USN to JPS, 4 Jun 42, sub: Evac of Sick andWounded from Overseas. SG: 704.-1. (4) Memo, SGfor JCS (Col Vittrup), 6 Jun 42. SG: 560.-2.

15 Ltr. SecWar to SecNav, 1 May 42, sub: Evac ofArmy Sick and Wounded from Overseas. AG: 560.

16 Memo, CofT for CG SOS, 13 Mar 42, sub: HospSpace 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, 18May 42, with reply dtd 20 May 42. HD: 560.2 "HospCons Br SGO—Hosp Ships." (3) Memo, Chief MiscBr SOS for Gen [Le Roy] Lutes, 24 Jun 42, sub: HospShips. 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.


Chief of Transportation to convert a por-tion of general ward beds of each ship'shospital into beds for mental patients.19

Thus during 1942 ratios (expressed in per-centages) of hospital beds to troop berthswere authorized for various types of trans-ports as follows:

Meeting standards set for ships' hospi-tals on vessels converted into troop trans-ports depended upon the time available toports for modifications and improvements.Throughout 1942 transports were has-tened into service and sent out heavilyloaded, sometimes with numbers of troopsthat exceeded ships' rated capacities by 10percent.20 Changes in hospital areas ofsuch vessels could be made only while theywere undergoing initial conversions for thetransport service or were in port betweenvoyages for maintenance and repairs.Hence their hospital facilities varied. Onsome, completely new hospital areas wereconstructed. On others, existing hospitalswere enlarged and improved. As a rule theTransportation Corps submitted to theSurgeon General's Hospital ConstructionDivision for review the plans for hospitalareas of vessels being converted. This Divi-

sion sometimes approved plans that wouldnot have been acceptable under ordinaryconditions, but it disapproved others inpart or in whole, and thus conversionswere sometimes delayed. To prevent suchdelays and to standardize improvementsmade at different ports on different typesof vessels, the Surgeon General's Office inNovember 1942 prepared a list of generalspecifications for ships' hospitals.21 Earlyin 1943 the Water Division of the Office ofthe Chief of Transportation sent it to allports for use as a guide. Minimum stand-ards thus established were as follows: a"suitable" surgical suite, minimal facilitiesfor pharmacy and laboratory, adequatetoilets for the hospital area with separatetoilets for isolation wards, safety devicesfor wards for mental patients, a smallX-ray unit with darkroom, berths of notmore than two tiers, and beds equal innumber to those authorized by SOS head-quarters. Preferably, the hospital was tobe located slightly aft of midship, not morethan one deck below the uppermost "con-tinuous weather deck," adjacent to cabinswhose berths could be used for patients,and relatively close to lifeboats. It was tobe well ventilated and lighted and was to

19 (1) Memo, CofT for SG, 28 Mar 42, sub: BasicPlan for Evac of Sick and Wounded. HD: 705. (2) LtrSPOPM 322.15, CG SOS to CGs and COs of CAs,PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: OprPlans 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 forWater Div OCT, 15 May 42, sub: Increased Trp Ca-pacities. TC: 541.1.

21 (1) Ltr, SG (Hosp Cons Div) for CofT, 26 Nov42, sub: Gen Specifications for Hosp Areas on Con-verted Trans. SG: 632.-1 (BB). (2) Memo, Maj JohnC. Fitzpatrick for Chief Hosp and Evac Br Plans DivSOS, 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: HastyConvs. SG: 632.-1 (BB).


have passageways wide enough for theremoval of patients on litters.22

Construction of new transports offeredthe possibility of assuring suitable ships'hospitals provided there was effective co-ordination among the Surgeon General'sOffice, the Office of the Chief of Transpor-tation, and the Maritime Commission.For a time, plans drawn by the MaritimeCommission were not submitted to theSurgeon General's Office and the latterconsidered hospitals on some of the newvessels unsatisfactory. After a series of con-ferences early in 1943 the Maritime Com-mission agreed to submit its plans there-after to the Transportation Corps and theSurgeon General's Office for review andcomment.23

Early in 1943 a significant change wasmade in accommodations for mental pa-tients on transports. Until that time someberths had been enclosed with wire cages,making spaces approximately 6 x 3 x 3feet each in which seriously disturbedmental patients might be placed to avoidendangering themselves and others. InJanuary 1943 the New York Port surgeonproposed the elimination of such "unnec-essary and inhumane" accommodations.The neuropsychiatry section of the Sur-geon General's Office supported this pro-posal. It pointed out that advances inmedical practice, such as the use of seda-tion, hydrotherapy, and diversional activ-ity, with minimum mechanical restraint,made it possible to care for mental pa-tients in specially constructed wards. TheChief of Transportation therefore re-quested the Maritime Commission toeliminate metal cages from future trans-ports and directed port commanders to re-move existing ones and provide suitablesecurity-ward space instead on othertransports. Although surgeons of several

ports argued that they would then be un-able to care for mental patients, especiallyon long voyages in tropical areas, theTransportation Corps and The SurgeonGeneral remained firm.24 To guide trans-port and port surgeons in caring for seri-ously disturbed patients without metalcages, they issued a memorandum on thecare of mental patients on transports inJuly 1943.25 Later in the war, as will beseen below, the Army reverted to the useof individual cells for severely disturbedpatients.

In the fall of 1942 British vessels, suchas the liners Queen Mary and Queen Eliza-beth, which since early 1942 had been car-rying American troops overseas,26 werebrought within the program for enlargingthe patient-capacity of transports. Sincethe British did not move helpless patientsin transports, the Queens had inadequatelaboratory and surgical equipment andeach had only 175 beds for patients. InOctober 1942 the Army started arrange-ments for the installation of a 300-bedhospital on each ship. British officials inWashington were at first unsympathetic to

22 Ltr, CofT (Water Div) to CGs PEs attn ATS,26 Jan 43, sub: Gen Specifications for Hosp Areas onConverted Trans, with incl. TC: 632.

23 Correspondence on ships' hospitals of troop shipsand reports of conferences with Maritime Commis-sion representatives are found in SG: 632.-1 (BB) andTC: 632.

24 (1) Ltr, Surg NYPE to SG (Col Tynes), 19 Jan43, sub: Psychotic Pnts on Army Trans. TC: 632. (2)Memo, SG for CofT 15 Feb 43, sub: Elimination ofCages for Care of Mental Cases on US Army Trans.SG: 632.1 (BB). (3) Ltr, CofT to US Mar Comm, 27Feb 43. TC: 632. (4) TC Cir 35, 1 Mar 43, Elimina-tion of Cages for Mental Pnts. (5) Letters from portsurgeons at San Francisco and New Orleans contain-ing 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.


the American plan for putting larger hos-pitals aboard, but changed their attitudeafter American officials explained thatshortages of shipping and lack of hospitalships made it imperative to evacuate pa-tients on transports. Final agreement wasthat the United States would install a300-bed hospital on each ship while in anAmerican port. The proportion of beds ingeneral wards, isolation wards, and mentalwards would be the same as that alreadyestablished for hastily converted trans-ports. When completed, each hospitalwould be operated by American Armypersonnel. The construction of new hospi-tal areas began early in November whenthe Queen Mary came into port. Severalmonths later work was begun on the QueenElizabeth.27

Renewed Efforts to GetArmy Hospital Ships, 1942-43

Neither the policy announced by theJoint Chiefs of Staff in the spring of 1942nor efforts to supply evacuation facilitiesin compliance with this policy silenceddemands for Army hospital ships. As earlyas April 1942 General Hawley (then Colo-nel), Chief Surgeon of the U. S. ArmyForces in the British Isles (later the Euro-pean Theater of Operations), announcedin a letter to The Surgeon General thepolicy upon which the European theaterwas to insist: helpless patients would notbe evacuated on ships subject to enemyattack (transports) but only on hospitalships plainly marked and operated underthe terms of the Hague Convention. Re-peatedly thereafter the European theaterrequested hospital ships of the War De-partment, stating in August 1942 that fivewould be needed by April 1943 and fivemore by the following September.28 To

these demands were added, in the fall of1942, requests for hospital ships from portsin the United States that were responsiblefor evacuating patients from scatteredisland bases.29 Some bases were not on theitinerary of regularly scheduled transportsand hence needed other means of evacu-ation. The most logical seemed to be theuse of hospital ships on a "pick-up" serv-ice. In response to these needs, the Sur-geon General's Office in October 1942recommended the procurement of threehospital ships, in addition to the threealready authorized by the Joint Chiefs ofStaff. They would be used to collect pa-tients from scattered island bases, to evac-uate casualties from large-scale landingoperations, or to supplement transports inevacuating patients from the more distantand larger theaters.30 The Chief of Trans-portation referred this recommendation tothe Joint Staff Planners. Earlier, inAugust, a request for three Convention-protected ships which General Eisenhower

27 (1) Memo, ACofS for Oprs SOS for SG, 6 Oct42, sub: Med Equip and Sups for US Hosp Facaboard HMT Queen Mary and Queen Elizabeth. SG:475.5-1 (BB). (2) Memo, ACofS for Oprs SOS forCofT, 6 Oct 42, sub: Instl of US Hosp Fac on HMTQueen Mary and Queen Elizabeth. HD: 705 (MRO,Fitzpatrick Daybook). (3) Memo, SOS Hosp and EvacBr for ACofS for Oprs SOS, 2 Nov 42, sub: Add HospFac on Two British Ships. SG: 705.-1 (BB).

28 (1) Ltr, USAFBI (Chief Surg, Col Paul R. Haw-ley) to SG, 25 Apr 42. SG: 560.2 (Gr Brit). (2) RadsCM-IN-4037 (11 Aug 42), CM-IN-6044 (17 Aug42), CM-IN-7813 (21 Aug 42), USASOS (London)to AGWAR; CM-OUT-5084 (16 Aug 42), CM-OUT-7479 (24 Aug 42), AGWAR to USASOS(London). OPD: In and Out Messages.

29 (1) Diary, Misc Br SOS (Col [William L.] Wil-son), 20 Jul 42, HD: 705 (MRO, Extracts from Hospand 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, CGSOS for SG, 16 Oct 42, sub: Rpt of Progress. SG:632.-1 (BB).


wanted by the end of September for theNorth African invasion had also been re-ferred to that group. In both instances, theJoint Staff Planners, weighing the need forvessels to transport troops and cargoesagainst the need for hospital ships, decidedthat additional vessels could not be sparedfor the latter purpose and reaffirmed theexisting policy of using transports as thenormal means of evacuation. On 12 No-vember 1942 the Joint Chiefs of Staff dis-approved requests for additional hospitalships.31

Early in 1943 events caused a change inexisting policy. To demands of the Euro-pean theater were added requests of theSouthwest Pacific and North Africa forhospital ships not only for evacuation tothe zone of interior but more particularlyfor intratheater use. In February 1943 theSouthwest Pacific informed the War De-partment that it was converting a Dutchship, the Tasman, into a hospital ship, andasked that it be certified under the termsof the Hague Convention.32 The NorthAfrican theater, like the European, hadadopted a policy of evacuating no helplesspatients in transports. Early in March1943 it refused to load litter patients onthe Acadia, which was making its secondtrip as an ambulance transport. Later thatmonth this theater cabled Washington fortwo hospital ships for use in evacuatingpatients to the United Kingdom.33 Con-currently, evidence was accumulating thatthe enemy would respect the terms of theHague Convention. Germany and Italypermitted British hospital ships to operateunmolested in the Mediterranean, andthey, along with Japan, had announcedthey were operating their own hospitalships. Furthermore, several Allied Gov-ernments, as well as the U. S. Navy, hadfollowed the lead of the British and placed

hospital ships under Red Cross (HagueConvention) protection.34

Along with insistent demands of the-aters for hospital ships and growing evi-dence of enemy respect for the HagueConvention, it appeared in the first half of1943 that loss of transport and cargo spacethrough conversion of vessels to hospitaluse was a less cogent reason than formerlyfor not authorizing hospital ships. By thattime the troop ship fleet had grownthrough new construction and the conver-sion of freighters. Moreover, British hospi-tal ships were occasionally being used totransport American patients from theEuropean theater to the United States. Arequest by that theater in January 1943that 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 Aug42; JCS 52/2, 29 Aug 42. HD: 705 (MRO, Fitz-patrick Ref file, Aug 42-May 43). (3) JCS 52/3, 12Nov 42. Records and Admin Br, Off ACofS G-3WDGS.

32 Rad CM-IN-9207, SWPA to AGWAR, 18 Feb43. HD: 705 (MRO, Fitzpatrick Daybook, Apr 42-Jun 43). For conversion plans for these ships see HD:SWPA 560.2 (Tasman and Maetsuycker); for lettersabout 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, OffACofS G-3 WDGS. (2) See list of hospital ships (USArmy and Navy, Allied Governments, and Axis Pow-ers) in State Dept file 740.00117 Eur War 1-1648. ByMay 1943 Japan had 20 hospital ships, while Ger-many and Italy had 33. The British Commonwealthof Nations had about 30 hospital ships for use in theAtlantic, Mediterranean, and Indian Ocean. TheU.S. Navy had converted the Solace into a modernhospital ship, and it was at Pearl Harbor on 7 De-cember 1941. It was designated as a Convention-pro-tected ship on 31 October 1942. The Navy ship Reliefwas likewise designated as a hospital ship on 5 Feb-ruary 1943.


transported by these ships on return tripsled to a study of the legality of such actionby the Army Judge Advocate General. InMarch 1943 he issued an opinion that hos-pital ships, whether British or American,might be used for the transportation ofmedical personnel and equipment withoutviolating the provisions of the Hague Con-vention.35 This meant that space on hospi-tal ships could be used for medical trans-port purposes to compensate, in part atleast, for the loss of vessels to ordinarytransport service.

Still another factor influencing decisionsabout hospital ships early in 1943 was thetardiness with which the three ships au-thorized by the Joint Chiefs of Staff inJune 1942 were being made available. Thedelay was caused largely by division ofresponsibility for them between the Armyand Navy and subsequent misunderstand-ings over submission of plans and selectionof types of hulls. Even the most optimisticestimated in the spring of 1943 that theywould not be ready until mid-1944.36

In view of these circumstances TheSurgeon General raised anew the hospitalship question. He now proposed that hos-pital ships be provided for the evacuationof all helpless patients. On 30 March 1943he recommended that the Acadia shouldbe registered immediately as a hospitalship under the Hague Convention, "inview of the urgency of the situation in theAfrican theater"; that a second transportshould be converted into a hospital ship assoon as possible; that completion of thethree ships being built by the Navy shouldbe "expedited"; and that five additionalvessels should be procured for use as hos-pital ships by 1 July 1944.37 Subsequently,in April 1943, representatives of the Chiefof Transportation, the Surgeon General'sOffice, and the ASF Hospitalization and

Evacuation Branch discussed additionaldetails of the proposed program. Theyagreed that vessels selected for conversionshould be suitable for use as hospital shipsbut should also have some characteristics,such as excessively slow speeds, whichmade them undesirable for service astransports with convoys. They agreed alsothat the Army should procure and operatehospital ships and that Army hospitalships should be provided with facilities foremergency diagnosis and treatment only,rather than with elaborate facilities fordefinitive surgical and medical care as onNavy hospital ships. Finally, they decidedthat the first step in achievement of thisprogram would be to request the JointChiefs of Staff to amend the policy onevacuation facilities established in May1942. Subsequently, Colonel Fitzpatrickprepared an impressive study for submis-sion on 24 April 1943 to the General Staff.Its crux was the recommendation that theJoint Chiefs of Staff (1) should approve theuse of Convention-protected hospital shipsas the normal means, when available, ofevacuating 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 Divfor JAG, 18 Mar 43, sub: Hosp Ships. SG: 560.2.

36 (1) Memos, CG SOS for VCNO, 14 Jul and 10Sep 42, sub: Hosp Ships for Evac of Sick andWounded from Overseas. TC: 564. (2) Memo, ColA[chilles] L. Tynes for SG, 11 Sep 42, sub: Rpt onConf on Cons of Hosp Ships. SG: 632.-1 (BB). Re-ports of progress in planning and converting theseships 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, 18Dec 42, sub: Procedure for Acquisition and Conv ofUSS Comfort (AH-6), USS Hope (AH-7), USS Mercy(AH-8). SG: 560.2.

37 Memo, SG for ACofS OPD WDGS thru CGASF, 30 Mar 43, sub: Hosp Ships, with 2 inds. SG:560.-2.


wounded, (2) should authorize steps toimplement this revision of policy at theearliest practicable date, and (3) shouldapprove the use of hospital ships on out-bound voyages for the transportation ofmedical supplies and personnel. The WarDepartment General Staff approved thisrecommendation and forwarded it on 12May 1943 to the Joint Chiefs of Staff.38

The provision of hospital ships for theNorth African theater did not await thisrecommendation. In response to NorthAfrica's request for two hospital ships, theOperations Division of the General Staffoffered on 7 April 1943, after consultationwith both the Chief of Transportation andThe Surgeon General, to convert theAcadia into a hospital ship if the theaterwas willing to forego its use in the trans-portation of troops. After both the Com-bined and Joint Chiefs of Staff had consid-ered the theater's acceptance of this offer,North Africa was notified on 22 April thatthe Acadia would be converted into a hos-pital ship. A second ship, the Seminole, wasselected and approved for use as a hospitalship a week later.39 Both ships werestripped of armament and other belliger-ent features; their hulls were paintedwhite with a horizontal green band oneach side; and red crosses, which could beilluminated at night, were painted on theirsides, decks, and funnels. On 6 May theSecretary of War informed the Secretaryof State of the designation of the Acadia asa hospital ship; four days later, of theSeminole. Structural work required in theconversion of the Seminole delayed her de-parture until September 1943, but theAcadia, which had already been fitted outas an ambulance transport, sailed fromNew York to North Africa on her maidenvoyage as a hospital ship on 5 June 1943.40

Six days later the Army received fullauthority to procure and operate its ownfleet of hospital ships. On 11 June 1943the Joint Chiefs of Staff amended the ear-lier policy, announcing that the helplessfraction of patients would be evacuated inhospital ships if they were available. Atthe same time they approved the use ofhospital ships for the transportation ofmedical supplies and personnel on out-bound voyages. To permit observance ofthe amended policy, the Joint Chiefs au-thorized the conversion of slow-speed pas-senger vessels and of EC-2 cargo ships(Liberty ships) to provide a total of 15hospital ships by 31 December 1943, 19by 30 June 1944, and 24 by 31 December1944. All but three—those already au-thorized for construction by the Navy—were to be procured, converted, manned,and operated by the Army alone. Since ithad already sent the Acadia on its maidenvoyage as a hospital ship and had begunthe conversion of the Seminole, the Armythus had authority to place nineteen ad-

38 (1) Ltr, CG ASF for ACofS OPD WDGS, 24Apr 43, sub: Hosp Ships, with 9 incls. OPD: 573.27.(2) Memo, CofT for CG ASF, 11 May 43, sub: HospShips. TC: 564. (3) Memo, CofSA for SecretariatJCS, 12 May 43, sub: Hosp Ships, with incl. OPD:573.27.

39 (1) Rads CM-IN-14498 (27 Mar 43); CM-IN-6760 (12 Apr 43); CM-IN-12911 (21 Apr 43),NATOUSA to WD. (2) Rads CM-OUT-SSSS (8Apr 43); CM-OUT-5910 (14 Apr 43); CM-OUT-9291 (22 Apr 43); CM-OUT-12622 (30 Apr 43),WD to NATOUSA. OPD: In and Out Messages.Under the CCS plan the British would furnish 10 hos-pital ships and 6 hospital carriers, and the UnitedStates would provide 2 hospital ships as soon as avail-able.

40 (1) Memo, ACofS OPD WDGS for CofS, 5 May43, sub: Designation of USAT Acadia as Hosp Ship.OPD: 573.27. (2) Ltrs, SecWar to SecState, 6 and 10May 43. Same file. For plans and problems of con-version see file SG: 632.-1 (BB) and HD: 560.2 (HospShips, Hosp Cons Br).


ditional hospital ships in operation by theend of 1944.41

The Hospital Ship Program, 1943-45

Selection of vessels for conversion intohospital ships was important to The Sur-geon General because their basic charac-teristics largely determined the success ofconversion. The width of a ship's beamdetermined whether passageways wouldbe wide enough to permit the handling oflitter cases. The size of its superstructuredetermined whether patients could be lo-cated above the water line in areas thathad natural ventilation and from whichpatients might be removed easily if it be-came necessary to abandon ship. Thecruising range of a vessel determinedwhether it was suitable for transoceanicservice, and its speed determined the num-ber of trips per month and thus the num-ber of patients it might evacuate. In June1943, therefore, The Surgeon General ar-ranged with the Chief of Transportationfor joint inspection of vessels before selec-tion for conversion.42

The ships chosen represented a com-promise. In several instances, vessels wererejected by the Surgeon General's repre-sentatives, either because they had speedsof less than ten knots, had fewer thanthree decks above the water line, or wereof too narrow beam. On the other hand,despite its objection to their slow speedand low deck heights, the Surgeon Gen-eral's Office had to agree to the conver-sion of six EC-2 cargo ships. The remain-ing fifteen ships (including the Acadia andSeminole) were of varying ages and speeds.Seven had been built between 1901 and1919; seven, between 1920 and 1926. Sixhad speeds of 10 to 12 knots; four, of 13 to14 knots; and five, of 15 to 16 knots. Some

had been coastwise vessels only and laterproved unsuitable for use in the Pacificduring stormy seasons.43 (Table 18.)

All of the vessels selected were convert-ed into hospital ships according to plansapproved by the Surgeon General's Hos-pital Construction Branch. Plans for theconversion of the six EC-2's were drawnby Cox and Stevens, naval architects inNew York City; those for the remainder,by the Maintenance and Repair Branchof the Water Division, New York Port ofEmbarkation. A civilian architect fromthe Surgeon General's Office, assignedtemporarily in New York, represented theMedical Department in the initial stagesof planning. Subsequently, completedplans were referred to the Surgeon Gen-eral's Hospital Construction Branch forfinal approval. In all planning, emphasiswas placed on the number of patients'berths that could be provided rather thanupon elaborate clinical facilities.44

A major problem in planning hospitalships was the location and arrangementof the surgical suite and other professionalrooms, wards for different types of pa-tients, and quarters for the ship's crew and

41 (1) JCS 315, 13 May 1943; JCS 315/1, 30 May43. 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 ofOprs ASF for SG and CofT, 18 Jun 43, sub: HospShips. SG: 560.-2.

42 Memo, Maj Gen Norman T. Kirk (SG) for LtCol John C. Fitzpatrick, 30 Jun 43, sub: Hosp Ships.SG: 560.-2 (BB).

43 For correspondence dealing with the hospitalship conversion program, inspection of and accept-ance or rejection of certain transports (e.g., RobinAdair, Manuel Arnos, Utahan, William L. Thompson),revision and changes in plans for hospital areas, prob-lems of construction, and Medical Department in-spections during conversion, see TC: 564, SG: 632.1(BB), SG: 560.2, and HD: 560.2 (Hosp Ships, HospCons Br).

44 Tynes, Construction Branch, pp. 94, 113.


medical complement. Experience in plan-ning ships' hospitals for transports and inconverting the Acadia and Seminole servedas a guide at first. More satisfactory stand-ards evolved as additional experience ac-cumulated with later conversions. Nor-mally the Surgeon General's Office pre-ferred to have the following located ondecks above the water line: quarters forofficers, nurses, and medical attendants;the surgical suite; clinical and administra-tive areas; and wards for litter patients,for patients who had communicable dis-eases, and for those who were seriouslydisturbed mentally. Decks at the waterline, or just below it, were considered suit-able for wards for neuropsychiatric andambulatory patients, for quarters for theship's crew, and for galleys and messrooms. Storerooms, the morgue, and thelaundry were placed in lower areas, in-cluding the hold. To achieve maximumstability, the surgical suite—consisting oftwo operating rooms, a sterilizing room, ascrub-up area, rooms for sterile and non-sterile supplies, and an X-ray and dark-room—was preferably placed on the maindeck slightly aft of center. To insure free-dom from unnecessary traffic, isolationand mental wards were considered bestlocated when they were aft. Clinical andadministrative areas, including the dress-ing room, pharmacy, laboratory, sur-geon's office, medical records office, chap-lain's office, Red Cross office, transporta-tion agent's office, post exchange, andcommissary, were considered best locatedon the deck above the water line near theforward gangway or side-port entrance, topermit easy access when the ship was inport.45

Wards were provided on all ships forpatients with communicable diseases, andfor mental, medical, and surgical cases.

Because of the large number of mental pa-tients requiring evacuation, the Move-ments Division of the TransportationCorps proposed in the fall of 1943 to de-vote approximately half the capacity ofeach hospital ship to accommodations forthem. Wards for such patients wereequipped for safety with concealed radia-tors and pipes, shatterproof electric lightfixtures, heavy doors with viewing panels,locks which could be operated by a masterkey, and protective bars over all portholes.For the care of acutely disturbed patientsthere were steel cells 3 to 4 feet wide and7 feet long. For patients with mild neuro-psychiatric disorders, large wards withminimum security devices were used. Iso-lation wards for patients with communi-cable diseases were separated into roomsaccommodating no more than eight (andpreferably four) patients, and wereequipped with separate bathrooms, dietkitchens, linen closets, utility rooms, andscrub-up areas. All wards had two-tieredberths and were provided with adequateadministrative areas, such as utility rooms,diet kitchens, and offices.46 In the summerof 1945 mesh wire enclosures were con-structed on the decks of some hospitalships to provide areas where mental pa-tients could get fresh air and exercise.47

In addition to the general arrangementof hospital facilities, the Surgeon General's

45 Letters dealing with recommendations made bythe 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 eachhosp ship). Blueprints and photographs of each hospi-tal ship are located in above files.

46 (1) Tynes, Construction Branch, pp. 101, 107ff.(2) Memo, CofT for SG, 9 Oct 43, sub: Hosp Ships.SG: 560.2. (3) Memo, SG for CofT, 4 Jan 44, sub:Mental Fac Aboard Hosp Ships. SG: 632.1 (BB).

47 Memo, CofT for SG, 12 Apr 45, sub: ProposedLocation of Mental Pnt Incls on Hosp Ships. SG:632.1 (BB).


SURGICAL WARD ON USAHS SHAMROCK

Office was also interested in features ofconstruction that promoted sanitation andcomfort. As a safety precaution and as abuffer against noise, it insisted that bulk-heads should be of double-thick fireproofmaterial that was easy to clean. White tilewas considered necessary for the decks ofwashrooms, operating rooms, sterilizingand workrooms, dressing stations, clean-ing gear rooms, utility rooms, diet kitch-ens, prophylactic stations, pharmacies,laboratories and autopsy rooms. For therest of the hospital area a deck covering ofcement composition or of heavy linoleumwas considered satisfactory. Deckheads ofa material similar to that used for bulk-heads were needed as protection againstdust in operating rooms, sterilizing rooms,dressing rooms, and smaller wards, and,

in addition, as a safety measure—for cov-ering exposed pipes and fixtures—in allmental wards.48

Numerous difficulties were encounteredin converting the vessels into hospitalships. Lacking a suitable table of organ-ization for hospital ship complements atthe beginning of the program, the Med-ical Department had to estimate the num-ber of officers, nurses, and attendants forwhom quarters would be needed on eachship. Late in 1943, when The SurgeonGeneral revised the existing table of or-ganization, some of the conversion plans

48 (1) Tynes, Construction Branch, pp. 101, 106.(2) Memo, SG for CofT, 26 May 43, sub: Steel Bulk-heading in Hosp Ships. SG: 632.1 (BB). (3) Ltr,Water Div NYPE to CofT, 2 Nov 43, sub: HospShips, with 4 inds. Same file.


SURGICAL WARD ON USAHS LOUIS A. MILNE

already prepared had to be modified toprovide different sets of quarters.49 Aboutthe same time, the decision to devote 50percent of each hospital ship's capacity toaccommodations for mental patientscaused further revisions in plans alreadydrawn. Changes in the size of the mer-chant marine crews, along with frictionbetween maritime unions on the one handand the Transportation Corps and Sur-geon General's Office on the other aboutthe size and location of crew quarters,tended to cause revisions in plans. In someinstances changes in approved plans wererequested by representatives of the Sur-geon General's Office (Maj. Howard A.Donald and Lt. Col. Achilles L. Tynes) asthey inspected work in progress at variousports.50 Of perhaps even greater impor-

tance were delays in shipyards. Some haddifficulty in hiring enough workmen tokeep conversion moving along rapidly.Others failed to get materials when theywere needed. Still others, heavily commit-ted to the Navy, devoted their workersand materials to naval landing craft withhigher priorities.51

As a result of these difficulties the entire

49 For example, see Memo, Lt Col A. L. Tynes forSG, 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 inSG: 560.2, 632.1 (BB), and in HD: 560.2 (Hosp ConsBr, Gen), 560.2 (Hosp Cons Br, under name of eachhosp 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 Feb44, sub: Hosp Ship Convs. TC: 564.


DRESSING STATION ON USAHS LOUIS A. MILNE

program was delayed. Only three Armyhospital ships were in service by the end of1943. One per month was placed in serv-ice from February through May 1944,and one of the three ships being con-structed by the Navy was commissionedthe next month. Thus by the end of June1944 there were nine hospital ships serv-ing the Army, instead of the nineteen an-ticipated. The next month seven morewere completed and in August and Sep-tember two additional Army hospitalships and the two remaining hospital shipsbeing constructed by the Navy for Armyuse were ready for their first trips. Thefinal two ships of twenty-four authorizedin June 1943 were placed in service inMarch and April 1945. (Table 18) Mean-while the Southwest Pacific had convert-

ed two vessels, the Tasman and Maetsuycker,for intra-theater use. Although controlledby the American Army, these vessels wereDutch hospital ships, sailing under Dutchregistry and certified under the HagueConvention by the Netherlands Govern-ment.52

As Army hospital ships were readied forservice, the problem of naming themarose. The Navy named its hospital shipsfor abstract qualities and hence desig-nated the three ships it was building forthe 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 andMaetsuycker); and State Dept: 740.00117 Eur War1939/1-1648 (Netherlands Hosp Ships). Also see WDMemo W40-21-43, sub: Use of SS Tasman as a HospShip, 20 Oct 43, in AG: 560 (16 Oct 43).


THE USAHS LARKSPUR

Trying not to trespass upon this systemand at the same time trying to designateArmy hospital ships appropriately, theSurgeon General's Office proposed in July1943 that they be named for flowers.Transportation Corps officials believedthat this might complicate rather thansimplify their identification as hospitalships. Since all of the vessels being con-verted were well known in the world'sshipping registers, an enemy encounteringone could identify it, if designated as ahospital ship under its existing name, byits ascribed physical characteristics andsilhouette. It was therefore decided to re-tain names that were not "entirely incon-sistent" with the vessels' new mission and

to name others for flowers. In the spring of1944 the Coast Guard objected to thispractice fearing that the Army's namingof hospital ships for flowers would causeconfusion with Coast Guard ships carry-ing the same names. As a result, at thesuggestion of the Surgeon General's Officemost hospital ships commissioned there-after were named for deceased Armymedical officers and nurses.53 (See Table18.)

53 (1) Memos, SG for CofT, 1 Jul 43; CofT for SG,22 Jul 43, sub: Names for Hosp Ships. (2) Ltrs, USCGto 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 Cir80-4, 5 Feb 44, with supp, 25 Mar, 30 May 44, and10 Feb 45.


Continuation of Efforts ToInsure Adequate Hospital Facilitieson Transports, 1943-45

Although standards for ships' hospitalshad been established by the middle of1943, meeting these standards continuedto involve certain problems. One was toobtain desired modifications of MaritimeCommission plans. In reviewing them theSurgeon General's Office sometimes foundmajor faults: failure to comply with direc-tives about the percentage of hospital bedsto be provided; unsatisfactory location ofhospital areas, as for example in the sterntwo decks below the lifeboat loading deck,instead of nearer midship and one deckhigher; improper arrangement of certainmedical facilities, such as the combinationof the surgical suite and the dispensary;and failure to provide such accommoda-tions as utility rooms and dressing sta-tions. Unless construction of ships was toofar advanced, the Commission generallymade the revisions requested by the Sur-geon General's Office.54

Less success was achieved in negotia-tions with the British to improve hospitalson their transports. Normally they fol-lowed a policy of making few if any struc-tural changes in ex-passenger vessels. InDecember 1943 this problem was referredto the Combined Military TransportationCommittee and, as a result, the Transpor-tation Corps and the Medical Depart-ment had to approve specifications forhospital areas aboard British transportsthat were considerably lower than thosefor American transports. For example, ac-cording to a decision of the Committee,British transports were not required tohave wards for mental patients or separateoperating and sterilizing rooms. Insteadof the latter, they had one room which

served as a combination surgeon's office,records room, sterilization room, dressingstation, and emergency operating room.55

Increases in the number of mental pa-tients to be evacuated and in the propor-tion of seriously disturbed cases requiredfurther changes in transports' hospitals. Inthe fall of 1943, on the recommendationof the Surgeon General's liaison officer,the Chief of Transportation directed thatcapacity for mental patients should be in-creased by 3 percent of the troop capacityof each Army-owned and chartered trans-port. He also requested the War ShippingAdministration to make similar changeson ships it operated for the Army. Thismeant an increase in authorized accom-modations for mental patients from 2 to 5percent of the troop capacity of Army-owned transports and from 1½ to 4½ per-cent of that of chartered transports. Thepercentage of berths for patients of othertypes remained unchanged. In order toprovide additional accommodations formental patients without diminishing troopcapacity, staterooms that were used onoutbound voyages for officers and non-commissioned officers were to be altered."Potential weapons" were to be removedand electrical fixtures supplied withguards; suitable doors were to be installed

54 (1) Tynes, Construction Branch, p. 117. (2) Ltr,SG to CofT, 16 Sep 43, sub: Gen Arrangement Plansfor Hosp Sec on C4-S-B2 Mar Comm Trp Trans.(3) Memo, SG for CofT, 27 Sep 43, sub: Hosp Facs onUS Army Trans, G-3 Type. (4) Ltr, Mar Comm toSG, 28 Sep 43, sub: C4-S-B2 Trp Trans, HospSpaces. All in SG: 632.-1 (BB).

55 (1) Ltr. CofT to SG, 18 Dec 43, sub: ProposedHosp 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 Mini-mum Standards Aboard Brit and Amer Trp Ships.SG: 560.-1 (Gr Brit). (3) Ltrs, CofT to CGs PEs, 15Mar 44; CofT to CGs TofOpns, 19 Apr 44, sub: Min-imum Standards on Brit and Amer Trans, with RptCMTC, 18 Feb 44, 82d Mtg. TC: 337 (Trp Trans).


and bars placed across portholes; andberths were to be modified so that thelower two could be fixed by bolting orwelding and the top one removed beforethe loading of patients.56

About a year later action was taken toprovide more suitable accommodationsfor severely disturbed patients. On 25 Oc-tober 1944, the Operations Division, WarDepartment General Staff, in a meetingwith representatives of the Chief of Trans-portation, The Surgeon General, andothers, decided that transports shouldhave locked cells for some patients andsmall wards for others. Subsequently, theTransportation Corps announced that in-dividual cells would be provided on trans-ports sailing to the Southwest Pacificequal in number to .75 percent of theirtroop capacities and on those sailing toother areas equal to .30 percent of theircapacities. Approximately half the re-maining accommodations for mental pa-tients were to be in small locked wardsholding twelve or fewer patients.57

A study in the winter of 1944 of the an-ticipated patient load indicated that,among other measures, fuller use wouldhave to be made of the British Queens and"maximum loading" of certain transportswould have to be authorized. A series ofconferences among Medical Department,Transportation Corps, and British repre-sentatives in the European Theater ofOperations and in Washington resulted inarrangements in January 1945 to use theQueen Elizabeth and the Queen Mary onwestbound trips primarily for the evacu-ation of patients. To increase their patient-carrying capacities to 3,500 and 3,000respectively (the number of patients whocould be fed three meals a day from theships' kitchens), additional pantries hadto be installed, accommodations for more

medical personnel provided, and facilitiesfor patients modified. These changes werelimited mainly to installing rails alongsidepatients' berths, furnishing additionalbedpan washers and sterilizers, and pro-viding food carts for serving hot meals topatients unable to attend mess forma-tions.58

To permit the "maximum loading" ofseventeen Army and three Navy trans-ports—that is, loading them with themaximum number of patients who couldbe properly fed and otherwise cared forregardless of lifeboat restrictions—similarchanges had to be made aboard these ves-sels. In March 1945 the Chief of Trans-portation established the following stand-ards for such changes: additional diet kit-chens, food-serving pantries, and foodcarts should be provided to insure theserving of food in a palatable condition;sufficient bedpan washers and sterilizersshould be installed to care for all litter pa-tients; additional mattresses and pillowsshould be provided; lee rails should be at-tached alongside the berths of all litter pa-tients and all ambulatory patients who

56 (1) Ltr, CG USAFFE to TAG, 24 Aug 43, sub:Evac of Psychotic Cases to US. with 2 inds. AG:704.11. (2) Ltr, CofT to CGs PEs, 18 Nov 43, sub: In-crease in Mental Pnt Capacity on Trans. 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 fromOverseas Comd. AG: 704.11 (3 Jun 44). (4) Seepp.399-400.

57 (1) Memo OPD 370.05, ACofS OPD WDGS forCG ASF, 27 Oct 44, sub: Evac of Mental Pnts fromthe SWPA. HRS: ASF Planning Div and ProgramBr file 370.05, "Hosp and Evac." (2) Memo, MvmtDiv OCT for Water Div OCT, 6 Nov 44, sub: MentalAccommodations on Trp Trans. SG: 705.

58 (1) Rads CM-OUT-72113 (3 Dec 44); CM-OUT-76241 (12 Dec 44), WD (prepared by Lt ColJ[ohn] C. Fitzpatrick) to Hq ComZ ETO. SG: 560.2.(2) Rpt, CMTC 67, 16 Jan 45, sub: Return of Pntsand Other Pers West-Bound on the Queen Elizabethand Queen Mary. SG: 705.


could not care for themselves without as-sistance; and additional dispensaries andsurgical dressing rooms should be con-structed for the routine dressings andemergency care patients might need enroute.59 These changes increased the ca-pacities of seven transports to an averageof more than 1,300 patients each, includ-ing mental and litter cases.60

Additional Hospital Ships andModifications for Pacific Service

In authorizing five additional Armyhospital ships in December 1944 to helphandle the patient load in 1945, the JointChiefs of Staff directed that changes invessels selected should be kept to the mini-mum necessary to fit them as "ambu-lance-type hospital ships." Recognizingthe necessity of this policy, The SurgeonGeneral agreed that existing deck struc-tures of these ships should be used to thegreatest possible extent, but insisted thateach ship should have a proper surgeryand X-ray department, adequate messingfacilities for feeding bed patients, and suit-able office space.61 In this instance theJoint Military Transportation Committeeselected the vessels to be used and onceagain the Surgeon General's Office col-laborated with the New York Port of Em-barkation in the preparation of plans forconversion. One of these ships was readyfor service by April 1945; another, twomonths later; and the third, in September1945.62 Work on the remaining two wassuspended after V-J Day and they wereagain placed in the transport service to re-turn troops from overseas areas.

While plans were being made to putfive additional Army hospital ships inservice, steps were taken to prepare thosealready available for Pacific duty. During1944 the surgeons of some complained

that ventilation of these vessels was so poorthat patients often found the heat andodors almost unbearable. Early in 1945representatives of The Surgeon Generaland the Chief of Transportation agreedthat it would be ideal to have hospitalships completely air conditioned, as werethose of the Navy, but in view of shortageof time they decided that only portions ofthem, such as operating rooms, clinics,and certain wards, should be air condi-tioned and that efforts should be made toincrease the exhaust ventilation of otherareas. This program was approved for thefive newly authorized ships, and duringMay, June, and July 1945, at least eightothers were routed to the New York Portof Embarkation for the installation of air-conditioning equipment.63

Medical Attendants for Serviceon Transports

Determining a Methodof Supplying Personnel

The question of how medical attendantswere to be supplied to care for patients

59 (1) Memo, CofT for Dir Nav Trans Serv, 22 Feb45, sub: Pnt Capacity Mt. Vernon, Wakefield and WestPoint. (2) Rads, WD for CGs PEs, UK Base Sec, HqComZ ETO, POA, MTO, SWPA, 14 and 22 Mar45. (3) Ltr, CG NYPE to CofT, 20 Apr 45, sub: In-crease of Litter Capacity of Trp Ships. All in TC: 569.

60 Total patient capacities of the vessels varied from404 on the Borinquen to 2,618 on the George Washing-ton. See list of maximum capacities in History . . .Medical Regulating Service . . . , sec 6.

61 (1) JCS 1199, 16 Dec 44, Hosp Ship Program;JCS 1199/1, 5 Feb 45, same sub. (2) Memo, ColA[chilles] L. Tynes for SG, 21 Dec 44, sub: Plans forProposed 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 VentilationSysts Aboard Hosp Ships. HD: 705 (MRO, NewmanStaybacks). (2) Memo, Mvmt Div OCT for GenR[obert] H. Wylie, 14 Jul 45, sub: Repair Status ofUS Army Hosp Ships. SG: 705.


being evacuated by Army troop transportarose early in the war. In January 1942,G-4 directed The Surgeon General andThe Quartermaster General to include inplans for sea evacuation operations rec-ommendations about the source and useof personnel for ships. In response TheSurgeon General proposed the establish-ment of Medical Department pools atports in the zone of interior and in thea-ters of operations. From such pools portcommanders in the zone of interior couldassign appropriate medical staffs to ships'hospitals on outbound transports and the-ater commanders could assign additionalattendants to care for patients on returntrips. After completing voyage assign-ments, the attendants could return to the-ater pools by the first available ship.When not on transport duty, they couldbe used to supplement the staffs of hospi-tals located near ports either in the zone ofinterior or in theaters of operations.64

SOS headquarters at first partially ap-proved The Surgeon General's plan. On18 June 1942 it authorized port com-manders to establish pools of Medical De-partment personnel, under control of portsurgeons, from which to furnish comple-ments for ships' hospitals. According to aguide supplied by The Surgeon General,the permanent complement aboard eachtransport was to consist of the ship's sur-geon and twelve enlisted men. Before de-parture of a transport from the UnitedStates, a port surgeon was to estimate thenumber of patients it would return fromtheaters and, according to a graduatedtable in the guide, was to assign necessaryattendants. In emergencies overseas com-manders could supply additional attend-ants.65 This system proved inadequate,perhaps for several reasons. Ports in theUnited States had trouble getting enough

medical personnel to operate the system.In the absence of a large backlog of pa-tients in theaters, it was impractical toestimate the number of evacuees to be re-turned. Finally, port pools were difficultto keep in operation because ships some-times were diverted and did not returndirectly to home ports.

The SOS Hospitalization and Evac-uation Branch therefore suggested a dif-ferent plan in August 1942. Calling for theuse of table-of-organization units listed inthe troop basis, it promised to insure theavailability of attendants at all times.Therefore SOS headquarters directed TheSurgeon General to prepare an appro-priate table. It was to provide not only forunits to care for groups of 25, 50, 75, 100,250, and 500 patients but also for units toserve as permanent medical complementsof transports. The latter were to operateships' hospitals on outbound trips andwere to serve as administrative and tech-nical nuclei around which supplementaryplatoons could function when patientswere being returned to the United States.The Surgeon General prepared the tableas directed, but protested against its adop-tion. Because table-of-organization unitswere inflexible, he contended, they werewasteful of personnel when used in oper-ations characterized by variable factors,such as ships' destinations, length of voy-

64 (1) Memo AG 573.27 (10-29-41), TAG for SG,26 Jan 42, sub: Hosp Space on Army Trans. HD: 541(Equip for Trans). (2) Ltr, SG to TAG, 16 Feb 42,sub: T/O for Hosp Ship and Tabulation of Med PersReqmts 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 andCOs of CAs, PEs, and Gen Hosps, and to SG, 18 Jun42, sub: Oprs Plans for Mil Hosp and Evac, withincls. (2) Ltr, SG to CGs all PEs, 29 Jun 42, sub: OprPlans for Mil Hosp and Evac, with 3 incls. Both inHD: 705 (Hosp and Evac).


ages, outbound loads, and the numberand type of patients on return trips.Nevertheless, the General Staff supportedSOS headquarters and directed the acti-vation often platoons in September. Thenext month, the table of organization for"Medical Hospital Ship Platoons, Sep-arate," was published. It provided for apermanent complement of medical per-sonnel that included one officer andtwelve enlisted men for each transport,and for supplementary platoons varyingin size from seven to eighty-eight officers,nurses, and enlisted men to care for dif-ferent numbers of patients.66

Publication of this table did not settlethe question entirely. In November 1942,when SOS headquarters was about to ac-tivate thirty additional platoons, The Sur-geon General again objected to their use.Whether because of this objection or forother reasons, SOS headquarters seems tohave compromised. Supplementary pla-toons were organized to serve aboardtransports carrying patients, but table-of-organization units to serve as the perma-nent medical complements were neveractivated. Instead, SOS headquarterscontinued to supply personnel for thispurpose in allotments to port com-manders.67

Measures to Conserve Personnel

Steady and large increases in evacua-tion in the latter half of the war, alongwith other demands for shares of a limitedsupply of medical personnel, especiallydoctors, intensified the problem of provid-ing attendants for patients aboard trans-ports. In the fall of 1943 the use of inflexi-ble table-of-organization units was ques-tioned by the Surgeon General's PersonnelBoard and by ASF headquarters as beingwasteful. The use of theater pools wasagain considered, but Lt. Col. John C.

Fitzpatrick, liaison officer of The SurgeonGeneral with the Chief of Transportation,defended the use of platoons. They con-stituted the surest way, he insisted, forASF to discharge its responsibility for thecare of patients after they left theater con-trol. In October 1943 representatives ofThe Surgeon General, the Chief of Trans-portation, the General Staff, and ASFheadquarters reviewed the entire questionand decided that "platoons should bemodified and retained." They agreed alsothat maximum use should be made of re-turning casual medical personnel to sup-plement the medical service on transports.These measures, they expected, wouldpromote manpower economy.68

Modifications were made not so muchin platoons themselves as in their use.When the table under which they wereorganized was revised in October 1943,nurses were eliminated, as the Chief ofTransportation recommended. Thereafterthey were to be furnished, if needed, bytheater commanders.69 Of more impor-tance, the Office of the Chief of Transpor-tation in November 1943 developed aguide for theaters to use in placing pla-toons aboard transports. This guide tookaccount of the fact that variations in types

66 (1) Memo, ACofS for Oprs SOS for SG, 28 Aug42, sub: T/O for Med Pers on Amb Ships and TrpTrans, with ind. (2) Memo, ACofS for Oprs SOS forDir Mil Pers SOS, 1 Oct 42, same sub. (3) Memo, SGfor 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 forTAG, 14 Nov 42, sub: Constitution and Activationof 30 Hosp Ship Plats, Sep. AG: 320.2 (1 Oct 42) (3).(2) Memo, Hosp and Evac Br Plans Div SOS for MobBr Plans Div SOS, 8 Dec 42, sub: Med Pers on ArmyTrans. HD: 705 (MRO, Fitzpatrick Daybook, Aug42-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, 28Oct 43, sub: Study of MD Pers. HD: 334 (KennerBd).

69 T/O&E 8-534, 21 Oct 43.


of patients required variations in the num-ber of attendants provided. For example,while two 100-bed platoons would be re-quired to care for 100 mental or litter pa-tients, a 25-bed platoon was sufficient fora like number of ambulatory or troop classpatients. A 100-bed platoon could care for150 patients if 75 percent were eitherambulatory or troop class. This guide,which geared the size of platoons to thetype as well as number of patients, wasdesigned to permit a flexibility in use thatwould contribute to economy. In Novem-ber 1943 it was sent to the Europeantheater; the following March, to theNorth African. In June 1944 it was issuedto all theaters in a revised directive onevacuation operations.70

Another economy measure was theelimination of small platoons. With actualand anticipated increases in the patientload early in 1944, it was unlikely thatthose with less than 100-bed capacitywould be needed. Small units—of 25-,50-, and 75-bed capacities—were author-ized one Medical Corps officer each, aswas the 100-bed unit. Thus the use ofsmall platoons to attend groups of patientsnumbering 100 or more was wasteful ofMedical Corps officers. In April 1944 theChief of Transportation requested ASFheadquarters to convert all platoons of25-, 50-, and 75-bed capacities, a total of184, to 100-bed units. This action in-creased their table-of-organization capac-ity from 7,275 to 18,400 patients withoutany increase in the number of MedicalCorps officers and with the addition ofonly 1,964 enlisted men and 184 DentalCorps officers. With the eighty-seven 100-bed platoons already organized, this gavea total table-of-organization capacity of27,100 patients.71 When additional pla-toons were required later, none of lessthan 100-bed capacity was organized.

Another measure to supply attendantsfor patients evacuated by transport wasthe use of medical personnel returning tothe United States in a duty status. Thenumber of enlisted men, officers, andnurses in this category increased as thewar lengthened and as they accumulatedenough overseas service to return home on"rotation." Under an agreement reachedin October 1943, the War Department on8 June 1944 directed theater commandersto form such personnel into provisionalmedical hospital ship platoons and to re-turn to the United States no MedicalCorps officer below the grade of coloneland no nurse whatever without assuringthe full use of his or her services en route.Subsequently, in the fall of 1944 and earlyin 1945, when the Chief of Transportationrequested the activation of additionalplatoons, The Surgeon General disap-proved, suggesting instead that theaters bedirected to form more provisional pla-toons.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 Mar44. 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 fromOverseas 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, CofTfor CG ASF, 20 Apr 44, sub: Request for Activationof 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: Procedurefor Evac of Pnts by Water or Air from OverseasComd. AG: 704.11 (3 Jun 44). (2) Ltr, CofT to CGASF thru SG, 25 Oct 44, sub: Request for Prov MedHosp Ship Plats, Sep. HRS: ASF Planning Div Pro-gram Br file, "Hosp and Evac." (3) Memo, CofT forCG ASF thru SG, 24 Mar 45, sub: Request for ProvMed Hosp Ship Plats, Sep, with 2 inds. SG: 322(Plat).


provide, within the amount of medicalpersonnel available, sufficient attendantsfor patients on transports. Attempts weremade to increase the use of regularly or-ganized platoons by reducing the timethey spent in the United States and in re-turning to theaters. Although such unitswere assigned to the Chief of Transporta-tion, for a time the commanders of portsactually controlled them while they werein the United States. In the fall of 1944their control was centralized in the Move-ments Division of the Office of the Chief ofTransportation. Knowing where platoonswere needed as well as schedules of shipsleaving from all ports, this Division couldarrange for the return of platoons to the-aters more quickly than could ports. Later,the War Department suggested that the-aters might establish air priorities forthem, in order to reduce the time nor-mally required for their return. Anothermeasure taken in the fall of 1944 was thedeployment of platoons from "isolatedtheaters," such as the Middle East, India,and South Pacific, to other more activetheaters, such as the European.73

Problems in the Use of Platoons

Questions arose about the control ofplatoons. The first ten were assigned to theNew York Port of Embarkation, but allothers were assigned to the Chief of Trans-portation and were attached to ports. InDecember 1942 The Surgeon Generalasked where and how they were to beplaced aboard transports carrying pa-tients. Representatives of his Office, of theOffice of the Chief of Transportation, andof SOS headquarters subsequently de-cided that platoons should be attached tooverseas theaters on a temporary dutybasis and that theater commanders should

be responsible for placing them on trans-ports as needed.74 After attachment totheaters platoons came under the admin-istrative control of theater commanders.This step gave rise to complaints that the-aters employed them improperly whenthey were not escorting patients to theUnited States. One complained of beingassigned to work in medical supply;another, of being required to sort mail.Nevertheless the War Department fol-lowed a policy of not interfering with the-ater commanders in the control of platoonsattached to their commands and inter-vened only when the care of patients wasaffected.75 When the Southwest Pacificfailed to place sufficient attendants ontransports evacuating patients during1944, the Movements Division of the

73 (1) History . . . Medical Regulating Service. . . , sec 3. (2) Rad CM-OUT-69352, WD to CGUSAF POA, 28 Nov 44. TC: 322 (Med Hosp ShipPlats). Similar messages were sent to other theaters.(3) Memo for Record, on draft Rad, WD to SWPAand POA, 26 Nov 44. HD: 705 (MRO, Gay Stay-back, 151). (4) Memo, CG ASF for CofT, 8 Dec 44,sub: Request for Prov Med Hosp Ship Plats, Sep.HRS: ASF Planning Div Program Br file, "Hosp andEvac."

74 (1) Ltr, TAG to CGs NYPE, 1st, 4th, 5th, and8th SvCs and to SG, 30 Sep 42, sub: Constitution andActivation of 10 Plats. AG: 320.2 (9-30-42) (10). (2)Ltr, TAG to CGs NYPE, 1st, 4th, 5th, 7th, and 8thSvCs and to SG and CofT, 16 Nov 42, sub: Consti-tution and Activation of 30 Plats (Sep) Ship Hosp.AG: 320.2 (1-10-42) (3) Sec 15. (3) Memo, CG SOSfor 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 Hospand Evac Br, 22 Dec 42. HD: Wilson files, "Diary."(6) Memo for Record, on Memo, CG SOS for SG, 24Dec 42, sub: Med Hosp Ship Plat, Sep. HD: Wilsonfiles, "Book 2, 26 Sep-31 Dec 42." (7) Memo, CofT forCGs PEs, 17 Jun 43, sub: Mvmt Orders, Med HospShip Plats, Sep. TC: 322 (Med Hosp Ship Plats).

75 (1) Ltr, CO 584th MHSP, HRPE to SG, 28 Jan44. sub: Duties Performed by a Med Hosp Ship PlatOverseas. HD: 705 (Hosp Ship Plats). (2) Memo,MRO (Gay) for Col J[ames] T. McGibony, 15 May45. sub: Misuse of Med Pers. HD: 705 (MRO, New-man Stayback, 159).


Office of the Chief of Transportationinitiated a War Department cablegram tothat theater calling attention to "re-peated reports" that it both overloadedtransports and supplied insufficient medi-cal personnel, even though platoons wereavailable. This message pointed out thatthe Army would suffer serious criticismunless such practices were corrected.76 In1945 reports reached the Surgeon Gen-eral's Office that nursing care on trans-ports returning from the Pacific was below"desirable standards." Believing the causeof this situation to be an inclusion in pro-visional platoons of enlisted men nottechnically qualified to care for patients,the Chief of Transportation had a WarDepartment message sent to the Pacificurging greater selectivity in choosing menfor provisional platoons.77

The medical hospital ship platoon, awartime development, seems to have justi-fied its existence. On V-E Day 176 regu-larly organized platoons were being usedto attend patients returning from theEuropean theater, and several monthslater there were 116 in the Pacific. Al-together there were 332 platoons in serv-ice in August 1945.78 Officers familiar withtheir work agreed generally that they per-formed excellently, in view of the difficultmission and adverse conditions—longhours, arduous tasks, and a minimum ofleave and recreational opportunities.Moreover, although some felt that den-tists, pharmacists, and laboratory tech-nicians were not really needed in suchplatoons, representatives of the SurgeonGeneral's Office agreed in May 1945, inreviewing experience with such units, thattheir table of organization needed nochange. After the war the Medical Regu-lating Officer proposed only one change—the second officer in each platoon might

be of any branch of the Medical Depart-ment instead of specifically of the DentalCorps.79

Hospital Ship Complements

Although the Army had no hospitalships in the first part of the war, as alreadypointed out, efforts were made to get themand the Surgeon General's Office drafteda table of organization for a medical hos-pital ship company early in 1942. Pub-lished in April, it provided for a unit of 14officers, 35 nurses, 1 warrant officer, and99 enlisted men to care for 500 patients,and for supplementary units of 2 officers,4 nurses, and 11 enlisted men for eachadditional group of 100.80 The approvalin May 1942 of the conversion of theAcadia into an ambulance transport and arequest in August 1942 by the Europeantheater for three hospital ships made itappear that units organized under this

76 Draft Rad, WD (Mvmt Div OCT) to CinCSWPA, 9 Oct 44, sub: Evac of Pnts from Milne Bay.HD: 705 (MRO, Fitzpatrick Stayback, 1495).

77 Draft Rad, WD (Mvmt Div OCT) to CinCAFPAC, CGs SFPE, SPE, LAPE, 20 Jul 45. HD: 705(MRO, Newman Stayback, 195).

78 Reports of locations, assignments, and move-ments of platoons were kept from March 1943 untiltheir inactivation in 1945-46. See monthly reportsin TC: 322 (Med Hosp Ship Plats); in HD: 705(MRO, Stayback files: Fitzpatrick, Jun 43-Apr 44;Zolnaski, Mar-Nov 44), and in SG: 705, Plats, week-ly Status Rpts, beginning in Mar 44.

79 (1) History . . . Medical Regulating Serv. . . , secs 3.7 and 3.8. (2) Memo for Record, Re-sources Anal Div SGO, 7 May 45, sub: Mtg of T/ORev Cmtee for Redeployment. HD: 705 (MRO,Newman Stayback, 151). (3) Memo, MRO for DirHosp and Dom Oprs SGO, 23 Nov 45, sub: ASF MDT/O&E. HD: 705 (MRO, Hodge Stayback, 514). (4)George F. Jeffcott, A History of the United StatesArmy Dental Service in World War II, Ch. X, pp.35-42. HD.

80 (1) Ltr, QMG to TAG, 14 Feb 42, sub: HospSpace on Army Trans. AG: 573.27. (2) T/O 8-537,1 Apr 42.


table would be needed. SOS headquarterstherefore directed The Surgeon Generalto plan to supply personnel for them.81 Asa result, four hospital ship companies wereactivated in October and November 1942.One was placed on the Acadia when itbecame an ambulance transport in De-cember 1942. The other three were notused until the first of the Army's hospitalships went into service in the summer of1943.82

After the Army began to select trans-ports for conversion under the 24-hospi-tal-ship program, the table of organiza-tion for hospital ship companies had to berevised. It was designed to supply person-nel for ships with 500 or more beds, butthose to be converted were to have vary-ing capacities, ranging from about 300 to700. Moreover, experience aboard theAcadia returning patients from NorthAfrica had revealed certain inadequaciesin the old table. Furthermore, Army hos-pital ships were to be manned by bothcivilians and soldiers—the former to oper-ate vessels and the latter to care for pa-tients. But there were some services whichmight be performed by either group.Hence a decision had to be made as towhich services each was to perform andmilitary personnel had to be providedaccordingly.83

The division of responsibility for border-line services came up in July 1943 whenplans were drawn for the conversion of thetransport Agwileon into the hospital shipShamrock. The Surgeon General's HospitalConstruction Branch discovered that theNew York Port of Embarkation had de-voted much space considered desirable forlitter patients—almost an entire deck lo-cated above the water line— to quartersfor the merchant marine crew. To increasethis vessel's capacity for litter patients, the

Water Division of the Office of the Chiefof Transportation directed reduction ofthe area occupied by the civilian crew bycutting down both the size of the crew andthe space allowed each of its remainingmembers. The steward's department wasthen cut from seventy to thirty-five.Despite some reduction in original spaceallowance for individual members of thecivilian crew, they continued to be pro-vided with more commodious quartersthan the Army allowed enlisted men. As aresult, The Surgeon General and theChief of Transportation agreed to use en-listed men as much as possible in order tosave space for patients.84 During the fallof 1943 the respective duties of the civilianand military crews were agreed upon andthe table of organization for hospital shipcompanies was revised. It was publishedon 7 December 1943 as Table of Organi-zation and Equipment 8-537T, HospitalShip Complement.85

While the new table provided for com-plements to serve on ships ranging in ca-pacity, by hundreds, from 200 to 1,000

81 (1) Memo, CG SOS for SG, 22 Aug 42, sub: AddHosp Ships. SG: 560.-2. (2) Memo, SG for CG SOS,24 Aug 42, sub: Request for Auth and Activation ofCertain Req SOS Med Units. SG: 320.3-1.

82 (1) Memo, CG SOS for ACofS G-3 WDGS, 10Oct 42, sub: Deletion of 107th Gen Hosp from Cur-rent Trp Basis, with Memo for Record. AG: 320.2(10-10-42). (2) Diary, SOS Hosp and Evac Br (Fitz-patrick), 31 Dec 42. HD: Wilson files, "Diary." (3)See pp. 398, 403-04.

83 (1) Ltr, CO 204th Hosp Ship Co to CG NYPEthru Surg NYPE, 8 May 43, sub: Request for Changein 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 Jul43, 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 ShipCos. SG: 320.3-1. (2) Rpt of Conf, Med Hosp ShipComplement, 30 Sep 43. SG: 560.-2. (3) Memo, SGfor CG ASF, 13 Nov 43, sub: T/O 8-537, Hosp ShipComplement. AG: 320.3 (20 Nov 43) (2).


beds, it differed from the old primarily inthe number of enlisted men authorized fornonmedical duties. A comparison of thecomplement authorized for a 500-bed shipunder the new table with that for a vesselof the same capacity under the old Oneillustrates the changes made. The numberof doctors—eight—remained the same.While the number of nurses was reducedfrom thirty-five to thirty-four, a hospitaldietitian was added. The number of den-tists was reduced from two to one, butMedical Administrative Corps officerswere increased from two to three. OneSanitary Corps officer and one chaplainwere added to the commissioned staff.Although the number of technicians wasreduced by one, the number of medicalsupply and administrative men was in-creased from twelve to seventeen. Greatestchanges affected enlisted men in the non-medical services and were governed by thedivision of duties between civilian andmilitary crews announced by the Trans-portation Corps in December 1943.86 Be-cause the civilian crew was to preparefood for all persons aboard, with the ex-ception of special diets for patients, theseventeen military cooks formerly author-ized were reduced to one. Since the mili-tary crew was to furnish cooks' helpers, thelatter were raised in number from ten totwelve. In addition, the military crew wasto supply guards for certain sections of theship (primarily those occupied by pa-tients), operate the laundry, and supplydining room service for assigned enlistedmen, patients, and both civilian and mili-tary personnel authorized to eat in thesaloon mess. It was also to provide roomservice for all patients and military per-sonnel. For these purposes forty-seven en-listed men were added. To permit them toserve in wards when not engaged in non-

medical duties, thirty-one were to betrained and classified as ward orderlies.

Division of responsibilities betweenmilitary and civilian crews in the fall of1943 did not eliminate all problems in-volved in using both civilians and enlistedmen on hospital ships. In February 1944the crews of two threatened to strike un-less civilians were placed in some of thejobs filled by enlisted men. To avoid aninterruption in evacuation operations,The Surgeon General and the Chief ofTransportation agreed to a compromise.87

Responsibility for furnishing dining roomservice in the saloon mess (for both thecivilian and military personnel eatingthere) and for supplying cooks' helperswas transferred to the civilian crew, andthe average number of civilians in thesteward's department was increased fromabout thirty-five to about forty-five. Thischange removed enlisted men from theirpoint of greatest contact with the civiliancrew and was expected to reduce frictionbetween the two groups. While it was notreflected in a reduction of the militarycrew until early in 1945, the change didaffect plans for the conversion of trans-ports into hospital ships, for the drawingsalready made had to be modified to pro-vide quarters for the additional civilians.Thereafter, the Chief of Transportationsupplied the Surgeon General's Officewith manning tables for each of the hospi-tal ships being provided, so that accom-

86 OCT Cir 164, sub: Div of Responsibility AboardUS Army Hosp Ships, 10 Dec 43, (revised 15 Mar44). HD: 705 (MRO, Fitzpatrick Staybacks, 840,970).

87 (1) Memo, Dir Hosp Admin Div SGO for ChiefHosp Cons Br Hosp Div SGO, ca. Feb 44, sub: Qtrsfor 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 AboardArmy-Opr Hosp Ships. HD: 705 (MRO, FitzpatrickStayback, 848).


modations for the civilian crew might beplanned and, at the same time, as muchspace as possible be saved for patients.88

Early in 1945 the table of organizationfor hospital ship complements was revised.Two of the five additional hospital shipsauthorized in December 1944 were tohave capacities exceeding 1,000 bedseach. The revised table took this situationinto account, providing for a complementfor a 1,500-bed ship. It also reflected theshift of responsibility for providing cooks'helpers from the military to the civiliancrew by reducing the number authorizedfor a 500-bed ship from ten to two. Thesetwo were kept to assist one military cookin the preparation of special diets for pa-tients. The number of "basic" soldiers wasalso reduced—from twelve to seven.Nevertheless, the total number of enlistedmen in the complement for a 500-bedship was reduced by only five, because twomen were added to perform nonmedicalfunctions, the number of technicians wasincreased from forty-four to forty-eight,and four men were added to conducteducational and physical reconditioningprograms. One nurse was eliminated.Otherwise the number of commissionedofficers remained the same. The new tablealso reflected a function not originally an-ticipated for Army hospital ships—hospi-talization of casualties resulting from theinitial phases of landing operations. UnlikeNavy hospital ships, which were fitted fordefinitive medical and surgical treatmentat sea, Army hospital ships were plannedand staffed to transport patients who hadalready received treatment in shore instal-lations and needed only a minimum ofmedical and surgical care en route. Aftersome had been used in support of amphib-ious operations, the suggestion was madethat the tables of organization of comple-

ments of such ships should be revised toinclude an appropriate concentration ofspecialists. The Surgeon General's Officebelieved that the sporadic use of Armyhospital ships for amphibious operationsdid not justify such action. Therefore thenew table authorized the reinforcement ofnormal complements with special medicalprofessional service teams when hospitalships were used in support of amphibiouslandings.89

Since a hospital ship complement wasassigned to each ship, the activation andtraining of complements was keyed to theprogram of converting transports to hospi-tal ships. From the time the first four wereactivated in the latter part of 1942 untilthe end of January 1945, twenty-five addi-tional complements were organized andtrained. Three were used on the Hope,Comfort, and Mercy. Twenty-four were usedon hospital ships operated by the Army,while two were never used because com-pletion of the ships for which they hadbeen organized was suspended when thewar ended.90

Problems in Providing Suppliesand Equipment for

Hospital Ships and Transports

Furnishing medical equipment andsupplies for patients evacuated by sea de-pended upon many variable factors.

88 (1) Tynes, Construction Branch, pp. 96-100. (2)Ltr SPTOW 231.81, CofT to SG, 7 Mar 44, sub: AuthManning 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, MROfor 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.


Among them were the type of ship (trooptransport, ambulance ship, or hospitalship), the size and patient capacity ofeach, the kinds of patients carried (litter,mental, and ambulatory), and the num-ber of days at sea (determined by thespeed of each vessel and the length of itsvoyage). For this reason the initial issue ofmedical items, as well as replacement is-sues after each voyage, required individualconsideration by port surgeons and medi-cal supply officers. Before the war theycollaborated locally with transport sur-geons in determining the needs of eachtransport and in supplying initial and re-placement allowances of medical items.91

In connection with more general planningfor sea evacuation operations early in1942, The Surgeon General proposed thatthis system be continued, but that portsurgeons be guided by lists of equipmentto be supplied by his Office. SOS head-quarters announced its approval of thisproposal on 18 June 1942.92 Meanwhile incollaboration with transport surgeons, themedical supply officer of the New YorkPort had prepared typical requisitions foruse in making initial issues of equipmentand supplies to transports hurriedly placedin service after the war began.93

The Surgeon General's guide, distrib-uted at the end of June 1942, containedlists of equipment and supplies for 60-dayvoyages for 500-bed hospital ships, 500-bed ambulance ships, and transports car-rying outbound troops in multiples of1,000 and inbound patients in multiples of100. Among the items included in eachlist were drugs and biologicals, surgicalgauzes, surgical instruments, dental sup-plies and equipment, laboratory suppliesand equipment, X-ray supplies and equip-ment, operating room equipment, and thelike.94 In the fall of 1942 the Surgeon Gen-

eral's Office revised these lists and in De-cember issued them in a new form.95

The problem of equipping and supply-ing hospital ships assumed new importanceafter the Army was authorized to provideand operate its own. Vessels selected forconversion under this program were tohave patient capacities varying from about300 to 700. It was therefore necessary forthe Surgeon General's Supply Division toprepare individual equipment lists, atleast for the first few ships converted.96

After they were prepared the Transporta-tion Corps was informed of fixed equip-ment and its dimensions, so that planscould be made for its installation, andmedical depots were instructed to makeinitial issues of supplies and equipment toeach hospital ship.97 In the winter of1943-44 the Surgeon General's Office de-veloped standard equipment lists for hos-pital ships with 200-, 500-, and 1,000-bedcapacities 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 (Equipfor Trans).

92 (1) 2d ind, Act SG to CG SOS (Dir Oprs), 8 Apr42, on Memo, CofT for CG SOS, 13 Mar 42, sub:Hosp Space on Army Trans. SG: 632.-1 (BB). (2) LtrSPOPM 322.15, CG SOS to CGs and COs of CAs,PEs, and Gen Hosps, and to SG, 18 Jun 42, sub: OprsPlans for Mil Hosp and Evac, with incl. AG: 704.

93 Ltr, Surg NYPE to SG thru CG NYPE, 18 Mar42, sub: Standardized Initial Med Sups for ArmyTrans, with 2 inds. HD: 541 (Equip for Trans).

94 Ltr, SG to CGs PEs, 29 Jun 42, sub: Opr Plansfor Mil Hosp and Evac, with 3 tables. HD: 705 (Hospand Evac).

95 (1) Memo, ACofS for Oprs SOS for SG, 22 Aug42, sub: Basic Equip Lists for Hosp Ships and Ships'Hosps.-AG: 573.27 (8-22-42). (2) Instructions forTransport 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 Equipfor Ships. SG: 475.5 (BB).


units.98 These lists were revised, along withthose for transports, in March 1944 andagain in April 1945.99

In addition to medical items shipsneeded other supplies and equipment.Medical Department units serving onships needed certain organizational equip-ment. To meet this need, tables of equip-ment were issued early in 1943 for medicalambulance ship companies and for medi-cal hospital ship companies.100 Certainhousekeeping items, such as mess equip-ment, beds, mattresses, and blankets, wererequired for ships' operating crews as wellas for medical staffs and patients. During1942 the Medical Department and theTransportation Corps worked out a divi-sion of responsibility for supplying them.In general the Transportation Corpsagreed to furnish all nonmedical items andall mess equipment, beds, mattresses,blankets, and linens not used for "strictlymedical" purposes.101

In planning to equip the Hope, Comfort,and Mercy, the Army and the Navy en-countered difficulty in dividing items forwhich each was responsible. The Armyunderstood that the Navy and its contrac-tors were to supply all medical equipmentthat was fixed, or attached, to these shipsand that the Army was to furnish all port-able medical equipment. It turned outthat the Army had to supply all, includingfixed medical equipment, such as dentaloperating chairs, operating tables, andX-ray machines.102 Uncertainty existedfor a while, also, over whether the Armyor the Navy with its contractors was tosupply housekeeping items. This matterwas clarified in an agreement by whichthe Navy was to supply all portable mess-ing equipment, linens, and blankets, andits contractors were to furnish all mat-tresses and pillows except those furnished

by the Navy for enlisted crews employedin ships' operations.103

During the first half of the war otherproblems developed in connection withthe equipment of ships. The Surgeon Gen-eral's Office believed that adjustable berthssimilar to beds used in hospitals wereneeded for seriously ill patients. As a re-sult, a particular type of adjustable berth,known as a "gatch bed," was developedfor use on Army hospital ships.104 Alternat-ing current (AC) electrical equipment,which the Medical Department had instock and procured in the early part of thewar, was unsuitable for use on ships whichhad direct current (DC) systems. To solvethis problem direct current equipment wasprocured in a few instances, but generallyconverters were placed on ships so thatequipment in stock could be used. Becauseof the possibility of creating signals thatwould reveal ships' positions to enemynaval craft, the use of electrotherapeuticequipment on transports was limited.105

98 Equip Lists Nos 97239-05 (200 bed); 97239-10(500 bed); 97239-15 (1000 bed); 97239-20 (100 bedexpansion units), in ASF Med Sup Catalog MED 3, 1Mar 44.

99 (1) ASF, MD Consolidated Equip List No 3, 5Mar 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 andTrans 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 ShipsHope, Mercy, and Comfort).

104 Ltr, SG (Tynes) to CofT (Water Div), 17 Nov42, sub: Plans for Double Deck Hosp Berth WithGatch 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. PowerSups for I.C. Sys. TC: 632 (Hosp Ships). (2) Memo,CG SOS (Lutes) for CofT, 8 Oct 42, sub: Electro-therapeutic and X-ray Equip Aboard US ArmyVessels. HD: 705 (MRO, Fitzpatrick Daybook).


A significant development occurred inthe latter half of the war in connectionwith the laundries of hospital ships. Laun-dries aboard ships were necessary if thequantities of linens carried were not to beinordinate. Yet laundry operations con-sumed a tremendous volume of fresh wa-ter, and while hospital ships could notafford to curtail laundry operations it wasimperative that fresh water for other usesreceive higher priority. To solve this prob-lem the Surgeon General's Office devel-oped a salt-water washing process. In thesummer of 1944 successful tests at the Na-val Receiving Station and the Army

Medical Center (both in Washington,D.C.) demonstrated that salt-water wash-ing was both safe and efficient. The proc-ess that was developed involved the use ofsalt water and certain detergents for sudsand first rinses and of fresh water for thefinal rinse and sour. This process, ulti-mately used on all Army hospital ships,reduced by about 80 percent the amountof fresh water ordinarily needed for laun-dry operations.106

106 (1) Historical Record, Laundry Section, Hos-pital Division, [SGO], 1 July 1944, pp. 22-25, andexhibit 27. HD: 024. (2) Diary, Hosp and Dom OprsSGO, 18 Aug 44, par 6, Laundry Sec. HD: 024.7-3.

CHAPTER XXIV

Providing the Meansfor Evacuation by Air

Experiences of World War II firmlyestablished air transportation as an accept-able if not preferable method of evacu-ation, not only within theaters but alsofrom overseas areas to the zone of interiorand from one point to another within thelatter. Because of insatiable demands fromall quarters for aircraft, the movement ofpatients by plane, even more than by sur-face vessels, had to be fitted in with thetransportation of troops and cargo. In the-aters this problem was often solved byinformal arrangements between local sur-geons and air force commanders. In thezone of interior agreement was reachedonly after a debate over whether specialplanes would be provided for evacuationalone or whether all transport planeswould have a dual purpose—the transpor-tation of troops and cargo in one directionand of patients in the other. The MedicalDepartment wanted special ambulanceplanes for use in all areas—combat zones,communications zones, and the zone of in-terior. AAF headquarters, on the otherhand, insisted upon maximum use of allplanes and therefore adopted a policy ofusing aircraft with other primary missionsfor evacuation also. Thereafter, the Medi-cal Department and the Army Air Forcescollaborated in arrangements for the

adaptation of transport planes to theevacuation mission.

Aircraft

Prewar Plans for Airplane Ambulances

Before the war, plans for the procure-ment and use of airplane ambulances werenebulous. Perhaps one reason was thatthere was no tradition of using specialplanes in wartime for evacuation only.With the development of air transporta-tion during World War I and the yearsthat followed, surgeons of various airfieldshad experimented with the developmentand use of small airplane ambulances.1

Repeatedly in the 1930's The SurgeonGeneral had requested the procurementof at least seven airplane ambulances forthe movement of patients in the UnitedStates during peacetime and for experi-ments upon which plans for their use inwartime could be based. In each instance,because of difficulty encountered in secur-ing sufficient funds for the procurement ofrequisite planes for training and for de-fense of the United States, the General

1 David N. W. Grant, "Airplane Ambulance Evac-uation," The Military Surgeon, vol. 88, No. 3 (1941), pp.238-43.

PROVIDING THE MEANS FOR EVACUATION BY AIR 427

Staff, on the advice of the Chief of the AirCorps, had disapproved The SurgeonGeneral's requests.2 Instead, a policyestablished as early as 1931 continued ineffect. Special airplane ambulances werenot normally provided, but regular trans-port planes were fitted with litter-holdingbrackets to enable them to move patientsfrom one hospital to another. In excep-tional cases only, training centers werepermitted to convert small planes into air-plane ambulances for crash-rescue work(that is, the rapid removal of persons fromairplane accidents to hospitals of theirhome stations).3

During 1940 opinion among medicalofficials as to the need for airplane ambu-lances in wartime crystallized. Experienceof the Germans in air evacuation duringthe Polish campaign, an account of whichappeared in the Army Medical Bulletin,4

perhaps contributed to this development.The chief of the Medical Division of theOffice of the Chief of the Air Corps, thesurgeon of GHQ Air Force, and The Sur-geon General agreed that two types ofplanes would be needed—small planes forthe transportation of one or two casualtiesfrom medical stations in divisional areasto hospitals farther in the rear, and largeplanes for the removal of greater numbersof patients from evacuation hospitals togeneral hospitals in communicationszones or the zone of interior. They agreedalso that such planes should be set asideexclusively for air evacuation and shouldbe under the control of theater headquar-ters.5 The Chief of the Air Corps and theGeneral Staff implied approval of thesepropositions, and the latter on 5 Septem-ber 1940 directed the Chief of the AirCorps to maintain plans for convertingstandard transport airplanes and suitablesingle-engine airplanes to ambulance use.6

This directive uncovered an importantproblem. While the procurement of largeambulance planes was expected to berelatively simple, since either civilian ormilitary transports could be readily con-verted by the installation of litter racks,the procurement of small airplane ambu-lances promised to be considerably moredifficult. In September 1940 the Chief ofthe Air Corps stated that no small planessuitable for conversion were either avail-able or anticipated for procurement. TheGeneral Staff then verbally modified itsdirective, relieving the Air Corps of re-sponsibility for maintaining plans for thewartime conversion of single-engine air-planes.7 Soon afterward, when the Gulf

2 (1) Memo, ACofS G-4 WDGS for CofSA, 8 Jun32, 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-4WDGS 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 WrightFld, 5 Dec 31, on Ltr, Maj Robert [E. M.] Goolrick,AC to CofAC thru Chief Mat Div Wright Fld, 23 Oct31, 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: AirplaneCasualty 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 DivOCofAC, 20 Jun 40. SG: 320.3-1. (2) Memo, ChiefMed Div OCofAC for SG, 2 1 Jun 40. Same file. (3)Ltr, SG to TAG, 11 Jul 40, sub: Air Corps Med TransGroup. AG: 320.2 Med (7-11-40).

6 (1) 2d ind, CofAC to TAG, 24 Jul 40, on Ltr, SGto 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 Sep40, same sub. All in AG: 320.2 Med (7-11-40).

7 (1) R&R Sheet Comment 1, Exec OCofAC to Tngand Oprs, Plans and Mat Divs OCofAC, in turn, 9Sep 40, sub: Air Amb Serv. AAF: 452.1-B (AmbPlanes). (2) R&R Sheet Comment 3, Plans DivOCofAC to Mat Div OCofAC thru Exec, 17 Sep 40,same sub. Same file.


Coast Air Corps Training Center re-quested procurement of single-engine air-plane ambulances for peacetime crash-rescue work, the Chief of the Air Corpsdisapproved the purchase of airplanes ex-clusively for ambulance service, butstated, strangely enough, that small planesalready in service might be converted intoambulances.8 A subsequent investigationconfirmed his earlier opinion that lightplanes in service were not suitable for con-version. Some were too old; others weretoo small; and still others had openingsthat were too small to admit litters andwere incapable of enlargement withoutweakening the fuselages of planes.9 Earlyin 1941, therefore, the Chief of the AirCorps permitted the conversion into am-bulances of three small planes of a newtype just being procured—0-49s—pro-vided this action did not seriously delaythe assignment of planes to observationsquadrons.10 By July 1941 it was reportedthat each of these had been converted tocarry one litter patient and a medical at-tendant, in addition to the pilot, and hadbeen assigned to training centers.11

Meanwhile the Surgeon General's Of-fice and the Medical Division of the Officeof the Chief of the Air Corps had beenmaking plans for the use of airplane am-bulances in both forward and rear areas ofcombat zones. During 1940 and 1941, aswill be seen later, they developed a tableof organization for units that would evac-uate patients in airplane ambulances andrequested the publication of informationabout such units in a Medical Depart-ment field manual. They also devoted at-tention to the problem of developing asmall plane suitable for use in front-lineareas. From the time when the NationalResearch Council suggested in October1940 that an Autogiro might solve this

problem, the Surgeon General's Officemaintained a steady correspondence withthe company producing such planes. InSeptember 1941 representatives of thatOffice and of the Medical Division of theOffice of the Chief of the Air Corps wit-nessed a demonstration of an Autogiroand discussed with company officials thecharacteristics desired in a front-line air-plane ambulance.12 By the latter part ofNovember the company producing Auto-giros submitted drawings for an ambu-lance. The Air Corps Materiel Divisionagreed that this type of plane, if success-fully developed, would be useful in for-ward areas, but believed that the one pro-posed would be unsuccessful because of itsweight. It recommended, therefore, thatfurther action on the question of an am-bulance Autogiro be suspended until aftercompletion and testing of others beingdeveloped for Air Corps tactical mis-sions.13

8 (1) R&R Sheet Comment 6, Mat Div OCofAC toMed Div OCofAC, 3 Dec 40, sub: Air Amb Serv. (2)R&R Sheet Comment 7, Med Div to Mat Div, 16Dec 40. same sub. (3) R&R Sheet Comment 10, PlansDiv OCofAC to Exec, OCofAC, 31 Dec 40, same sub,with approval by CofAC. All in AAF: 452.1-B (AmbPlanes).

9 Memo, Fld Serv Sec Mat Div Wright Fld for TecExec Mat Div Wright Fld, 17 Jan 41, sub: Info . . .Regarding Amb Airplanes. AAF: 452.1-B (AmbPlanes).

10 (1) R&R Sheet Comment 1, Mat Div OCofAC toExec OCofAC, 23 Feb 41, Comment 3, Tng and OprsDiv OCofAC to Exec OCofAC, 1 Mar 41; and Com-ment 4, Exec OCofAC to Mat Div OCofAC, 4 Mar41, sub: Amb Airplanes. All in AAF: 452.1-B (AmbPlanes).

11 Memo, Mat Div Wright Fld for Mat DivOCofAC, 29 Jul 41, sub: 0-49 Amb Airplanes. AAF:452.1-B (Amb Planes).

12 See SG: 452.-1, and Off file, Research and DevBd SGO, "Amb Airplane."

13 (1) Memo, Mat Div OCofAC for Mat Div WrightFld, 28 Nov 41, sub: Amb Autogiro. AAF: 452.1-B(Amb Planes). (2) Memo, Mat Div Wright Fld forMat Div OCofAC, 3 Jan 42, same sub. Same file.


C-46 TRANSPORT PLANE READY TO UNLOAD PATIENTS. The ambulanceon the right is a ¾ ton (4x4) knock-down type.

Decision Not To Provide SeparateTransport Planes for Evacuation

Soon after war began, the need for airevacuation was met by the peacetimepractice of using regular transports. Thefirst occasion requiring the movement byair of large numbers of patients occurredin January 1942 during construction ofthe Alcan Highway to Alaska. The sec-ond occurred in Burma in April 1942. Inboth instances regular transport planes(C-47s) already equipped with litterbrackets were pressed into ambulanceservice.14

Successful evacuation by transports didnot remove the desire of some militaryagencies for separate airplane ambu-lances. In July 1942 the Alaska DefenseCommand asked for a large airplane am-bulance, and was supported in its requestby the Western Defense Command. The

next month The Surgeon General re-quested an airplane ambulance for use intransporting patients from the Newfound-land Base Command to the United States.These requests produced a confirma-tion—in view of the wartime demand forplanes for other purposes—of the existingpolicy of not providing special planes forambulance service only, but of equippingall transports with litter brackets so theymight be used for evacuation as well as fornormal missions.15

AAF headquarters encountered somedifficulty in the observance of this policy.

14 Frederick R. Guilford and Burton J. Soboroff,"Air Evacuation: An Historical Review," Journal ofAviation Medicine, Vol. 18 (December, 1947), pp.601-16.

15 (1) Ltr, CG Alaska Def Comd to CG Western DefComd, 14 Jul 42, sub: Aircraft Amb for Alaska, with2 inds. AG: 452 (7-14-42). (2) Ltr, CG Eastern DefComd to CG AAF, 31 Jul 42, sub: Air Amb Evac ofPnts from Newfoundland Base Comd, with 4 inds.SG: 705.-1 (Newfoundland)F.


INTERIOR OF C-46 TRANSPORT PLANE, equipped with webbing strap littersupports.

Litter brackets were not always installedin transport airplanes, particularly in newtypes developed to meet wartime needs.In August 1942 the Air Service Commandstated that C-53 transport planes werebeing procured without litter supportsand that the makers of these planes con-sidered it impossible, because of difficultyin obtaining parts for litter racks forC-47s, to install them in C-53s beforeJanuary 1943. The commanding general,Army Air Forces, then directed the Ma-teriel Command to review its transportprocurement program to assure the instal-

lation of litter supports in planes duringtheir manufacture and to provide for theirinstallation in all C-53s purchased with-out them.16 Several months later the AirTransport Command requested that littersupports be provided by manufacturersfor all C-46s. Expressing irritation withfailure to equip transport planes with littersupports, the AAF Directorate of Military

16 1st ind, Chief Fld Serv Air Serv Comd AAF toCG Air Serv Comd AAF, 4 Aug 42, and 3d ind, CGAAF to CG Mat Comd AAF, 21 Aug 42, on Ltr, ChiefOverseas Div Air Serv Comd AAF to Chief Fld ServAir Serv Comd AAF, 20 Jul 42, sub: Litter Racks forC-53 Airplanes. AAF: 370.05 (Evac).


INTERIOR OF C-54 TRANSPORT PLANE equipped with metal litter supports.

Requirements called upon the MaterielCommand for a report. In reply thatCommand summarized the situation. AllC-47s were completely equipped withlitter supports during production. Whilea shortage of critical materials had pre-vented installation in the first twenty-fourC-46s delivered, all others would comeequipped. Beginning in December 1942,all C-53s would be provided with litterbrackets by manufacturers. Meanwhile,the Air Forces would install them in 200planes of that type already delivered.Beginning in January 1943, supports forten litters would be placed in each C-60.

Finally, all new types of transports wouldbe equipped with litter supports whendeliveries began.17

Small Planes for Ambulance Serviceat Training Centers

The question of the assignment to train-ing centers of small ambulance planes forrescue work was raised again when the

17 R&R Sheet Comment 1, CG ATC to Mil ReqmtsDir AAF, 26 Oct 42; Comment 2, Mil Reqmts DirAAF 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 forC-46 Airplanes. AAF: 370.05 (Evac).


Southeast Air Corps Training Center re-quested in May 1942 the assignment ofone each to its flying training schools.While the AAF Directorate of MilitaryRequirements observed a policy of neitherdeveloping nor altering an airplane so asto provide an additional type, it was will-ing that planes of other types be used tocarry patients. It therefore directed theAAF Materiel Command on 18 June1942 to examine all small transport andliaison planes being procured in order todetermine which could be readily adapt-ed, with least modification, to carrylitters.18

The Materiel Command reported inAugust 1942 that small planes most suit-able for adaptation to ambulance servicewere the AT-7 and the C-64. The AirForces had 127 of the former on hand, and300 C-54s were being procured. Eithercould be modified to carry at least two lit-ters and a medical attendant, in additionto the pilot. They would be more suitablethan the O-49s (L-1s) already converted,because the latter required more extensivemodification and carried only one litterand a medical attendant, in addition tothe pilot. The Materiel Command there-fore requested authority to have a localsubdepot modify one AT-7 and to have amanufacturer modify one C-64 in pro-duction, in order to determine whichwould be preferable as an ambulance.19

This recommendation was consideredby AAF headquarters, along with a re-quest of the Flying Training Commandfor assignment to the Gulf Coast, WestCoast, and Southeast Air Force TrainingCenters of sixty-two small ambulanceplanes and of thirteen larger planes ofgreater cruising range, such as C-60s.20

On 20 August 1942 the Assistant Chief ofAir Staff for Training, A-3, announced

that all small planes being procured wereearmarked for other missions.21 AT-7swere in such demand for the navigationtraining program that C-60s were beingmodified to supplement them. All C-64sbeing procured were to be used in com-munications work, pilot dispersal, andlight cargo movement. Consequently itwas decided not to modify AT-7s, but tohave manufacturers equip all C-64s, be-ginning in January 1943, with bracketsfor three litters. Since none of the latterwere assigned to the Flying TrainingCommand, the commanding general,Army Air Forces announced on 8 Novem-ber 1942 that it would have to meet its re-quirement for airplane ambulances byhaving litter supports installed in planesalready on hand.22

The issue of airplane ambulances in theUnited States came up again on 12 Jan-uary 1943 when the Air Surgeon proposedthe assignment of L-1Bs—liaison planes

18 Ltr, CG Southeast AC Tng Ctr to CG Flying TngComd AAF, 7 May 42, sub: Amb Airplanes, with 5thind, 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 forAmb Serv. (2) R&R Sheet Comment 1, Mat ComdAAF to War Orgn and Mvmt Dir AAF, 16 Aug 42,sub: Amb Airplanes. Both in AAF: 452.-1 (AmbPlanes).

20 Ltr, CG Flying Tng Comd AAF to CG AAF, 5Aug 42, sub: Amb Airplanes. AAF: 452.-1 (AmbPlanes).

21 R&R Sheet Comment 5, AC of Air Staff for TngA-3 to War Orgn and Mvmt Dir AAF and Indiv TngDir AAF, 20 Aug 42, sub: Amb Planes. AAF:452.-1-B (Amb Planes).

22 (1) Interoffice Memo, Capt John P. Marshall MatComd AAF to Col Seesums, 19 Aug 42, sub: AmbAirplanes. (2) R&R Sheet Comment 3, Indiv Tng DirAAF 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 DirAAF to Indiv Tng Dir AAF, 2 Nov 42, same sub. (3)Memo, CG AAF for CG Flying Tng Comd AAF, 8Nov 42, same sub. All in AAF: 452.1 (Amb Planes).


modified by manufacturers to carry onelitter and one medical attendant, in ad-dition to the pilot—to meet a need ex-pressed by the Second Air Force. Soonafterward the Flying Training Commandrenewed its attempt to get airplane ambu-lances. By this time—the spring of 1943—training programs, such as the glider tow-ing program, were being curtailed andsmall liaison planes (L-1s) formerly usedwere no longer needed. As a result, someof them were assigned for ambulance serv-ice to the Second Air Force, and the Fly-ing Training Command was permitted tomodify about 100 liaison-type planes tomeet its needs.23 Soon afterward the AAFRequirements Division announced offi-cially a policy which it had formerly ob-served without publicity. When a trainingstation needed a special airplane to beheld always in readiness purely as an am-bulance airplane, its requirement wouldbe treated as a special one and would bemet by the conversion of a suitable avail-able plane. Such conversions were to beheld to a minimum and were to be madeonly when specifically approved by AAFheadquarters.24

The Question of Airplane Ambulancesfor Use in Combat Zones

After the war began, the Air Surgeonand The Surgeon General continued toplan for the use of small airplane ambu-lances in combat zones. Their problem inthis instance was twofold: (1) to find asuitable plane and (2) to get it deliveredin appropriate numbers for use by evac-uation units.

Various types of planes were considered.It was agreed that a successful one wouldhave to accommodate at least two littersand a medical attendant, in addition to its

pilot, and would have to be able to go inand out of small fields over tops of treesand other obstructions. Before the war, asmentioned above, The Surgeon Generalhad thought that an Autogiro might bedeveloped with these characteristics. InMay 1942 an aircraft corporation sub-mitted photographs of a small airplaneambulance which it had developed.25

Both The Surgeon General and the AirSurgeon proposed that it be studied anddemonstrated, even though it could ac-commodate only a pilot and one patient,26

but after consultation with the AAF Di-rectorate of Military Requirements theMateriel Command informed the com-pany that the Army had no use for such aplane. It stated that litter bearers were themost effective means for removing casual-ties from battlefields with rough terrain;that even if the terrain were suitable forlanding, a plane was too vulnerable a tar-get to risk in advanced areas; and, finally,that any plane that lacked room for amedical attendant was unsatisfactory.27

Somewhat later, in June, another manu-facturer demonstrated to representatives

23 (1) R&R Sheet Comment 1, Air Surg to MilReqmts Dir AAF, 12 Jan 43, and Comment 3, WarOrgn and Mvmt Dir AAF to Air Surg, 16 Mar 43,sub: Airplane Amb (L-1A). AAF: 452.1 (AmbPlanes). (2) Routing Slip, [Lt Col] C. W. G[lanz], MilReqmts Dir AAF to Col M[ervin] E. Gross, 15 May43. AAF: 370.05-A (Evac).

24 AAF Mil Reqmts Policy No. 41, 25 May 43, sub:Amb Airplanes — Provisions for Evac Wounded byCargo Airplanes. AAF: 370.05-A (Evac).

25 Ltr, Aeronca Aircraft Corp to Hon John J. Mc-Cloy, Asst SecWar, 20 Apr 42, with incl. SG: 452.1.A similar letter to the Commanding General, ArmyAir 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, AirSurg 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 MatComd to Aeronca Aircraft Corp, 5 May 42. AAF:452.1-B (Amb Planes).


of the Air Surgeon and The Surgeon Gen-eral a small plane which he had convertedinto an ambulance. It was likewise con-sidered unsatisfactory because it also hadroom for only one patient and a pilot.28

Meanwhile, the Air Forces had begun theinvestigation, already mentioned, of smalltransport and liaison planes which train-ing centers might adapt to ambulance use.Apparently the Air Surgeon believed thatthis might result in discovery of an exist-ing plane that could be used in combatzones as well as in the zone of interior.29

Despite uncertainty about the avail-ability of a suitable plane for use in for-ward areas, the Air Surgeon continued toplan in those terms. One method of get-ting approval for his plans was to haveairplane ambulances considered as or-ganic equipment of evacuation units. Onecould assume that upon activation of suchunits, planes authorized for them wouldbe made available. When the Air Surgeonrevised the table of organization for airevacuation units during 1942, he includedtwenty small planes along with an equalnumber of flight officers in the table forthe air evacuation squadron, light.30 Thistable was approved by certain sections ofthe 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 forit came up, the Directorate of MilitaryRequirements objected. Not having beenconsulted in advance, it had made noplans for supplying evacuation units witheither planes or pilots. It insisted thatlitter bearers and automobile ambulancescould best move patients from divisionalmedical stations to rear areas, for pick-upby transport planes. It maintained, there-fore, that squadrons equipped with smallplanes, or "puddle jumpers," were not re-

quired and should not be provided.32 Thecommanding general, Army Air Forces,supported Military Requirements, and itsposition was subsequently announced aspolicy in May 1943.33

Consideration of Helicoptersfor Air Evacuation

Announcement of this policy did notquash the hopes of many, including theAir Surgeon, The Surgeon General, andArmy Ground Forces headquarters,34 thata suitable plane for evacuating patientsfrom front-line areas might be found andits use approved. Late in 1942 a civiliandoctor in Virginia had pressed upon theWar 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, 7Nov 42, sub: Air Evac and Air Trans of Med Supsand Pers. HD: 580.1 Air Evac.

30 (1) R&R Sheet Comment 1, Air Surg to WarOrgn and Mvmt Dir AAF, 15 Sep 42, sub: Air Evac,with incl. AAF: 370.03. (2) Rpt of Mtg, ATC, 13 Oct42, sub: Air Evac of Wounded. AAF: 370.05 (Evac).

31 (1) R&R Sheet Comment 3, Ground-Air SupportMil Reqmts Dir AAF to Mil Reqmts Dir AAF, 24Nov 42, sub: Conversion of Airplanes to EvacWounded. AAF: 370.05 (Evac). (2) Hubert A. Cole-man, Organization and Administration, AAF Medi-cal Services in the Zone of the Interior (1948), p. 689.

32 (1) R&R Sheet Comment 4, Dir Mil ReqmtsAAF 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 MilReqmts 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 DirMil Reqmts AAF, 12 Nov 42, sub: Conv of Airplanesto Evac Wounded. AAF: 370.05 (Evac). (2) MilReqmts Policy No. 41, 25 May 43, sub: Amb Air-planes—Provisions for Evac Wounded by Cargo Air-planes. AAF: 370.05-A (Evac).

34 For the Army Ground Forces' viewpoint, see:10th ind, CG AGF to CG ASF, 20 Nov 43, on Ltr,Dept of Air Tng Fld Artillery Sch to CG ASF thruRepl and Sch Comd AGF, 7 Sep 43, sub: Air Evac byLight Airplane. AAF: 452.-1 (Amb Planes).


helicopters in front-line medical service.35

Both the Air Surgeon and The SurgeonGeneral quickly adopted the idea as a so-lution to the problem of evacuating pa-tients by air from inaccessible areas incombat zones and called upon the AAFMateriel Command for information inthis connection.36 The Command reportedearly in 1943 that it had been testing heli-copters for a period of eight months. Al-though it had begun the procurement ofseveral types, none of them were expectedto be delivered before the middle of 1943.The Command had already given pre-liminary consideration to the use of heli-copters for evacuation and was requiringthat they be fitted for the external attach-ment of "capsules" suitable for carryinglitter patients. It was anticipated that thiswould enable each XR-5 and R-5 heli-copter to carry four litter patients andeach XR-6 to carry two. In collaborationwith the Aero Medical Research Labora-tory, the Materiel Command was study-ing the possibility of modifying XR-5 andXR-6 helicopters so they might carry fourand two litters respectively within theirfuselages, rather than in externally at-tached capsules. Meanwhile, it expectedthat an XR-5 helicopter, with capsulesattached, would be ready for testing bySeptember 1943 and that additional onescould be procured, after their use as am-bulances had been approved, in from tento eighteen months.37

Progress in the general helicopter pro-gram was apparently not as rapid as hadbeen expected. In the winter of 1943-44the Air Forces had on hand only eight ornine serviceable helicopters and expectedthat few more would be delivered beforethe latter half of 1944.38 The developmentof an ambulance helicopter had alsolagged. Believing that patients should not

be transported in capsules beyond thereach of medical attendants except inemergencies, the Air Surgeon succeededin having a "requirement" establishedearly in March 1944 for a helicopter thatcould accommodate at least four litter pa-tients and an attendant within its fuselage.In conformity with established policy, theAAF Requirements Division directed thatany helicopter developed to meet this re-quirement should be suitable for basic useas a cargo plane and should be equippedfor carrying litters only if this did not in-terfere with such use.39 The Air Surgeonalso apparently requested the procure-ment of 150 helicopters for use by his pro-posed air evacuation squadrons but hereconsidered the matter after discussionwith the AAF Requirements Division. Inview of the shortage of helicopters of alltypes and the lack of one that could trans-port patients within its fuselage, he agreedin March 1944 not to organize helicopterevacuation squadrons but instead to use

35 (1) Ltr, Dr Huston St. Clair to Maj Gen W[il-helm] D. Styer, CofS SOS, 23 Nov 42. Off file, Re-search and Dev Bd SGO, "Amb Airplanes." (2) Ltr,same to Col G[ustave] E. Ledfors, Air Surg Off, 7 Dec42. AAF: 452.1 (Helicopters). (3) Ltr, Mr. G. H. Dorr,Spec Asst to SecWar to Col W[ood] S. Woolford, AirSurg Off, 31 Dec 42. Same file.

36 (1) Ltr, SG to Chief Engr Div Wright Fld, 21 Dec42, sub: Helicopter Dev. AAF: 452.1 (Helicopters).(2) Memo, Air Surg for Mat Comd Wright Fld, [22Dec 42], same sub. AAF: 452.1 (Amb Planes).

37 (1) Memo, Mat Comd AAF for SG, 16 Jan 43,sub: Helicopter Dev — Util as Air Amb. (2) Memo,Mat Comd AAF for Air Surg, 3 Mar 43, sub: Heli-copter Dev for Air Amb Serv. Both in AAF: 452.1(Helicopters).

38 (1) Memo, CG AAF for ACofS G-3 WDGS, [12Dec 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, andReqmts Div AAF to Air Surg, 23 Mar 44, sub: Statusof Helicopters. Both in AAF: 452.1 (Helicopters).


LOADING A PATIENT ON AN L-5 PLANE

for emergency evacuation helicopters or-dinarily employed otherwise.40 Soonafterward he stated that it was AAF policyto use C-64 and L-5 airplanes equippedto carry litters for the evacuation of pa-tients singly or in small numbers.41 Mean-while, the general helicopter programcontinued, and toward the end of the warthere were indications that some mightsoon be modified to carry patients withintheir fuselages and that they would beavailable in sufficient numbers for assign-ment to overseas commands.42

Relaxation of the Policy Limiting the Useof Special Planes for Evacuation

Despite AAF policy against the use ofairplanes exclusively for evacuation, as-

signment of additional transport planes tosupply enough "lift" for evacuation in ad-dition to normal operations became anaccepted practice in the zone of interior

40 R&R Sheet Comment 1, Air Surg to Oprs, Com-mitments, and Reqmts Div AAF. 4 Mar 44, and Com-ment 2, Oprs, Commitments, and Reqmts Div AAF toAir Surg, 7 Mar 44, sub: Use of Helicopters for AirEvac. AAF: 452.1 (Helicopters).

41 5th ind, CG AAF (Air Surg) to CG Air ServComd, 24 May 44, on Memo, 2d Lt William R. Kee,AC for Air Surg, thru Channels, 17 Apr 44, sub: Evacof Wounded by Air. AAF: 370.05 (Evac). Also see TheAir Surgeon's Bulletin, vol. I, No. 8 (1944), p. 19 andvol. I, No. 9 (1944), p. 16.

42 (1) R&R Sheet Comment 1, Reqmts Div AAF toMat Div AAF, 31 May 45, sub: Litter Capsules forHelicopters. (2) Ltr AG 320.3 (11 Apr 45) OB-I-AFRTH, TAG to CG ETO, 5 May 45, sub: AAFHelicopter Program. Both in AAF: 452.1 (Helicop-ters).


during the later war years. This practicebegan in January 1944, when three C-47swere temporarily used to move 661 pa-tients from Stark General Hospital toother hospitals in the zone of interior. Sev-eral months later the Air Transport Com-mand temporarily assigned twelve C-47sto its Ferrying Division for a similar "spe-cial operation." These operations were sosuccessful that, after the Ferrying Divisionwas made responsible for air evacuationin the zone of interior in May 1944, twelveplanes were permanently assigned to thatmission. They could, of course, be usedfor the transportation of other persons andof cargo when not carrying patients. Thenext month twelve additional C-47s wereassigned to provide planes for evacuation.As the number of patients arriving fromtheaters increased and the calls for airevacuation became more frequent, thenumber of transport planes assigned tothe Ferrying Division for evacuation oper-ations grew until it reached forty-nine bySeptember 1944.43

As patients continued to be evacuatedfrom theaters to the zone of interior in reg-ular transport planes, efforts were madeduring 1944 and 1945 to increase thenumber of patients they carried. The in-crease was accomplished in two ways. Onewas the installation of newly developedwebbing-strap litter supports. More pa-tients could be accommodated in planesusing these supports than in thoseequipped with metal-type supports. In thesummer of 1944 the Air Forces installedwebbing-strap litter supports in C-54salready in use and provided for their in-stallation in others during production.44

Another method of increasing the use ofairplanes for evacuation was to modify thesystem of determining the number of pa-tients theaters would evacuate by air. In

the spring of 1944, it will be recalled, theAir Transport Command authorized the-aters to ignore the old system of prioritiesfor air transportation and determine lo-cally the proportion of space on returningtransport planes that would be reservedfor patients.45

Medical Flight Attendants

Early Plans for Medical Personnelfor Air Evacuation

Since plans for air evacuation duringthe period before the war and well into itsfirst year were tentative only, plans forunits to be employed in such operationswere of necessity also uncertain. In theprewar years The Surgeon General andthe Medical Division of the Air Corps col-laborated in the development of an organ-ization—sometimes called a task force—that would be used exclusively for theevacuation of patients from forward torear areas of theaters of operations andperhaps to the zone of interior. Whilethere were differences of opinion on somepoints—such as the name of the organiza-tion, the number of subordinate units itshould have, and the amount of personnel

43 (1) Organizational History of the Ferrying Divi-sion, June 20, 1942 to August 1, 1944, pp. 271-78.ATC: Hist Div. (2) Initial Medical History (11 Febru-ary 1943 to 30 June 1944), Headquarters Ferrying Di-vision, Air Transport Command. HD: TAS. (3) Quar-terly Medical History, Headquarters Ferrying Divi-sion, Air Transport Command, 1 July-30 September1944. HD: TAS. (4) Memo, Air Surg for SG, 27 Jul44. SG: 580. (5) Memo, Comdt Sch of Air Evac forCG 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 thruCG 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.


required for each unit—there was generalagreement on major issues. An air ambu-lance organization should be composed ofboth Air Corps and medical personnel, theformer to maintain and operate ambu-lance airplanes and the latter to care forpatients. This organization should operateunder the control of theater headquarters,augmenting surface evacuation, andshould perhaps be assigned on the basis ofone unit per field army. Medical officersand enlisted men of the organizationwould not only serve as attendants to pa-tients during flights but would also oper-ate medical stations at large airfields,fifteen to fifty miles from the front, and atsmall emergency landing fields, two to tenmiles from the front. They would collectand transport patients by motor ambu-lances to such stations, care for them asthey awaited air evacuation, and loadthem on planes for transportation to therear.46

Several tables of organization for an airevacuation unit were developed throughthe collaboration of the Surgeon, GHQAir Force; the Medical Division of the AirCorps; and the Surgeon General's Office.One submitted in July 1940 was disap-proved by the General Staff because air-plane ambulances were included as or-ganic elements of medical rather than AirCorps units of the evacuation organiza-tion.47 Another, submitted by The Sur-geon General in October 1940, apparentlyremained in the G-3 Division of the Gen-eral Staff without action until the latesummer of 1941. It was then revised andresubmitted for approval in November.48

It was published shortly afterward as thetable of organization for a medical air am-bulance squadron. This squadron was tobe a companion unit for an Air Corpstransport group composed of a headquar-

ters squadron, a flight squadron, light,equipped with eighteen single-engine liai-son planes for front-line evacuation, andtwo flight squadrons, heavy, eachequipped with twelve two-engine trans-port planes for intra-theater evacuation.The medical squadron was to consist of aheadquarters section, a single-enginetransport ambulance section, and twotwo-engine transport ambulance sections.It was to have 45 Medical Departmentofficers, no nurses, and 218 enlisted men.One unit of this type, the 38th MedicalAir Ambulance Squadron, was activatedat reduced strength as a test unit in May1942.49

After AAF was charged with responsi-bility for air evacuation in the summer of1942, the Air Surgeon's Office developeda new plan for an air evacuation unit,called an air evacuation group. This groupwas to be composed of a headquarters

46 (1) Ltr, SG to TAG, 11 Jul 40, sub: AC MedTrans 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 ComdtMFSS, 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 Sur-geon, vol. 88, No. 3 (1941), pp. 238-43. (5) FM 8-5,Mobile Units of MD, 12 Jan 42, pp. 157-69.

47 (1) Ltr, Surg GHQ, AF to Chief Med DivOCofAC, 20 Jun 40. SG: 320.3-1. (2) Memo, ChiefMed Div OCofAC for SG, 2 1 Jun 40. Same file. (3)Ltr, SG to TAG, 11 Jul 40, sub: AC Med TransGroup. AG: 320.3 Med (7-11-40). (4) Memo, ACofSG-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/OMed Bn, Airplane Amb, with 3 inds. (2) DFG-3/42108, ACofS G-3 WDGS to CofAAF, 15 Augand 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 AirStaff to TAG, 19 Nov 41, sub: T/O for Med AirplaneAmb 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.


squadron; an air evacuation squadron,light; and three air evacuation squadrons,heavy. While it was anticipated that theheavy squadrons would consist of medicalpersonnel only and would use planes ofeither troop carrier or air transport com-mands, the light squadron was to havetwenty small planes and twenty pilots as-signed as organic elements. The lightsquadron was to consist of only enlistedmen and officers, but the heavy squadronwas to have nurses also. The entire groupwas to have 49 Medical Department offi-cers, 20 Air Corps officers, 78 nurses, and458 enlisted men. It was anticipated thatair evacuation groups would be assignedas the situation required to air forces, the-aters, defense commands, task forces, orfield armies.50 The Air Staff having ap-proved the plan for this organization, theI Troop Carrier Command activated sucha unit in October 1942, using initially offi-cers and men transferred from the 38thMedical Air Ambulance Squadron. Thisunit—the 349th Air Evacuation Group—at first consisted of a headquarters squad-ron and one heavy squadron. In Novem-ber, when a light squadron and two addi-tional heavy squadrons were activated andassigned to it, the 349th Air EvacuationGroup was given the mission of trainingpersonnel for air evacuation operations.51

Meanwhile, as already explained, the AirStaff had decided that transport planeswould not be earmarked for evacuationonly and that small ambulance airplaneswould not be provided for use in forwardareas. This decision cut short the life of thesquadrons just activated because it de-stroyed the basic concept underlying theirformation.

With the decision to consider air evacu-ation as a secondary mission of planesengaged in general transport service, a

different kind of organization was needed.The Air Surgeon therefore developed asmaller unit, the Medical Air EvacuationTransport Squadron (MAETS), whosetable of organization was issued in advanceform at the end of November 1942 andwas published in regular format in Febru-ary 1943. This unit had no personnel forthe movement of patients in motor ambu-lances or the operation of medical stationsat loading points. It consisted of a head-quarters and four evacuation flights, eachmade up of six flight teams. A command-ing officer, a chief nurse, an administra-tive officer, and 29 enlisted men comprisedthe headquarters. Each flight, headed bya flight surgeon, consisted of 6 flight nursesand 8 enlisted men, of whom 6 were surgi-cal technicians. Flight teams, made up ofone nurse and one technician, could beplaced on transport planes as needed.52 InDecember 1942 members of the threeheavy air evacuation squadrons alreadyactivated were used to form six medicalair evacuation transport squadrons. Thenext month the light air evacuation squad-ron was disbanded and its personnel wasabsorbed by the 349th Air EvacuationGroup. Subsequently, during 1943 and1944, additional MAETS were organized,trained, and sent overseas.53

50 (1) Coleman, op. cit., pp. 685-87, 703. (2) R&RSheet Comment 1, Air Surg to Dir War Orgn andMvmt AAF, 15 Sep 42, with incl. AAF: 370.03. (3)Rpt, Mins of Mtg, ATC, 13 Oct 42, Air Evac ofWounded. AAF: 3 70.05.

51 (1) Medical History, I Troop Carrier CommandFrom 30 April 1942 to 31 December 1944. HD: TAS(2) Coleman, op. cit., p. 689. (3) Guilford and Sobo-roff, op. cit.

52 (1) An Rpt, FY 1943, Oprs Div Air Surg Off.DAF: SGO Hist Br. (2) T/O 8-447, Med Air EvacTrans Sq, 15 Feb 43.

53 (1) Guilford and Soboroff, op. cit. (2) Unit Cards,801st thru 831st Med Air Evac Trans Sqs, filed inOrgn and Directory Sec Oprs Br Admin Servs DivAGO.


School of Air Evacuation

Charging the 349th Air EvacuationGroup with the mission of training per-sonnel for air evacuation operations indi-cated recognition by the Air Surgeon ofthe need for specialized training for suchwork. Despite the fact that it was not to beused in the theaters of operations as origi-nally anticipated, the 349th continued inexistence as a training school until June1943. At that time the Air Forces estab-lished a School of Air Evacuation at Bow-man Field, Kentucky. This school oper-ated under the Troop Carrier Commanduntil August 1944. Then, after a shortperiod of operation directly under AAFheadquarters, it was merged in October1944 with the School of Aviation Medicineat Randolph Field, Texas. During theperiod from June 1943 through September1945 it trained in air evacuation duties109 medical officers, 1,331 nurses, and 837enlisted men.54

Method of Controlling and SupplyingFlight Attendants

Teams of one nurse and one MedicalDepartment technician per plane contin-ued in use throughout the war. As airevacuation operations within the UnitedStates began to assume significant propor-tions early in 1944, ATC headquartersannounced in April that additional nursestrained in air evacuation would be as-signed to ATC hospitals and would beused, along with enlisted technicians qual-ified to assist them, to form flight teams forplanes transporting patients between hos-pitals in the United States.55 When theFerrying Division took over domestic airevacuation soon afterward, it acquiredflight surgeons, flight nurses, and enlisted

technicians as part of its bulk allotment ofMedical Department personnel for use inair evacuation only.56 For evacuationwithin theaters of operations and for flightsbetween theaters and the zone of interior,flight teams were supplied by medical airevacuation transport squadrons. The tableof organization for these squadrons wasrevised in July 1944, reducing the numberof enlisted men in squadron headquartersfrom twenty-nine to twenty-four. Person-nel in the squadron's four flights, each ofwhich contained six flight teams, remainedunchanged, but the rank of nurses wasraised.57 Squadrons used for intra-theaterevacuation were attached to troop carriercommands or to Air Transport Commanddivisions in theaters. Those for evacuationfrom theaters to the zone of interior wereassigned to ATC wings until the end of1944. Gradually thereafter the squadronsassigned to ATC wings were disbandedand flight teams used to accompany pa-tients from theaters to the United Stateswere grouped under the 830th MedicalAir Evacuation Squadron Headquarters,organized in the office of the ATC surgeonin Washington in November 1944. By theend of the year this squadron consisted of44 flights; by April 1945 the number hadbeen increased to 56; and by July, to 78.This centralization of administrative and

54 (1) Coleman, op. cit., pp. 691ff. (2) Guilford andSoboroff, op. cit. (3) An Rpt, FY 1943, Oprs Div AirSurg Off. DAF: SGO Hist Br. (4) AAF Reg 20-22,22 Jul 43.

55 ATC Memo 25-6, 29 Apr 44, sub: Med Air Evac.AAF: 370.05.

56 (1) Organizational History of the Ferrying Divi-sion, June 20, 1942 to August 1, 1944. ATC: Hist Div.(2) Quarterly Medical History, Headquarters Ferry-ing Division, Air Transport Command, 1 July-30September 1944. HD: TAS.

57 (1) T/O&E 8-447, 19 Jul 44. (2) DF, CG AAF toACofS G-3 WDGS, 8 Jul 44, sub: T/O&E 8-447,Med Air Evac Sq. AG: 320.3 (2 Jun 44) (1).


operational control resulted in a saving ofoverhead personnel and permitted therapid reassignment of flight teams to areaswhere they were needed most. It also per-mitted the establishment of a procedure inthe spring of 1945 which enabled eachflight team to accompany patients to theUnited States. Formerly, flight teams lo-cated along ATC routes had flown fromtheir home stations to stations en routeand then had returned to home stations.58

The economy of men made possible byair evacuation was a major factor in en-abling the War Department to meet thedemands for large-scale transportation ofpatients in 1944 and 1945 with the limitednumber of attendants at its disposal. Earlyin 1944, when there was concern in Wash-ington lest there be not only insufficientshipping but also insufficient personnel tomove the patient load anticipated for thelatter half of the year, the Surgeon Gen-eral's Office and ASF headquarters askedfor an increase in air evacuation from the-aters as a means of saving manpower.59

The saving was possible, for one reason,because air evacuation was so much fasterthan surface evacuation that patients re-quired the care of only nurses and enlistedtechnicians. Moreover, for such short pe-riods, fewer attendants per patient wereneeded. The saving of personnel can beillustrated by comparing the number ofattendants required for a trip by hospitalship with the number required for thesame trip by planes that did not stop tochange medical attendants or to give pa-tients treatment at hospitals en route. Insuch a case, the transportation of 500 pa-tients by hospital ship required eight doc-tors, eight other officers, thirty-four nurses,and 135 enlisted men. To transport a simi-lar number of patients by air in one con-tinuous flight required seventeen planes

(assuming that each carried thirty pa-tients) with seventeen teams consisting ofone nurse and one technician each, or atotal of thirty-four persons, together withthe personnel rounding out the flights towhich these teams were attached—threedoctors and six enlisted men. The economyis more strikingly realized if man-days arecompared. For example, the transporta-tion of 500 patients across the Atlantic byhospital ship normally required approxi-mately seven days and therefore usedabout 1,295 man-days of medical attend-ance, while the same evacuation could beaccomplished by airplane within from oneto two days, depending upon whether ornot an overnight stop was made in New-foundland, and required from forty-threeto eighty-six man-days only.60

Efforts To Supply AppropriateEquipment for Air Evacuation

Confirmation as policy during 1942 ofthe peacetime practice of using opera-tional planes instead of special airplaneambulances for the evacuation of patientsrequired the development of specialequipment that could be used easily andquickly to adapt cargo and transportplanes to their secondary mission—the

58 (1) Guilford and Soboroff, op. cit. (2) History ofthe Medical Department, Air Transport Command,1 January 1945-31 March 1946. HD: TAS. (3) AAFManual 25-0-1, Flight Surgs Ref File, 1 Nov 45. HD:321 (AAF).

59 Memo, CG ASF for ACofS OPD WDGS, 26 Apr44, sub: Air Evac from ETO and NATO. HRS: ASFPlanning Div Program Br file, "Hosp and Evac,vol. 3."

60 This paragraph is based upon a comparison ofthe tables of organization of hospital ship complementsand medical air evacuation transport squadrons andupon comments by Brig Gen. Albert H. Schwichten-berg on a first draft of this chapter. Also see Journal ofthe American Medical Association, Vol. 141, No. 8 (1949),pp. 540-41.


evacuation of patients. Early in 1942 theAir Forces began to use Douglas remov-able metal-type litter racks, which had al-ready been designed for this purpose, toenable large cargo planes such as theC-47s to carry eighteen litter patients.61

These racks had important disadvantages.Their detachable parts frequently werelost or damaged in stowage, and replace-ments had to be stocked at various fields.Furthermore, it was discovered in the fallof 1942 that standard racks did not ac-commodate all types of American litterscurrently in use in combat theaters. TheMateriel Center at Wright Field (Ohio)therefore undertook a series of experi-ments, and by the early part of 1944 it de-veloped litter supports made of webbingstraps.62 They were superior to Douglasmetal-type racks in many ways. The rackshad to be disassembled after each evac-uation mission and stowed in floor com-partments while two sets of webbing strapscould be spaced and anchored perma-nently along the roof and side walls of theinteriors of planes. Douglas racks weighednearly 200 pounds in comparison with110 pounds for webbing-strap supports.Metal supports would accommodate onlyeighteen litter patients in certain aircraft,but webbing straps would hold twenty-four. Preparation of planes for evacuationwith webbing-strap supports could be ac-complished in six to eight minutes, a frac-tion of the time needed to assemble andinstall metal-type racks. In March 1944,therefore, the use of metal-type racks wascurtailed and airplane production wasmodified to require the installation of thenew supports.63 The Air Forces later issuedtechnical orders to guide those engaged inair evacuation operations in the use ofwebbing-strap supports in C-47, C-47A,C-46, C-64, and C-54 airplanes.64

Litters were important items becausethey served as patients' beds duringflights. Before the war the Air Corps hadused a metal litter, based upon the bestfeatures of the Navy's Stokes litter. It wasnoninflammable, easy to disinfect, andcould be carried, with a patient strappedin, in either a horizontal or a vertical posi-tion, but it was costly, bulky, heavy, anddifficult to carry.65 At the beginning of thewar, therefore, the Air Corps substitutedfor it aluminum-pole litters which hadbeen developed in 1937 especially for AirCorps use. In 1942 growing shortages ofaluminum stimulated development of astraight carbon-steel-pole litter. A poten-tial steel shortage in turn brought aboutthe development early in 1943 of bothstraight and double-folding laminated-wood-pole litters. The latter could be col-lapsed into a smaller space than others,and it soon came to be generally regardedas the best of Medical Department foldinglitters and ideal for Air Forces use.66

When aluminum and steel again be-came available in the summer of 1943, the

61 David N. W. Grant, "A Review of Air Evacua-tion Operations in 1943," The Air Surgeon's Bulletin,vol. I, No. 4 (1944), p. 1.

62 Tec Instruction 1255, Hq Mat Comd AAF Hq toTec Exec Mat Ctr, Wright Fld, Ohio, 9 Sep 42, sub:Correction of Standard Type Litter Support Now Be-ing Installed in Army Trans Aircraft. AAF: 452.1-B(Amb Planes).

63 D. M. Clark, "Litter Support Installations for theC-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 (30Nov 44); 00-75-3 (5 Jan 44); 00-75-4 (15 Jan 44); AirEvac 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, AHistory of Wartime Research and Development ofMedical 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).


Air Forces shifted procurement back tostraight steel-pole and folding aluminum-pole litters. Those issued were unpopu-lar—the former because of its weight andthe latter because it did not fold up wellin field use.67 The folding laminated-wood-pole litter continued to be preferreduntil February 1944. At that time the AirForces recommended that straight alumi-num-pole litters be procured for the re-mainder of the war. This change was duenot so much to dissatisfaction with thespecial folding litter as to basic changes inaircraft construction. By the early part of1944 doors and internal capacities of cargoand transport planes had been so enlargedthat difficulties formerly encountered inloading, unloading, and stowing litterswere no longer problems in air evacua-tion. Thus the litter which had been de-signed originally for Air Force use wassupplanted, in Air Force procurement, bythe standard Ground Force litter. In thesummer of 1945, general preference forstraight aluminum-pole and folding lami-nated-wood-pole litters was sanctioned bykeeping only these two types classified asstandard.68

Supplies and equipment for the care ofpatients during flight similarly had to bespecially designed and selected becauseweight and space were important factorsin air movements. At the beginning of thewar, two medical chests had been devel-oped for the Air Corps as Medical De-partment items. A flight service chest,standardized before and improved duringthe war, was furnished each air evacuationtransport squadron. An airplane ambu-lance chest, developed by the Air Corpsand a plastics corporation in St. Louis,Mo., for issue to each flight team, waslighter and contained a minimum of sup-plies and equipment to care for the imme-

diate needs of patients.69 The latter typeof chest appears to have been satisfactoryonly for trips requiring six to nine hours.For shorter trips, like those in the NorthAfrican campaign, the chest was too largeand frequently was not used at all if anurse had to provide medical care unas-sisted. For longer ones, medical evacua-tion personnel considered the chest toosmall for efficient use.70 Variation in dis-tances between theaters and the zone ofinterior and in the types of patients evac-uated was so great that standardization ofa chest for universal use was impractical.Therefore, improvisations of cabinet-typecontainers for long trips and the develop-ment of experimental kits for short tripscontinued to the end of the war.71

The provision of adequate oxygenequipment and improvement of facilitiesto control and restrain psychotic patientswere other problems the Air Forces faced.The availability of oxygen was essential tominimize physiological changes due to thealtitude at which flight was maintained.The Air Forces developed and issued aportable continuous-flow therapeutic-oxy-gen kit to be used for both air evacuationand air and sea rescue. Beginning in thesummer of 1944, each air evacuation teamreceived 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), and400.114/3023 (Chest, Amb, Airplane, Empty). (2)T/E 8-447, 30 Nov 42. (3) Ltr, SG to CG SOS, 14Jan 43, sub: Airplane Amb Chest, with 5 inds. SG:428.

70 (1) Weekly Staff Rpts, Staff Mtgs ASO, 13 Sep43. 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 AirSurgeon's Bulletin, vol. II, No. 11 (1945), p. 401.


standard oxygen system available for thecrew and able-bodied passengers.72 Arather knotty problem developed from thetransportation of psychotic patients. Sinceplanes had no facilities for isolation, suchpatients constituted a potential danger toothers during flight. Although the AirTransport Command returned severalhundred of them from the Southwest Pa-cific to the zone of interior during 1944and 1945, it was not until the end of thewar that the Command produced a reallysuitable flexible restraint.73

Although feeding was a normal part ofpre- and post-flight care, a serious prob-lem in feeding patients developed whenflights extended over long periods of time.Cargo and transport planes had no facil-ities for cleaning or washing dishes, trays,or silverware; and their crews lacked ex-perience in preparing suitable meals forpatients from a limited variety of availablefoods. By January 1944 this problem be-came serious and the Air Forces started asurvey to find a solution. Nevertheless,provisions for feeding patients being evac-uated from theaters continued to be littlemore elaborate than sandwiches, hot cof-fee, and cold drinks carried in thermosjugs. Patients transported in the domesticair evacuation system, operated by theFerrying Division of the Air TransportCommand, were more fortunate. In No-vember 1944 Wright Field began testingand later approved for installation inplanes of the Ferrying Division a galleyunit containing four large cups to heatfood, a container for coffee, and two "hotcups" for preparing chocolate, soup, andbouillon, as well as drawers for the storageof food.74

Both patients and medical attendantscomplained of fatigue on long flights, pa-tients because of lying on litters for sever-

al hours and medical attendants becauseof lifting and changing the position of pa-tients frequently. An air mattress wastherefore developed by the Air Forces tofit on Army litters. It took little space instowage, weighed little, inflated easily,and could be washed with soap and water.Authority was granted in January 1945to issue twenty-four air mattresses to eachflight team.75

Patients transported by air along bothtropical and arctic routes suffered fromuncomfortable temperatures in planeswhen they landed for servicing. Early in1944 the Air Forces collaborated with theQuartermaster Corps and other agenciesin the development of portable air condi-tioners to cool planes' interiors at stop-over points. By August 1944 the SupplyDivision of the Air Surgeon's Office hadissued forty-two air conditioners to the AirTransport Command for use both in thezone of interior and in overseas theaters.76

In arctic areas, large heaters that couldbe moved up to planes on the ground wereused to warm cargo areas until planeswere ready for flight.77

72 (1) The Air Surgeon's Bulletin, vol. II, No. 3 (1945),pp. 78-79, and vol. II, No. 4 (1945), pp. 106-07. (2)T/O&E 8-447, C 1, 11 Dec 44.

73 History of the Medical Department, Air Trans-port Command, 1 January 1945-31 March 1946, pp.91-97. HD: TAS.

74 (1) A mimeographed copy of a broad plan tostudy certain equipment problems in connection withair evacuation of patients, developed around January1944, 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, 21Aug 44, sub: Summary of Med Insp of ATC and StasIn 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.


Until the fall of 1943 loading and un-loading litters in high-door planes wereaccomplished manually. When air evac-uation increased in the latter part of 1943,this method was discarded generally infavor of a fork-lift truck with a "litteradaptor" made from a simple woodenpallet platform used to move and storecargo. The mechanical loading and un-loading of patients proved to be rapid,safe, and comfortable and was adopted atmost Air Transport Command installa-tions throughout the world by the end ofthe year.78

The exchange of property used in airevacuation constituted a difficult prob-lem. A patient was seldom separated fromhis litter and blankets until he reached ahospital. When the Air Forces releasedpatients to Ground or Service Forces in-stallations, comparable equipment seldomwas returned in exchange and the AirForces sustained a gradual loss.79 This wasparticularly important in the case of littersin the first part of the war because theGround and Service Forces were usingstraight-pole litters while the Air Forcespreferred and used folding-pole litters.The Air Surgeon and The Surgeon Gen-eral were acquainted with the problemand by the middle of 1943 began to studymeans of solving it.80 A new procedurewas established by directives issued by theAir Transport Command in April and theWar Department in June 1944. Accord-ing to it, the Air Transport Command wasto furnish necessary medical supplies foruse in flight, while commanding officers ofmedical installations, through medicalsupply officers, were to be responsible forproviding such equipment as litters andblankets. When a hospital requested airtransportation for a group of patients, ashipping ticket was to be prepared by its

medical supply officer listing necessarylitters, blankets, splints, etc. The flightnurse was to turn in the shipping list to themedical supply officer of the receivinghospital where it would be signed andmailed to the originating hospital. Later,the equipment was to be turned in to adepot for return to the theater by boat. Ifthe originating hospital was in the zone ofinterior, the equipment would be shippeddirectly to that hospital.81 This system didnot work as well as anticipated. Shippingby water was slow and did not always re-turn property as fast as it was used. As aresult, successive efforts were made during1944 to increase the number of blanketsand litters supplied to air evacuationsquadrons so that a pool of this equipmentcould be established overseas.82

Changes in the table of organizationand equipment for air evacuation squad-rons reflected both the development ofspecial equipment for air evacuation oper-ations and attempts to eliminate shortagesof equipment in theaters of operations. Thetable, first published on 30 November1942, authorized the Air Forces to issuesuch items as flight clothes and equipmentto nurses and enlisted technicians and theMedical Department to issue blankets,litters, and flight service medical chests.As revised in June 1943, this table doubledthe allowance of blankets, undoubtedly to

78 John M. Collins, "Litter Loading Device," TheAir Surgeon's Bulletin, vol. I, No. 9 (1944), p. 22.

79 Diary, SOS Hosp and Evac Br (Fitzpatrick), 27Nov 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 Jun44, sub: Procedure for Evac of Pnts by Water or Airfrom 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 toT/O&E 8-447. AG: 320.3 (2 Jun 44).


cover shortages growing out of unsatisfac-tory operation of the property-exchangesystem.83 Medical supplies were to berequisitioned from medical depots oper-ated by the Air Service Command accord-ing to requirements determined by theSupply Division of the Air Surgeon's Of-fice.84 A revision of the table in July 1944authorized the Air Forces to issue fourportable oxygen assemblies per air team,and it increased the number of litters persquadron from 432 to 576. Five monthslater, a further change reflected the sub-stitution of the Air Forces' newly devel-oped therapeutic-oxygen kit for the port-

able assembly. It also authorized anincrease in straight aluminum-pole littersfrom 576 to 1,500, and the addition of3,732 olive drab blankets for each squad-ron. The increase in litters and blanketswas made to cover part of the shortages ofthese items in the theaters. Anotherchange in the table, published 25 January1945, added as Air Forces organizationalequipment 576 pneumatic mattresses persquadron.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 Theatersof Operations

The evacuation units discussed in pre-ceding chapters were those used primarilyin the movement of patients in and to thezone of interior, though some were usedalso within theaters of operations. Men-tion has been made earlier, in chaptersshowing how the zone of interior providedhospital units for overseas service,1 of otherevacuation units that cared for and trans-ported patients from front-line areas rear-ward through combat zones to mobilehospitals. Certain aspects of these units—such as changes in their organization, per-sonnel, and equipment, and the mannerin which they were activated, trained, andused in the United States—need to beconsidered at this point.

Organization, Personnel, and Equipment

Units designed for the care and trans-portation of patients in combat zones, asalready pointed out,2 either were organicelements of larger nonmedical organiza-tions such as infantry regiments and divi-sions, or were separate units intended forassignment to corps and armies. Everyregiment and every separate battalion ofeach arm or service, except medical, had amedical detachment as one of its organicparts. While the size and organization ofmedical detachments varied according to

the size of the units to which they be-longed, their functions remained the same.Aid men of the medical detachment ac-companied troops into combat, givingcasualties emergency medical care at thefront lines. Its litter bearers then carriedcasualties, except those still able to walk,back to aid stations where medical techni-cians and medical officers treated themfor return to duty or prepared them forfurther transportation. Units that wereorganic elements of divisions—medicalregiments, battalions, or squadrons, de-pending upon the type of division con-cerned—collected casualties from aidstations and transported them first to col-lecting stations and then to clearing sta-tions farther to the rear, sorting them ateach station for additional treatment andreturn to duty or for preparation for fur-ther evacuation. Units that were assigneddirectly to corps and armies, such as med-ical battalions and medical regiments,collected and treated for return to duty orprepared for evacuation the casualties oftheir respective areas. In addition, armyevacuation units transported casualtiesfrom divisional clearing stations to mobilehospitals in army areas and supplied rein-forcements for divisional medical services.

1 See above, pp. 38-49, 144-66, 214-37.2 See above, pp. 4, 38-39.


While the system of evacuating casualtiesthrough the combat zone was not alteredin any significant respect during the war,certain changes occurred both before andduring the war in the units operating thissystem. These changes were designed pri-marily to achieve mobility, flexibility, andeconomy.

The medical battalion of the infantrydivision was developed in the prewaryears, it will be recalled,3 as a result of theemergence of the triangular division toreplace the square division. The latter'sorganic medical unit was a medical regi-ment which consisted of a regimentalheadquarters and band, a headquartersand service company, a collecting bat-talion of three companies, an ambulancebattalion of three companies, and a clear-ing battalion of three companies. It wasauthorized 66 officers and 980 enlistedmen to serve a division of 946 officers, 12warrant officers, and 21,314 enlisted men.4

The medical battalion, which served thetriangular division of 624 officers, 6 war-rant officers, and 14,615 enlisted men,contained 34 officers and 476 enlistedmen. It consisted of a headquarters andheadquarters detachment, a clearing com-pany, and three collecting companies.5

Containing litter bearers, collecting-sta-tion personnel, and ambulances, each col-lecting company was capable of supportinga regimental combat team, whether itoperated separately or in close conjunctionwith the division of which it was a part.6

Although not designed specifically for thepurpose, this battalion was used also as theevacuation unit for corps troops. The med-ical regiment continued in existence, serv-ing National Guard divisions until theywere reorganized as triangular divisions in1942. Like the medical battalion, it alsohad a function for which it was not specifi-

cally designed; that is, it served as anevacuation unit with army troops.7 Thusmedical battalions and medical regimentscould be either divisional or nondivisionalunits, depending upon their assignmentand use.

A nondivisional medical unit developedin the prewar years for use in the evacu-ation system, though not in the actualtransportation of patients, was the medicalgas treatment battalion. While other med-ical units had some means of treating atleast small numbers of gas casualties, nonewas adequately equipped to treat the in-flux of casualties which might result fromthe use of gas on a large scale. The Sur-geon General's Office therefore prepareda table of organization for a medical gastreatment battalion, and the General Staffapproved it despite misgivings that such aunit might duplicate the functions of othermedical units or of the quartermaster steri-lization and bath battalion. The medicalgas treatment battalion was made up of aheadquarters and three clearing compa-nies. Each of the latter, having two bathand four treatment sections, was expectedto bathe and treat gas casualties and toprovide them with noncontaminatedclothing in preparation for return to dutyor 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-3WDGS 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 TreatmentBn, 2 Oct 41.

EVACUATION UNITS FOR THEATERS OF OPERATIONS 449

In the first few months after the UnitedStates entered the war, the tables of organ-ization of existing combat zone evacuationunits were revised and new units weredeveloped for use with new combat organ-izations. During 1942 the Army GroundForces experimented with new types ofdivisions—mountain, jungle, airborne,and motorized.9 Although organizations ofthese types were used overseas little, or notat all, the fact that some of them wereanticipated for use made it necessary formedical units to be prepared for them.Therefore, during 1942 tables of organiza-tion were developed for appropriate medi-cal units for service with new types offorces.10 Concurrently, changes were madein existing units. To indicate the nature ofthese changes, it will suffice to consider re-visions in the tables of organization ofthree of the more common types: the med-ical detachment of the infantry regiment,the medical battalion of the infantry divi-sion, and the medical regiment serving thefield army.

Unlike the infantry regiment which itsupported, the medical detachment's en-listed strength increased appreciably—from 96 to 126—when its table of organi-zation was revised in April 1942. The in-clusion of additional surgical techniciansaccounted primarily for this increase. Thenumber of officers—eight physicians andtwo dentists — remained unchanged.Changes were made at the same time inthe transportation authorized for the de-tachment. Seven ¼-ton trucks (jeeps),seven ¼-ton trailers, and one 2½-ton truckreplaced one motorcycle, fourteen ½-tontrucks, and two 1½-ton trucks.11

The infantry division's medical battal-ion, according to early plans, was to re-ceive an increase in enlisted men and invehicles as well. Its table of organization

issued in April 1942 called for 8 additionalenlisted men, an increase in Medical Ad-ministrative Corps officers from 5 to 8, areduction in Medical Corps officers from27 to 25, and no change in Dental Corpsofficers (2). The battalion's vehicles, exclu-sive of trailers, rose from 87 to 93. Theaddition of trucks accounted for this in-crease, the number of ambulances—36—remaining the same.12 About the time thistable was published, the War Departmentordered a reduction in motor vehicles.13

The Surgeon General then decided to usethe revised version of the table of organiza-tion of the medical battalion for motorizeddivisions being organized, and to developa new table for the medical battalions ofinfantry divisions.14 The new table, sub-mitted for publication in July15 but issuedwith an earlier date, reduced the numberof motor vehicles by thirteen. None of thevehicles eliminated were ambulances, andtrailers were added to replace some of thecargo space lost. Fewer motor vehicles re-quired fewer drivers and mechanics, andhence the new table provided for fourteenfewer enlisted men than formerly. In addi-tion, one Medical Corps officer was elimi-nated, reducing the total for the battalionfrom twenty-five to twenty-four. Thenumber 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 UNITEDSTATES 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 GoverningT/Os and T/BAs. AG: 320.2 (3-13-42)(5).

14 Memo, SG for CG SOS, 6 Jun 42, sub: Changesin T/Os. AG: 320.3 (10-30-41)(2) Sec 8.

15 Memo, CG SOS for TAG thru ACofS G-3WDGS, 16 Jul 42, sub: T/Os, Med Bn. AG: 320.3(10-30-41)(2) Sec 8.


officers (eight) and of Dental Corps offi-cers (two) remained unchanged.16

The revision of the table of organizationof medical regiments early in 1942 pro-vided for an entirely new type of organiza-tion. Instead of having three battalions(collecting, ambulance, and clearing), thenew regiment had two battalions thatwere similar to the medical battalions ofinfantry divisions, each having three col-lecting companies and one clearing com-pany. The collecting companies of battal-ions of medical regiments were almostidentical with those of divisional medicalbattalions, but clearing companies of theformer differed from those of the latter inhaving three instead of two clearing pla-toons in order to provide increased treat-ment facilities in army areas. This revisionof the medical regiment was based on twoof its functions as an army unit: the evacu-ation of divisional clearing stations andthe reinforcement of divisional medicalservices. Having battalions and companiessimilar to those of divisional medical bat-talions, the new medical regiment wouldsimplify the problem of supplying rein-forcing units to divisions in combat and,it was anticipated, would permit betterambulance evacuation of divisional clear-ing stations. This change in the organiza-tion of the medical regiment resulted in anincrease of Medical Department officersfrom 66 to 76 and of enlisted men from980 to 1,078. It also resulted in an increasein vehicles, the number of ambulances ris-ing from sixty to seventy-two.17 To provideeven more ambulances for field armies, ifthey should be needed, and for communi-cations zones as well, The Surgeon Gen-eral developed about the same time a tableof organization for separate motor ambu-lance battalions. It was approved andpublished in April 1942.18

In the fall of 1942 the need for economyin personnel and vehicles—which, it willbe recalled, affected the organization ofhospital units 19—also resulted in changesin the tables of evacuation units. In re-sponse to a War Department directive toreduce personnel and equipment, espe-cially vehicles, in all Army organizations,20

AGF headquarters established a Reduc-tion Board in November 1942 to reviewall AGF-type units and to squeeze out the"fat."21 In the process of shrinking theinfantry division as a whole, the Board inMarch 1943 cut the personnel and vehi-cles of both the regimental medical de-tachment and the divisional medical bat-talion. In the detachment 1 medical officerand 23 enlisted men were eliminated,leaving 7 physicians, 2 dentists, and 103enlisted men. This cut apparently provedtoo great, for about four months latertwenty-three enlisted men were restored tothe regimental medical detachment,bringing the total to 126 for the rest of thewar. The only change made in the vehi-cles of the detachment was the replace-ment of its 2½-ton truck with a 1½-tontruck. As in the case of the cut in enlisted

16 T/O 8-15, Med Bn, 1 Apr 42. T/O 8-65, MedBn, 1 Apr 42, was amended at the end of July to be-come T/O 8-65, Med Bn, Motorized (C 1, 31 Jul 42).

17 (1) T/O 8-21, Med Regt, 1 Apr 42. (2) DF G-3/42108, ACofS G-3 WDGS to TAG, 5 Mar 42, sub:Med Regt, with Memo for Record and memos of ex-planation prepared by SGO. AG: 320.3 (10-30-41)(2) Sec 8.

18 (1) T/O 8-315, Med Amb Bn, Motor, 1 Apr 42.(2) DF G-3/42108, ACofS G-3 WDGS to TAG, 6Mar 42, sub: T/Os, with Memo for Record andmemos 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, discussesthe Reduction Board and its work.


men, this change was reversed in July1943.22

Reductions made in both the personneland vehicles of the divisional medical bat-talion were more lasting. In March 1943its Medical Corps officers were decreasedfrom 24 to 22 and its enlisted men from470 to 430, but its Medical AdministrativeCorps officers were increased from 8 to 11and its dentists from 2 to 3. The clearingcompany of the medical battalion sufferedthe greatest decrease in enlisted men,twenty being eliminated, of whom twelvewere orderlies who normally served in theclearing station. In each collecting com-pany the number of litter bearers was re-duced from thirty-six to thirty-one. TheReduction Board believed that the use ofjeeps to evacuate casualties from the bat-tlefield warranted this action, but sup-ported the Ground Surgeon in opposing areduction in the number of ambulancesbecause it believed that twelve would beneeded to evacuate casualties from eachregiment and would not be available un-less included in the table of organization.Nevertheless, the commanding general,Army Ground Forces, directed a cut oftwo in each collecting company, therebyreducing the number in the entire medicalbattalion from thirty-six to thirty. Fourother motor vehicles, three of which werecommand cars, were also eliminated.23

Cuts were made also in the personnel andvehicles of other organic medical units,but being similar in nature to those alreadydescribed, they need not be discussed here.

Although experience in maneuvers andin theaters of operations indicated thatmedical battalions and regiments, organ-ized under existing tables, were not en-tirely suitable for use with corps and armytroops respectively, it remained for theReduction Board of AGF headquarters to

initiate a change in corps and army evac-uation units. The chief cause of dissatis-faction with existing units was theirinflexibility. To provide greater flexibility,permitting the assignment of collecting,clearing, and ambulance companies in anycombination required to fit a particularsituation, and thereby to promote econ-omy of both personnel and equipment,the Reduction Board in February 1943proposed the elimination of such largetable-of-organization units as the medicalregiment and the separate ambulance bat-talion, and the substitution of small ad-ministratively self-sufficient units, such ascompanies, which could be grouped fortraining and tactical use under separatebattalion and group headquarters detach-ments.24 This proposal reflected a generaltrend in the Army Ground Forces "awayfrom the organic assignment of resourcesto large commands according to ready-made patterns, and toward variable orad hoc assignment to commands tailor-made for specific missions"25—a trendthat was to end during 1943 in the disap-pearance of type armies and corps. Inaccordance with the Reduction Board'sproposal, the Ground Surgeon's Office

22 T/O 7-11, Inf Regt, 1 Mar 43 and T/O&E7-11, 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, Col-lecting Co, Med Bn, 1 Mar 43; and T/O 8-18, Clear-ing Co, Med Bn, 1 Mar 43. (2) M/S GNRQT/24549,sub: T/O 8-16, 8-17, and 8-18, with following com-ments: CG AGF to Reqmts AGF, 5 Dec 42; Reduc-tion Bd to CG AGF, 8 Dec 42; and CG AGF toReqmts AGF, 9 Dec 42. AGF: 320.3.

24 (1) M/S GNRQT/31566, Reduction Bd toReqmts 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.


prepared tables of organization for head-quarters and headquarters detachments ofmedical battalions and groups, and foradministratively self-sufficient collecting,clearing, and ambulance companies. TheReduction Board, staff officers in AGFheadquarters, and the Surgeon General'sOffice approved these tables and theywere published in May 1943.26 Thereafter,instead of being rigid table-of-organizationbattalions and regiments, evacuation unitsof corps and armies were flexible battal-ions and groups made up of combinationsof collecting, clearing, and ambulancecompanies that varied as the situationdemanded.27

A further step in the trend toward theformation of small units that could be usedin variable combinations was the develop-ment of tables of organization for teams orsections that could be grouped together toform platoons that could be furthergrouped to form companies. Like othertechnical services, the Medical Depart-ment prepared a table of organization forsuch units. The Medical Departmenttable, issued in July 1943, provided foradministrative, depot, motor ambulance,veterinary, and miscellaneous teams orsections. The three ambulance sectionsprovided for by this table had 3, 6, and 10ambulances respectively and could beassigned wherever required. One of themiscellaneous sections, the "attached med-ical section," was designed to providemedical service for nonmedical battalionsthat were organic parts of larger units butwere assigned alone to special missions.28

Early in 1944 the general movementalready under way to replace MedicalCorps officers with Medical Administra-tive Corps officers wherever possibleaffected the make-up of evacuation unitsalso.29 In battalion and group headquar-

ters, for example, administrative officersreplaced physicians as operations officers(S-3s). Of perhaps more significance wasthe substitution in the medical detach-ments of combat battalions and regimentsof Medical Administrative Corps officersfor Medical Corps officers as battalionsurgeons' assistants. The Ground Surgeonconcurred in The Surgeon General's pro-posal to make this substitution in the med-ical detachments of coast artillery, anti-aircraft artillery, engineer, signal, andordnance battalions, but he disapprovedat first the recommendation that it be ex-tended to the medical detachments ofinfantry regiments and tank battalions.The latter organizations had such a highpercentage of casualties, he stated, that areduction of Medical Corps officers in theirmedical detachments would seriously im-pair the efficiency of their medical serv-ices.30 In February 1944, on the advice ofthe Fifth Army Surgeon in Italy, theGround Surgeon reversed himself on thispoint. Thereafter, in the medical detach-

26 (1) M/S GNRQT/31566, sub: Med T/Os, Com-ment 5, Ground Med Sec to Reqmts AGF thru Re-duction Bd. 11 Mar 43; Comment 6, Reduction Bdto CG AGF, 3 [sic] Mar 43; Comment 7, Sec GenStaff AGF to Ground Med Sec, 12 Mar 43; Com-ment 8, Ground Med Sec to Sec Gen Staff AGF, 16Mar 43; Comment 10, Sec Gen Staff AGF to Reduc-tion Bd, 18 Mar 43. AGF: 320.3. (2) Memo for Rec-ord, 29 Mar 43, by Ground Med Sec. Ground Medfiles: Transfer Binder Journal, 1943.

27 T/O&E 8-22, Hq and Hq Det, Med Group, 20May 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: Con-

servation of MC Offs. (2) Memo, CG AGF (GroundMed Sec) for CofSA, 22 Feb 44, same sub. (3) DF,ACofS G-3 WDGS to TAG, 1 Mar 44, same sub. Allin AG: 320.3 (10-30-41)(2). (4) WD Cir 99, 9 Mar44.


ment of the infantry regiment, for exam-ple, there were five Medical Corps, twoDental Corps, and three Medical Admin-istrative Corps officers instead of sevenMedical Corps and two Dental Corps offi-cers. One Medical Corps and one MedicalAdministrative Corps officer, instead oftwo Medical Corps officers, served witheach of the three battalion medical sec-tions. In the detachment's headquartersthere were two Medical Corps officers, in-stead of one as formerly, to insure a re-placement if needed for one of the battal-ion surgeons.31

Further changes were made in existingevacuation units, and new units were pro-posed and developed in the latter half of1944 and the early part of 1945. Late inMay 1944 a War Department circulardirected a reduction in the number of basicprivates in all but a few of the Army'stable-of-organization units.32 Basic pri-vates were soldiers in excess of the comple-ment of personnel needed to perform thefunctions for which units were designedand were provided to serve as replace-ments for losses occurring in the firstphases of combat or, when in garrison, formen who would normally be absent be-cause of furloughs, sickness, and the like.Until May 1944 basic privates representedan addition of about 10 percent to the nor-mal operating strength of a unit. In Maythe War Department directed that they bereduced by approximately one-half. Thisled to a reduction in the number of basicprivates in the medical battalion of aninfantry division from thirty-nine totwenty-two.33 Separate medical units suchas collecting, clearing, and ambulancecompanies were similarly reduced, butmedical detachments serving with cavalryand infantry divisions were exempted.34

In the latter part of 1944 the Ground

Surgeon proposed changes in the evacu-ation units of both divisions and armies. Ithad been recognized for some time, hestated, that the clearing companies of di-visional medical battalions needed three—instead of two—clearing platoons, in orderto provide one clearing platoon to workwith each of three collecting companies insupport of the three regimental combatteams of each infantry division. Moreover,reports from theaters of operations, ac-cording to the Ground Surgeon, empha-sized that the collecting-station platoonsof separate collecting companies were notneeded in army areas of combat zones.There the need was for more litter bearers.Likewise, the ambulance platoons of sepa-rate collecting companies were not re-quired in army areas because separateambulance companies were authorized asarmy units. The Ground Surgeon there-fore proposed to eliminate collecting com-panies as army evacuation units, and tosubstitute for them additional separateambulance companies and separate litterbearer companies. For the latter he pre-pared a tentative table of organization. Hefurther proposed that the men and officersformerly assigned to collecting-station pla-toons of army collecting companies shouldbe used to form third platoons for theclearing companies of divisional medicalbattalions. Despite the fact that thechanges recommended were expected notonly 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. GroundMed 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 onchange 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.


medical service in division and army areasof combat zones but also to save both com-missioned and enlisted personnel, theDeputy Chief of Staff of the Army GroundForces disapproved the Ground Surgeon'sproposal in December 1944 because heconsidered it undesirable to make suchchanges "at this late date in the war."35

The question of whether or not themedical gas treatment battalion shouldcontinue to exist arose in the latter part of1944. Earlier its table of organization hadbeen superseded by a table providing for agas treatment team that was smaller andmore restricted in its functions,36 but unitsalready in theaters of operations continuedin existence. The Technical Division of theSurgeon General's Office contended inJune 1944 that they were not needed be-cause oxygen and drugs could be adminis-tered to gas casualties by gas treatmentteams and other medical units, the decon-tamination of equipment and clothing wasnot a proper function of the Medical De-partment, and the ability of gas treatmentbattalions to locate and decontaminatepersonnel as soon after exposure as neces-sary was doubtful.37 The Ground Surgeonalso questioned the utility of such battal-ions and considered them wasteful of per-sonnel.38 Moreover, since gas warfare hadnot been used, medical gas treatment bat-talions in theaters of operations had notperformed the functions for which theywere intended. Nevertheless, because theyhad constituted a "convenient reserve,"theaters wished to retain them. So also didthe Chief of the Chemical Warfare Serv-ice. In October 1944, therefore, The Sur-geon General requested and received per-mission to revise and reinstate the table oforganization of the gas treatment battalionas an authorized unit.39

One of the uses which theaters had

made of gas treatment battalions was tohold and care for patients awaiting evacu-ation at railheads and airports. No unitdesigned specifically for this purpose hadbeen provided, despite information fromNorth Africa as early as the fall of 1943that they were needed,40 and theaters hadhad to use whatever means were availableto meet their needs. This practice hadbeen wasteful of both personnel andequipment. Early in 1945, therefore, afteran inspection of the medical service of theEuropean theater by one of his represen-tatives, the Assistant Chief of Staff, G-4,directed The Surgeon General to preparea table of organization for a medical hold-ing unit.41 The resulting unit, a medicalholding battalion authorized in May 1945,consisted of a headquarters and threeholding companies, each capable of han-

35 (1) Memo for Record, on M/S, Comment 4,Ground Med Sec to ACofS G-1 AGF, 15 Dec 44, nosub. (2) M/S, Comment 1, Ground Med Sec to GenStaff AGF, 18 Sep 44, sub: T/O&E 8-29 (Proposed)Med Litter Bearer Co, Sep. Both in Ground Medfiles: Chronological file, Folder 2. (3) M/S, Comment1, Ground Med Sec for ACofS G-3 AGF, 17 Jun 44,no sub. Ground Med files: Chronological file, Folder1. (4) Memo, SG for CG ASF, 1 Oct 43, sub: Recomd

for Changes in Med Dept Orgn, (SG: 320.3-1) pro-posed a third platoon for the clearing companies ofthe medical battalions of infantry divisions. After thewar, 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 onMS) 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 Treat-ment Bn, 11 Nov 44.

40 (1) Memo, CG AAF for SG, 17 Sep 43, sub:Aerial Evac of Casualties. (2) Memo, Dir HospAdmin Div SGO for Dir Plans Div SGO, 22 Sep 43,no sub. Both in HD: 705 "Hosp and Evac (HoldingUnit) MTO."

41 (1) 2d ind, SG to CG ASF, 3 Mar 45, on unlo-cated basic ltr. HD: 320.3-1 (T/O&E). (2) An Rpt,Tec Div SGO, FY 1945. HD.


dling 300 patients. Had this battalion notbeen developed so late in the war, its usewould have saved manpower, for it wasauthorized 26 officers and 404 enlistedmen as compared with 45 officers and 411enlisted men of the medical gas treatmentbattalions which some theaters used asholding units.42

Changes occurred during the war in theequipment as well as the personnel andvehicles of evacuation units. Changes inmedical supplies and equipment reflectedimprovements in items already authorizedor additions of items shown by experienceto be needed. For example, early in 1944an improved portable field autoclave re-placed an older item of that type in theclearing companies of medical battalionsof infantry divisions. At the same time thenumber of chests of surgical supplies wasincreased, and portable electric suctionapparatus was added to enable clearingstations to aspirate blood from pleural andabdominal cavities.43 Toward the end ofthat year and the early part of 1945 acombined otoscope and ophthalmoscopewas added to the list of items furnishedclearing companies, to permit clearingstations to make better examinations ofpatients with diseased or injured ears.44

Other changes were made at intervals inthe lists of medical supplies and equip-ment of evacuation units in order to im-prove the standard of emergency medicalservice under combat conditions.45

Changes were also made in the equip-ment of evacuation units to increase theirmobility. For example, early in the warthe Medical Department developed apack carrier for battalion medical equip-ment. This carrier—a canvas containermounted on a wooden frame—permittedthe supplies and equipment used in bat-

talion aid stations to be packed in loads(averaging about forty pounds each) thatcould be carried by individuals of battal-ion medical sections.46 Later in the war,after aluminum became available for thepurpose, aluminum-pole litters were sub-stituted, it will be recalled, for heavierones made of steel.47 Another change con-tributing to greater mobility in evacuationwas the development of litter racks forjeeps, permitting in many instances thesubstitution of motor for pedestrian evac-uation in front-line areas. Although suchracks were produced locally for use byevacuation units much earlier, they werenot included in tables of equipment asstandard 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 USAFPOA, 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, withC 1, 17 Jan 44.

44 (1) M/S, Comment 1, Ground Med Sec to ACofSG-4 AGF and Reqmts AGF, 23 Aug 44, sub: Addi-tion to T/Es of Certain Med Units. Ground Med files:Chronological file, Folder 2. (2) T/O&E 8-138, Clear-ing Co, Mountain Med Bn, 4 Nov 44, and T/O&E8-18, Clearing Co, Med Bn, 14 Feb 45, for example.

45 Examples of these changes may be found by com-paring the T/O&Es of various evacuation units.

46 (1) An Rpt, Equip Br Tng Div SGO, 1942. HD.(2) Memo, SG for Chief Surg SWPA, 1 Dec 42. SG:705 (Australia)F. (3) Memo, [Maj] A[lfred] P. T[hom]for Col Shambora, 2 Mar 43, sub: Comments on Les-sons 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 ofMedical Field Equipment (1946), pp. 75-80. (2) Forexample, 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 HumanCasualties in the European Theater of Operations.Study No. 92. HD. (3) T/O&E 8-16, Hq and HqDet, Med Bn, 14 Feb 45, and T/O&E 7-11, Inf Regt,1 Jun 45.


Efforts to increase mobility by reducingthe size and weight of equipment weremade in the case of evacuation units, as inthat of hospital units already discussed.49

During the winter of 1942-43 the cubageof the equipment (including vehicles) ofthe infantry division's medical battalionwas reduced from about 1,900 to about1,475 ship tons, a ship ton being 40 cubicfeet.50 Information about the cubage ofthe equipment of other evacuation unitsin the fall of 1942 is not readily available,but it is perhaps safe to assume that simi-lar reductions were made in the equip-ment of those units. After the reductionsmade in the winter of 1942-43, the cubageof equipment of evacuation units under-went little change until the early part of1945. At that time there seems to havebeen a tendency for it to increase slightly.For example, the equipment of the infan-try division's medical battalion increasedin cubage from about 1,475 to about 1,600ship tons in February 1945. Similar in-creases occurred early in 1945 in theequipment of other evacuation units.51

Another measure to increase the mobil-ity and improve the standard of combatzone medical service was the developmentby the Medical Department of certain ve-hicles for special purposes. The organiza-tion and growth of the Armored Forcemade it apparent during 1941 that newtypes of medical equipment would beneeded. During the fall of that year theArmored Force itself began to experimentwith the development of a surgical truckfor use as a mobile clearing station. Soonafterward, the Surgeon General's Officesecured authority to initiate a researchproject in that field. During its course, theMedical Department Equipment Labora-tory co-ordinated its developmental workwith the Armored Force, the Surgeon

General's Office, and the QuartermasterCorps. The pilot model of such a truckwas delivered to the Laboratory in July1942. Called a "truck, surgical," this ve-hicle consisted of a van body mounted ona standard 2½-ton (6 x 6) chassis. Withinthe body of the truck were a 50-gallonwater tank; a sink with hot and cold wateroutlets; cabinets for supplies, equipment,and accessories; and three dome lights.Medical items such as those used in clear-ing stations were supplied and installed bythe Medical Department. A tent, largeenough to shelter twenty litter patients,was supplied to provide space outside thetruck for patients awaiting evacuationfarther to the rear. These trucks were de-livered on a basis of six per division to allarmored divisions in the United Statesduring late 1942 and early 1943.52

A surgical operating truck for use byauxiliary surgical groups was developedduring the latter half of 1943. It differedfrom the surgical truck of the armoreddivision largely in that it was suppliedwith greater quantities of more elaborateequipment. While the surgical truck of thearmored division had only equipment andsupplies for emergency medical treatmentto be given inside the truck, the surgicaloperating truck carried enough surgicalinstruments and equipment to performapproximately 100 major surgical oper-ations. Surgery was not performed in thetruck, 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 Manual-Orgn, Tec, and Logistical Data, 10 Oct 43 and 21Dec 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.


sterilizing room. Such trucks, along withauxiliary surgical groups, often served asfar forward as divisional clearing stations,supplementing them when the evacuationload was heavy. By the end of October1945, 207 surgical operating trucks hadbeen delivered for use by the Medical De-partment. In addition to surgical trucks,the Medical Department developed otherspecial vehicles for use in theaters of oper-ations. They were a mobile dental labora-tory truck, mobile optical repair truck, amobile dental operating truck, and aharmy medical laboratory truck. Develop-ment of these vehicles contributed to themobility and flexibility of medical servicein a fast-moving war.53

Activation, Training,and Use in the United States

The responsibility for activating, train-ing, and using in the United States theevacuation units that would operate incombat zones of theaters of operations be-longed almost exclusively to the GroundForces. Before the reorganization of theWar Department in March 1942,54 allfield medical units were trained under thesupervision of General Headquarters. Inthe division of responsibility for medicalunits between the Ground and ServiceForces that followed the reorganization,55

the Ground Forces (successor to GeneralHeadquarters) inherited the responsibilityfor training all medical units used in com-bat zones and gained in addition theresponsibility for preparing their tables oforganization and equipment, recommend-ing their inclusion in the troop basis, andactivating such units.

Planning for the troop basis duringmost of 1942 was conducted in terms of

standard or fixed organizations. Medicalunits that were organic elements of com-bat forces whose structure was fixed bytables of organization, such as infantrydivisions, were automatically included inthe troop basis along with their parentunits. While the structure of combat forceslarger than divisions was not governed bytables of organization, corps and armiesnormally had standard numbers of unitsof various sorts early in the war. For ex-ample, for emergency medical care andevacuation each corps generally had amedical battalion; each army, three med-ical regiments.56 In the latter part of 1942the Ground Surgeon proposed that eachArmy should have, in addition, a separateambulance battalion to assist in the evac-uation of casualties from divisional clear-ing stations.57 Soon afterward, the stand-ard army and corps were abandoned asyardsticks for determining the number ofservice units needed.58 In addition, earlyin 1943, as mentioned above, nondivision-al medical units organized under inflex-ible tables of organization, such as medicalregiments, were replaced by flexible bat-talions and groups made up of variablecombinations of separate ambulance, col-lecting, and clearing companies. Whilethese changes did not affect the automaticinclusion in the troop basis of medicalunits that were organic elements of com-

53 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 CGsAGF, AAF, and SOS, 31 Mar 42, sub: Policies Gov-

erning T/Os and T/BAs. AG: 320.2 (3-13-42)(5).57 M/S, Ground Med Sec to [ACofS] G-4 [AGF],

10 Aug 42, sub: Revision of Type Army and TypeArmy Corps Trps—Med. HD: 322 AGF (Units, Med)1942.

58 Greenfield et al., op. cit., pp. 354-71.


bat forces still organized under tables oforganization, they did require the estab-lishment of a new basis for estimating theevacuation units that would be needed forservice with corps and armies. Thereafter,this basis was a ratio of medical companiesto divisions or to a certain number oftroops. For example, it was consideredthat an army or task force needed a col-lecting company and a clearing companyfor each of its infantry divisions; and anambulance company for every group of12,000 soldiers.59 On this basis the GroundSurgeon proposed in November 1943 thata troop basis having 105 combat divisionsshould include 105 collecting, 105 clear-ing, and 105 ambulance companies.60 Thetroop bases subsequently approved didnot follow this recommendation. For ex-ample, in April 1944, when planning wasin terms of 89 divisions, the troop basis in-cluded 162 collecting, 104 clearing, and75 ambulance companies.61 The discrep-ancy between the ratio recommended bythe Ground Surgeon and that in whichseparate medical companies were author-ized can perhaps be explained by the factthat the troop basis was determined in thelatter part of the war more by requests oftheaters for units of specific types than byrecommendations of staff officers in Wash-ington.62 In May 1945, just before the warin Europe ended, there were in the troopbasis for the support of 89 divisions the fol-lowing corps and army evacuation units:137 collecting companies, 75 clearingcompanies, 96 ambulance companies, andheadquarters detachments for 80 medicalbattalions and 16 medical groups. All butone of these units, an ambulance com-pany, had already been deployed to the-aters of operations.63

The activation and training of medical

evacuation units were so closely inter-twined with the activation and training ofother Ground Forces units that any ac-count of them would reflect generally alarger picture already described in con-siderable detail elsewhere.64 Medical unitsthat were organic elements of any of thecombat arms or of any service other thanmedical were activated and trained alongwith their parent organizations. Corpsand army medical units were activatedaccording to a schedule based upon rec-ommendations of the Ground Surgeon.During most of 1942 they were trainedunder the supervision of division com-manders. In the latter part of that yearand the early part of 1943, however, AGFheadquarters established special localheadquarters (Headquarters and Head-quarters Detachments, Special Troops) tosupervise the training of all nondivisionalAGF-type service units, including those ofthe Medical Department. At least one ofthese headquarters had a Medical Corpsofficer on its staff. The Ground Surgeonexercised general supervision over thetechnical training of all Ground Forcesmedical units and, on the basis of inspec-tions 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 TrpBasis and Summary of Trp Basis Study. Ground Medfiles: Chronological file, Folder 1.

61 Troop Basis, Calendar Year 1944, 1 Apr 44Revision. 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 CombatTroops (Washington, 1948), pp. 426-560 in UNITEDSTATES ARMY IN WORLD WAR II.


informed as to the state of their readinessfor shipment to theaters of operations.65

Details of the training of Medical De-partment units will be included in a vol-ume on that subject planned for this series,but one aspect of their training needs tobe considered here. Unlike station andgeneral hospital units that were trainedby the Army Service Forces, evacuationunits trained by the Ground Forces werecharged with actually providing medicalservice concurrently with their training inthe zone of interior. To carry out this dualmission, they needed both personnel andequipment, but they suffered from a short-age of both. Lack of a sufficient number ofMedical Corps officers in the ArmyGround Forces prevented the assignmentof full complements to units in training.Although the ratio of assigned to author-ized Medical Corps officers varied fromtime to time and from unit to unit, it wasoften less than 50 percent.66 Early in 1943the shortage was so great that the DeputyChief of Staff of the Army directed theArmy Ground Forces to amend the tablesof organization of medical units for whichit was responsible by including in each aremark that medical and dental officerswould be furnished "only as required andavailable within the continental limits ofthe U. S." 67 Early the next year theGround Surgeon reported that with oneexception—the 92d Division—it was pos-sible to assign only one Medical Corpsofficer, instead of the seven authorized, toeach infantry regiment participating inmaneuvers in Louisiana.68

The shortage of equipment did not lastas long as the shortage of personnel. It wasmost severe during 1942 and the earlypart of 1943.69 At that time the GroundSurgeon reported that repeated requests

of the Surgeon General's Office to issuefuller allowances of supplies and equip-ment always met with the same answer—that production was great enough to meetonly the needs of units scheduled for earlyshipment to theaters of operations.70 Bythe middle or latter part of 1943 the sup-ply situation had improved and by theend of the year some units reported thatthey had on hand approximately all oftheir equipment.71 Early in 1944 theGround Surgeon reported that all med-ical units engaged in maneuvers in Louisi-ana had about 95 to 100 percent of theirequipment with them.72

Despite shortages of equipment andpersonnel, evacuation units dischargedtheir mission of furnishing medical service

65 (1) Memo, Asst Ground Surg for [ACofS] G-4[AGF], 15 Nov 42, sub: Activation Plan for Non-DivMed Units. (2) M/S, Ground Med Sec to [ACofS]G-3 [AGF], 30 Jan 43, sub: Rpt on Readiness of TypeMed Units. Both in Ground Med files: Chronologicalfile, Folder 1. (3) An Rpt, Surg Third Army, 1942.HD.

66 For example, see An Rpts, Surgs Second andThird Armies, 1942, 67th Med Group, 1943, and 66thMed Group, 1944. HD.

67 Memo, Dep CofSA for CG AGF, 10 Mar 43, sub:Availability of Physicians. Ground Med files: Chrono-logical file, Folder 1. For an example of this remarksee T/O&E 7-11, Inf Regt, 15 Jul 43.

68 Memo, Ground Surg for ACofS G-4 AGF, 26Feb 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 InfDiv, 1943; 31st, 67th, 69th, 341st, and 343d MedGroups, 1943. HD.

72 Memo, Ground Surg for ACofS G-4 AGF, 26Feb 44, sub: Rpt of Insp, Louisiana Maneuver Area,22-24 Feb 44. Ground Med files: Chronological file(Col W. E. Shambora).


while still in training. While in garrison,Ground Forces medical units were not de-pendent upon the issuance of their ownorganizational equipment for use in med-ical service, because The Surgeon Generalhad established a policy before the war—and it was continued—of supplying dis-pensary buildings erected in trainingareas of Army camps with medical sup-plies and equipment from station stocks.73

Medical units of infantry divisions nor-mally supplied personnel for the operationof six to seven of such dispensaries in theirown divisional areas. Each dispensarygenerally served a particular segment of adivision. For example, each regimentalmedical detachment operated a dispen-sary for all persons in the infantry regi-ment to which it belonged. The medicalservice rendered by dispensaries consistedof routine immunizations, blood-typing,monthly physical inspections, and dailysick calls. Soldiers found by medical ex-amination at sick call to need hospitalcare were usually transported to station orregional hospitals in ambulances of divi-sional medical battalions. Ambulancesand aid men also accompanied troops onlong marches and on all training exercisesof a dangerous nature, such as firing onranges. In order to interfere with trainingformations as little as possible and to giveas many men as possible experience inproviding actual medical service, the per-sonnel of divisional medical units oftenserved in dispensaries on a rotationalbasis.74 Nondivisional medical units, suchas army medical regiments and groups,also operated dispensaries in garrison—sometimes for their own personnel onlyand sometimes for persons belonging toother units as well. In addition, units ofthese types were at times split up to sup-

ply medical service for troops in widelyseparate areas. For example, during 1943a detail of twenty-five enlisted men andtwelve ambulances of the 1st MedicalRegiment gave ambulance service to vari-ous infantry units stationed in northernCalifornia, while various collecting andclearing units of the Regiment handledthe medical service of troops in southernCalifornia, and a platoon of one of itsclearing companies served an artillerytraining center at Yakima, Wash.75

On maneuvers Ground Forces medicalunits used organizational equipmentwhich had been issued to them for train-ing purposes or for later use in theaters ofoperations. It was the Ground Surgeon'sopinion that such experience was invalu-able and that no medical unit should beshipped to theaters of operations withouthaving first become acquainted with itsown equipment through use.76 Divisionalmedical units operated in support of thedivisions to which they belonged, settingup aid, collecting, and clearing stations,and evacuating and caring for both actualand simulated casualties.77 Nondivisionalunits performed a variety of functions, inaddition to caring for corps and armytroops and evacuating casualties from di-visional clearing stations. For example,during maneuvers in 1942 the 68th Med-

73 The Annual Report, Surgeon First Army, 1941,spoke of the establishment of this policy. Its continu-ance was mentioned in the Annual Reports, Surgeons,Camp Hood (Texas) and Indiantown Gap MilitaryReservation (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; 264thMed Bn, 1943; and 66th Med Group, 1944. HD.

76 Interv, MD Historian with Col Shambora, 22 Apr49. HD: 000.71.

77 An Rpts, Surgs, 4th Motorized Div, and 65th,69th, 79th, 86th, 98th, and 99th Inf Divs, 1943. HD.


ical Regiment operated the following in-stallations: a convalescent hospital, amedical supply depot, clearing stations fordepot and army troops, and an infirmaryfor corps troops. During maneuvers in1943 the 134th Medical Regiment estab-lished aid and prophylactic stations intowns within the area of operations, main-tained clearing stations for army troops,evacuated casualties from division andarmy clearing stations to evacuation hos-

pitals and from the latter to named stationhospitals, and provided personnel for theoperation of a provisional medical supplydepot.78 Regardless of the missions as-signed, Ground Forces medical units onmaneuvers gained valuable practical ex-perience and at the same time suppliedmedical service for the troops with whichthey 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 briefreview of the general subject it is pertinentto give first of all certain summary figureswhich indicate the Medical Department'stotal accomplishment in the field of hospi-talization and evacuation during the war.In the period from January 1942 throughAugust 1945, there were approximately5,100,000 admissions to Army hospitalsin theaters of operations and 8,900,000 tohospitals in the zone of interior.1 In thesame period, more than 518,500 patientswere debarked by the Army at ports plus121,400 by aircraft in the United Statesfor transportation to zone of interior hos-pitals. (Table 16) Meanwhile, evacuationunits that were organized and trained inthe United States transported many thou-sands of patients from front-line areas tomedical stations and hospitals in theatersof operations. The number of patients onthe registers of hospitals in theatersreached a peak of almost 266,500 at theend of January 1945.2 In a single month—May 1945—more than 57,000 patientswere evacuated from theaters to the zoneof interior. And by the end of June 1945the number of patients on the rolls ofArmy hospitals in the United States roseto more than 318,000. (Table 13) Themanner in which the Medical Depart-ment prepared for and discharged thisunprecedented task of hospitalization andevacuation has been the subject of thisvolume. From the details already pre-sented, certain generalizations can bemade and certain conclusions drawn to

emphasize some of the problems involvedin the accomplishment of this mission.

Like the rest of the Army and the WarDepartment, the Surgeon General's Officeand the Medical Department were in themidst of preparations and therefore notready for a global war when it overtookthem in December 1941. The partialmobilization that began with the passageof the Selective Training and Service Actin the fall of 1940 had caused only a par-tial adjustment from peacetime to whatmight be expected in wartime. Tables oforganization, tables of equipment, andequipment lists of medical units had beenrevised, but more with considerations ofdesirability than possibility in mind. Dataon hospitalization and evacuation inWorld War I had been analyzed and wereavailable as a basis for estimating require-ments. They had already been used in theestablishment of an authorized ratio ofbeds to troops for hospitals in the UnitedStates, but whether or not World War Iexperience would be applicable to WorldWar II remained to be seen. Hospitaliza-tion and evacuation units had been or-ganized and were being trained, but theywere few in number. Also, there was un-certainty as to the role of these particularunits—whether they would remain in the

1 These figures are "preliminary pending publica-tion of final tabulations based on the individual med-ical records." Memo, Eugene L. Hamilton, ChiefMed Statistics Div SGO for Clarence Smith, Histor-ical Unit AMS, 3 Mar 53, sub: Hosp Admissionsduring World War II. HD: 705.

2 Statistical Review, World War II, App R, p. 237.


United States as training units or be sentoverseas as functional units. Plans hadbeen made to call others into active servicein the event of war, that is, reserve hospitalunits affiliated with civilian schools andhospitals. With regard to hospital servicein the United States and its territories,experience in expanding hospital facilitieshad shown the undesirability of depend-ing upon existing buildings and had re-vealed many unsatisfactory features inplans for cantonment-type hospitals. Blue-prints were drawn, therefore, for hospitalsof a new type, to be of two-story semi-permanent construction. An improvedgeneral-service ambulance had been de-veloped and put into use; but plans formotor vehicles of other types, such asmultipatient ambulances, were still inthe experimental stage. Two unit and fourward cars for hospital trains had beendelivered, but they had not yet been usedin the actual transportation of patients.Although the ships' hospitals of sometransports had been enlarged and im-proved, it was uncertain whether theArmy or Navy would operate transports,and therefore evacuate patients from over-seas areas during wartime. Moreover,basic decisions as to whether hospital shipswould be authorized or not, and as towhether the Army or the Navy wouldoperate them, remained to be made. Evac-uation from theaters and transportation ofpatients from ports to general hospitals inthe United States proceeded according topeacetime procedures, with little indica-tion of changes that would be required fora wartime load. Plans for air evacuationwere in the hopeful more than the practi-cal stage. And plans for the internal ad-ministration of hospitals and the globaloperation of a system of hospitalizationand evacuation were in terms of expand-

ing peacetime procedures rather than ofsubstituting new procedures designed forthe task that lay ahead. Finally, a shortageof medical supplies and equipmentplagued medical officers from the highestto the lowest levels of command.

Reasons for the unpreparedness of theMedical Department for war—or at leastsome of them—are reasonably clear. Plan-ning of the Army for many years had beenin terms of defending the United Statesagainst sudden attack, and even duringthe period of peacetime mobilization therewas uncertainty as to whether UnitedStates troops would be employed overseas.Furthermore, appropriations for prepared-ness were meager, and there was hesitancyeven on the part of the President to appearaggressive in planning for a possible war.Finally, the Surgeon General's Office—and perhaps the entire Medical Depart-ment—found it difficult, apparently, tobreak peacetime habits of thought andaction and to plan imaginatively for theaccomplishment of its mission during apossible future war.

For the Medical Department, as for therest of the Army, the first year and a halfof the war was a time of meeting emergen-cy needs and completing mobilization,while at the same time preparing for fullscale war. Needs of the moment receivedfirst consideration. As they were met, em-phasis gradually shifted to evaluating ex-perience as it accumulated and to plan-ning more effectively for the future. Despitemany difficulties, sufficient hospitals wereconstructed and placed in operation tomeet the Army's requirements during itsrapid growth and training in the UnitedStates. The necessity of speed and econo-my, however, dictated abandonment ofnew plans for hospitals of semipermanentconstruction and the erection of canton-

SUMMARY AND CONCLUSIONS 465

ment-type hospitals on unsatisfactory ex-isting plans, with attendant alterations,additions, and repairs. Eventually, avail-ability of materials and general dissatisfac-tion with the hospitals under constructionresulted in the erection of buildings of athird type—one-story buildings of brick ortile—considered by the Surgeon General'sOffice to be the best for emergency con-struction. Toward the completion of theconstruction program, efforts were madeto co-ordinate plans of the Army for hos-pital construction with those of other agen-cies and with postwar needs. Concurrentlywith the establishment of additional hospi-tals in the United States, hospitalizationand evacuation units were sent overseas,and others were organized and placed intraining for later service. Contrary toearlier plans, standard Army hospitalunits rather than affiliated reserve unitsconstituted the primary means of meetingthe first needs for hospitals overseas. Someof the latter—as well as nonaffiliated hos-pital units—remained in training in thiscountry for long periods after their activa-tion, and the question arose of whether ornot they might be used—as evacuationunits were—to provide medical serviceconcurrently with and as a part of theirtraining in the United States. The Sur-geon General withstood the demands ofhigher headquarters to plan toward thatend, and the problem of making effectiveuse of numbered hospital units in theUnited States remained unsolved. By thespring of 1943, after the most urgent needsof theaters had been met, measures weretaken to evaluate their existing facilitiesfor hospitalization and evacuation and toplan more effectively to meet their futureneeds.

The early part of the war was also a timeof establishing basic policies and proce-

dures that were to endure throughout theconflict. An early decision of importancewas that the Army would operate trans-ports and evacuate patients aboard them.A corollary decision toward the middle of1943 was that the Army would also oper-ate hospital ships to supplement the spaceavailable for evacuation on transports.Procedures that required only minor ad-justments later in the war were establishedto co-ordinate the activities of theaters,ships' surgeons, ports of embarkation, andcorps areas (later called service com-mands) in the evacuation of patients fromtheaters to hospitals in the zone of interior.In addition, a procedure for evacuatingpatients from theaters in regularly sched-uled transport airplanes was also estab-lished, but it was policy during this periodto keep air evacuation to a minimum. De-spite the wishes of The Surgeon Generaland the Air Surgeon, AAF headquartersruled that airplanes would not normallybe set aside or built for evacuation only.Hopeful plans for forward-area air evacu-ation were thereby shelved. Procedureswere also developed—albeit directives an-nouncing them were unclear and in someinstances contradictory—for the move-ment of patients by hospital train in theUnited States. While hospitals and thehospital system in the zone of interior con-tinued for the most part to operate underpeacetime procedures, the designation ofgeneral hospitals as centers for specializedtreatment and the establishment of a pol-icy of hospitalizing patients near theirhomes occurred early in 1943. These ac-tions came too late to influence the loca-tion of general hospitals, and had not hadtime by the middle of 1943 to affect appre-ciably procedures for evacuation in thezone of interior. The desirability of short-ening the length of time patients stayed in


hospitals was recognized and efforts to-ward that end were begun. They per-tained primarily to procedures in admin-istrative channels outside Army hospitals.Finally, attempts of the Air Surgeon to setup separate convalescent facilities for AirForces patients, along with an awarenessby the Surgeon General's Office and otherMedical Department officers of the desir-ability of convalescent-reconditioning pro-grams, caused the establishment early in1943 of convalescent centers and an-nexes—the forerunners of convalescenthospitals of later years.

The early period of the war also affordedan opportunity to review plans alreadymade and to adjust them to the new situ-ation. The mobility of war on land massesand the character of operations in islandareas highlighted the necessity of modify-ing existing hospitalization and evacuationunits. In some instances, new units weredeveloped. In others, theaters were left toadapt existing units to new uses. Severalconditions—shortages of personnel andshipping space, and the nature of combatoperations—combined to initiate a trendthat was to be carried to greater lengthslater—the reduction of personnel andequipment authorized for units and instal-lations of all types and sizes. In this con-nection, certain other practices began: thesubstitution of Medical Administrative forMedical Corps officers in administrativepositions in theater of operations units andin zone of interior installations, and thereplacement of general service men withlimited service men, civilians, and enlistedwomen in hospitals in the United States.Experience with unit cars for hospitaltrains revealed their impracticability, andthe Surgeon General's Office substitutedfor them a new type of car, called a warddressing car. The Office successfully op-

posed a proposal to develop at this time afourth type of car—one that would includenot only a dressing room and berths forpatients but also a small kitchen. The Sur-geon General's recommendation for thedevelopment of a forward-area ambulancewas disapproved by higher authority, butthe general-service ambulance was modi-fied to facilitate its shipment to and use intheaters of operations. Experiments withmultipatient ambulances were unsuccess-ful, but other vehicles—such as surgicaltrucks—were developed for use in theevacuation system in theaters.

The task of providing hospitalizationand evacuation in the first year of the warwas complicated by the fact that it had tobe accomplished while a major reorgani-zation in the War Department was takingplace. The creation of three major com-mands — Ground, Air, and ServiceForces—required delineations of responsi-bility for hospitalization and evacuation,and raised questions concerning the extentof The Surgeon General's authority. Re-sponsibility for units to be used in theatersof operations was readily divided betweenThe Surgeon General and the GroundSurgeon, but the Air Surgeon's responsi-bility and authority, and his relationshipwith The Surgeon General, were not suffi-ciently delineated to prevent recurringinstances of friction between them; par-ticularly when the Air Surgeon attemptedto set up a completely separate hospitalsystem for the Air Forces. The establish-ment within ASF headquarters of a groupconcerned with hospitalization and evacu-ation and headed by a Medical Corps offi-cer had a variety of effects. This groupassumed the lead in planning and in co-ordinating the activities of the many agen-cies involved in evacuation operations,with the full concurrence, apparently, of


the Surgeon General's Office. When it en-tered the field of hospital operations itencountered opposition. Whether the goodit accomplished in this field counterbal-anced the ill-feeling and friction which itengendered is difficult to determine accu-rately even now. Progress had been madeby the middle of 1943 in composing differ-ences and solving problems arising fromthe reorganization, but further adjust-ments in relations and authority remainedto be made in the latter part of the war.

The last two years of the war werecharacterized by the necessity of providinghospitalization and evacuation for an all-out war with more limited resources thanhad been anticipated. The problem ofestimating requirements therefore de-manded continual and increasing atten-tion. By the latter half of 1943 it began tobe evident that estimates based on WorldWar I statistical data were too high forWorld War II. In the fall of 1943, whenevacuation policies were established andbed ratios were authorized for theaters forthe first time, there occurred the first at-tempt to use World War II experience as asource of data for estimating requirements.Soon afterward the Surgeon General'sOffice completed an estimate of the patientload for 1944 for use in planning evacu-ation from theaters and in determininghospitalization for both theaters and thezone of interior. Facilities provided on thebasis of this estimate seemed excessive dur-ing 1944 and, as the personnel situationbecame more restrictive, various agenciesof the War Department urged retrench-ment. Reductions followed in the ratio ofbeds (to troops) authorized for station hos-pitals in the United States and for fixedhospitals in most theaters of operations.Early in 1945, when requirements in-creased, general and convalescent hospi-

tals in the United States had to be ex-panded rapidly, more hospital train carshad to be procured, and additional hospi-tal ships had to be rushed to completion.Experience in estimating requirementsduring 1944 and 1945 pointed up the im-portance of collecting casualty and diseasedata early in the war for planning pur-poses. It also highlighted the necessity anddifficulty of correlating far in advanceestimates of requirements with estimatesof the time when they would occur. Fur-thermore, it emphasized the importanceof co-ordinating plans for hospitalizationin theaters with plans for evacuation andfor hospitalization in the zone of interiorin order to avoid duplication and the un-economical use of limited resources.

Limited resources affected hospitaliza-tion and evacuation in more ways than indemanding repeated estimates of require-ments. Shortages of personnel led to wide-spread application in the latter half of thewar of practices already begun on a smallscale. Further reductions occurred in therelative amounts of personnel authorizedfor hospitalization and evacuation units aswell as for named hospitals in the UnitedStates. Medical Administrative Corps offi-cers were used more extensively to replaceMedical Corps officers in administrativeand semiprofessional positions; and lim-ited service enlisted men, civilians, andenlisted women replaced the major por-tion of able-bodied enlisted men in zone ofinterior installations. The extent to whichreductions and substitutions of personnelwere made supports the belief that hospi-talization and evacuation organizationswere overgenerous in their use of person-nel at the beginning of the war. It alsosuggests that the Medical Departmentmight have avoided many difficulties inadjusting to changes eventually required


by circumstances and higher authorities ifit had been more realistic in the first place,reducing amounts of personnel authorizedfor various units and installations to thatactually required and using from the startgreater proportions of Medical Adminis-trative Corps officers, limited service en-listed men, civilians, and enlisted women.Personnel shortages also required theadoption of new practices in the latter halfof the war, such as the use of provisionalplatoons to care for patients on transports,the employment of enemy protected-personnel in the medical service of theatersand the zone of interior, and the substitu-tion of small units that could be used inflexible combinations for larger rigid table-of-organization units, such as regimentsand battalions, in combat areas.

Restrictions on new construction in thelatter part of the war led to the practice ofexpanding existing hospitals by usingmedical-detachment barracks for hospitalpatients, theater-of-operations-type bar-racks for detachments, and post barracksfor convalescent patients. While severalstation hospital plants were converted intogeneral hospitals, earlier plans and pro-posals to meet in the same manner a grow-ing need for general hospital beds in thelatter part of the war proved impracticalbecause of a shortage of specialists to manadditional general hospitals. Toward theend of the war, the removal of restrictionson the use of certain materials formerly inshort supply permitted a program of hos-pital improvement to correct some of thedeficiencies in cantonment-type buildingserected earlier. Although hospital con-struction was curtailed about the middleof 1943, the major portion of the programof constructing hospital cars and ships oc-curred after that time—primarily becausethe need for them was either not fully

comprehended or not recognized in theform of authorizations earlier. Demandsfrom theaters in the Pacific in the latterpart of the war focused attention upon theneed for prefabricated hospital buildingsfor use in overseas areas. The war endedbefore this need could be satisfactorily met.

Important changes were made in thezone of interior hospital system in the lat-ter part of the war—partly because of lim-itations upon available resources but alsofor other reasons, such as competitionbetween the Air Surgeon and The Sur-geon General for the control of segmentsof hospitalization, the desirability of pro-viding a helpful psychological atmospherefor convalescent patients, and the emer-gence of new needs. The existing programof specialization in general hospitals wasextended to promote the effective use ofscarce specialists. The development of re-gional hospitals represented an attempt toeliminate duplication inherent in theoperation of dual sets of hospitals (Air andService Forces) by providing hospitaliza-tion on a regional or geographic instead ofa command basis. The establishment ofconvalescent hospitals not only provideda better psychological environment forconvalescent patients but also permittedtheir care in less expensive facilities thangeneral hospitals. The operation of specificgeneral hospitals solely for prisoner-of-warpatients reduced administrative and se-curity problems and contributed eventu-ally to personnel economy. Although therewere no significant changes in the systemof hospitalization and evacuation in over-seas areas, efforts were made to providetheaters with additional types of units,such as medical holding battalions, mo-bile army surgical hospitals, and conva-lescent camps, in order to meet existingand emerging needs effectively. Changes


did occur in the system of evacuation fromtheaters to the United States. Aside fromimprovements in procedures already es-tablished, the most important modifica-tion was the creation of a Medical Regu-lating Unit in Washington to centralizecontrol over the use of hospital beds andover the flow of patients and to co-ordinatethe movement of patients by sea, rail, andair. This step reflected a growing use ofhospital ships, airplanes, and government-owned hospital cars in the evacuationprocess, contributed to stricter observanceof the policies of caring for patients inspecialized centers and in hospitals neartheir homes, and revealed the desirabilityof locating general and convalescent hos-pitals in relation to population densityrather than troop concentrations.

In connection with changes in the hos-pitalization and evacuation system camechanges in the internal organization andprocedures of zone of interior hospitals.They occurred near the end of the warand came largely as a result of emphasisby ASF headquarters on the achievementof efficiency and economy through man-agement engineering. Attempts to stand-ardize hospital organization—a prerequi-site to the simplification of administrativeprocedures—amounted to conformancewith the standard organization of ASFposts more than improvements and inno-vations in hospital organization as such.The introduction of management engi-neering led to work-load studies, work-simplification measures, and the stream-lining of certain administrative proce-dures, especially those affecting the lengthof time patients remained in hospitals and,consequently, the number of beds re-quired. Another factor affecting bed re-quirements—the performance of adequatediagnostic procedures to permit the admis-

sion to hospitals of only those patientsneeding hospital care—was not touched,and the work of dispensaries in this respectremained "one of the weakest links in thewhole medical program."3

Growth of the patient load in the laterwar years, coupled with changing policies,procedures, and circumstances, led to thedevelopment of new transportation facili-ties for evacuation. Despite its earlier ob-jection to a proposal for a hospital car witha dressing room, berths for patients, and asmall kitchen, the Surgeon General'sOffice adopted the idea when its necessitybecame obvious. That Office also pro-moted the procurement of kitchen cars forhospital trains when it became apparentthat railroad companies would be unableto supply the Army with sufficient diningcars. To assist in the movement of patientsfrom ports to near-by hospitals, The Sur-geon General proposed, and higher au-thority approved, the development of amultipatient ambulance. A front-line am-bulance was developed experimentally,but it was not authorized for procurementbecause ASF headquarters and the WarDepartment General Staff insisted uponthe use of standard Army vehicles only.Toward the end of the war litter racks thatcould be attached to jeeps to enable themto evacuate patients from forward areaswere standardized for issuance to evacu-ation units. While airplane ambulanceswere never authorized or developed, im-provements in litter supports permittedincreases in the capacities of transportplanes for evacuation. Eventually, an in-crease in the availability of planes led to amodification of existing policy and the as-

3 Comment by Dr. Eli Ginzberg, formerly Dir, Re-sources Anal Div SGO, incl to Ltr to Col Calvin H.Goddard, 5 Nov 51. HD: 314 (Correspondence onMS) V.


signment to several commands of planesfor use primarily in the movement ofpatients.

Further adjustments to the new organi-zation of the War Department occurred inthe latter half of the war. The SurgeonGeneral expanded and strengthened hisOffice, particularly the divisions concernedmost immediately with hospitalization andevacuation. Concurrently, ASF headquar-ters abolished its Hospitalization andEvacuation Branch and transferred manyof its functions and some of its personnel tothe enlarged and strengthened SurgeonGeneral's Office. Eventually, The SurgeonGeneral was restored to his former posi-tion of having direct contact with the WarDepartment General Staff. Meanwhile,though still under ASF headquarters, hisOffice developed means of exercising closersupervision over service command hospitalactivities, and limits of the respective juris-dictions of the Air Surgeon and The Sur-geon General gradually evolved. TheSurgeon General was never in a position,though, to exercise a controlling influence

over the entire hospitalization and evacu-ation system of the Army. Perhaps an im-portant reason for this was that, as a resultof the dual position he held, he seemed attimes to be bidding against himself. AsThe Surgeon General of the entire Army,he was responsible—to some extent, atleast—for apportioning medical resourcesamong major commands (Air, Ground,and Service Forces) and between the zoneof interior and theaters of operations. Onthe other hand, as surgeon on the staff ofthe commanding general, Army ServiceForces, he was responsible for providing asgood a medical service in the zone of inte-rior as possible. This required him to actin a disinterested manner on matters in-volving him as an interested party. Never-theless, despite difficulties caused by itsorganizational structure, the War Depart-ment and its agencies, including the Sur-geon General's Office, managed success-fully with limited resources to provideadequate hospitalization and evacuationfor an Army of over 8,000,000 menengaged in a global war.

List of AbbreviationsAAF Army Air ForcesAAR Association of American RailroadsAC Air CorpsACofS Assistant Chief of StaffAct ActingAdd Additional, additionAdmin Administration, administrative, administratorAFPAC U. S. Army Forces, PacificAG The Adjutant General, Files ofAGF Army Ground Forces; Army Ground Forces, Files ofAGO Adjutant General's OfficeAGWAR Adjutant General, War DepartmentAlmt AllotmentAmb AmbulanceAML Army Medical LibraryAn AnnualAnal AnalysisAR Army RegulationsASF Army Service ForcesAsgmt AssignmentASO Air Surgeon's OfficeATC Air Transport Command; Air Transport Command, Files ofATS Army Transport ServiceAuth Authority, authorized, authorizationAWC Army War College, Files ofBd BoardBn BattalionBPE Boston Port of EmbarkationBr BranchC ChiefCA Corps areaCASU Corps Area Service UnitCBI China-Burma-IndiaCCS Combined Chiefs of StaffCDD Certificate of disability for dischargeCE Chief of Engineers, Files of; Corps of Engineers


CG Commanding GeneralCinC Commander in ChiefCir CircularCiv CivilianCMTC Combined Military Transportation CommitteeCmtee CommitteeCO Commanding OfficerCo CompanyCofAC Chief of the Air CorpsCofEngrs Chief of EngineersCofF Chief of FinanceCofOrd Chief of OrdnanceCofSA Chief of Staff, U. S. ArmyCofT Chief of TransportationComd CommandComZ Communications zoneConf ConferenceCons Construction, constructing, consultantConv Convalescent, conversation, conversionCo-ord Co-ordinationCPA Central Pacific AreaCPE Charleston Port of EmbarkationDAF Department of the Air ForceDef DefenseDep DeputyDet DetachmentDev DevelopmentDF Disposition formDir Directorate, directorDistr DistributionDiv DivisionDom DomesticD/S Disposition slipEM Enlisted menEngr Engineer, engineeringEquip EquipmentEst EstimateEstab Establish, establishmentETOUSA European Theater of Operations, U. S. ArmyEvac Evacuation, evacuatingFac Facility, facilitiesFld FieldFM Field manual

LIST OF ABBREVIATIONS 473

FY Fiscal yearGen GeneralGHQ General HeadquartersGO General OrderHD Historical Unit, Army Medical Service, Walter Reed Army

Medical Center (formerly Historical Division, Office of TheSurgeon General)

Hist HistoryHosp Hospital, hospitalizationHq HeadquartersHRPE Hampton Roads Port of EmbarkationHRS Historical Records Section, Departmental Records Branch,

Adjutant General's OfficeIAS Informal action sheetIG The Inspector General; The Inspector General, Files ofIncl Inclosure, inclosedInd IndorsementIndiv IndividualInfo InformationInit InitialedInsp InspectionInstl InstallationInterv InterviewJAG The Judge Advocate GeneralJCS Joint Chiefs of StaffJMTC Joint Military Transportation CommitteeJPS Joint Staff PlannersLab LaboratoryLAPE Los Angeles Port of EmbarkationLtr LetterMAC Medical Administrative CorpsMar Comm Maritime CommissionMat Material, MatérielMC Medical CorpsMD Medical DepartmentMFSS Medical Field Service SchoolMHSP Medical hospital ship platoonMil MilitaryMin MinuteMisc MiscellaneousMob MobilizationMOOB Mobilization and Overseas Operations Branch, Office of The

Surgeon General


MOOD Mobilization and Overseas Operations Division, Office of TheSurgeon General

MPD Military Personnel DivisionMR Mobilization RegulationsMRO Medical Regulating OfficerMRS Memo routing slipMRU Medical Regulating UnitM/S Memorandum sheet or slipMSO Medical Supply OfficerMTOUSA Mediterranean Theater of Operations, U. S. ArmyMvmt MovementNATOUSA North African Theater of Operations, U. S. Armyn d No dateNOPE New Orleans Port of EmbarkationNP Neuropsychiatric, neuropsychiatryNYPE New York Port of EmbarkationOCE Office, Chief of EngineersOCofAC Office, Chief of the Air CorpsOCS Office, Chief of Staff, U. S. ArmyOCT Office of the Chief of TransportationOff Office, officerOO Office OrderOPD Operations Division, War Department General StaffOPMG Office of The Provost Marshal GeneralOpr OperationOrd Ordnance; Chief of Ordnance, Files ofOrgn OrganizationOSW Office, Secretary of War, Files ofPE Port of embarkationPers Personnel, personalPlat PlatoonPMG The Provost Marshal GeneralPMP Protective Mobilization PlanPnt PatientPOA Pacific Ocean AreaProcmt ProcurementProv Provisional, provisionPtbl PortablePW Prisoner of warQMG The Quartermaster GeneralRad RadiogramRecomd RecommendationReg Regulation, regulating

LIST OF ABBREVIATIONS 475

Regt RegimentRepl ReplacementReq RequiredReqmt RequirementRes Reservation, resolution, reserveRev RevisionRpt ReportR&R Sheet Routing and record sheetRR RailroadRy RailwaySCSU Service Command Service UnitSecWar Secretary of WarSep SeparateServ ServiceSFPE San Francisco Port of EmbarkationSG The Surgeon General; The Surgeon General, Files ofSGO Surgeon General's OfficeSHAEF Supreme Headquarters, Allied Expeditionary ForcesSOS Services of SupplySPA South Pacific AreaSPE Seattle Port of EmbarkationS/S Summary sheetSta StationStr StrengthSup SupplySupp SupplementSurg Surgeon, surgicalSurv SurveySvC Service commandSWPA Southwest Pacific AreaSyst SystemTAG The Adjutant GeneralTAS The Air Surgeon's Historical Division, Files ofT/BA Table of basic allowancesTC Transportation Corps; Chief of Transportation, Files ofT/E Table of equipmentTec TechnicalTel TelephoneTemp TemporaryTfc TrafficTM Technical manualTn TrainTng Training


T/O Table of organization; theater of operationsT/O&E Table of organization and equipmentTofOpns Theater of OperationsTrans Transportation; transportsTrf TransferTrp TroopT/S Transmittal sheetUSAF United States Air ForcesUSAFBI U. S. Army Forces in the British IslesUSASOS U. S. Army, Services of SupplyUSFET U. S. Forces, European TheaterUtil Utilization, utilitiesVeh VehicleWAAC Women's Army Auxiliary CorpsWAC Women's Army CorpsWD War DepartmentWDCSA Office, Chief of Staff, U. S. Army, Files ofWDGS War Department General StaffWDMB War Department Manpower BoardWPB War Production BoardWRGH Walter Reed General HospitalZI Zone of interior

Bibliographical Note

Primary Sources

The most important collections of sourcematerial for this volume were the centralfiles of the Surgeon General's Office andthe files of the Historical Unit, Army Med-ical Service, Walter Reed Army MedicalCenter. The central files of the SurgeonGeneral's Office for the war period havebeen retired and are now in the custody ofThe Adjutant General. They contain offi-cial correspondence, memoranda, and re-ports originating in the Surgeon General'sOffice, as well as numerous documentsreceived by this Office from other sources,both military and civilian. These files, likethose of most Army agencies, are arrangedby subject under a numerical or decimalsystem. For example, documents on theconstruction of hospitals are filed under632; of cars for hospital trains, under531.4; and of hospital ships, under 560.To include here all of the numerical classi-fications of documents used in the prepa-ration of this volume, or even those usedmost often, is both undesirable and unnec-essary because the list would be too longand would duplicate information readilyavailable in footnotes throughout thevolume.

The files of the Historical Unit areextensive, having been built up by theHistorical Division, Office of The SurgeonGeneral (predecessor of the HistoricalUnit) during the war years. Of particularimportance in the Historical Unit files arethe annual reports submitted during thewar by The Surgeon General, divisions of

the Surgeon General's Office handlinghospitalization and evacuation matters,surgeons of large commands, and com-manding officers of hospitalization andevacuation units and installations thatranged from 3,000-bed hospitals to sepa-rate ambulance companies. Althoughthese annual reports obviously must beused with caution, because surgeons andcommanders in some instances undoubt-edly attempted to present the most favor-able view possible of their activities, theycontain a wealth of information not other-wise available. In addition, many of themcontain excellent discussions of MedicalDepartment shortcomings, because theyafforded surgeons and commanders anopportunity to complain about mattersover which they were disturbed but hadno control. The absence of complete setsof annual reports of the Air and GroundSurgeons for the war years is regrettable.The Historical Unit also has custody ofwartime working files of several divisionsof the Surgeon General's Office. The mostimportant among them for this volumewere those of the Mobilization and Over-seas Operations Division, the MedicalRegulating Unit, and the Resources Anal-ysis Division. To supplement these papers,the Unit periodically borrowed wartimedocuments from current office files of theMedical Facilities Planning Branch (form-erly Hospital Construction Branch), Med-ical Statistics Division, Resources AnalysisDivision, Supply Division, and MedicalResearch and Development Board of theSurgeon General's Office. The Historical


Unit also has a large decimal file; most ofthe papers in it, however, are carboncopies of those in The Surgeon General'scentral files. Supplementing these files andsometimes serving as a clue to the locationof other important documents are thediaries of divisions of the Surgeon Gen-eral's Office covering the period from thefall of 1943 to the end of the war. In addi-tion, the Historical Unit has a copy of thetestimony and report of the Committee toStudy the Medical Department (1942)and a compilation of recommendations ofthe Committee and actions on them by theSurgeon General's Office. Portions of thesedocuments were extremely useful for in-formation on relations between the Sur-geon General's Office and the SOS Hos-pitalization and Evacuation Branch andon developments in hospitalization andevacuation up to the end of 1942. Also ofinterest for this volume, the HistoricalUnit has microfilm of The Adjutant Gen-eral's unit cards (large cards giving inabbreviated form the chronology and his-tory of individual military units) of Medi-cal Department organizations, includinghospitalization and evacuation units. (Theoriginal cards are filed in the Organiza-tion and Directory Section, OperationsBranch, Administrative Services Division,Adjutant General's Office.) Other docu-ments and materials belonging at presentto the Historical Unit were used in thisstudy, but it is unnecessary to mentionthem specifically.

When this volume was written, the His-torical Unit had in its custody, on indefi-nite loan, three blocks of files of consider-able significance. The Wilson files—socalled because they were built up and usedby Col. William L. Wilson, M. C.—wereon loan from the Historical Records Sec-tion, Departmental Records Branch, Ad-

jutant General's Office. Covering a periodfrom May 1941, when Colonel Wilson wasin G-4, until June 1943, shortly after he leftASF headquarters, these files are actuallyunofficial records of the ASF Hospitaliza-tion and Evacuation Branch. They containa full set of staybacks, a diary, a decimalfile, a subject file, and a file of operationalplans submitted by medical installations inthe United States. The Ground MedicalSection files, containing papers from theGround Surgeon's Office, were on loanfrom Headquarters, Army Field Forces,Fort Monroe, Va. Important but not asextensive as would be desired, these filescontain several sets of staybacks and manyannual reports of Army Ground Forcesmedical units. On loan from the AirForces, but recently returned to the His-torical Division, Office of The SurgeonGeneral, Department of the Air Forces,were files of the Air Surgeon's HistoricalDivision. In addition to annual reportsand wartime histories of many AAF medi-cal installations and commands, these filescontain several folders of the Air Surgeon'scorrespondence, including interofficememos, on hospitalization and evacuation.

Next in importance to the files of theSurgeon General's Office and the Histori-cal Unit for this study were certain files ofASF headquarters and the War Depart-ment General Staff, which are in the cus-tody of the Historical Records Section,Departmental Records Branch, AdjutantGeneral's Office. The most useful ASF fileswere those of the Control and PlanningDivisions, and the folders dealing withMedical Department activities that werekept and used during the war by GeneralsSomervell, Styer, and Lutes. Of the Gen-eral Staff files, those of G-4 were naturallymost rewarding, but those of G-1, G-3,and OPD were also consulted with success

BIBLIOGRAPHICAL NOTE 479

in many instances. Conclusive informa-tion, particularly about controversies ordisputes that reached high levels of author-ity for decision or solution, could be foundoften only in the files of the Chief of Staff,U. S. Army, the Assistant Secretary ofWar for Air, and the Secretary of War.Other files in the custody of The AdjutantGeneral which it was frequently necessaryto use were those of the technical servicesthat assisted the Medical Department inits hospitalization and evacuation opera-tions; among them were the Quartermas-ter Corps, the Corps of Engineers, and theTransportation Corps. While the wartimefiles of AAF and AGF headquarters wereavailable and useful, it was particularlydisturbing to be unable to find amongthem anything resembling central files ofthe offices of the Air and Ground Sur-geons. Finally, and certainly not of leastimportance, were the files maintained byThe Adjutant General during the war.Because his Office was the War Depart-ment's office of record, all official commu-nications to and from the General Stafffound their way into the AG files.

Printed primary sources were also usedin the preparation of this volume, but be-cause of the wide circulation they enjoyedit is unnecessary to indicate the deposi-tories in which they are located. Obvious-ly Army regulations, War Departmentcirculars, field manuals, technical manu-als, tables of organization and equipment,and the like, are basic sources for any mili-tary history. Of interest because theyhelped the writer fit the history of hospi-talization and evacuation into a largerpicture are the biennial reports of theChief of Staff of the Army and the annualreports of the Secretary of War. Althoughno systematic search was made of Con-gressional committee reports, a few were

used when they appeared to have a directbearing on the subject under considera-tion.

As noted at greater length in the pref-ace, the writer also derived much informa-tion from interviews and correspondencewith persons active in Medical Depart-ment affairs during the war.

Secondary Sources

While there are no published mono-graphs or special studies on Army hospi-talization and evacuation during WorldWar II, there are a number of unpub-lished preliminary histories and historicalmonographs on Medical Department ac-tivities that have been helpful to the writerof this volume. Among them are a groupof studies prepared by the Historical Divi-sion, Office of The Surgeon General, im-mediately after the end of the war. Theyare the following: [Samuel M. Goodman],A Summary of the Training of Army Serv-ice Forces Medical Department Personnel,1 July 1939-31 December 1944; Harold P.James, Transportation of the Sick andWounded; John B. Johnson, Jr., andGraves H. Wilson, A History of WartimeResearch and Development of MedicalField Equipment; Richard L. Laughlin,[History of] Reconditioning [in the U. S.Army in World War II]; Edward J. Mor-gan and Donald O. Wagner, The Organi-zation of the Medical Department in theZone of the Interior; and Richard E. Yates,The Procurement and Distribution ofMedical Supplies in the Zone of Interiorduring World War II. Two unpublishedhistories prepared by Florence A. Blanch-field and Mary W. Standlee, OrganizedNursing in the Army in Three Wars (1950)and The Army Nurse Corps in World WarII (1950), supplied background informa-


tion for the discussion of the "shortage"of nurses in zone of interior hospitals.Hubert A. Coleman, Organization andAdministration, AAF Medical Services inthe Zone of Interior (1948), was particu-larly helpful in the preparation of sectionson AAF hospitalization and evacuation.Parts of this work are essentially copies ofhistories or reports submitted by AAFmedical installations to the Air Surgeon'sOffice and like all such documents mustbe used with care. The chapters actuallyprepared by Coleman and his assistantsare scholarly and reliable. The HistoricalUnit has copies of all of the works namedabove. Two of my colleagues, Blanche B.Armfield and John H. McMinn, deservespecial mention because they not onlymade available drafts of chapters of vol-umes which they are preparing on Medi-cal Department organization and person-nel, respectively, but they also gave theauthor full benefit of their knowledge boththrough frequent discussions and throughcriticisms of his manuscript.

A variety of other unpublished historieswere consulted, often with unexpectedlygood results. Wartime histories of the Plan-ning and Control Divisions of ASF head-quarters supplied information that un-doubtedly existed in documents whichcould not be located in ASF files. Historiesof Medical Department activities of theAir Transport Command, its Ferrying Di-vision, I Troop Carrier Command, and theFourth Air Force were used to supple-ment information found in the files of AAFheadquarters. Wartime histories of Medi-cal Department activities in overseas com-mands, on file in the Historical Unit, sup-plied information that occasionally threwlight upon some aspects of zone of interiorhospitalization and evacuation.

Another group of documents which the

author used, but with caution, needs to bementioned. While some purport to be his-tories, all of them are in fact final reportsof the offices concerned. On file in the His-torical Unit, they are as follows: MargaretD. Craighill, History of Women's MedicalUnit [Office of The Surgeon General];History of Medical Liaison Office to theOCT and Medical Regulating Service,Office of The Surgeon General; History,Office of the Surgeon, Second Corps Areaand Second Service Command, from 9September 1940 to 2 September 1945;Historical Record, Laundry Section, Hos-pital Division, [Office of The SurgeonGeneral]; History of the Organization andEquipment Allowance Branch, [Office ofThe Surgeon General]; Rene M. Juchli,Record of Events in the Treatment of Pris-oners of War, World War II; and AchillesL. Tynes, Data for Preparation of Histori-cal Record of Construction Branch of theSurgeon General's Office during the Ex-pansion Period of the Army and WorldWar II.

Published histories, or those well alongin the publication process, used in thepreparation of this volume need only to belisted. Among them are several volumes(including three in manuscript form) ofthe UNITED STATES ARMY INWORLD WAR II: Ray S. Cline, Wash-ington Command Post: The Operations Division(Washington, 1951); Stetson Conn andByron Fairchild, Defense of the Americas,Vol. I (MS.); Kent R. Greenfield, RobertR. Palmer and Bell I. Wiley, The Organi-zation of Ground Combat Troops (Washington,1947); Ulysses Lee, The Employment ofNegro Troops (MS.); Maurice Matloffand Edwin M. Snell, Strategic Planning forCoalition Warfare, 1941-42 (Washington,1953); John D. Millett, The Organizationand Role of the Army Service Forces (Washing-

BIBLIOGRAPHICAL NOTE 481

ton, 1954); Robert R. Palmer, Bell I.Wiley and William R. Keast, The Procure-ment and Training of Ground Combat Troops(Washington, 1948); Jesse A. Remingtonand Lenore Fine, The Corps of Engineers:Construction in the United States (MS.);Erna Risch, The Quartermaster Corps: Or-ganization, Supply and Services, Vol. I (Wash-ington, 1953); Mattie E. Treadwell, TheWomen'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 ofWesley F. Craven and James L. Cate(eds.), The Army Air Forces in World War II(Chicago, 1948 and ff). Other publishedhistories consulted were: Percy M. Ash-burn, A History of the Medical Department ofthe United States Army (Boston, 1929); Ro-

land W. Charles, Troopships of World War II(Washington, 1947); Engineer, Office ofthe Chief, General Headquarters ArmyForces, Pacific, Engineers in Theater Opera-tions in ENGINEERS OF THE SOUTH-WEST PACIFIC, 1941-45, Vol. I. (1947);Logistical History of NATOUSA-MTOUSA(Naples, Italy, 1945); The Medical Depart-ment of the United States Army in the WorldWar, Vol. I (Washington, 1923), Vol. V(Washington, 1923), Vol. VIII (Washing-ton, 1925), and Vol. XIII (Washington,1927); William C. Menninger, Psychiatryin a Troubled World (New York, 1948); andHoward A. Rusk, "Convalescence andRehabilitation," in Morris Fishbein (ed.),Doctors at War (New York, 1945). Varioususeful historical articles were found also inThe Air Surgeon's Bulletin, the Army MedicalBulletin, the Journal of Aviation Medicine, andThe Military Surgeon.

UNITED STATES ARMY IN WORLD WAR II

The following volumes have been published or are in press:

The War DepartmentChief of Staff: Prewar Plans and PreparationsWashington Command Post: The Operations DivisionStrategic Planning for Coalition Warfare: 1941-1942Strategic Planning for Coalition Warfare: 1943-1944Global Logistics and Strategy: 1940-1943Global Logistics and Strategy: 1943-1945The Army and Economic MobilizationThe Army and Industrial Manpower

The Army Ground ForcesThe Organization of Ground Combat TroopsThe Procurement and Training of Ground Combat Troops

The Army Service ForcesThe Organization and Role of the Army Service Forces

The Western HemisphereThe Framework of Hemisphere DefenseGuarding the United States and Its Outposts

The War in the PacificThe Fall of the PhilippinesGuadalcanal: The First OffensiveVictory in PapuaCARTWHEEL: The Reduction of RabaulSeizure of the Gilberts and MarshallsCampaign in the MarianasThe Approach to the PhilippinesLeyte: The Return to the PhilippinesTriumph in the PhilippinesOkinawa: The Last BattleStrategy and Command: The First Two Years

The Mediterranean Theater of OperationsNorthwest Africa: Seizing the Initiative in the WestSicily and the Surrender of ItalySalerno to CassinoCassino to the Alps

The European Theater of OperationsCross-Channel AttackBreakout and PursuitThe Lorraine CampaignThe Siegfried Line CampaignThe Ardennes: Battle of the BulgeThe Last Offensive

The Supreme CommandLogistical Support of the Armies, Volume ILogistical Support of the Armies, Volume II

The Middle East TheaterThe Persian Corridor and Aid to Russia

The China-Burma-India TheaterStilwell's Mission to ChinaStilwell's Command ProblemsTime Runs Out in CBI

The Technical ServicesThe Chemical Warfare Service: Organizing for WarThe Chemical Warfare Service: From Laboratory to FieldThe Chemical Warfare Service: Chemicals in CombatThe Corps of Engineers: Troops and EquipmentThe Corps of Engineers: The War Against JapanThe Corps of Engineers: The War Against GermanyThe Corps of Engineers: Military Construction in the United StatesThe Medical Department: Hospitalization and Evacuation; Zone of InteriorThe Medical Department: Medical Service in the Mediterranean and Minor

TheatersThe Ordnance Department: Planning Munitions for WarThe Ordnance Department: Procurement and SupplyThe Ordnance Department: On Beachhead and BattlefrontThe Quartermaster Corps: Organization, Supply, and Services, Volume IThe Quartermaster Corps: Organization, Supply, and Services, Volume IIThe Quartermaster Corps: Operations in the War Against JapanThe Quartermaster Corps: Operations in the War Against GermanyThe Signal Corps: The EmergencyThe Signal Corps: The TestThe Signal Corps: The OutcomeThe Transportation Corps: Responsibilities, Organization, and OperationsThe Transportation Corps: Movements, Training, and SupplyThe Transportation Corps: Operations Overseas

Special StudiesChronology: 1941-1945Military Relations Between the United States and Canada: 1939-1945Rearming the FrenchThree Battles: Arnaville, Altuzzo, and SchmidtThe Women's Army CorpsCivil Affairs: Soldiers Become GovernorsBuying Aircraft: Materiel Procurement for the Army Air ForcesThe Employment of Negro TroopsManhattan: The U.S. Army and the Atomic Bomb

Pictorial RecordThe War Against Germany and Italy: Mediterranean and Adjacent AreasThe War Against Germany: Europe and Adjacent AreasThe War Against Japan

Index

Adjutant General, The, 8, 124, 127, 128, 243, 245,263

Administration, hospitalprewar period, 25, 26-377 Dec 1941-mid-1943, 121-39mid-1943-1946, 170, 198-99, 238-78, 344, 345

Admissions, hospital. See Hospitalization statistics;Patients.

Air ambulance squadrons, medical, 438Air base commanders, responsibility for transferring

debarked patients to hospitals, 341-42Air conditioning

for airplanes, 444for hospital ships, 414for hospitals, 97-99, 295-96

Air Corps. See also Air Surgeon, Office of the;Army Air Forces,

control of hospitals, 11control of patient-reassignment, 130fire prevention in hospitals, 23helps develop air evacuation unit, 437-38and special airplanes for evacuation, 427, 428

Air evacuation group, 438-39Air evacuation transport squadrons, medical, 339,

439Air Surgeon, Office of the. See also Grant, Maj.

Gen. David N. W.agrees on procedures for air evacuation in ZI, 358approves new hospital admission procedure, 263and bed requirements, 206-07develops air evacuation units, 438-39establishes bed credits in regional hospitals, 240favors convalescent hospitals for AAF, 118, 119favors using regional hospitals for patients from

overseas, 186, 188, 210initiates reconditioning programs in hospitals, 118plans special planes for evacuation in combat

areas, 433, 434, 435proposes specialized and regional hospitals, 184recommends establishment of AAF general hos-

pitals, 107responsibility for air evacuation, 338, 339, 357urges separate hospitals for AAF overseas, 174-

76Air Transport Command

agrees on procedure for air evacuation in ZI, 358announces increased medical personnel for air

evacuation, 440assignment of air evacuation personnel to sub-

ordinate commands of, 440-41dispensaries of, 175encourages evacuation to ZI by air, 326responsibility for air evacuation, 338-39, 340,

357, 358

Air Transport Command-Continuedresponsibility for medical supplies used in air

evacuation, 445Airplanes for evacuation, 338, 346, 358, 426-37.

See also Evacuation, air.Alaska, 3, 142, 337-38, 429Ambulance battalions, 450, 451, 457Ambulance Body Manufacturers Industry Advisory

Committee, 365Ambulance companies, 38, 452, 453, 458Ambulance ship companies, medical, 424Ambulance transports, 396, 398. See also Evacu-

ation to zone of interior by sea; Hospital ships.Ambulances, 321, 360-69American Car and Foundry Company, 385, 388American theater, bed requirements of, 217, 227,

233, 302Apartment houses, converted to hospitals, 66Armored Force, special medical equipment for, 456Army Air Forces, 11, 54, 119, 133, 136, 326, 338,

358. See also Air Corps; Air Surgeon, Officeof the; Air Transport Command; MedicalRegulating Service, AAF.

agrees to creation of regional and convalescenthospitals, 184-85

and bed requirements, 205-06converts trucks to ambulances, 367defense command patients in hospitals of, 104designates hospitals for debarkation, 193-94designates regional hospitals, 184establishes all-Negro hospital, 110establishes convalescent centers, 120and evacuation equipment for airplanes, 326,

441-44jurisdiction over station hospitals, 103operates convalescent centers, 108plans to establish holding facilities, 193-94policy on special airplanes for evacuation, 357,

426, 431-37reassigns AAF patients, 124, 242-43relinquishes buildings for hospital use, 87responsibilities for hospitalization and evacuation,

57-58, 287, 320, 321, 338, 358, 445-46scope of treatment in station hospitals of, 183-84separate hospitals, 12, 106-09, 174-76, 181

Army Ground Forces. See also Ground Surgeon.conference on establishment of separate con-

valescent facilities, 119consulted on medical equipment lists, 59criticizes method of packing hospital equipment,

147directed to substitute MAC for MC officers, 133establishment, 54-55

486 HOSPITALIZATION AND EVACUATIONS, ZONE OF INTERIOR

Army Ground Forces—Continuedfavors delaying establishment of separate con-

valescent facilities, 119and hospital bed requirements, 301hospitals in ZI for, 104-06and issue of equipment to T/O hospitals in ZI,

152, 155jurisdiction over medical units, 58-59, 173, 457,

458-59recommends modification of field ambulance, 365reduces transport of evacuation hospitals, 146responsibilities for hospitalization and evacu-

ation, 57responsibility for medical T/O's, 59revises hospital T/O's, 149supports activation of training units at half

strength, 141supports special airplanes for evacuation in com-

bat areas, 434Army Medical Center. See Installations and units,

medical.Army Nurse Corps

deficiencies in training, 32draft of, proposed, 252-53duties assigned to Wacs, 258ratio to patients, 251-52, 280shortages, 31, 251-52substitutes for, 249-50, 252-53

Army Service Forces, 119, 182, 183, 192, 197, 222,230, 236-37, 248, 266, 314, 325-26, 390, 416.See also Adjutant General; Chief of Staff, ASF;Command Installation Branch; Control Divi-sion; Hospitalization and Evacuation Branch;Medical Regulating Unit; Mobilization Divi-sion; Plans and Operations, Director of; Pro-vost Marshal General; Reduction Board;Requirements Division; Services of Supply;Somervell, Lt. Gen. Brehon B,

agrees to creation of regional and convalescenthospitals, 184

approves convalescent facilities, 120, 189attitude toward use and equipment of T/O

hospitals in ZI, 156authority over SGO, 171-72and bed requirements, 200, 201, 202, 203, 205,

207, 211, 217, 225, 229, 231, 233, 301believes SGO should be more active in planning

hospitalization and supervising hospital oper-ations, 176-77

complains of hospitals' delay in diagnosis, 242considers separate general hospitals for AAF, 108control of T/O hospitals in ZI, 173delegates authority to make minor changes in

hospital construction program, 288-89and development of hospital trains and cars,

382, 383, 384-85, 387directs changes in hospital program, 87

Army Service Forces—Continuedestablishes procedure for closing surplus hospitals,

314and evacuation policy, 229and improvement of hospital facilities, 289-90,

291-92, 293, 294, 295-96jurisdiction over station hospitals, 103and method of reporting hospital beds, 207, 208modifies retirement and disability discharge pro-

cedures, 243, 244, 245orders precut hospital buildings for Pacific, 298personnel policy, 111, 222-23, 249, 253, 254, 261,

265and procurement of ambulances, 367, 368and procurement of hospital cars, 385, 387proposes changes in SGO, 176provides hospitals for AGF patients in ZI, 105publishes accounting procedure for hospital cars,

354responsibility for hospital construction, 286responsibility for selecting hospital locations, 88supports air evacuation, 326, 358supports standard organization for hospitals, 271transfer of personnel to SGO from, 177

Australia, hospitals for, 143. See also SouthwestPacific Area.

Autogiros for evacuation, 428. See also Helicoptersfor evacuation.

Baehr, George, 81, 82, 83Barracks for housing hospital beds, 20, 288Battalions, medical. See Field medical units.Bed credits, hospital, 35, 115, 240, 321, 322, 346-47Bed requirements, hospital. See also Dispersion

factor; Hospitals, general; Hospitals, station,agencies determining, 200estimates 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, 170Beds, shortages of hospital, 24-26Blesse, Brig. Gen. Frederick A., 9, 55Bliss, Brig. Gen. Raymond W., 176, 261Budget, Bureau of the, 86, 291, 293-94, 396Buildings, hospital. See Hospital construction;

Repair and maintenance, hospital.Burma, 429. See also China-Burma-India theater.

California-Arizona Maneuver Area, 105-06, 156Central Pacific Theater. See also Hawaii, hospitals

in; Pacific Ocean Areas.absorbed in Pacific Ocean Areas, 230bed requirements, 217, 218, 227, 230, 233, 235bed statistics, 220-21enlarges hospitals, 219evacuation policy for, 235hospital ships for, 327hospitals for AAF in, 175hospitals sent to, 143hospitals from South Pacific sent to, 228

INDEX 487

Central service systems for hospitals, 292-93Chemical Warfare Service, 268, 454Chief of Staff, ASF, 107, 230Chief of Staff, War Department

announces air evacuation policy, 338approves SG's recommendation on hospital con-

struction, 18decides publication date for hospital manning

guide, 31directs ETO to use transports for evacuating pa-

tients, 209, 328-29directs full use of air evacuation by ETO, 329grants increased hospital train personnel to serv-

ice commands, 391notes delay in retirement procedure for officers, 36orders organization of WAC companies for hos-

pitals, 258plans to require double-bunking in barracks in

emergency, 81and project for emergency hospitalization, 81, 82,

83promotes demobilization of medical personnel,

301requests IG to investigate disagreement on hos-

pital construction, 17restricts transfer of prisoner-of-war patients to

U. S., 197suggests 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, 224bed requirements, 217, 218, 227, 233, 235bed statistics, 220-21evacuation policy for, 215, 216, 235hospitals from South Pacific sent to, 228uses mobile as fixed hospitals, 218

China theater, 233, 234, 235. See also China-Burma-India theater.

Chinese Army, hospital bed requirements for, 218,227, 233

Civilian Conservation Corps, 26Civilian Defense, Office of, 66, 81, 82, 83Civilian employees, 31, 32, 33, 40, 109, 249-50, 252,

253, 255-56Civilians, Army hospitals for, 112Clearing companies, separate, 451-52, 453, 458Collecting companies, separate, 451-52, 453, 458Combined Chiefs of Staff, 404Combined Military Transportation Committee, 412Command Installation Branch, ASF, 294Committee to Study the Medical Department

approves SG's position on planning, 64considers problem of convalescent patients, 118criticizes inadequacy of certain facilities in hos-

pitals, 99effect of recommendations on policies and proce-

dures of Medical Department, 61

Committee to Study the Medical Department—Con.gives causes for shortcomings of hospital con-

struction, 93-94proposal of separate convalescent accommoda-

tions opposed by SG, 118proposes changes in hospital administration, 122,

123, 127, 268recommends maximum hospitalization for pa-

tients, 129recommends use of Waacs in hospitals, 136

Congress, 85, 91, 95, 111, 294Construction Planning Branch, SOS, 79Consultants, 123, 289Contract surgeons, 109Control Division, ASF

authority over hospitals, 172collaborates in drawing up subsistence procedures

for hospital trains, 354considers problem of limited personnel, 181helps revise hospital administrative procedures,

262, 263investigates complaints against railroads concern-

ing reservations for patients, 355lends statistician to OTSG, 177revises disability-discharge procedure, 244supports SG's sole authority to estimate overseas

bed requirements, 86Convalescent annexes. See Hospitals, convalescent.Convalescent camps, 279Convalescent centers. See also Hospitals, convales-

cent.theater-of-operations-type, 148, 279-80zone of interior

functions, 188operated by AAF, 108, 120, 188operated by ASF, 189retiring boards at AAF, 246transfer of patients to, 109

Corps areas, 30, 55, 97, 133. See also Servicecommands.

arrange movement of patients by train, 321-22authorize transfer of patients from station to gen-

eral hospitals, 35control of hospitals, 11given authority to procure civilian employees for

station hospitals, 33inspect hospitals, 30jurisdiction over numbered hospitals, 47reassignment of patients, 124, 130report expenditures for repair and maintenance

of hospitals, 95responsibility for hospitalization and evacuation

plans, 66responsibility for training, 11-12, 47review medical supply requisitions, 137-38share responsibility for selecting hospital sites, 20

Cox and Stevens (naval architects), 405Crews, hospital-ship civilian, 420, 421, 422


Defense commands, 104Defense Health and Welfare Services, Office of, 82.

See also Health, and Medical Committee.Defense Plant Corporation, 388Demobilization. See Redeployment and demobili-

zation.Dental assistants, civilian, 40, 256Dental clinics, 295Dental Corps, 31Dental laboratory trucks, 457Dentists. See Dental Corps.Dependents of military personnel, 26Depots, medical supply, 38, 39, 43Deputy Chief of Staff, War Department

approves creation of regional and convalescenthospitals, 184

approves separate general hospitals for AAF, 107authorizes expansion equipment for hospitals, 222and bed requirements, 203, 216, 217, 227, 228-

29, 229-30, 233and evacuation policy, 229-30failure to meet his authorizations, 222more favorable to SG's policy, 210orders preparation of plan for combined use of

hospitals, 184orders reduced ratio of nurses to hospital beds,

252and proposed use of regional hospitals for patients

from overseas, 186restricts transfer of patients, 240and staffing the MD, 154, 155

Desert Training Center. See California-ArizonaManeuver Area.

Detachments, medical, 4, 447, 449, 450Dietitians, civilian, 33, 40Dietitians, civilian apprentice, 256Discharges for disability. See Patients.Dispensaries, 460, 469Dispersion factor, 187nDisposition boards, 245-46Divisions, hospitals for combat, 217Doctors. See Contract surgeons; Medical Corps.Donald, Maj. Howard A., 409Dormitories, converted to hospitals, 66

Eisenhower, Gen. Dwight D., 401-02Emergency expansion of hospitals

planning for ZI, 80-84for theaters, 216, 217, 219, 222, 225, 227, 232

Engineers, Corps ofcontrol of hospital by, 11corrects defects in hospital construction (ZI) , 294defects of overseas hospitals erected by, 296-97and development of hospital trains and cars, 370,

371, 372, 375, 379, 380-81, 383develops new-type hospital buildings for theaters,

298-99

Engineers, Corps of—Continueddirected to reduce planned hospital construction,

79follows established bed ratios in constructing

station hospitals in ZI, 78helps formulate guides for use of air-conditioning

equipment, 98-99helps plan modified type-A hospitals, 76and improvements to hospitals (ZI), 98, 100, 289,

293, 294, 295responsibility for hospital construction and main-

tenance in ZI, 9, 21, 45, 92-96, 176, 288, 289responsibility for selecting sites and locations for

hospitals in ZI, 90, 91types of ZI hospital construction favored by, 68-

69, 75-76England, hospitals for, 143. See also European

theater.Enlisted men

attitude toward Wacs, 258disagreement between SG and WDGS over pro-

portions on hospital staffs, 31-32efforts to secure additional, 5, 42-43key technicians kept in ZI, 253-54limited service men, 134-35, 249, 253, 254-55replacement of able-bodied men, 131, 134-37,

254-55, 257specialists, changes in T/O's affecting, 40strength less than authorized, 32T/O allowances for, 281, 282training deficiencies, 32-33training 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, 224asked for information to assist in estimating medi-

cal requirements for ZI, 202authorized to expand general and station hospi-

tals, 236bed requirements, 217, 218, 225, 226, 227, 228-

30, 232, 233, 234-37, 300estimate of evacuation by air from, 326estimates of evacuation from, 329evacuation by air from, 326, 339evacuation policy for, 215, 216, 225, 229, 232,

233, 234, 235, 236, 300, 330evacuation by sea from, 205, 209, 326, 327, 329-

30, 401hospital centers in, 282hospital trains for, 380, 381hospitalization for AAF in, 175hospitalization statistics, 220-21, 300length of patients' stay in hospitals of, 229mission to, for improving use of hospitals, 237prisoner-of-war hospitals in, 236short shipment of hospitals to, 228, 234

INDEX 489

European theater—Continuedshortage of evacuation facilities from, 328uses field hospitals for surgical hospitals and

holding units, 235Evacuation, air. See also Airplanes for evacuation;

Autogiros for evacuation; Helicopters for evac-uation.

equipment for, 441-46estimates of, theaters to ZI, 226, 325, 326ETO directed to make full use of, to ZI, 329number of patients evacuated to ZI by, 324, 326,

327, 328, 329, 330, 337number of patients moved in ZI, 322, 346, 357,

358, 359personnel for, 437-41procedures, theaters to ZI, 338procedures in ZI, 322, 357-59

Evacuation, chain of. See Hospitalization and evac-uation, doctrine of.

Evacuation policydefinition, 165effects of, 214-15SG recommends an official, 165theaters to ZI, 214-16, 219, 225, 227, 229-30,

232-33, 234, 235, 236, 300, 301, 330Evacuation procedures. See also Hospitalization

and evacuation, general directives on.theaters to ZI, 331-45, 465in ZI, 346-59, 465

Evacuation requirements, theaters to ZI, 226, 234,323-30

Evacuation statistics, 210, 324, 463. See also Re-ports; Evacuation, air; Evacuation to zone ofinterior by sea; Trains and cars, hospital;Trains, passenger, movement of patients inzone 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 ofinterior 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, 445Expansion capacity of hospitals. See Emergency

expansion of hospitals.

Federal Security Administration, 86Field medical units. See also Air ambulance

squadrons, medical; Air evacuation group;Air evacuation transport squadrons, medical;Ambulance ship companies, medical; Hospitalship complements; Hospital ship platoons;Installations and units, medical; Tables oforganization and equipment; Train units,hospital.

ambulance battalions, 450, 451, 457

Field medical units—Continuedambulance companies, 38, 452, 453, 458ambulances for, 360-65battalions, gas treatment, medical, 448, 454battalions, medical

composition, 448, 449, 450, 451, 452, 453equipment, 449, 451, 455, 456functions, 447, 448number, 457number of headquarters detachments for,

458Protective Mobilization Plan provides for,

38replace medical regiments, 39

clearing companies, separate, 451-52, 453, 458collecting companies, separate, 451-52, 453, 458destinations overseas changed, 163detachments, medical, 4, 447, 449, 450groups, medical, 452, 458holding battalions, medical, 454-55hospital centers, 281-82hospitals. See also Hospitals: affiliated, convales-

cent, evacuation, field, general, portable surgi-cal, station, surgical.

bed requirements in, 214-37definition of "fixed hospitals," 5definition of "mobile hospitals," 4enlargement, 219, 279equipment, 5, 41-42, 45, 46, 48, 49, 140-42,

146-48, 151-60, 163, 216-17, 283-86expansion of, 219functions in ZI, 44, 45, 47-48, 49, 151-60,

465housing overseas, 296-99housing in ZI, 152, 153, 156, 159jurisdiction over, 12, 46-47, 172, 173modernizing hospital assemblages, 42Negro, 162new types of, 143-46number, 149-51, 160, 222, 231, 233, 234sent from ZI, 143, 160, 218, 234staffing, 44-45, 49, 140, 141summary of developments, 165-66training, 32, 44, 46-47, 151-60use of, as training and filler units, 160use overseas, 48-49

laboratories, medical, 38-39, 43litter bearer companies, separate, 453mobilization plans for, 38-39number in 1939, 5personnel of, used to supplement enlisted men in

hospitals, 32regiments, medical

composition, 39, 448, 450elimination proposed, 451equipment list revised, 41, 450functions, 447


Field medical units—Continuedregiments, medical—Continued

number, 5, 457part of field army, 38Protective Mobilization Plan provides for, 38replaced by medical battalions, 39

squadrons, medical, 39, 40, 447teams, medical, 452training, supply, and use of nonhospital medical

units by AGF in ZI, 457-61troop, medical, 38

Finance, Chief of, SOS, 126Fire hazard

existence of, 16, 100protection against, 14, 23, 24, 96

Fitzpatrick, Col. John C., 56, 180, 320, 403-04, 416Flight surgeons, 108

G-1 Division, War Department, 9, 171directs revision of T/O's, 148directs study of patients' discharge procedure, 127and hospital bed requirements, 301and manning guides for hospitals, 30-31orders equal work-hours for Wacs and nurses, 257recommends establishment of convalescent facili-

ties, 119G-3 Division, War Department, 9, 219

approves agreement as to responsibility for hos-pitalization and evacuation, 57

approves air evacuation unit, 438approves, conditionally, establishment of hospital

centers, 198approves procurement of hospital equipment, 151approves quota of hospitals for troop basis, 150,

151authorizes increase in general hospital beds for

mobilization, 39and bed requirements, 217, 231, 233suggests affiliating numbered with named hospi-

tals, 32G-4 Division, War Department, 9, 55, 171. See

also Moore, Brig. Gen. Richard C.approves prisoner-of-war hospitals, 197and bed requirements, 205-06, 208, 210, 211,

217, 225, 227, 231-32, 233, 302certain members advocate hospital ships and

troop transports owned and operated by Army,396

and construction and repair of hospitals, 15-16,17, 18, 19, 22, 68, 69

criticizes SOS plan for hospitalization and evac-uation, 65

and establishment of convalescent facilities, 119,202

and expansion of hospital capacity, 78-79favors separate hospitals for AAF, 107and issuance of hospital assemblages, 141-42

G-4 Division, War Department—Continuedlimits improvements to hospitals, 294notes deficiency of hospital assemblages, 46orders holding of equipment for medical units, 46orders planning for ships' medical personnel, 415proposes use of hotels for convalescents, 119and question of using regional hospitals for pa-

tients from overseas, 186questions propriety of allotting funds for modern-

ization of hospital assemblages, 42and reconditioning facilities, 292requests development of island-type hospital, 144requests procurement of ships, 396-97requires reports on closing surplus hospitals, 314sends representative to study ETO hospitals, 237

Gas treatment battalions, medical, 448, 454General Headquarters, 9, 10, 11, 55

approves troop transports and hospital ships forevacuating patients, 396

expects enemy violation of Hague Convention, 396medical units for, 38

General Headquarters Air Force, 427, 438General 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; WarDepartment Manpower Board.

advises on fixing responsibility for reassignment ofpatients, 130

advocates use of numbered hospitals as operatingunits in ZI, 44, 45

agreement on use of hospital ship platoons, 416agrees to continuing in hospitals Wacs unassigned

to companies, 258approves air evacuation policy, 338approves changes in number and capacity of

station hospitals, 182approves facilities for reconditioning, 291attitude toward ZI hospitals for AGF patients,

105authorizes attachment of technical-service teams

to units of other technical services, 284authorizes hospital personnel desired by SG, 31authorizes hospitals to order officers to appear

before retiring boards, 246authorizes issue of medical equipment, 45authorizes new type of construction for hospitals,

24authorizes selection of hospital sites, 20authorizes speedier transfer of officers' records to

hospitals, 246and bed requirements, 200, 203, 206, 207, 209,

227, 231, 301-02begins drive for more efficient use of personnel,

153considers separate hospitals for AAF, 107and development of hospital trains and cars, 371

INDEX 491

General Staff, War Department—Continueddirective on hospitalization and evacuation, 65directs incapacitated officers to appear before

retiring boards, 243directs use of civilian buildings for hospitals when

practicable, 72disagreement with SG over proportion of enlisted

men on hospital staffs, 32disapproves additional T/O hospitals, 150disapproves air evacuation unit, 438effect of WD reorganization on, 54encourages evacuation to ZI by air, 326forbids more housing for T/O hospitals in ZI, 159functions in relation to SG and the MD, 8-9, 171-

72insists on simplicity in hospital construction, 68and manning guides for hospitals, 30-31orders activation of hospital ship platoons, 416policies affecting admissions to hospitals, 238-39policy on use of hospital ships, 403, 404refuses higher ratio of Wacs in hospitals, 257requires revision of T/O and E's, 49responsibility for hospital construction, 286reverses decision against establishing all-Negro

hospitals, 110and special plans for evacuation, 427standardizes types of automobile chassis, 361and substitution of MAC for MC officers, 133, 251urges use of Waacs, 136

Geneva Convention, 112-13, 197, 394-95Ginsberg, Eli, 177, 180Grant, Maj. Gen. David N. W., 11, 175. See also

Air Surgeon, Office of the.Greenleaf, Lt. Col. Henry C., 56Ground Surgeon. See also Army Ground Forces.

attitude toward replacement of MC by MACofficers as battalion surgeons' assistants, 452

and bed requirements, 217estimates evacuation units required, 458proposes changes in evacuation units, 453-54questions value of gas treatment battalion, 454schedules activation of medical units, 458supervises training of medical units, 458-59supports transfer of responsibility from T/O

convalescent hospitals in ZI to AGF, 173Groups, medical, 452, 458

Hague Convention, 394, 395, 396, 397, 402, 403Hall, Col. John R., 9, 21, 22, 23, 24, 75-76, 99Hawaii, hospitals in, 3, 4, 142Hawley, Maj. Gen. Paul R., 327, 401Health and Medical Committee, 81, 82Helicopters for evacuation, 434-36. See also Auto-

giros for evacuation.Hines, Frank T., Administrator of Veterans Affairs,

and Chairman, Federal Board of Hospitaliza-tion, 86

Holding battalion, medical, 454-55

Holding facilities, 194Hospital centers

T/O type, 40, 281-82zone of interior, 39, 198-99, 270, 273-78

Hospital commanders, 66, 97, 123, 136, 244, 314Hospital construction, overseas, 48, 296-99Hospital construction, zone of interior. See also

Repair and maintenance, hospital.amount, 24, 211conversion of existing buildings, 14-16, 18, 66,

70-73, 90, 93, 287-88co-ordination of Federal hospital construction-

planning proposed, 86curtailment of, 85-87, 159, 169, 201, 287defects of, 23, 293delaying factors, 100improvement of existing hospital plants

acoustic clinics, 289administration activities, more space for, 99,

292-93air conditioning, 97-99, 295-96brace shops, 289constant-temperature rooms, 289deaf, centers for, 290eye, ear, nose, and throat clinics, more space

for, 99flooring, replacement of, 96, 288, 293, 294garages, ambulance, 23hardware, improved, 294heating corridors, 96-97housing for Wacs, 136, 288kitchens, enlargement of, 22lawns and grounds, improvement of, 294mess halls, enlargement of, 22neuropsychiatric-social therapy clinics, 290neuropsychiatric treatment, centers for, 290nurses' call systems, 295, 296occupational therapy, more space for, 99,

290painting, 288, 294paraplegics, centers for, 290plaster and dressing rooms, 289plastic surgery, centers for, 290post exchanges, 23, 99recreation, more space for, 99, 290-91rheumatic fever treatment, centers for, 290roofing, replacement of, 96safety devices, 22, 96, 100service activities, more space for, 99space, better utilization of, 22storehouses, 22strong rooms, 23surgeries, enlargement of, 22walkways, inclosed, 288, 294walls, sealing, 288, 294wards, additional, 22X-ray work, more space for, 99, 289

necessity for, 4


Hospital construction, zone of interior—Con.plans

defects, 21revision, 22, 23standardization, 21

policy, summary of, 76-78, 87responsibilities for, 14, 18, 20-21, 22, 60-61,

92-94, 286-87tentage, use of, 70types 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, 105two-story semipermanent, 23-24, 68, 69two-story semipermanent (Type A modi-

fied), 76, 78Hospital ship complements, 408-09, 419-22, 424Hospital ship platoons, 335, 336, 415-19Hospital ships. See also Ambulance transports;

Evacuation to zone of interior by sea; Trans-ports, troop.

added functions, 422advocated, 396-97air-conditioning for, 414British, transport U.S. patients, 402-03delays in conversion to, 409-10estimates of evacuation by, 325, 326, 328facilities, 403, 405-08, 414list of, 406medical personnel for, 419-22names for, 410-11Navy, 330number, 326, 327, 328, 410number of patients evacuated by, 324, 326-27,

330procurement, 396-97, 401-05, 414responsibility of commanders of, 337responsibility for operating, 395-98, 403, 404shortage of, 236, 328speed, 403, 405supplies and equipment for, 423-25where used, 401-02

Hospitalization and Evacuation Branch, SOS(ASF). See also McDonald, Brig. Gen. Rob-ert C.; Wilson, Col. William L.

abolished, 159-60, 172aids SG in getting information on operational

plans, 165attitude toward use and equipment of T/O

hospitals in ZI, 151changes proposed location of general hospitals, 90concurs in limitation of TC's control of hospitals,

115controversy over planning, 63-67delimits responsibilities for evacuation to ZI, 335,

339

Hospitalization and Evacuation Branch—Con.and development of hospital trains and cars, 379,

380established, 56favors ship-to-hospital movement of patients, 114functions, 56, 172, 320obtains increase in bed ratios, 83orders report on evacuation, 333-34position reduced, 172proposes medical T/O's for ships, 415relations with SGO, 61, 466-67reviews recommendations for construction and

alteration of hospitals, 60secures reports on hospitalization and evacuation

overseas, 164, 165supports activation of training units at full

strength, 141on type and use of hospital ships, 403

Hospitalization and evacuation, doctrine of, 4-5Hospitalization and evacuation, general directives

on, 65-67, 83Hospitalization, Federal Board of, 76, 86, 87, 129Hospitalization statistics. See also Bed require-

ments; Reports.overseas

admissions to hospital, 463beds authorized, 220-21beds available, 300, 301, 302beds occupied, 220-21T/O beds, 220-21

zone of interioradmissions to hospital, 463beds authorized, 25, 204, 211, 212, 213beds available, 3, 25, 68, 80, 102, 211-12beds occupied, 25, 80, 102, 204, 211, 212,

213, 463patients remaining, 211patients reported, 212, 213

Hospitals, affiliatedactivation of, 141departure from ZI, 144, 160-61establishment, 42, 49list of evacuation hospitals, 158list of general hospitals, 157method of staffing, 44, 140number, 140, 156proposed, 5-6a secondary means in emergency, 465transfer of personnel to other units, 228

Hospitals, civilian, 104. See also St. Elizabeth'sHospital; Veterans Administration.

Hospitals, convalescent. See also Convalescentcenters; Installations and units, medical.

theater-of-operations-typenumber, 150, 151, 217part of field army, 38, 150Protective Mobilization Plan provides for, 38responsibility for, in ZI, 173sent from ZI, 160

INDEX 493

Hospitals, convalescent—Continuedzone of interior

advantages, 190antecedents, 117, 119-20, 189authorized, 189barracks for added space in, 209, 287bed requirements, 202, 208, 209, 211, 302,

303bed statistics, 211, 213, 315closure of surplus, 315construction, 286equipment, 190establishment considered, 103, 117, 118form part of hospital centers, 198-99functions, 5, 189, 211, 244improvements to, 294, 295location, 348number, 189, 208, 315organization, 270, 273-75reconditioning facilities at, 291retiring boards in, 246transfer of patients to, 348urged to speed disposition of patients, 240

Hospitals, debarkation. See Hospitals, port anddebarkation.

Hospitals, efficiency of, 107Hospitals, evacuation

affiliated, 6, 158authorized at half-strength, 43beds allotted in, 218defects of, 145deployment of, 163development of new-type, 145-46equipment, 140-41, 145, 146, 285functions, 4-5increase authorized, 42number, 140, 150, 151, 217part of field army, 38Protective Mobilization Plan provides for, 38revisions of T/O, 148, 149sent from ZI, 143, 144, 160

Hospitals, fielddevelopment, 143-45number, 145, 151, 222, 223, 231, 233, 234revision of T/E, 285sent from ZI, 160, 218transport reduced, 146use as mobile hospitals, 218, 236

Hospitals, fixed, definition of, 5Hospitals, general. See also Installations and units,

medical.theater-of-operations-type

affiliated, 6, 157for AGF in ZI, 105conversion of, to convalescent facilities, 280deployment, 161equipment, 140, 147, 157expansion, 236

Hospitals, general—Continuedtheater-of-operations-type—Continued

functions, 5neuropsychiatric, 282number, 39, 42, 140, 150, 151, 156, 222,

223-31, 233, 234revisions of T/O, 40, 149, 280, 281sent from ZI, 142, 143, 144, 160, 218

zone of interiorAAF tries to obtain separate, 106-09administration and organization, 26, 28, 29,

123, 125, 126-27, 128, 267-73air evacuation from, 358barracks converted to wards in, 288bed credits in, 35, 115, 321, 346-47bed 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, 287civilian employees, 255commanders of, relation to post commanders,

191commands served by, 106construction and repair, 19, 68-69, 201, 286,

294, 295, 296convalescent annexes, 119, 120, 188-89convalescent center to perform some of same

functions as, 108conversion of station hospitals to, 86, 87, 288decline in number of ZI patients in, 346disposition of patients in, 130, 240enlargement, 80, 86, 87flight surgeons in, 108form part of hospital centers, 198-99functions, 3, 108, 184, 185-88, 211furloughs for patients in, 187hospital train personnel assigned to, 389-90increase authorized, 87jurisdiction over, 60, 184list of, 304-13manning guides for, 131-32, 248-49, 250merger with station hospitals, 190-91method of reporting beds in, 207-08number, 3, 68, 101, 106, 116, 286occupational therapy in, 99organization, 29, 125, 269, 272, 276personnel allowances, 132for prisoner-of-war patients, 195-98prisoner-of-war patients in, 113proposed closure of, 205reconditioning facilities in, 291reductions in staff, 249, 250removal of convalescent patients from, 181retiring boards at, 246revert to command of SG, 314siting and location, 88-90, 91, 92, 348


Hospitals, general—Continuedzone of interior—Continued

specialty centers at, 116-17training T/O units at, 151-52transfer of patients between, 347transfer of patients to, 35, 109, 183, 348use of Negroes in, 111use as port and debarkation hospitals, 113,

114, 115, 191-93use of prisoners of war in, 112-13welfare services in, 267

Hospitals, joint use of by Army and Navy, 85, 86Hospitals, port and debarkation, 103, 113-16,

191-94, 288, 295, 344-45, 347, 358Hospitals, portable surgical, 146, 151, 173, 217, 218Hospitals, prisoner-of-war

overseas, 236zone of interior, 103, 112-13, 195-98, 200

Hospitals, receiving and evacuation, 192Hospitals, regional. See also Installations and units,

medical.bed credits in, 240bed credits in general hospitals for, 348bed requirements, 200, 203, 205, 206, 208, 211-12bed statistics, 182, 204, 211, 213closure of, 314-15establishment of, 183-84functions, 185-88, 192, 210, 244improvements to, 294-95, 296jurisdiction over, 184, 185manning tables, 248-49merger of, with station hospitals, 190method of reporting beds in, 207number, 185organization, 271for prisoner-of-war patients, 197reconditioning facilities at, 291retiring boards at, 246transfer of patients to, 209use of Negroes in, 111welfare services in, 267

Hospitals, short-shipment of, 228, 234Hospitals, station. See also Installations and units,

medical.theater-of-operations-type

for AGF in ZI, 105conversion to convalescent facilities, 280deployment, 162equipment, 140, 141, 147, 156, 285expansion, 236ineffectiveness of 250-bed type for island

service, 144new varieties, 145number, 39, 140, 150, 151, 222, 223, 231revision of T/E, 285revisions of T/O's, 149, 280, 281sent from ZI, 142, 143, 144, 160, 218staffing, 141

Hospitals, station—Continuedzone 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, 73convalescent centers equipped and staffed as,

108conversion to general hospitals, 86, 87, 106,

209, 288designation of some as regional hospitals, 185disposition of patients, 130functions, 3, 108, 182-85hospital train personnel assigned to, 389-90jurisdiction over, 103-06manning guides, 30, 131-32, 248-49merger with regional and general hospitals,

190-91method of reporting beds in, 207number, 3, 68, 101, 104, 315for Negroes, 110-12for prisoners of war, 113, 195, 196, 197reconditioning facilities in, 291reduction, 181-82, 286retention for postwar use, 303reversion of regional hospitals to, 314-15size, 103-04training T/O units at, 151-52transfer of patients from, 35, 108-09, 209,

240, 348use by AAF for general hospital purposes,

106-07use for debarked patients, 115, 192-94use of Negroes in, 111use of vacated, 170for Waacs, 109-10

Hospitals, surgical. See also Hospitals, portablesurgical; Installations and units, medical.

affiliated, 6authorized at half strength, 43conversion of, to evacuation hospitals, 146defects of, 145equipment, 141increase authorized, 42numbers, 140, 150part of field army, 38Protective Mobilization Plan provides for, 38revisions of T/O, 41, 148, 149sent from ZI, 143, 144, 160, 164

Hospitals, total capacity and number of zone ofinterior, 25, 68, 80, 204, 211, 212

INDEX 495

Hotels for conversion to hospitals, 66, 81-82, 87,90, 287

Iceland, hospital for, 143India-Burma theater, 233, 234, 235. See also

China-Burma-India theater.India, hospitals for, 143. See also China-Burma-

India theater.Infantry, Chief of, 11Inspection 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, 181considers quality of hospital construction too

high, 80hears of idle MC officers, 152-53influences hospitalization, 171inspects hospitals, 30medical representative in office of, 9and question of using regional hospitals for pa-

tients from overseas, 186, 187recommends use of AAF station hospitals as

general hospitals, 183-84reports on duplication of hospital facilities, 185,

203reports slight use of staging area hospitals, 192requested to investigate disagreement between

SG and G-4, 17-18Installations and units, medical

namedAAF Regional Station Hospital, 73AAF Station Hospital, Atlantic City, 73AAF Station Hospital, Chicago, 73AAF Station Hospital, Palm Beach, 73Army hospitals for civilians at Ordnance

depots, 112Army Medical Center, 283Army and Navy General Hospital, 3, 34-35,

73, 116, 304Ashburn General Hospital, 304Ashford General Hospital, 73, 266, 304, 357Barnes General Hospital, 19, 115, 190, 304Battey General Hospital, 304Baxter General Hospital, 125, 267-68, 304Bermuda Hospital, 48Billings General Hospital, 19, 191, 304Birmingham General Hospital, 191, 193,

249, 304, 367Borden General Hospital, 108, 305Boston POE Station Hospital, 193Bronx Area Station Hospital, 73Brooke General Hospital, 305, 358Brooke Hospital Center (Fort Sam Hous-

ton), 199Bruns General Hospital, 305Bushnell General Hospital, 129, 305Camp Beauregard Station Hospital, 34

Installations and units, medical—Continuednamed—Continued

Camp Blanding Station Hospital, 34Camp Bowie Station Hospital, 28Camp Butner Hospital Center, 199Camp Carson Hospital Center, 199Camp Claiborne Station Hospital, 34Camp Crowder Station Hospital, 119Camp Custer Station Hospital, 21Camp Edwards General Hospital, 193Camp Edwards Hospital Center, 199Camp Edwards Station Hospital, 192, 193,

269, 343Camp Forrest Station Hospital, 197Camp Haan Regional Hospital, 193Camp Jackson Station Hospital, 15Camp Kilmer Station Hospital, 192, 193Camp Leonard Wood Station Hospital, 21Camp Livingston Station Hospital, 110Camp McCoy Station Hospital, 196Camp Maxey Station Hospital, 121Camp Myles Standish Station Hospital, 192,

343Camp Ord Station Hospital, 16Camp Patrick Henry Station Hospital, 192,

193Camp Pickett Hospital Center, 199Camp Roberts Station Hospital, 21Camp Shanks Station Hospital, 73, 192, 193Camp Wallace Station Hospital, 21Charlotte, N. C., Station Hospital, 73Crile General Hospital, 305Cushing General Hospital, 305Dante Station Hospital, 73, 191Darnall General Hospital, 37, 73, 116, 129,

305Deshon General Hospital, 73, 306DeWitt General Hospital, 306Dibble General Hospital, 289, 306England General Hospital, 73, 188, 306Finney General Hospital, 306Fitzsimons General Hospital, 3, 34, 116, 306Fletcher General Hospital, 307Fort Belvoir Station Hospital, 105Fort Benjamin Harrison Station Hospital,

191Fort Benning Station Hospital, 15, 17, 119Fort Bliss Station Hospital, 117, 121, 191Fort Bragg Station Hospital, 28, 110Fort Des Moines Station Hospital, 110Fort Devens Station Hospital, 191Fort Dix Station Hospital, 191Fort Francis E. Warren Station Hospital, 20Fort George G. Meade Regional Hospital,

289Fort Huachuca Station Hospital, 110, 111Fort Jackson Station Hospital, 260Fort Knox Station Hospital, 28



Fort Lewis Station Hospital, 28, 367Fort McClellan Station Hospital, 15Fort Oglethorpe Station Hospital, 110Fort Rosecrans Station Hospital, 21Fort Sam Houston Station Hospital, 19Foster General Hospital, 307Gardiner General Hospital, 73, 307Glennan General Hospital, 196, 197, 307Halloran General Hospital, 73, 115, 136,

191, 193, 262, 303, 307, 342, 343, 344,345, 366, 390

Hammond General Hospital, 307Harmon General Hospital, 307Hoff General Hospital, 19, 73, 307Jefferson Barracks Station Hospital, 117, 119Kennedy General Hospital, 308LaGarde General Hospital, 19, 113, 114,

115, 191, 193, 308Lawson General Hospital, 19, 29, 116, 308,

341, 357Letterman General Hospital, 3, 34, 113, 114,

115, 191, 192, 193, 308, 343, 345, 366,367

Los Angeles Station Hospital, 73Lovell General Hospital, 19, 115, 117, 126,

191, 192, 303, 308McCaw General Hospital, 309McCloskey General Hospital, 309McGuire General Hospital, 191, 193, 309Madigan General Hospital, 193, 308, 343Madigan Hospital Center (Fort Lewis), 199Mason General Hospital, 73, 129, 191, 193,

303, 309, 343Mayo General Hospital, 268, 269, 309Medical Department Equipment Laboratory,

360, 361, 364, 365, 456Medical Field Service School, 41Moore General Hospital, 309New Haven Station Hospital, 73Newton D. Baker General Hospital, 266, 309Nichols General Hospital, 310Northington General Hospital, 310Oakland Area Station Hospital, 73Old Farms Convalescent Hospital, 189, 314,

315Oliver General Hospital, 73, 310O'Reilly General Hospital, 19, 119, 262, 310Pasadena Area Station Hospital, 73Percy Jones Convalescent Hospital, 198Percy Jones General Hospital, 73, 198, 310Percy Jones Hospital Center (Fort Custer),

199, 276Presidio of Monterey Station Hospital, 16Prisoner of War General Hospital No. 2

(Camp Forrest), 197, 310


Prisoner of War No. 2 Hospital Center(Camp Forrest), 199

Ream General Hospital, 73, 311Rhoads General Hospital, 73, 311St. Petersburg (Fla.) Station Hospital, 73Schick General Hospital, 262, 311School of Air Evacuation, AAF, 357, 440School of Aviation Medicine, 440Seattle Area Station Hospital, 73Stark General Hospital, 19, 28, 113, 115,

191, 192, 193, 311, 343, 345, 358, 390Staten Island Station Hospital, 73Sternberg General Hospital, 3Thayer General Hospital, 311Tilton General Hospital, 19, 114, 116, 191,

303, 311Torney General Hospital, 73, 108, 311Trinidad Hospital, 48Tripler General Hospital, 3Tuskegee Station Hospital, 110U.S. Army General Hospital, Camp Butner,

311U.S. Army General Hospital, Camp Carson,

312U.S. Army General Hospital, Camp Edwards,

312U.S. Army General Hospital, Camp Pickett,

312Valley Forge General Hospital, 129, 136,

312Vancouver Barracks Station Hospital, 190Vaughan General Hospital, 312Wakeman General Hospital, 312Wakeman Hospital Center (Camp Atter-

bury), 199Walter Reed General Hospital, 3, 19, 34, 37,

41, 60, 73, 116, 266, 312, 357William Beaumont General Hospital, 3, 42,

191, 313Winter General Hospital, 313Woodrow Wilson General Hospital, 313

numbered. See also Tables on 144, 157, 158, 161,162, 163, 164.

11th Station Hospital, 49, 16215th Evacuation Hospital, 147, 16325th Station Hospital, 162, 22438th Medical Air Ambulance Squadron, 43873d Evacuation Hospital, 104, 158167th Station Hospital, 49, 162168th Station Hospital, 49, 162, 224268th Station Hospital, 162, 223, 224335th Station Hospital, 223, 224349th Air Evacuation Group, 439, 440383d Station Hospital, 224830th Medical Air Evacuation Squadron,

440

INDEX 497

Interstate Commerce Commission, 356-57Ireland, Northern, hospitals for, 143. See also

European theater.

Joint Chiefs of Staffapproves conversions to hospital ships, 328, 404decision on use and control of ships for evacuation,

397, 402, 404estimate of evacuation, theaters to ZI, 328and procurement of hospital ships, 402, 404, 414

Judge Advocate General, SOS, 128, 403

Keller, Lt. Col. William C., 56, 378Kenner, Maj. Gen. Albert W., 181Kenner Board, 181Kirk, Maj. Gen. Norman T., The Surgeon General

advocates more hospital train personnel for servicecommands, 391

arranges compromise on AAF hospitalization, 108becomes SG, 170gets approval for higher maintenance standards

for hospitals, 294inspects theater medical services, 283member of committee to investigate hospitaliza-

tion for AAF in UK, 175opposes separate AAF station hospitals, 183orders program for establishing convalescent an-

nexes, 119policies, 170pushes program for more hospital beds, 210requests reduction of scope of treatment in AAF

station hospitals, 183secures restoration of service command surgeons

to staff position, 172stops development of multipatient ambulance,

366-67views on use and equipment of T/O hospitals in

ZI, 157-59Kramer, Col. Floyd, 21

Laboratories, medical, 38-39, 43Laboratory truck, dental, 457Laundry service of hospitals, 284Liberia, hospital in, 162Linen-control procedure, 264-65Litter bearer companies, separate, 453Litters, 442-43, 455Location. See Sites and locations, selection of.Love, Brig. Gen. Albert G., 15, 22, 31Lutes, Lt. Gen. LeRoy B., 55, 56, 63

McDonald, Brig. Gen. Robert C., 156-57, 158MacLean, Lt. Col. Basil C., 122, 176, 261McGibony, Lt. Col. James T., 176Magee, Maj. Gen. James C., The Surgeon General

appointment, 9appoints adviser on hospital administration, 122asks for authority over hospital construction, 92

Magee, Maj. Gen. James C., The SurgeonGeneral—Continued

asks for funds to modernize hospital assemblages,42

asks G-4 for increased bed ratio, 13-14conception of sphere of Hospitalization and Evac-

uation Branch, SOS, 56conservative tendencies, 53criticizes suggestions for changes in hospital ad-

ministration, 122, 123defends plan for hospitalization and evacuation,

64ends term as SG, 156opinion on effect of WD reorganization on MD, 55opposes establishing special hospitals for convales-

cents, 118and project for emergency hospitalization, 81, 82-

83recommendation on hospital construction ap-

proved by CofS, 18resists attempt of AAF to obtain separate general

hospitals, 107, 118secures approval of policy on hospitalization for

task forces, 58trip to North Africa, 165

Manning guides and tables. See Personnel.Maritime Commission, 396-97, 400, 412Marshall, Gen. George C. See Chief of Staff, War

Department.Medical Administrative Corps

allowance for hospitals, 132, 280shortages, 133, 251substitutes for MC officers, 31, 133-34, 148, 228,

250-51, 259, 280, 452-53Medical Corps

allowances for hospitals, 132, 250, 280deficiencies in training, 32female, 109, 110flight surgeons, 108replacement of, 131, 133-34, 148, 228, 250-51,

259, 452-53shortages, 31, 132, 151, 223, 250specialists, 40, 106, 183, 194, 250

Medical Department Board, 371Medical Department Technical Committee, 364Medical Regulating Service, AAF, 320-21, 358-59Medical Regulating Unit, SGO. See Surgeon Gen-

eral, Office of the.Mediterranean theater. See also North African

theater.authorized to expand general and station hospi-

tals, 236bed requirements, 233, 235, 300bed statistics, 220-21evacuation policy for, 235, 300, 330hospital ships for, 326number evacuated by sea from, 326


Mediterranean theater—Continuedopposes air evacuation of mental patients to ZI,

339Meiling, Col. Richard L., 338Middle East theater, 217, 227, 233. See also

Liberia.Military Personnel Division, ASF, 253Military Police, Corps of, 281Mobilization, 19, 38-43Mobilization Division, ASF, 172, 178Moore, Brig. Gen. Richard C., 14, 17

Named installations. See Installations and units,medical.

National Association of Colored Graduate Nurses,111

National Research Council, 283, 429Navy, 85, 86, 104, 395-97, 403, 424Negroes, 110-12, 223-24Nelson, Col. Harry J., 56Neuropsychiatric patients, accommodations for

aboard ships, 327, 331-32, 398-99, 400, 406-07,408, 409, 412, 413

neuropsychiatric centers, 290neuropsychiatric social therapy clinics, 290security and safety devices, 22, 99, 100, 380-81,

407, 413, 444in special T/O hospitals, 283at ZI general hospitals, 37

Newfoundland, 174, 338, 429Normal beds, definition of, 101North African theater. See also Mediterranean

theater.asked for information to assist in estimating bed

requirements for ZI, 202bed requirements, 217, 218, 219, 225-26, 227,

233, 235evacuation policy for, 215-16, 219, 227, 235evacuation by sea from, 226expands hospitals, 219hospital laundry service, 283hospital ship assigned to, 404hospital train for, 381hospitals for, 143, 160housing for hospitals, 296length of patients' stay in hospitals of, 229needs medical holding units, 454rejects troop transports for evacuating patients,

402reports defects in field ambulance, 363requests hospital ships, 402uses mobile for fixed hospitals, 218

Numbered units. See Field medical units; Instal-lations and units, medical.

Nurses' aides, 250, 256, 257Nurses, Army. See Army Nurse Corps.Nurses, cadet, 252Nurses, civilian, 31, 252, 255

Office of Strategic Services, 201Officers, Medical Department. See Army Nurse

Corps; Dental Corps; Medical AdministrativeCorps; Medical Corps.

Offutt, Col. Harry D., 10, 41, 66, 67, 97, 130OPD. See Operations Division, War Department.Operations Division, War Department

approves procurement of hospital equipment, 151and bed requirements, 216, 225, 226, 231changes destination of units, 162-63considers hospitals for AAF in Central Pacific,

175difficulty in supplying hospital assemblages, 143grants hospital ship to North Africa, 404issues forecast of units needed overseas, 219lacks figures on beds available overseas, 164responsibility, 171

Optical repair truck, 457Ordnance Department, 268, 365, 366, 367-68Organization, hospital. See Administration,

hospital.Organization, tables of. See Tables of organi-

zation and equipment.Organizations, medical. See Installations and

units, medical.

Pacific Ocean Areas, 220-21, 230, 232, 233, 235.See also Central Pacific theater; South Pacifictheater.

Pacific theater, 235, 301, 330. See also CentralPacific theater; Pacific Ocean Areas; South-west Pacific Area.

Panama Canal Zone, hospitals in, 4, 142Patients. See also Neuropsychiatric patients, ac-

commodations for.admission procedure, 263-64, 344-45admission rate of, to hospitals, 232classification for transport to ZI, 331-32, 338,

339-40disability discharges and retirement procedures,

36, 126-28, 243-47, 262length of stay in hospitals, 35-37, 124-31, 214,

229, 232limiting admissions to hospitals, 238-39priority for travel on passenger trains, 355-57reassignment of, 242-43transfer between hospitals, 34, 35, 108-09, 115,

183, 185, 198, 209, 240-41Personnel. See also Army Nurse Corps; Civilian

employees; Dental Corps; Enlisted men; Medi-cal Administrative Corps, Medical Corps;Negroes; Prisoners of war; Tables of organi-zation and equipment; Women's Army Corps.

changes in hospital system to economize on, 170manning guides and tables, 30-31, 248-49, 250,

251, 389, 415shortages, 31-32, 222-23, 227

INDEX 499

Personnel—Continuedsize and composition of hospital staffs, 131-37,

248-60uneconomical use of, 467-68

Philippines, hospitals in, 3, 4. See also SouthwestPacific Area.

Physical therapists, civilian, 33, 40Pilgrim State Hospital, 87Planning Division, ASF, 172, 173, 178, 226, 284Plans Branch, SOS, 154-55Plans and Operations, Director of, ASF, 203-05PMP. See Protective Mobilization Plan.Port commanders

assign medical personnel to ships, 415control hospital ship platoons, 335-36, 418control of hospitals, 113control of movement of patients, 114, 321furnish personnel for evacuation, 321instructions for combat surgeons, 336-37report on evacuation to ZI, 333-34responsibility for evacuation from theaters, 331,

334-35responsibility for hospitalization plans, 66responsibility for transferring debarked patients

to hospitals, 341-44, 346President

to approve or reject hospital construction plans,86

interest in rehabilitating casualties, 189-90orders inquiry into adequacy of hospitalization

for AAF in UK, 175orders retention of patients in hospitals until

full recovery, 241and project for emergency hospitalization, 82

Prisoners of war, 112-13, 234, 250, 260. See alsoHospitals, prisoner-of-war.

Protective Mobilization Plan, 38-39, 43Provost Marshal General, 112, 176, 196Public Health Service, United States, 83, 86Pullman Company, 371-72, 374, 381

Quartermaster Corpsapproves use of flies with hospital tents, 297collaborates to improve laundry service, 284collaborates in planning construction of new-type

hospital, 23complains that changes of plans delay hospital

construction, 22considers 2½-ton truck chassis unsuitable for

ambulance body, 366develops new-type hospital tent, 297helps develop air conditioning for evacuation air-

planes, 444helps develop ambulances, 361helps develop hospital cars, 371-72helps plan cantonment-type hospitals, 14, 22

Quartermaster Corps—Continuedhospital assemblages not to include item supplied

by, 154-55laundry teams for hospitals overseas, 284opposes expanding existing hospitals instead of

new construction, 15provides for fire-protection in hospitals, 23recommends conversion of troop transports to

hospital or ambulance ships, 396responsibility for construction and maintenance

of buildings transferred to Engineers, 60responsibility for hospital construction, 20-21selection of hospital sites, 20supplies ambulances, 361

Railroad Interterritorial Military Committee, 356Reclassification procedure, physical, 243, 246Reconditioning programs, 117-19, 290-92. See

also Rehabilitation of patients.Redeployment and demobilization, 208, 300-15Reduction Board, ASF, 450-52Regiments, medical. See Field medical units.Rehabilitation of patients, 189-90. See also Re-

conditioning programs.Repair and maintenance, hospital, 60-61, 94-96.

See also Hospital construction.Reports

Essential Technical Medical Data, 165, 283of evacuation to ZI, 332-35, 340of hospital beds, 164, 165, 182, 207-08, 240, 347of patients in debarkation hospitals, 347-48sanitary, 165telegraphic, from overseas, 222

Requirements Division, SOS (ASF)accepts SG's estimate of bed requirements, 86approves hospital program, 86-87considers improved facilities in hospitals, 99-100considers quality of hospital construction too

high, 80and development of hospital trains and cars, 380insists on speed in selecting hospital locations, 90refers decision on light field ambulance to AGF,

365suggests improvements in field ambulance, 363suggests reduction of hospital construction re-

quirements, 86Resources Division, SOS, 98Retiring boards, 243, 245, 247Reynolds, Maj. Gen. Charles R., The Surgeon

General, 5-6, 9Rogers, Col. John A., 67Roosevelt, Franklin Delano. See President.Roosevelt, Mrs. Franklin Delano, 111

St. Elizabeth's Hospital, 37, 129Sams, Brig. Gen. Crawford F., 237School buildings, converted to hospitals, 66, 287Schwichtenberg, Col. Albert H., 176, 177


Secretary of War. See also Separation Board,Office of the Secretary of War.

approves affiliated hospitals, 6approves agreement on hospitalization, 108authorizes hospitals for civilians at Ordnance

depots, 112considers separate hospitals for AAF, 107, 108directed to provide hospitalization for WAAC,

109directs exemption of Air Corps stations from

corps area control, 11favors liberal estimates of bed requirements, 209-

10fixes responsibility for reassigning patients, 130orders appointment of retiring boards at all gen-

eral hospitals and AAF convalescent centers,246

promotes demobilization of medical personnel,301

SG given direct access to, 172Secretary of War, Civilian Aide to, 111Separation Board, Office of the Secretary of War,

243Service commands. See also Corps areas.

allotments of hospital train personnel to, 390-91alteration of service command surgeons' relations

with SG, 60inspection of hospitals in, 172-73jurisdiction over hospital train personnel, 390-91make personnel authorizations, 248report substitution of MAC for MG officers, 133responsibilities for hospitalization and evacuation,

59-60, 92, 113, 286-87, 314, 342-43, 349-53,389

surgeons of, restored to staff positions, 172Third Service Command operates temporary

hospital for AGF, 105urged to speed disposition of patients, 240, 242and use of Waacs in hospitals, 136views on use of T/O hospitals in ZI, 159

Services of Supply. See also Army Service Forces;Construction Planning Branch; Finance, Chiefof; Hospitalization and Evacuation Branch;Judge Advocate General; Lutes, Lt. Gen. Le-Roy B.; Plans Branch; Requirements Division;Resources Division; Training, Director of.

approves air evacuation from Newfoundland BaseCommand, 338

approves system for furnishing medical supplieson transports, 423

and bed requirements in hospitals, 80, 84and change in patients' discharge procedure, 128conference on converting nonhospital buildings

to hospital use, 92created, 54, 55delays publication of directive on reconditioning,

119

Services of Supply—Continuedand development of hospital trains and cars, 377-

78directs reduction in size and weight of hospital

equipment, 147directs revision of T/O's, 148directs SG to act on recommendations of Wad-

hams Committee, 122disapproves light ambulance, 364establishes procedure for movement of patients

by rail, 350favors delaying establishment of separate con-

valescent facilities, 119and hospital facilities on troop transports, 398lacks figures on beds available overseas, 164and medical complements for ships, 415, 416,

418, 420orders classification of patients for transport to

ZI, 331orders evacuation reports, 332permits air conditioning for hospital cars, 377personnel policy, 133, 134, 135, 136plans to require double bunking in barracks in

emergency, 81policy on lost personnel records, 126and project for emergency hospitalization, 81,

82, 83promotes planning for hospitalization and evacua-

tion, 63-67requests procurement of hospital ships, 397responsibility for hospitalization and evacuation,

55-61, 63, 320responsibility for selecting hospital locations, 90suggests civilian buildings for general hospitals, 70and use and equipment of T/O hospitals in ZI,

152, 153, 154, 155SHAEF. See Supreme Headquarters, Allied Expe-

ditionary Forces.Shambora, Col. William E., 55Ships' hospitals. See Transports, troop.Signal Corps, 281Sites and locations, selection of, 19-20, 60, 88-92,

195Snyder, Maj. Gen. Howard McC., 9, 84, 117, 127,

131, 183, 216Somervell, Lt. Gen. Brehon B., 55, 64, 92, 93, 141,

205, 226, 261-62, 294South Pacific theater. See also Pacific Ocean

Areas.absorbed in Pacific Ocean Areas, 230bed requirements, 217, 218, 219, 230, 234, 235bed statistics, 220-21evacuation from, by Navy, 333evacuation policy for, 215-16, 235hospital ships for, 327hospitals sent to, 143hospitals sent to other theaters from, 228

INDEX 501

South Pacific theater—Continuedproposed transfer of hospitals to Central Pacific

from, 175Southwest Pacific Area. See also Australia, hospi-

tals for; Philippines, hospitals in.advocates issue of equipment to units in training,

152bed requirements, 217, 218, 227, 228, 230, 233,

235bed statistics, 220-21, 301converts mobile to fixed hospitals, 218develops portable surgical hospital, 146estimates of evacuation from, 329evacuation policy for, 215-16, 235expands hospitals, 219, 227favors air evacuation of mental patients to ZI,

339hospital centers in, 282hospital ships for, 327, 402hospitals from South Pacific sent to, 228housing for hospitals, 296, 297-99laundry service for hospitals, 283-84Negro hospital in, 162neuropsychiatric patients evacuated from, 327reports defects in field ambulance, 363use of hospital ship platoons, 418-19

Specialty centers. See Hospitals, general.Squadron, medical, 39, 40, 447Strecker, Edward A., 175Supplies and equipment. See also Ambulances;

Evacuation, air; Hospital ships; Trains andcars, hospital; Transports, troop,

for theaters of operations, 456-57. See alsoEmergency expansion of hospitals; Field medi-cal units; Tables of Organization and Equip-ment.

for zone of interior medical installations1939-7 Dec 1941, 33-347 Dec 1941-1946, 137-39

Supreme Headquarters, Allied ExpeditionaryForces, 239

Surgeon, duties of, 8Surgeon General, The, 8, 107. See also Surgeon

General, Office of the; Kirk, Maj. Gen. Nor-man T.; Magee, Maj. Gen. James C.; Rey-nolds, Maj. Gen. Charles R.

Surgeon General, Office of theattitude toward expanding the medical service, 6attitude toward use and equipment of T/O hos-

pitals in ZI, 151-60comes under jurisdiction of SOS, 55controversy over planning hospitalization, 63-67opposes general-hospital-type care in AAF hos-

pitals, 182-88opposes separate hospitals for AAF overseas, 174organization for hospitalization and evacuation,

9-10, 61-63, 176-80

Surgeon General, Office of the—Continuedresponsibility 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 elementsAAF Liaison Unit, 177Administration Branch, 177Construction Branch, 173, 176, 177Control Division, 177, 180, 181, 262-63Dental Division, 10Evacuation Branch, 177, 180, 351Facilities and Personnel Utilization Branch,

177, 180, 182, 191, 194, 201-03, 225,239

Finance and Supply Division, 10Hospital Administration Division, 176, 182,

257, 358Hospital Construction Branch, 286, 288, 294,

295, 298, 383, 405Hospital Construction Division, 61, 62, 75,

94, 96, 119, 154, 176, 394, 399Hospital Construction and Repair Subdivi-

sion, 9, 18, 35Hospital Division, 177, 180, 181, 200, 262,

263Hospitalization Division, 10, 35, 61, 62, 136,

154Hospitalization and Evacuation Division, 176Hospitalization Subdivision, 10Inspection Branch, 178Liaison Branch, 176Medical Regulating Unit, 180, 209, 240, 314,

328, 329, 334, 347-49, 351, 352, 358-59,469

Medical Statistics Division, 263Military Personnel Division, 10Mobilization and Overseas Operations

Branch, 222, 225Mobilization and Overseas Operations Divi-

sion, 178, 228, 230, 232Nursing Division, 10Operations Service, 153, 176, 177, 180, 198Organization and Equipment Allowance

Branch, 283Personnel Division, 136Personnel Service, 153, 173, 180Planning Division, 61, 62-63Planning and Training Division, 9, 39, 371,

373Plans Division, 214, 219-22Policies Branch, 176Preventive Medicine Service, 283Prisoner of War Liaison Unit, 177, 197Professional Administrative Service, 180Professional Consultants Divisions, 173Professional Service, 153Professional Service Division, 10


Surgeon General, Office of the—Continuedsubordinate elements—Continued

Reconditioning Consultants Division, 180,291

Resources Analysis Division, 180, 187, 208,210, 239, 241, 303, 314, 333

Special Planning Division, 178Strategic and Logistic Planning Unit, 178,

226Supply Division, 41Supply Service, 153, 173, 180, 222Technical Division, 178, 281, 381, 392, 454Theater Branch, 178Training Division, 61, 62, 63, 136, 153, 159Training Subdivision, 26Transportation Liaison Unit, 177, 180Troop Units Branch, 178Veterinary Division, 10Women's Medical Unit, 177, 180

Surgical trucks, 456-57

Tables of distribution for Women's Army Corps, 258Tables 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, 5question of including certain items in, 283-85responsibility for preparing, 10, 59, 457revision, 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, 254-55Task forces, hospitals for, 143Teams, medical, 452Technical manuals

hospitalizationTM 8-260, 26, 27, 29, 122TM 8-262, 263-64, 265

reclassification and retirementTM 12-245, 246

Theater commanderscontrol of hospital ship platoons, 418-19directed to form provisional hospital ship platoons

417responsibility for air evacuation to ZI, 335-36,

338-39, 340responsibility for medical personnel on ships, 415

Train units, hospital, 388-90Training, Director of, SOS, 155Training for hospital and evacuation units, 9-10,

11-12, 32, 47, 440. See also Field medicalunits.

Trains and cars, hospital. See also Evacuation inzone of interior by rail.

accommodations for, at piers, 114air conditioning, 354-55, 375-77conversion of commercial to hospital cars, 369-

70, 372-73, 378, 385medical personnel for, 388-91number of cars, 346, 373, 374, 375, 388, 389number of patients moved by, 346, 355number of trains, 349, 369, 373, 375procedures for operating, 349-55procurement of hospital cars, 372, 373, 374, 375,

379, 380, 382, 383, 385, 387-88supplies and equipment for, 391-93types for overseas, 370, 371-72, 380-81types for ZI, 369-75, 377-80, 381-88

Trains, passenger, movement of patients in zone ofinterior by

number of patients moved, 346priority for, 355-57procedure, 320-21, 349, 350, 351, 352-53,

354-57Transportation Corps. See also Port commanders.

and accommodations for patients on troop trans-ports, 327, 328, 329, 332, 398, 399, 400

agreements with railroads on operation of carsfor patients, 353-54

agrees to convert staging-area hospitals to de-barkation hospitals, 192

and air conditioning for hospital cars, 375-77asked for opinion on use of Waacs in hospitals,

136and bed requirements, 202concurs in establishment of evacuation reports,

332confers on plans for hospitalization and evacu-

ation, 63, 65control of hospitals, 113, 115and development of hospital trains and cars, 379,

381, 382, 385draws plans for conversion of cargo vessels to

hospital ships, 405estimates evacuation from theaters, 325favors air conditioning on hospital ships, 414and hospital ship civilian crews, 420, 421and hospital ship procurement, 401, 403, 405instructions for transport surgeons and hospital

ship commanders, 336-37and medical personnel for ships, 416, 418personnel assigned to hospitals, 268prepares technical bulletin for maintenance of

hospital cars, 354and priority for patients on passenger trains, 356procures hospital cars, 380, 382, 383, 388proposes conversion of troop transports to hos-

pital or ambulance transports, 398raises standards for ships' hospitals, 413-14

INDEX 503

Transportation Corps—Continuedresponsibility for equipping ships' medical per-

sonnel, 424responsibility for evacuation, 320responsibility for evacuation to ZI, 331, 334-35responsibility for medical supply on hospital

ships and transports, 423responsibility for moving patients by rail in ZI,

349, 350, 351-53Transports, troop. See also Evacuation to zone of

interior by sea.conversion to hospital ships, 328, 394-414enlargement of patient capacity, 329estimates of evacuation by, 226, 325, 328medical personnel, 414-19medical supplies and equipment, 423, 424number evacuated by, 324, 326, 327, 330number used for evacuation, 394patient capacity of, officially established, 327,

329recommended for evacuating patients from large

theaters, 396responsibilities of surgeons of, 336-37responsibility for operating, 395, 396, 397ships' hospitals on, 398-401, 412-14sole means of evacuating patients by sea, 321-22use for evacuating patients opposed, 205, 235,

236use for evacuation required, 209, 236

Troop, medical, 38Tynes, Col. Achilles L., 96, 176, 409

United States Army Forces, Pacific, evacuationpolicy for, 235

Units, medical. See Field medical units; Installa-tions and units, medical.

Veterans Administrationconfers on change in patients' discharge pro-

cedure, 128hospital at Los Angeles taken over by Army, 104

Veterans Administration—Continuedobjection to construction of hospitals unsuitable

for postwar use, 74-75ordered to submit all hospital construction plans

to Federal Board of Hospitalization, 86participates in planning modified type-A hospital,

76patients in Army hospitals restricted, 26proposed use of VA hospital plans by Army, 76transfer of patients from Army hospitals to hos-

pitals of, 129, 241transfer of surplus Army hospitals to, 303treatment of Army patients in hospitals of, 25,

34, 37, 115

WAAC (Women's Army Auxiliary Corps). SeeWomen's Army Corps.

WAC. See Women's Army Corps.Wadhams Committee. See Committee to Study the

Medical Department.Walson, Col. Charles M., 26Walter Reed General Hospital. See Installations

and units, medical.War Department Manpower Board

and bed requirements, 203, 205, 206, 231improved relations with Office of SG, 210influences hospitalization, 171proposes closing some general hospitals, 205and reduction of hospital staffs, 248, 249, 259

War Production Board, 75, 86, 93, 98, 365Welsh, Col. Arthur B., 31, 178Western Defense Command, requests air evacuation,

429Wickert, Col. Howard T., 62Wilson, Col. William L., 9, 56, 63, 64, 65, 67, 152,

156Women's Army Corps

hospitals for, 109-10, 176use in hospitals, 135-37, 249, 255, 256-59

Woolford, Col. Wool S., 338Work-measurement and work-simplification pro-

grams, 265-66

U.S. GOVERNMENT PRINTING OFFICE: 1989 242-456/00014

The Medical Corps Hospitalization and Evacuation, Zone of Interior

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