Medical Statistics of the United States Army, Calendar Year 1953

CHAPTER IV

Medical Resources

ARMY MEDICAL SERVICE COMMISSIONED PERSONNEL

The worldwide distribution of authorized and actual strengths of the various corps of the Army Medical Service for 31 December 1952 and 31 December 1953 is indicated in source table 23. At the beginning of 1953 (31 Dec. 1952), 20,820 commissioned personnel had been authorized for the Army Medical Service; the strength of all corps then totaled 18,886?or 1,934 below the authorized strength. By the end of the calendar year (31 Dec. 1953), the authorized strength had been reduced to 18,864; however, the actual strength (18,419) was still below authorization by nearly 500 commissioned personnel.

Reserve component officers constituted the major elements of the active Army Medical Service Officer Corps during 1953. An evaluation of the numbers of Regular Army and Reserve component officers serving in these corps, as indicated in source tables 24 and 25, reveals the following percentage composition for the beginning and end of the year:

Reserve Components

Virtually all of the Reserve component gains in the Medical and Dental Corps during 1953 resulted, either directly or indirectly, from the operation of the Doctor Draft Act (Public Law 779, 81st Congress, as amended by Public Law 84, 83d Congress). To a slightly lesser degree this same statement was applicable to the Veterinary Corps.

With the diminution and subsequent cessation of combat in Korea during 1953, the legislative authority for the involuntary recall of Medical Service Corps, Army Nurse Corps, and Women?s Medical Specialist Corps officers

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was permitted to terminate on 30 June 1953 without Departmental efforts for extension.

There existed some shortages of allied specialist personnel in the Medical Service Corps and  since such type personnel were not obtainable through Officer Candidate Schools or Reserve Officer Training Corps programs, the Assistant Chief of Staff, G-1, granted authority for the direct appointment and concurrent call to active duty of certain specialists, such as clinical psychologists, bacteriologists, biochemists, parasitologists, serologists, entomologists, optometrists, psychiatric social workers, medical social workers and sanitary engineers. The directive establishing this program was published on 18 May 1953. The Assistant Chief of Staff, G-1, initially limited the number of appointments under this program to 216 allied specialists.

During the latter part of calendar year 1952 an involuntary recall of 500 Army Nurse Corps and 125 Women?s Medical Specialist Corps, USAR officers was authorized. Continental Army commanders were assigned quotas and were directed to order the eligible personnel to active duty during the months of April through June 1953. During the month of April an evaluation of the program was completed and revealed that of approximately 835 Army Nurse Corps and 152 Women?s Medical Specialist Corps officers nominated for call to active duty, only 282 ANC and 74 WMSC officers were found to be eligible for call to active duty. The actual strength of the Women?s Medical Specialist Corps for 31 December 1952 and 31 December 1953 averaged 11 percent below authorization. The actual strength for the Army Nurse Corps for the same dates averaged 8.5 percent below authorization. Since the quotas cited above were not met and a shortage of ANC and WMSC personnel continued to exist, a request was forwarded to the Assistant Chief of Staff, G-1, for authority to involuntarily recall another 218 ANC and 47 WMSC, USAR officers. The Assistant Chief of Staff, G-1, returned the request without action due to the fact that the legislative authority to recall involuntarily Reserve component personnel was scheduled to expire on 30 June 1953 (Section 21, UMT&S Act, as amended) and it was not feasible to accomplish the newly proposed program prior to the expiration of its legal basis. A review of the involuntary program input, scheduled for the months of April through June 1953, revealed that only approximately 146 ANC, USAR officers out of the 835 nominated actually reported to active duty. The most prominent causes for this low input were that many of these officers had married since becoming members of the USAR and many of the others were occupying jobs that were classified as essential to the national health and not available for military service.

In the main, losses from the Reserve component elements of the various corps of the Army Medical Service represented separations upon completion of obligatory periods of service. These obligatory periods of service resulted from the operation of the doctor draft act and involuntary recall programs The Army Medical Service was able to retain only a negligible percent of the involuntary officers beyond their periods of obligatory service.

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During 1953, the experience indicated below was reported for the various corps of the Army Medical Service, in terms of the percentage of officers? ligible for separation?who renewed their categories of service. To illustrate:  of all Medical Corps officers who became eligible for separation during the year, 9.4 percent renewed their tour of duty.

These experience factors, however, include both those who were serving voluntary categories as well as those serving involuntary categories.

Regular Army

The actual strengths of all of the Regular Army components of the Army Medical Service Corps were below the levels authorized, as indicated in source table 25.

The Medical Service Corps and the Veterinary Corps were the only corps of the Army Medical Service to register increases in their total strengths during the course of the year. The increase in the Medical Service Corps was primarily composed of Regular Army appointments tendered outstanding Reserve officers serving on active duty.

The fact that the other corps of the Army Medical Service did not commission sufficient personnel to offset their losses was not due to lack of procurement effort. Procurement programs were in operation. They could not, however, compensate for the apparent lack of appeal that a military career held for medical professional people.

During 1953, losses exceeded gains in all corps except the Medical Service and Veterinary Corps. In the other corps, resignations constituted an average 77 percent of all losses during the year (table XVI.) This loss by resignation

TABLE XVI.?REGULAR ARMY LOSSES BY CAUSE, 1953

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was higher during 1953 inasmuch as the resignation criteria were considerably liberalized during the year. On 18 September 1953, DA Circular 84 lifted the rigid restrictions on resignations that had been in effect since the beginning of the Korean emergency. The serious trend of resignations among the younger Medical Corps officers was clearly evident by the end of the year.

Authorizations

For Medical Corps officers, the authorization for the year represented a phasing down in compliance with a Department of Defense directive placing the Medical Corps under a ratio to troop strength control. The Secretary of Defense, on the advice of the Health Resources Advisory Committee, Office of Defense Mobilization, directed the Secretary of the Army by memorandum dated 18 May 1953 to reduce the number of Medical Corps officers on duty. The directive from the Office of the Secretary of Defense authorized the Army a Medical Corps strength of not more than three physicians for each 1,000 troop strength, plus the number of military interns and one-half of the Medical Corps officers in residency training. The Army was permitted until 30 June 1954 to attain this ceiling by normal attrition. This ceiling represented a substantial reduction in physicians over that which had prevailed previously in the Army Medical Service.

INPATIENT MEDICAL WORKLOAD IN ARMY MEDICAL TREATMENT FACILITIES

During 1953 the Army Medical Service had in operation a total of 137 hospitals?69 located in the continental United States and 68 overseas. Ten of the hospitals in the United States were class II facilities, providing not only general definitive care but also specialized treatment for certain specified conditions.¹   All of the remaining hospitals in the United States were class I facilities; of these, 14 were specialized treatment hospitals, designated as such during the course of the Korean Conflict to take care of the increased inflow of evacuees from the Far East. In addition to the 137 hospitals, worldwide, there were a small number of infirmaries (14), all of which were in the continental United States. Of the hospitals overseas, 17 were nonfixed facilities located in Korea. On account of a steadily declining workload during 1953, the number of hospitals in operation was reduced. By the end of the year, 9 class II, 9 class I specialized, and 41 other class I hospitals were functioning in the continental United States. Overseas, the number had been cut to 58, of which 10 were nonfixed facilities in Korea.

Admissions

There were 729,301 total admissions (source table 26) to Army hospitals and infirmaries in 1953 as against 876,796 in the preceding year, representing a

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¹Basic terminology, such as the meaning of ?hospital,? ?infirmary,? ?class II facility,? etc., is explained in AR 40-600, ?Medical Treatment Facilities,? 16 October 1950.

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decrease of 17 percent.  This decrease, due largely to the cessation of the Korean Conflict, occurred for each category of personnel except Navy and Marine Corps personnel, dependents of military personnel, retired military personnel, and Bureau of Employment Compensation beneficiaries, each of which increased slightly. The 1953 decline in inpatient admissions would have been even more marked if the incidence of respiratory conditions had not been moderately high during the 1952-53 winter season. Army patients accounted for the majority of patients admitted (61 percent); other active duty military (Air Force and Navy-Marine) accounted for an additional 4 percent.

It should be noted that the data shown in source table 26 represent the sum of all admissions to hospitals or infirmaries, whether the admission was an initial hospital admission or was by transfer from another hospital. Thus, while not quite 450,000 admissions of Army personnel were included in the total admissions to Army hospitals or infirmaries in 1953, only 356,364 of these were initial admissions and the remainder (about one-fifth) were transfers.

The initial admissions of Army personnel to Army hospitals and infirmaries (356,364) was about 96 percent of all the initial hospital and infirmary admissions of Army personnel, there having been not quite 15,000 initial admissions of Army personnel to Navy and Air Force hospitals and infirmaries. Thus, the total number of initial admissions of Army personnel to U. S. military hospitals and infirmaries was 371,274. This hospital-infirmary figure constituted about 60 percent of all of the admissions of Army personnel to medical treatment on an excused-from-duty basis (hospital or quarters).

Census

The patient census data shown in source table 26 represent an average of all inpatients remaining on the hospital or infirmary register during the report year, and the numbers of such patients remaining as of the end of 1952 and 1953. Census figures include not only those patients occupying beds but also those not occupying beds, i.e., patients remaining on the rolls who are subsisting elsewhere, on leave, AWOL, etc.; or who have been placed on duty status with the hospital duty detachment or a nearby military installation; or ordered home or to a Veterans Administration hospital on permanent change of station (PCS) pending final action on separation or retirement for disability.  This latter group accounts for much of the difference between the census and occupancy figures for facilities in the continental United States.

Occupied Beds

The average daily number of patients occupying beds in hospitals and infirmaries during 1953 was 35,637, of which 23,727 (67 percent) were active duty Army personnel; 1,435 (4.0 percent), Air Force; 507 (1.4 percent), Navy and Marine Corps; 3,661 (10 percent), dependents of military; 326 (0.9 percent), retired military; 549 (1.5 percent), Veterans Administration beneficiaries; and 3,425 (9 percent), enemy prisoners of war (source table 26).

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The steady decline in the number of beds occupied continued during 1953, extending the downtrend which began in mid-1951. Several factors contributed to this, the more important being (1) the termination of the Korean Conflict; (2) reduction in hospital admissions through continuing emphasis on the policy of treating more patients on an out-patient basis; (3) continued efforts to identify and eliminate unnecessary hospitalization from administrative procedures; (4) reduction of the Army?s strength; and (5) advances in military medicine and medicine generally which lowered the rate of admission and the duration of treatment.

Army patients comprise a larger percentage of all patients occupying beds (67 percent) than they do of all admissions (61 percent). This is because Army patients have a longer average duration in bed-occupying status than other categories of patients. Conversely, since dependents of military spend a shorter time in hospital, they constitute a larger proportion of all admissions than of all occupied beds. In 1953, the average duration in bed-occupying status for all Army nonbattle patients alone (22) was almost three times that for dependents of military personnel. A direct comparison, however, between the length of stay averages for these two types of personnel is of questionable meaning. The principal reason for the marked difference in the length of stay of these two patient categories is that they measure different periods. In the case of the non-Army patient in an Army hospital, the period of time in prehospitalization and convalescent care is not a part of the period of hospitalization, since it is spent at home. For the soldier, however, it is frequently necessary to admit him to or retain him in hospital because, in the military environment, the equivalent kind of care is available only at hospitals.

The 1953 decline in the number of beds occupied in Army hospitals and infirmaries in continental United States continued the downward trend which first set in during the summer of 1951. By the end of November 1953, the total number of beds occupied had decreased to 16,875, or about 45 percent below the number occupied at the end of July 1951?30,662. (November is used to avoid the effect of Christmas holiday season absences.) Slightly more than half of the drop in Army patients occupying beds in the United States during the period (to 12,358 from 25,179) was due to the decline in the hospital noneffective rate expressed in terms of beds occupied?sometimes called the hospitalization ratio?for nonbattle patients of U. S. origin. Except for increases during the respiratory season, this rate declined steadily through 1953. For the year, the average number of beds occupied by Army patients per 1,000 average strength was 15.7 in 1953 compared with 19.0 in 1952. Thus, expressed as a ratio, the percentage of Army personnel occupying beds in hospital on the average day in 1953 was only 1.57 percent.

Operating Beds

The decline in the 1953 patient load resulted in a parallel reduction in the number of operating beds, i.e., those which medical treatment facilities are staffed and equipped to operate and are currently set up and in all respects

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CHART O. ? OPERATING BEDS AND PATIENT LOADS, ARMY HOSPITALS IN CONTINENTAL UNITED STATES

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ready for the care of patients. For the Army as a whole, the number of operating beds at the end of 1953 was 42,604, down 36 percent from the figure a year earlier. Operating beds in class II hospitals in continental United States were reduced to 10,850 from 13,550 during this same period, while the total for class I specialized hospitals was cut even more sharply, from 11,250 to 5,700.  For all class I hospitals in the United States (those under the jurisdiction of the Army commanders) the number of such beds was decreased from 19,536 to 13,308. Overseas, the drop in operating beds (including the nonfixed facilities in Korea) was precipitous after the end of the Korean hostilities. After the fighting ended in July, the battle casualties load declined rapidly as these patients were either returned to duty or evacuated to the United States. This, coupled with the prisoner exchange ?Operation Big Switch? in August (in which the number of enemy prisoners released was far greater than the number of our personnel returned) caused the total number of beds occupied in Army hospitals in Korea to drop sharply, from 6,781 at the end of July to 2,729 at the year?s end, with a marked effect on the total occupancy figure, worldwide.