PART THREE
HOSPITALIZATION IN THE LATER WAR YEARS
MID-1943 TO 1946
CHAPTER X
Adjustments and Changes in the Zone of Interior Hospital System
As the tempo and extent of the war increased, changes andadjustments were made in the hospital system. Among the more important reasonsfor them were the necessity of using limited personnel resources-particularlydoctors-more effectively than formerly; the continuing efforts of the AirSurgeon to gain greater control over hospitalization of Air Forces men; thenecessity of caring for large numbers of prisoners of war; and the growingnumber of patients requiring specialized treatment and care. In the fall of 1943several groups attempted to solve the problem of limited personnel resources.Among them were the "Kenner Board," a group of officers appointed byThe Surgeon General and headed by Brig. Gen. Albert W. Kenner to study MedicalDepartment personnel utilization; the Hospital and Control Divisions of theSurgeon General's Office; the ASF Control Division; and the Inspector General'sOffice. These groups agreed that certain steps were desirable: reduction in sizeand number of station hospitals; merger of neighboring hospitals to eliminateoverlapping and duplication; and removal of convalescent patients from the wardsof general hospitals. They disagreed on the question of how to operate two setsof hospitals (those of the Army Air Forces and those of the rest of the Army)with a minimum of duplication of facilities and waste of personnel. Subsequentlytheir opinions were reflected in changes made in the hospital system.1
Closure of Surplus Station Hospital Facilities
The first adjustment needed was the closure of stationhospital plants, or parts of them, to keep step with the shrinkage in militarypopulation as troops moved over-
1(1) Mins of Mtgs and Rpt of Bd of Off to Study the Util of MC Offs, 17 Sep 43-6 Nov 43. HD: 334 "Kenner Bd." (2) Memo, Dr. Eli Ginzberg, Control Div ASF for Chief Oprs Serv SGO thru Dir Control Div ASF, 30 Nov 43, sub: Surv of Gen Hosps. SG: 333.1-1. (3) Memo, Lt Col Basil C. MacLean, Hosp Admin Div SGO for Gen [Raymond W.] Bliss thru Col [Albert H.] Schwichtenberg, 6 Nov 43, sub: Observations Based on Recent Visits . . . to 9 Gen Hosps. Off file, Gen Bliss' Off SGO, "Util of MCs in ZI" (19)#1. (4) Notes on Visit to McCloskey, O'Reilly, and Percy Jones Gen Hosps, 11 Dec 43, by Col Tracy S. Voorhees, Control Div SGO. SG: 333.1-1. (5) Memo, WDCSA 333 (4 Nov 43), DepCofSA for IG, 4 Nov 43, sub: Util of Med Off Pers in ZI Instls. AG: 320.2 (18 Apr 44) (1).
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seas. When this was done doctors no longer needed to care fortroops in training could be released for assignment either to hospitalsscheduled for overseas service or to general hospitals in this country. In thefall of 1943 both the Surgeon General's and the Air Surgeon's Offices madesurveys to this end.2 By the closeof the year "considerable reductions" had been made in the sizes ofAAF hospitals, and the Surgeon General's Office was planning a generalprocedure for adjusting capacities of all station hospitals to the trooppopulations which they served.3 Toavoid overcrowding in hospital plants that were by then larger than needed, TheSurgeon General's Hospital Administration Division proposed a resumption ofthe practice of placing beds in wards only and of allotting to each bed 100square feet of floor space, a practice which had been abandoned earlier when theneed for beds was greater. This Division also recommended that local commandersbe held responsible for reducing the sizes of station hospitals to authorizedcapacities.4
ASF headquarters and the General Staff approved theseproposals and published regulations to effect them early in 1944.5Concurrently The Surgeon General's Facilities Utilization Branch began to urgeservice command surgeons to increase efforts to shrink station hospitals undertheir supervision.6 To judge theprogress made, The Surgeon General changed the way in which station hospitalbeds were reported in the summer of 1944. Until that time hospitals reported"constructed capacities"-that is, the number of beds which plantswere constructed to hold-and hence reports showed neither the number of bedsactually in use nor the number currently authorized. Under the new system theyreported "authorized beds"-that is, beds for which were allottedsupplies and personnel. The first such reports revealed that considerableprogress had been made in the contraction of station hospitals.7On 26 May 1944 the reported capacity (constructed capacity) of all AAF andASF station hospitals had been about 259,000, or 6.2 percent of the zone ofinterior troop strength. By 7 July 1944 the "authorized capacity" ofstation hospitals was reported to be about 134,000 (3.3 percent of the troopstrength at that time) and of station and regional hospitals together about198,000 (4.9 percent).8
Establishment of Regional Hospitals
Closure of surplus AAF and ASF station hospitals did not eliminate theproblem of operating dual sets of hospitals (for the Air Forces and for the restof the Army) without duplication of plants and
2(1) Ltr, Asst to Chief Med Br S&S Div Hq 9th SvC to COs ASF Hosps 9th SvC, 26 Oct 43, sub: Util of Hosp Fac. SG: 632.-1. (2) Ltr, SG to CG 2d SvC attn SvC Surg, 23 Dec 43, sub: Anal of Data Obtained in Recent Questionnaire of SG on Req Hosp. SG: 705.-1 (2d SvC)AA. (3) Tabs C and D of Memo, CG AAF (Air Surg) for CofSA attn G-4, 7 Oct 44, sub: Reduction of ZI Hosps. HRS: G-4 file, "Hosp and Evac Policy."
3Ltr, SG to Budget Off for WD, 27 Dec 43, sub: Sta Hosp Beds in ZI Instls. SG: 632.-2.
4(1) Diary, Hosp Admin Div SGO, 4 Jan 44. HD: 024.7-3. (2) Ltr, SG to Budget Off for WD, 27 Dec 43, sub: Sta Hosp Beds in ZI Instls. SG: 632.-2.
5(1) WD Cir 43, 1 Feb 44. (2) AR 40-1080, C 2, 9 Jun 44. (3) ASF Cir 196, 27 Jun 44.
6Ltr, CG ASF by SG (Oprs Serv Hosp Div, Fac Util Br) to CGs SvCs attn SvC Surg, 28 Apr 44, sub: Redesignation of Sta Hosp Bed Capacities. HD: Resources Anal Div file, "Hosp."
7Form SG-396, Weekly Health Report, was revised 1 May 1944. The revised version was first used in Report 27, vol. IV, for the week ending 7 July 1944. Weekly Rpts, AML.
8(1) Weekly Health Rpts, vol. IV, No 21, and No 27. AML. (2) ASF Monthly Progress Rpt, Sec 7, Health, 31 Jul 44, p. 34, compared bed capacities of ASF sta hosps as of 26 May 44 and 30 Jun 44.
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waste of personnel, and attempts to solve it led to a majorchange in the hospital system early in 1944. Although prohibited from operatinggeneral hospitals and caring for overseas patients, the Air Forces, it will berecalled, had built up station hospitals to the point where many were staffedand equipped to give general-hospital-type care, and the Air Surgeon opposedtransferring Air Forces patients to general hospitals, operated by the ServiceForces, when there were AAF station hospitals capable of treating and caring forthem. On the other hand, Surgeon General Kirk opposed separate Air Forcesstation hospitals.9 If they were tocontinue, he contended, their staffs should be reduced in quantity and qualityto the level required to care for only minor ills and injuries, and patientsfrom the Air Forces as well as from the rest of the Army who required treatmentfor serious ills and injuries should be concentrated, along with specialists totreat them, in general hospitals. In the fall of 1943 he attempted to achievethis goal (1) by requesting the General Staff either to permit him to reassigndoctors from AAF hospitals as he saw fit or to direct the Air Forces to releasespecialists for duty with the Service Forces10and (2) by proposing a revision of the policy governing transfer of patients togeneral hospitals. ASF headquarters approved the latter suggestion and a revisedpolicy was published in November 1943. In addition to establishing criteria forthe selection of cases for transfer to general hospitals, this policy clearlylimited station hospitals to such operations as appendectomies, herniotomies,and the treatment of simple fractures of the extremities.11The inference was that specialists were not needed in station hospitals.
Almost immediately the Air Forces protested that suchrestrictions would reduce their hospitals to dispensaries and would waste theskills and abilities of their staffs.12 DespiteThe Surgeon General's insistence that, on the contrary, Medical Corps officerswould be used more effectively if specialists and patients requiring specializedcare were concentrated rather than scattered,13the Deputy Chief of Staff of the Army directed a compromise between thepositions of the Air Surgeon and The Surgeon General. The Air Forces were torelease some medical officers for ASF assignments but the policy on the transferof patients to general hospitals was to be revised to permit AAF stationhospitals to perform any operations, however complicated, for which they hadadequate staffs.14
Early in 1944 The Inspector General reopened the question ofthe manning and use of AAF station hospitals. Reporting on a survey made byGeneral Snyder, he
9Statement of Maj Gen Norman T. Kirk, Rpt, SGs Conf with Chiefs Med Br SvCs, 14-17 Jun 43, pp. 7-8. HD: 337.
10(1) Memo, SG for CofSA thru CG ASF, 13 Sep 43, with 1st ind, CG ASF to CofSA, 13 Sep 43. HRS: Hq ASF Gen Styer's files, "Med Dept." (2) Memo SPGAP 320.2 (8 Nov 43), Dir MPD ASF for ACofS G-l WDGS, 8 Nov 43, sub: Critical Shortage of Med Specialists in ASF. SG: 322.051-1.
11(1) Ltr SPMCR 300.5-5, SG to AG, 10 Nov 43, sub: Policy Regarding Trf of Pnts to Named Gen Hosps. AG: 704.11(10 Nov 43) (1). (2) WD Cir 304, 22 Nov 43.
12Memo, CG AAF for ACofS G-1 WDGS, 2 Dec 43, sub: Med Serv. AG: 704.00 (2 Dec 43).
13(1) Memo SPMC 701.-1, SG for Dir MPD ASF, 9 Dec 43, sub: Med Serv-AF. (2) T/S SPGAM 705 (Gen) (3 Dec 43)-31, CG ASF to ACofS G-1 WDGS, 13 Dec 43, same sub. (3) Ltr SPMCM 322.051-1, SG to CG ASF, 15 Dec 43, sub: MC Offs for Asgmt to ASF T/O Units. All in AG: 704.11 (2 Dec 43).
14(1) Memo WDCSA 705 (24 Dec 43) DepCofSA for ACofS G-1 WDGS, 24 Dec 43, sub: Sec 2, WD Cir 304, 22 Nov 43. AG: 704.11 (2 Dec 43). (2) WD Cir 12, 10 Jan 44.
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recommended on 13 January 1944 that AAF station hospitalsthat were staffed and equipped to serve as general hospitals should be used inthat capacity for patients not only from the Air Forces but from the Service andGround Forces as well. The Deputy Chief of Staff accordingly directed thecommanding generals of the Air and Service Forces to prepare a combined plan forhospitalization "on a regional and military population basis, irrespectiveof command or service jurisdictional boundaries."15
To comply with this directive and still maintain the statusquo, The Surgeon General drew up a plan based upon the Secretary of War'spolicy of permitting only the Service Forces to operate general hospitals and ofassigning all overseas evacuees, with few exceptions, to their care. He proposedthat general hospitals should be of two types, those staffed for specializedtreatment and those staffed for "all work," and that station hospitalsof both the Air and Service Forces should be staffed according to manning tablesapplicable to both alike.16 The Air Surgeon, on the other hand,attempted to use this opportunity to get authority to operate hospitals equal inall respects to those of the Service Forces. He proposed that hospitals bedesignated as specialized hospitals, regional hospitals, and station hospitals;and that they be staffed on the basis of their workloads and functions insteadof by manning tables.17 Since none were to be called generalhospitals, none would be restricted by the Secretary of War's policy andhospitals of all three types could presumably be operated by both the Air andService Forces.
When representatives of the Air Surgeon and The SurgeonGeneral could not agree upon a plan to submit to the Deputy Chief of Staff, the Air Forces designated certain of theirinstallations as "regional hospitals" and called attention to thisdevelopment as their way of complying with the directive.18Subsequently,the entire problem of agreement upon a joint plan was referred to the Chiefs ofStaff of the Air and Service Forces for solution.19
The outcome was a major change in the hospital system. Agreedupon by the AAF and ASF Chiefs of Staff, approved by the Deputy Chief of Staffof the Army, and authorized in April 1944, it represented a compromise betweenthe proposals of The Surgeon General and the Air Surgeon. To the familiarstation and general hospitals were now added the regional hospital, an entirelynew species, and the convalescent hospital, an outgrowth of the convalescentcenters and annexes already in use on a small scale. The Service Forces alonewere to continue to operate general hospitals, but both the Air and ServiceForces were to operate station, regional, and convales-
15(1) Ltr IG 333.-Med Pers, IG to DepCofSA, 13 Jan 44, sub:Util of Med Off Pers in ZI Instls. (2) Memo, DepCofSA for CGs ASF and AAF, 26Jan 44, same sub. Both in Off file, Gen Bliss' Off SGO, "Util of MCs inZI" (20)#2.
16Memo, SG for CG ASF, 29 Feb 44, sub: Util of Med Off Pers in ZI Instls, in Rpt to CG ASF from SG, Plan for Util of Med Off Pers in ZI, 29 Feb 44. HD: 322.051-1.
17(1) Memo, Hq AAF for SG, 26 Feb 44, sub: Proposed Plan,SGO, for the Util of MC Offs in ZI. Off file, Gen Bliss' Off SGO,"Util of MCs in ZI" (19) #1. (2) Draft Memo, CGs AAF and ASF forDepCofSA, [Feb 44], sub: Util of Med Off Pers in ZI Instls, prepared by Hq AAF.HD: Resources Anal Div files, "Hosp."
18(1) A History of Medical Administration and Practice inthe Fourth Air Force (1945), vol. I, pp. 43-44. HD: TAS. (2) An Rpt, 1944, AAFRegional Hosp Maxwell Fld. HD. (3) Draft Memo, CGs AAF and ASF for DepCofSA,[Feb 44], sub: Util of Med Off Pers in ZI Instls, prepared by Hq AAF. HD:Resources Anal Div files, "Hosp."
19History of Control Division, ASF, 1942-45, App, p.246. HD.
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cent hospitals. Regional hospitals were to be staffed notonly to care for patients requiring merely the treatment usually given instation hospitals but also to serve as general hospitals for zone of interiorpatients. General hospitals were to have the most highly specialized staffs andto them were to be transferred all patients evacuated from theaters ofoperations, except those needing only convalescent care. General hospitals werealso to accept patients from the zone of interior who needed specializedtreatment not given in regional hospitals. Hospitals of all four types were toserve troops on an area basis, irrespective of the command to which the troopsor the hospital belonged, and a hospital was to transfer patients to anotherhaving better qualified personnel only if patients needed treatment which thetransferring hospital was not staffed to give.20Thus, while theService Forces retained the right to operate all general hospitals and in themto care for all theater of operations evacuees who needed further hospitaltreatment, the Air Forces gained the right to operate regional hospitals whichwere, in effect, general hospitals for zone of interior patients.
Although this change in the hospital system did not achieve integration of Air and Service Forces hospitalization, it did produce certain advantages. In June the War Department designated as regional hospitals thirty AAF and thirty ASF station hospitals agreed upon between The Surgeon General and the Air Surgeon.21 Soon afterward both The Surgeon General and the Air Surgeon issued directives covering the transfer of patients from station to regional hospitals.22 For several months ASF station hospitals had difficulty in adjusting to the idea of transferring complicated cases to regional instead of general hospitals, and there was little joint use of hospitals by the Air andService Forces;23 but by the latter part of 1944 The Inspector Generalreported that the establishment of regional hospitals had eliminated muchduplication.24 During 1945, when the patient load became heavybecause of the influx of patients from theaters of operations, the care of themore serious and complicated cases from the zone of interior in regionalhospitals permitted general hospitals to devote themselves almost entirely tothe treatment of overseas evacuees.25
The question of whether regional hospitals could take over still more of thegeneral hospital load-and perhaps become general hospitals themselves-cameup early in 1945. When The Surgeon General asked for about 70,000 more beds ingen-
20WD Cir 140, 11 Apr 44.
21Memo, 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 Cir228, 8 Jun 44. The number of regional hospitals was adjusted later as the needarose. For example, see WD Cirs 352, 30 Aug 44, and 115, 11 Apr 45.
22(1) Ltr, SG to CGs SvCs attn SvC Surg, 6 Jul 44, sub: Bed Credits in Regionaland Gen Hosps, Tab G to IG Rpt, 28 Dec 44. (2) Ltr, CG AAF (Air Surg) to CG TngComd AAF, 2 Sep 44, sub: Bed Credits. (3) AAF Reg 25-17, 6 Jun 44, sub: AAF Hospand Evac in Continental US. All in HRS: WDCSA 632 (25 Sep 44),"Hosp in ZI."
23(1) Ltr, CG ASF (Dep SG) to CG 9th SvC, 21 Sep 44, sub: Specialized Hosp. SG: 323.3 (9th SvC)AA. Similar letters found undersame file number for different service commands. (2) Memo, 1st Lt Robert J.Myers, AUS, Med Stat Div SGO for Capt Edward A. Lew, 18 Sep 44, sub: Distr ofPnts in Regional Hosps as of 25 Aug 44. SG: 632.2.
24Memo, Act IG for DepCofSA, 28 Dec 44, sub: Hosp Fac in ZI. HRS: WDCSA 632 (25 Sep 44) Case No 28, "Hosp Fac in ZI."
25(1) Tab B of Memo, Dir Hosp Div and Dir Resources Anal Div SGO for Dir HD SGOthru Chief Oprs Serv SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (2) Interv, MD Historian with Lt Col James T. McGibony, MC, formerlyChief Hosp Div SGO, 20 Feb 50. HD: 000.71.
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eral and convalescent hospitals to handle the growing influx of patients fromoverseas, G-4 directed the Air Forces to investigate the possibility of caringfor overseas patients in AAF regional hospitals.26 Taking the position thatmaximum use had to be made of all available beds in order to justify requestsfor additional beds in general and convalescent hospitals, G-4 later directedthat overseas casualties should be placed in 4,000 beds in AAF regionalhospitals which the Air Surgeon offered for that purpose. G-4 stated that thiswas an emergency measure and did not alter current policies (presumably thepolicy established by the Secretary of War in 1943 that all overseas patients,with minor exceptions, should be treated in general hospitals).27TheAir Surgeon, who formerly had attempted to get separate general hospitals forthe Air Forces and wanted to care for overseas casualties in AAF hospitals,urged immediate compliance with G-4's directive.28
The Surgeon General opposed this move. Having previously estimated that therewere 12,000 vacant beds in AAF and ASF regional hospitals, he agreed thatregional hospitals could be used for the purpose proposed but held that therewere certain objections to doing so and that the expedient should be resorted toonly in an emergency which, he contended, had not yet arisen.29ASFheadquarters supported The Surgeon General and appealed G-4's directive tothe Deputy Chief of Staff. The latter referred the question for investigation on19 March 1945 to The Inspector General, who recommended two months later (14May) that vacant beds in both ASF and AAF regional hospitals should be used inthe manner proposed by G-4. G-4 then sought the Secretary of War'sapproval of a directive making this recommendation effective. On 20 June the Secretary met with G-4and The Surgeon General, whose opinions on The Inspector General's report hehad already received. By that time "events had overtaken thisdisagreement," G-4 reported, for the war in Europe had ended, and"there was no longer a necessity" of using regional hospital beds totake the load off the general hospital system. The Surgeon General concurredwith this statement and the original demand was accordingly dropped.30
This development did not alter the fact that occupancy of general hospital beds at the end of June-despite provision of addi-
26MemoWDGDS 7486, ACofS G-4 WDGS for CG AAF, 11 Jan 45, sub: Care of Add Pnts at AAF Regional Hosps. HRS: G-4 file, "Hosp and Evac Policy."
27(1) Memo, CG AAF (Air Surg) for ACofS G-4 WDGS, 13 Feb 45,sub: Care of Overseas Casualties in AAF Regional Hosps. HRS: G-4 file,"Hosp and Evac Policy." (2) Memo WDGDS 9049, Dep ACofS G-4 for CG AAFand 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 RegionalHosp Beds. Same file.
28Memo, Air Surg for ACofS G-4 WDGS, 22 Mar 45, sub: Progress Rpt on Care of Overseas Casualties in AAFRegional Hosps. HD: TAS 210.72lb, "Care of Overseas Casualties in AAF Hosps."Other memorandums on this subject are in the same file.
29T/S, Act SG to ACofS G-4 WDGS thru CG ASF, 22 Feb 45, sub:Care of Overseas Casualties in AAF Regional Hosps. HRS: G-4 file, "Hosp,vol. II."
30(1) 1st ind SPOPG (27 Feb 45), CG ASF to DepCofSA, 5 Mar 45,on Memo WDGS 9049, Dep ACofS G-4 WDGS for CGs ASF and AAF, 27 Feb 45, sub: Careof Overseas Casualties in AAF Regional Hosps. HRS: Hq ASF Planning Div file, 700"Hosp and Evac." (2) Memo, DepCofSA for IG, 19 Mar 45, sub: ZI Hosp.HRS: Hq ASF Lt Gen Lutes' files, "Hosp and Evac, Jun 43-Dec 46."(3) Memo WDSIG 333.9-Hosp Fac (2), IG for DepCofSA, 14 May 45, sub: Rpt ofSurv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (4) Memo, Chief Planning Br G-4for ACofS G-4 WDGS, 21 Jun 45, sub: Conf with SecWar on Rpt of Surv of ZI Hosps,with incl, Memo, Col Kyle (aide to SecWar) for SecWar [31 May 45], sub: ZI Hosps.HRS: G-4 file, "Hosp, vol. IV."
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tional beds in the first half of 1945, placing large numbersof general hospital patients on leave and furlough for 90 days, and adoption ofmeasures to speed the disposition of patients-ran above what was normallyconsidered the saturation point (80 percent of capacity) while the occupancy ofregional hospital beds was considerably lower.31Whether thissituation was preferable to redistributing the patient load depended on thecogency of arguments against the suitability of regional hospitals for handlingoverseas patients. Several were of doubtful weight, such as that the use ofthese hospitals would "not have facilitated" observance of the WarDepartment's policy of hospitalizing patients near their homes. On this pointthe Inspector General's Office and indeed The Surgeon General's ownResources Analysis Division estimated that 15 to 20 percent of the bedsavailable in regional hospitals were located in areas where population was densebut general hospital beds few in number. To the argument that existing space ingeneral hospitals (that is, on 5 March 1945) was still adequate, the reply mighthave been that it was being kept so partly by establishing additional beds ingeneral hospitals which The Surgeon General had requested. It was also arguedthat filling the beds of regional hospitals with long-term patients would use upexcess capacity needed to provide extra hospitalization for troops that would bereturned from Europe for redeployment to the Pacific. To this the InspectorGeneral's Office replied that the need in the latter case would arise onlyafter the peak load had been passed. Nor did the Inspector General's Officeagree with The Surgeon General's contention that difficulties would resultfrom mixing overseas patients with those from the zone of interior in regional hospitals. Greater importance may or may not beattached to The Surgeon General's argument that the administrativedifficulties of adding a large number of hospitals to those already treatingoverseas patients would have outweighed the gain of 12,000 beds. But it couldnot be denied, of course, that "diversion of patients from the generalhospital system would prevent control of treatment by the agency now chargedwith their care."32
This last argument perhaps held the key to the entire matter.After the establishment of regional hospitals to serve in effect as generalhospitals for zone of interior patients, the chief remaining distinction betweenhospital systems of the Air and Service Forces was that ASF general hospitals,but no AAF hospitals at all, were authorized to care for patients returning fromoverseas areas for further medical
31See below, pp. 210-12. Normally a hospital was consideredfull when 80 percent of its beds were occupied, because some of its beds werealways required for dispersion. In August 1944 the Facilities UtilizationBranch, SGO, proposed reducing the "dispersion factor" in estimatingrequirements from 20 to 15 percent because of a "liberal furloughpolicy." (Memo, Eli Ginzberg for SG, 18 Aug 44. HD: Resources Anal Divfile, "Hosp.") In estimating requirements in January 1945 no beds fordispersion were included "on the assumption that furloughs will provide thenecessary number of empty beds." (Memo, Asst SG for Act Dir Plans and OprsASF, 8 Jan 45, sub: Gen Hosp Program, ZI. SG: 323.3.)
32(1) 1st ind SPOPG (27 Feb 45), CG ASF to DepCofSA, 5 Mar45, on Memo WDGDS 9049, Dep ACofS G-4 WDGS for CGs ASF and AAF, 27 Feb 45, sub:Care of Overseas Casualties in AAF Regional Hosps. HRS: Hq ASF Planning Divfile, 700 "Hosp and Evac." (2) T/S, Act SG to Dep ACofS G-4 WDGS thruCG ASF, 22 Feb 45, same sub. HRS: G-4 file, "Hosp, vol. II." (3) Memo WDSIG 333.9-Hosp Fac (2), IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (4) Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 20 Jan 45, sub: Sta and Regional Hosp Backup for Gen Hosp Syst. SG: 632.2.
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and surgical treatment. To have placed some of them in AAFregional hospitals would have narrowed if not eliminated that distinction. Anofficer who participated in these transactions afterward interpreted thecontroversy in these terms-the desire of the Air Surgeon to eliminate thatdistinction and the determination of The Surgeon General to maintain it.33This view seems plausible when the previous efforts of the Air Surgeon to securea hospital system equal to that of the Service Forces are considered. It mayalso derive color from the fact that The Surgeon General, in tracing for thebenefit of the Secretary of War the events leading up to the controversy,started with a reference to the Air Surgeon's attempt to secure generalhospitals for AAF casualties in 1943.34 Further evidence to support such aninterpretation is the accusation by the Air Surgeon and members of his staffthat The Surgeon General was using delaying tactics. They charged that while heagreed to employ regional hospital beds for overseas casualties in an emergencyhe deliberately spun out negotiations in an effort to avoid taking that step atall.35 In any event, the distinction between general and regionalhospitals remained, and it continued to be the official policy of the Army totreat overseas evacuees in general hospitals only.
Development of Convalescent Hospitals
Convalescent hospitals were first authorized as types of Armyhospitals in the zone of interior in April 1944, but their origin lay in theearly war years.36 Under authority granted by the Secretary of War in July 1943, the Air Forces announced the establishment of eight convalescentcenters in September 1943. They were to operate in conjunction with station hospitals and were to rehabilitateAAF patients who had been treated in other hospitals or who had been evacuatedfrom theaters of operations solely because of operational fatigue.37 In June1943 the Service Forces began to establish convalescent annexes in hospitalbarracks, leased schools and inns, or vacated Army housing. Operated as parts ofgeneral hospitals, such annexes normally housed convalescent patients only fromthe hospitals to which they belonged, but one of them-the convalescent annexof England General Hospital, set up in leased hotels with a capacity for 2,600patients-served as a convalescent center for patients from other generalhospitals as well.38 Partly because of difficulties in findingsuitable housing for annexes, the program was slow in getting under way andconvalescent patients accounted for approximately 75 percent of the patient loadof general hospitals in the fall of 1943. Groups studying the hospital system atthat time agreed that convalescent patients should be removed from the wards
33Interv, MD Historian with Col John C. Fitzpatrick, MC,formerly MRO, SGO, 18 Apr 50. HD: 000.71.
34Memo, Chief Planning Br G-4 for ACofS G-4 WDGS, 21 Jun 45, sub:Conf with SecWar on Rpt of Surv of ZI Hosps. HRS: G-4 file, "Hosp, vol.IV."
35(1) Record of Tel Conv between [Maj] Gen [D. N. W.] Grant and[Brig] Gen Raymond W. Bliss, 7 Mar 45. HD: TAS 210.72lb "Care of OverseasCasualties in AAF Hosps." (2) Memo, [Lt Col Alonzo A. Towner, MC] for GenGrant, n d. Same file.
36See above, pp. 117-20.
37AAF Memo 20-12, 18 Sep 43. HD: AAF Memo 5-20 series.
38(1) 1st ind SPRMC 322 (18 Jun 43), CG ASF to SG, 22 Jun 43, on unknown basic ltr. SG: 632.-1. (2) Res Adopted by Fed Bd of Hosp, incl to Memo SPRMC 632 (19 Oct 43), CG ASF for CofEngrs, 27 Oct 43, sub: Auth for Estab of Conv Retraining Units at Gen Hosps. CE: 683 Pt I. (3) Ltr, SG to CG ASF, 30 Oct 43, sub: Program for Providing Conv Fac. SG: 632.-1. (4) An Rpt, 1944, Surg 2d SvC. HD.
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of general hospitals to permit fuller use of the latter'shighly specialized staffs.39
During 1944 the convalescent hospital program receivedimpetus from several sources. Early that year, after his Office had estimatedthe patient load for 1944, The Surgeon General requested that additional beds beprovided in convalescent "facilities," rather than in generalhospitals, to save personnel and to permit the reconditioning of patients forreturn to duty in a nonhospital atmosphere. In March ASF headquarters approvedthis proposal, and during subsequent months service commands, acting under ASFauthority, established convalescent centers in vacated barracks at Daytona Beach(Florida), Camp Lockett (California), Camp Carson (Colorado), Camp Atterbury(Indiana), Fort Sam Houston (Texas), Fort Custer (Michigan), and Fort Devens(Massachusetts).40
Meanwhile, a War Department circular authorized convalescenthospitals, as distinct from convalescent centers, annexes, and facilities.Accordingly, in June 1944 the War Department designated as convalescenthospitals two ASF and five AAF convalescent centers which The Surgeon Generaland the Air Surgeon selected for that purpose. Two months later, thirteenadditional ASF convalescent centers were designated as hospitals, andsubsequently other changes were made in the number in operation.41These hospitals remained in an experimental stage for the rest of 1944. Those ofASF served as places for housing and feeding ambulatory patients and forpreparing them through physical and military training for return to duty.Changes in barracks provided for such hospitals were held to a minimum. Theytherefore lacked classrooms, shops, and gymnasiums that were later-in 1945-considered essential. In addition, the scope of activities ofconvalescent hospitals was not clearly defined; their organization was notprecisely outlined by higher authorities; and they had little personnel andequipment of their own.42
An exception to this general situation was the Old FarmsConvalescent Hospital, in Avon, Conn. Established in May 1944 as a result of TheSurgeon General's and the President's interest in the rehabilitation ofblinded war casualties, this hospital soon afterward received personnel andequipment for a social-adjustment training program which continued throughoutthe war.43
In the fall and winter of 1944 several events brought theconvalescent hospital program to full fruition. During a movement of higherauthorities to reduce the numbers of beds in the United States, G-4 took upthe matter of convalescent hospitals and in November, as a part of a compromisesolution of the bed requirement problem, authorized 40,000 beds in AAF
39(1) Memo, unsigned and unaddressed, 23 Aug 43, sub: Status ofProgram for Estab of Conv Retraining Units. SG: 632.-1. (2) Memo, Dir HospAdmin Div SGO for Chief Oprs Serv SGO, 4 Dec 43, sub: Rpt of Trip to . . . Gen Hosps. SG: 333.1-1.
40(1) See below, pp. 201-02. (2) Memo, SG for CG ASF, 10 Mar 44, sub: Conv Fac. Off file, Gen Bliss' Off SGO, "Med Clarification of Disposition Policy." (3) ASF Cir 93, 4 Apr 44. (4) An Rpts, 1944, Surg 1st, 4th, 5th, 6th, and 7th SvCs; and An Rpts, 1944, Brooke Gen and Conv Hosps and Mitchell Conv Hosp. HD.
41WD Cirs 140, 11 Apr 44; 228, 7 Jun 44; and 352, 30 Aug 44.
42(1) Memo, SG for Dir Pers ASF, 22 Jul 44, sub: Estab of Conv Hosps. HD: 322 "Estab of Conv Hosps." (2) Memo, Eli Ginzberg for Pres WDMB, 23 Aug 44. HRS: ASF Planning Div file, 700 "ZI Hosp." (3) ASF Monthly Progress Rpt, Sec 7, Health, 31 May 44. (4) An Rpts, 1944, Surg 2d, 4th, 5th, and 7th SvCs; An Rpt, 1944, Mitchell Conv Hosp; An Rpts, 1945, Brooke and Wakeman Hosp Ctrs. HD.
43(1) History, Old Farms Convalescent Hospital [1947]. HD:319.1-2. (2) SG Ltr 162, 11 Sep 43.
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and ASF convalescent hospitals.44 This establisheda basis for the procurement of personnel and equipment for such installations. Afew weeks later, on 4 December 1944, the President directed the Secretary of Warto permit no overseas casualty to be discharged from the service until he hadreceived "the maximum benefits of hospitalization and convalescentfacilities," including "physical and psychological rehabilitation,vocational guidance, prevocational training and resocialization."45Such unlimited support from the Commander in Chief helped the Medical Departmentto get necessary means for an elaborate convalescent program, which The SurgeonGeneral's Reconditioning Consultants Division announced in December 1944.46
During the first half of 1945, ASF convalescent hospitalswere supplied with personnel and equipment of their own; the barracks in whichthey were located were remodeled; shops, classrooms, gymnasiums and recreationalfacilities were provided; and elaborate programs consisting of technical andprevocational training, general education, vocational counseling, occupationaltherapy, recreation, athletics, and entertainment were set up.47Thus, toward the end of the war, emphasis in the convalescent program shiftedfrom the preparation of patients for return to duty to their preparation forreturn to civilian life.
The operation of convalescent hospitals was a major factor inenabling the Medical Department to care for the peak load of patients in thesummer of 1945. It contributed to maximum use of specialists in generalhospitals. Furthermore, convalescent hospitals provided a better psychologicalenvironment for the care of many patients, especially those suffering fromneuropsychiatric disorders, than did general hospitals.48 Their value in the treatment ofmedical and minor surgical cases, however, was questioned in the middle of 1945,49 and general hospitals gradually adopted a practice of dischargingpatients of those types directly to civilian life.
Merger of Adjacent Hospitals
Besides suggesting the removal of convalescent patients fromgeneral hospitals, groups studying the hospital system in the fall of 1943proposed the merger of adjacent hospitals into single installations. Theestablishment of regional hospitals accomplished this in part, for in some casesnearby station hospitals were either wholly or partially merged with regionalhospitals.50 In the same period the Ninth Service Commandconsolidated the Vancouver Barracks Station Hospital with Barnes GeneralHospital, which was located on the same post.51 The next April TheSur-
44Memo, ACofS G-4 WDGS for CGs ASF and AAF, 17 Nov 44, sub: ZI Hosps. SG: 322 "Hosp Misc."
45Ltr, Franklin D. Roosevelt to SecWar, 4 Dec 44. HRS:ASF Control Div file, 705 "Cut-back in Gen and Conv Fac."
46(1) ASF Cir 419, 22 Dec 44, sub: Conv Hosp Revised Program.(2) TM 8-290, Educ Reconditioning, Dec 44. (3) TM 8-291, OccupationalTherapy, Dec 44. (4) TM 8-292, Physical Reconditioning, Dec 44.
47(1) An Rpt, FY 1945, SG. HD. (2) Richard L. Loughlin, [History of] Reconditioning [in the U. S. Army in World War II], (1946), HD. (3) Memo WDSIG 333.9 Hosp Fac (2), IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (4) An Rpts of Conv Hosps for 1945. HD. (5) Memo, Lt Col Gerard R. Gessner for Chief Hosp Div SGO, 4 Jun 45. HD: 333. 1-1.
48An Rpt, FY 1945, SG; and An Rpt, FY 1945, Hosp and Dom Oprs, SGO. HD.
49Memo, Dir Resources Anal Div SGO for Chief Oprs Serv SGO, 7Jun 45, sub: Criteria for Reduction in Hosp Fac. SG: 323.3 "Hosp."
50Memo, IG for DepCofSA, 28 Dec 44, sub: Hosp Fac in ZI.HRS: WDCSA 632 (25 Sep 44).
511st ind, CG 9th SvC to CG ASF attn SG, 22 Sep 43, on Ltr,SG to CG 9th SvC, 24 Aug 43, sub: Combination of Sta Hosp with Gen Hosp. SG:323.7-5 (Barnes GH)K.
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geon General's Facilities Utilization Branch made a studyof other sets of general and station hospitals located on the same Army posts,comparing personnel required to operate them as separate installations with thatneeded for their operation as consolidated hospitals. It appeared that fewerMedical Corps officers, particularly specialists, and fewer nurses would beneeded if station hospitals were merged with near-by general hospitals.52The Surgeon General's Office anticipated more efficient operation from thesupervision of the activities of two installations by one rather than twocommanding officers. Moreover, the commanders of general hospitals were subjectto less control by post commanders than were those of station hospitals-anadvantage from The Surgeon General's viewpoint. The mergers were not expectedto increase the number of general hospital beds immediately, because generalhospitals thus enlarged would still have to care for troops stationed on theirposts. Later as troops moved overseas, beds formerly used for station hospitalpatients could be transferred to general hospital use.53Accordingly, five station hospitals were consolidated with five generalhospitals in the summer of 1944, as follows: Fort Devens Station Hospital withLovell General Hospital, Fort Dix Station Hospital with Tilton General Hospital,Fort Bliss Station Hospital with William Beaumont General Hospital, FortBenjamin Harrison Station Hospital with Billings General Hospital, and DanteHospital in San Francisco with Letterman General Hospital.54
Attempts To Limit the Use of General Hospitals as Debarkation Hospitals
Another change in the hospital system occurred when TheSurgeon General modified the existing practice of using general hospitals located near ports as receiving and evacuationhospitals. Throughout the later war years Halloran, Stark, and Letterman GeneralHospitals continued to serve as debarkation hospitals, the latter two beingdevoted almost exclusively to that function as the evacuation load grew heavier.At various times during 1944 and 1945 other general hospitals-Lovell, Barnes,McGuire, Birmingham, LaGarde, Madigan, and Mason-served also in that way.55General hospitals accepted their roles as receiving and evacuation, ordebarkation hospitals reluctantly because the processing of patients in transitdid not require the fullest use of specialized equipment and staffs and becausehospitals engaged in that function had alternating periods of activity andidleness, depending upon the arrival of ships with patients.56 Severalofficers in the Surgeon General's Office were also dissatisfied with thepractice of having
52Memo, Chief Fac Util Br SGO for Chief Oprs ServSGO, 24 Apr 44, sub: Pers Study of Five Contiguous Sets of Sta and Gen Hosps.HD: Resources Anal Div file, "Hosp."
53(1) Ltr, SG to Fed Bd Hosp, 27 Jun 44, sub: Combination ofNamed Gen Hosp and Adj Sta Hosp. SG: 323.7-5. (2) Draft Ltr, SecWar (prepared by SGO) to Fed Bd Hosp, 12 Jul 44. SG: 322 "Hosp." (3) Interv, MD Historian with Maj Gen Norman T. Kirk, 20 Nov 51. HD: 314 (Correspondence on MS)V.
54Diary, 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 Jun44; No 32, 11 Aug 44; No 34, 25 Aug 44; and No 40, 6 Oct 44. AML. (2) An Rpt, FY1945, Hosp and Dom Oprs, SGO. HD. (3) Memo, Dir Resources Anal Div SGO for DirHD SGO, 25 Sep 45, sub: Operational Problems and Accomplishments in Med Serv,World War II. HD: 319 "Hosp." (4) Memo, SG for WDMB, 4 Oct 44, sub:Debarkation Hosps. SG: 322 "Hosp."
56(1) Memo, CO Halloran Gen Hosp for CG 2d SvC attn Surg, 21Feb 44, sub: Increased Bed Capacity. 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 Expansion by Conversion, McGuire Gen Hosp, with inds. SG: 632.-1 (McGuire GH)K.
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general hospitals perform dual functions. The MedicalRegulating Officer, for example, thought that this practice interfered withefficient operation of the evacuation system, and others agreed with hospitalcommanders that it was wasteful of both personnel and equipment.57 Whenchanges in the hospital system were being considered early in 1944. The SurgeonGeneral proposed establishment of a new type of hospital, to be known as areceiving and evacuation hospital and to be manned and equipped to perform onlythe processing of patients in transit.58 This proposal was notaccepted, and the circular outlining the revised hospital system in April 1944provided for the continued use of existing types of hospitals-station,general, or regional -for debarkation purposes.59 After that, inthe summer of 1944, Stark, Letterman, and Halloran separated general hospitalfunctions from debarkation work, becoming to that extent two hospitals in one.60
As the need for beds in both general and debarkationhospitals increased, The Surgeon General attempted to keep to a minimum the useof general hospitals for debarkation processing. In the summer of 1944 hesecured approval of ASF headquarters to use the Camp Edwards Station Hospital,instead of Lovell General Hospital, as a debarkation hospital for the port ofBoston. This action, he explained, would make available more general hospitalbeds in New England, a heavily populated section with only two generalhospitals. It would also help to economize in the use of Medical Corps officers,since debarkation hospitals required less elaborate staffs than generalhospitals.61 In the winter of 1944, as he planned to meet higher bedrequirements which his Office had estimated for 1945, The Surgeon General proposed to use other station hospitals-thoselocated at staging areas and operated by the Chief of Transportation-to freesome general hospitals of debarkation work and to provide additional debarkationbeds that would be needed for the anticipated load of casualties.62A survey made by the Inspector General's Office had already shown that stagingarea hospitals were being used only slightly, since few troops were being movedoverseas.63 The Chief of Transportation agreed to convert hospitalsin the staging areas of the ports of Boston (Camp Myles Standish), New York(Camp Kilmer and Camp Shanks), and Hampton Roads (Camp Patrick Henry) intodebarkation hospitals.64 This action made it
57(1) Memo, Lt Col John C. Fitzpatrick, MRO, for Col A. H. Schwichtenberg, Hosp Div SGO, 23 May 44. TC: 370.05. (2) Memo, Same for Chief Oprs Serv SGO, 1 Sep 44, sub: Rpt of Visit to San Francisco. HD: 705 (MRO, Fitzpatrick Stayback). (3) Memo, Lt Col Basil C. MacLean for Brig Gen R. W. Bliss, Chief Oprs Serv SGO thru Col A. H. Schwichtenberg, Dir HospAdmin Div, 2 Feb 44, sub: The More Efficient Util of Army Hosp Fac. Off file, Gen Bliss' Off SGO, "Util of Army Hosp Fac."
58Classification of Med Instls, Tab B to SGs Plan for theUtil of Med Off Pers in ZI, 29 Feb 44. HD: 322.051-1.
59WD Cir 140, 11 Apr 44.
60An Rpts, 1944, Stark, Halloran, and Letterman Gen Hosps.HD.
61(1) Memo, Dep SG for CG ASF, 1 Jun 44, sub: Util of Comd Fac: Designation of Cp Edwards a Gen Hosp. Off file, Gen Bliss' Off SGO, "Util of Army Hosp Fac." (2) Ltr, CG 1st SvC to CG ASF attn SG, 7 Jun 44, sub: Instls for Debarkation Hosp. SG: 322.15-1. (3) An Rpt, 1944, Cp Edwards Sta Hosp. HD.
62Memo, SG for Act Dir Plans and Oprs ASF, 8 Jan 45,sub: Gen Hosp Program, ZI. SG: 323.3.
63Memo, Act IG for DepCofSA, 28 Dec 44, sub: Hosp Fac in ZI. HRS: OCS 632 (25 Sep 44) Case No 28,"Hosp Fac in ZI."
64(1) 1st ind SPTOM 632, CofT to SG, 17 Jan 45, on Memo, SGfor Med Liaison Off, OCofT, 9 Jan 45. SG: 632. (2) Diary, Lt Col H. A. Huncilman,Planning Div ASF, 25, 27, and 29 Jan 45. HRS: Hq ASF Planning Div file, 700"ZI Hosps." (3) Diary, Hosp Div SGO, 31 Jan 45. HD: 024.7-3.
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TABLE 12-ASF DEBARKATION HOSPITALS
Port and Hospital | October 1944 | March 1945 | June 1945 | August 1945 | ||||||||
Total Beds | Dbktn Beds | Gen Hosp Beds | Total Beds | Dbktn Beds | Gen Hosp Beds | Total Beds | Dbktn Beds | Gen Hosp Beds | Total Beds | Dbktn Beds | Gen Hosp Beds | |
Boston | ||||||||||||
Edwards | 2,128 | 2,128 | 0 | a3,200 | 800 | 2,400 | 2,950 | 900 | 2,050 | (b) | --- | --- |
Boston POE | --- | --- | --- | 1,700 | 1,700 | 0 | 1,700 | 1,700 | 0 | --- | --- | --- |
New York | ||||||||||||
Halloran | 4,134 | 2,799 | 1,335 | 5,350 | 2,700 | 2,650 | 5,350 | 2,700 | 2,650 | 5,350 | 2,700 | 2,650 |
Kilmer | --- | --- | --- | 2,000 | 2,000 | 0 | 2,000 | 2,000 | 0 | 2,000 | 2,000 | 0 |
Shanks | --- | --- | --- | 2,300 | 2,300 | 0 | 2,300 | 2,300 | 0 | --- | --- | --- |
Mason | --- | --- | --- | 3,032 | 1,000 | 2,032 | 2,532 | 500 | 2,032 | 3,032 | 500 | 2,532 |
Hampton Roads | ||||||||||||
McGuire | 1,777 | 1,577 | 200 | --- | --- | --- | --- | --- | --- | --- | --- | --- |
Patrick Henry | --- | --- | --- | 1,100 | 1,100 | 0 | 1,100 | 1,100 | 0 | --- | --- | --- |
Charleston | ||||||||||||
Stark | 2,400 | 2,162 | 238 | 2,400 | 2,125 | 275 | 2,400 | 2,125 | 275 | 2,400 | 2,125 | 275 |
New Orleans | ||||||||||||
LaGarde | 926 | 150 | 776 | 1,176 | 0 | 1,176 | 1,300 | 0 | 1,300 | --- | --- | --- |
Los Angeles | ||||||||||||
Birmingham | 1,727 | 717 | 1,010 | 1,777 | 800 | 977 | --- | --- | --- | --- | --- | --- |
Camp Haan | --- | --- | --- | --- | --- | --- | 800 | 800 | 0 | 800 | 800 | 0 |
San Francisco | ||||||||||||
Letterman | 2,338 | 2,000 | 338 | 3,500 | 3,140 | 360 | 3,500 | 3,140 | 360 | 3,500 | 3,140 | 360 |
Seattle | ||||||||||||
Madigan | 3,880 | 500 | 3,380 | 4,300 | 1,000 | 3,300 | 4,300 | 1,000 | 3,300 | 4,380 | 1,000 | 3,380 |
| 19,310 | 12,033 | 7,277 | 31,835 | 18,665 | 13,170 | 30,232 | 18,265 | 11,967 | 21,462 | 12,265 | 9,197 |
All Sta Hosps Used for Debarkation purposes | 2,128 | 2,128 | 0 | 7,100 | 7,100 | 0 | 7,900 | 7,900 | 0 | 2,800 | 2,800 | 0 |
All Gen Hosps Used for Debarkation purposes | 17,182 | 9,905 | 7,277 | 24,735 | 11,565 | 13,170 | 22,332 | 10,365 | 11,967 | 18,662 | 9,465 | 9,197 |
aCamp Edwards StationHospital was designated a General Hospital in February 1945.
bIn this table no figures are listed for beds in hospitals atthe times when those hospitals were not being used for debarkation purposes.
Sources: (1) Memo SPMCH, SG for WDMB, 4Oct 44, sub: Debarkation Hosp. SG: 322 Hosp. (2) Weekly Hosp Rpts, vol. II, No.13, 30 Mar 45; No. 25, 22 Jun 45; and No. 35, 31 Aug 45.
unnecessary to devote more space in Halloran GeneralHospital to debarkation work and made it possible to free all of McGuire GeneralHospital and the Camp Edwards Station Hospital, which was converted into ageneral hospital, for specialized medical and surgical treatment. (Table 12) Laterin 1945 the Camp Haan Regional Hospital took over from Birmingham GeneralHospital the processing of patients debarked at Los Angeles.65Thus, the Surgeon General's Office tried gradually to limit the practice ofusing general hospital facilities for debarkation work.
As the evacuation of patients by air increased during 1944and 1945 the Air Forces selected certain station and regional hospitals locatednear important landing fields to receive and process patients
65(1) Memo, Dir Resources Anal Div SGO for Maj [James J.] Souder, 22 Mar 45, sub: Debarkation Beds. HD: Resources Anal Div file, "Hosp." (2) Diary, Hosp Div SGO, 7 and 11 Apr 45. HD: 024.7-3. (3) Memo, CG ASF for CofEngrs, 11 Apr 45, sub: Pnt Unloading Fac, Cp Haan Hosp. SG: 322 "Hosp."
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brought to them. By October 1944 beds were set aside ineleven AAF hospitals for this purpose.66 Six were used for debarking patientsin emergencies only. The other five, located at Mitchel Field (New York), CoralGables (Florida), Hamilton Field (California), Great Falls (Montana), andPortland (Oregon), were devoted almost exclusively to processing patientsevacuated by air.67 In the late spring of 1945 the Air Forces, withthe concurrence of The Surgeon General, planned to establish a new type of zoneof interior installation, called a holding facility, at the Fairfield-SuisunField (California). It was designed to perform only one function-theprocessing of patients who were in transit to other hospitals for definitivetreatment.68 Although the war ended before it was constructed, itsapproval represented a further development in the movement toward the use ofless elaborate facilities than general hospitals for debarkation purposes.
Extension of the Practice of Establishing Specialized Centers
Extension and further development of the practice ofestablishing centers for specialized treatment in general hospitals constitutedanother adjustment in the hospital system during the later war years. Until themiddle of 1944 specialty centers in general hospitals took up only a smallproportion of their total beds and were established piecemeal to meet needs asthey arose, without regard to eventual requirements for beds for specializedtreatment. This situation came about because an army in training needed lessspecialized care than one in combat, because it was difficult to predict typesand amount of specialized treatment that would be needed, and because hospitals themselves opened successivelyrather than all together. By the time of the invasion of Europe, the peakpatient load had been estimated and the last of the general hospitals, with theexception of four temporary ones authorized in 1945, were about to beginoperation. Enough experience in hospital admissions had accumulated to permit abreakdown of the anticipated patient load in terms of types of wounds, diseases,and injuries. Furthermore, an increasing shortage of specialists made theirconcentration for maximum use more imperative than ever. Thus, whatever the needfor 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 Utilization Branch collaborated with hisprofessional consultants in a study of the need for specialized centers and inthe preparation of a comprehensive plan to meet it.69
The general features of this plan, announced in a WarDepartment circular in August 1944, remained unchanged through the remainder ofthe war. Related
66AAF Debarkation Hosp, incl to Memo, SG for WDMB, 4 Oct 44,sub: Debarkation Hosp. SG: 322 "Hosp."
67Memo, Act IG for DepCofSA, 28 Dec 44, sub; Hosp Fac inZI. HRS: OCS 632 (25 Sep 44) Case No 28, "Hosp Fac in ZI."
68(1) S/S, CG AAF to ACofS G-4 WDGS, CofSA, and SecWar, 27Apr 45, sub: Debarkation Hosp, Fairfield-Suisun Army Air Fld. (2) DF WDGDS12801, ACofS G-4 WDGS to CofSA, 10 May 45, same sub. (3) Ltr, SecWar to Brig Gen Frank T. Hines, Chairman Fed Bd Hosp, 15 May 45. All in HRS: OCS 632.
69(1) Ltr, SG to CG 4th SvC attn SvC Surg, 14 Jun 44,sub: Specialized Gen Hosp. SG: 323.7-5 (4th SvC)AA. Similar letters were sentto the rest of the service commands. (2) Plan for Specialized Hosp, by [Dr.] Eli Ginzberg, Spec Asst to Dir Hosp Div SGO, 27 Jul 44. HD: Resources Anal Div file, "Hosp." (3) ASF Monthly Progress Rpt, Sec 7, Health, 31 Jul44, pp. 29-31.
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specialties were grouped in the same hospital to improve thequality of professional care. For example, neurosurgical and neurologic centerswere established together, and centers for general medicine were set up inhospitals specializing in the treatment of arthritis, tuberculosis, andrheumatic fever. Attempts were made to locate specialty centers in relation topopulation density, to permit compliance as far as possible with the policy ofhospitalizing patients near their homes. Success in such attempts was limited byat least two factors: (1) there were proportionately fewer general hospitals indensely populated areas such as the Northeast than there were in the South andSouthwest, where they had been located initially to serve large concentrationsof troops in training, and (2) it was either possible or desirable to establishonly a limited number of centers-in some instances as few as two-in certainspecialties such as tuberculosis, arthritis, and treatment of the blind.
The size of centers increased as the patient load grew.Although professional consultants of the Surgeon General's Office believedthat they should be kept reasonably small, the Facilities Utilization Branchconsidered it more economical of personnel, particularly specialists, to limitthe number but increase the size of centers. In the fall of 1944, for example,amputation centers were increased from 500 to 750 beds each and neurosurgicalcenters from 250 to 500. Subsequently, to care for the peak patient load,capacities were further increased, some centers having 2,000 or more beds.
Centers for additional specialties were established to meetnew needs and achieve fuller use of specialists of all kinds. For example,patients suffering from tropical diseases and trench foot became so numerous as to warrant thedesignation of centers for the treatment of those conditions, and a shortage ofinternists prompted the establishment of general medicine as a specialty.General and orthopedic surgery also became specialties as the field of surgerywas narrowed by the establishment of centers for various surgical specialties.As a result, the major portion of beds in general hospitals was gradually givenover to specialized treatment, and general hospitals became in effectspecialized hospitals. By the time the peak patient load was reached in June1945, there were 234 centers for 21 specialties with a total of 132,178 beds in65 general hospitals in the United States.70
General Hospitals for Prisoners of War
A further change in the hospital system resulted from thecapture by American forces of large numbers of prisoners of war. For German andItalian prisoners who became sick or were injured while in internment camps inthis country, the system of hospitalization formerly established was changedonly slightly during the latter half of the war. Such prisoners continued to betreated in station hospitals located either in internment camps or on near-byArmy posts and, when they needed a higher type of care, in general
70(1) See last note above. (2) WD Cir 347, 25 Aug 44. (3) ASF Cir 284, 30 Aug 44. (4) Ltr SPMCH 323.3 (7th SvC)AA, SG to CG 7th SvC attn Surg, 10 Aug 44, sub: Specialized Gen Hosps. HD: Resources Anal Div file, "Hosp." (5) Tab B to Memo, Dir Hosp Div and Dir Resources Anal Div for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (6) Table entitled "Authorized Patient Capacities in General Hospitals by Specialty as of 30 June 1945," prepared by Resources Analysis Division,30 June 1945. Off file, Resources Analysis Div, SGO.
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hospitals operated for U. S. Army patients. All Japaneseprisoners were concentrated, since they were few in number, in the stationhospital at Camp McCoy, Wis.71
In the second half of 1943 the offices of The Surgeon Generaland The Provost Marshal General collaborated in establishing procedures for thereception, examination, and transportation of a new category of prisoners -thoseevacuated as patients from theaters of operations.72 Early the nextyear they restated these procedures and designated five general hospitalslocated near ports to receive and sort such patients and to transfer them toother hospitals for further treatment. At the same time, they specified certaingeneral hospitals for the care of tuberculous, insane, blind, and deafprisoners; and, in order to simplify the observance of security andadministrative regulations, they adopted a practice of concentrating allprisoners who needed general-hospital-type care-those evacuated as patientsfrom theaters of operations as well as those transferred from internment camps-inone general hospital if possible, and in not more than three in any instance, ineach service command.73 These steps did not solve all problems.Some general hospitals continued to be inadequately prepared to carry outsecurity measures; and even though prisoners were concentrated more thanformerly, they were still scattered among hospitals in nine service commands.Such dispersal made difficult the work of a commission charged with determiningthe eligibility of some prisoners for repatriation as well as that of a groupresponsible for certifying others for "protected status" as medicalpersonnel, under the terms of the Geneva Convention.74
In anticipation of an influx of prisoner-of-war patients after the invasion of Europe and in the hope of solving some of the administrative problems caused by the existing system of hospitalization, The Surgeon General's liaison officer with The Provost Marshal General proposed in July 1944 that at least one general hospital be devoted exclusively to German prisoners of war. It could be used to sort incoming patients, to treat those needing general-hospital-type care, to process those eligible for repatriation, and to hold others awaiting certification as protected personnel.75 His superior, the Deputy Chief for Hospitals and Domestic Operations, adopted this idea and announced on 21 July 1944 that The Surgeon General was designating Glennan General Hospital as a German prisoner-of-war general hospital.76
Two months later The Surgeon General asked for an entire Army post for use as a second hospital ofthis 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, OPMC. (3) TWX, PMG to CG each SvC, 4 Jan 45, in An Rpt, FY1945, PW Liaison Unit SGO. HD. (4) Diary, Hosp Div SGO, 7 Oct 44. HD: 024.7-3.(5) Hosp, Evac, and Disposition of PW Pnts in US, by Lt Col James T. McGibony,MC. HD: 383.6.
72WD Cir 214, 15 Sep 43.
73PW Cir 11, 8 Feb 44. Off file, PW Off, OPMG.
74(1) Memo SPMGA 383.6 (59), Maj Rene H. Juchli for Act Dir PW Div OPMG, 23 Feb 44, sub: Rpt of Second Repatriation of German PW. (2) Memo SPMGA 383.6 (59), same for Asst PMG, 10 Apr 44, sub: Immed Designation of Cp for Reception of Protected Pers and Repatriable PW. (3) Ltr, same to PMG, 13 May 44, sub: Rpt of Third Repatriation Move, German PW. (4) Ltr, same to Dir Hosp Admin Div SGO, 13 Aug 44, sub: Rpt of Handling PW as Observed at NYPE and Halloran Gen Hosp. All in HD: 319.1-2.
75Memo, Chief PW Liaison Unit SGO for SG attn Col A. H.Schwichtenberg, 17 Jul 44, sub: Reception, Hosp, Treatment, and Disposition ofPnts among PW and Protected Pers. HD: 319.1-2.
76Memo, Dep Chief for Hosp and Dom Oprs SGO for PMG, 21 Jul 44,sub: Hosp Fac for PW. HD: Resources Anal Div file, "Hosp."
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pressure at this time to reduce the number of beds inhospitals in the United States, ASF headquarters suggested the use of vacantbeds in existing hospitals instead. The Surgeon General objected to thisproposal, averring that all existing general hospital beds-according to hisestimates-would be needed by the end of the year for American patients, thatthe treatment of prisoner-of-war patients who needed general-hospital-type carein station hospitals would violate the terms of the Geneva Convention, and thatthe dispersion of prisoner-patients among many regional and station hospitalswas wasteful of both medical and police personnel. Early in October, therefore,ASF headquarters and G-4 approved the designation of the station hospital atCamp Forrest (Tennessee) as Prisoner of War General Hospital No. 2.77 Theestablishment of a third prisoner-of-war general hospital was made unnecessaryby a change in policy. At the end of October 1944 the Chief of Staff directedthe European theater not to transfer prisoner-of-war patients to the UnitedStates except rabid Nazis and those desired for questioning for intelligencepurposes.78 After V-E Day, the repatriation of prisoners made itpossible to return Glennan General Hospital to the treatment of Americans inJune 1945, to discontinue the general hospital at Camp Forrest in December 1945,and to close that camp itself in April 1946.79
The operation of two general hospitals devoted exclusively tothe care of prisoner-of-war patients simplified administrative and securityproblems and ultimately saved American medical personnel. Prisoner-patientsarriving at ports in this country were transferred to either Glennan or CampForrest. There they were sorted into three groups. Those who were convalescent were transferred to convalescent annexes; thoserequiring care for only minor ills or injuries were sent to near-byprisoner-of-war station hospitals; and those requiring more specializedtreatment were kept at one of the prisoner-of-war general hospitals. Inaddition, prisoners who were eligible for repatriation or for certification asprotected personnel were held in special facilities at these hospitals. Aftertheir eligibility had been verified, the former were returned to Germany and thelatter were assigned to the staffs of prisoner-of-war hospitals to care fortheir compatriots.80 For a time, prisoner-of- war general hospitalshad duplicate staffs of American and German personnel. In January 1945 the chiefof The Surgeon General's Prisoner of War Liaison Unit reported that the Germanstaffs of such hospitals were requesting repatriation because they were givenlittle opportunity to do actual medical and surgical work. He recommended theremoval of all American medical personnel except the minimum required for keysupervisory positions. The next month the Surgeon General's Office issueddirectives
77(1) Memo, SG for CG ASF, 13 Sep 44, sub: Add Hosp Fac for PW Pnts. SG: 383.6. (2) Memo, SG for CofS ASF, 4 Oct 44, sub: Hosp Fac for German PW Pnts. SG: 322 "Hosp." (3) Diary, Hosp Div SGO, 6 Oct 44. HD: 024.7-3.
78(1) Rad CM-OUT-53129, Marshall to Eisenhower, 27 Oct 44. SG: 383.6. (2) Memo SPMOC 383.6 (30 Oct 44), CG ASF for SG, n d, sub: Hosp Facfor German PW Pnts. Same file.
79(1) Diary, Hosp Admin Br Hosp Div SGO, 8 May 45. HD: 024.7-3.(2) Diary, PW Liaison Unit SGO, 24 May 45. Same file. (3) Hosp, Evac, andDisposition of PW Pnts in the US, by Col McGibony, MC. HD: 383.6.
80(1) Diary, Hosp Div SGO, 7 Oct 44. HD: 024.7-3. (2) Memo, Chief Med Liaison Br for Asst PMG, 27 Jan 45, sub: Study of Enemy Repatriation. HD: 319.1-2. (3) Ltr, Chief PW Med Liaison Unit SGO to SG and PMG, 7 Apr 45, sub: Rpt of Visit to PW Gen Hosp No 2, Cp Forrest, Tenn. Same file.
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to require compliance with this recommendation.81
Establishment of Hospital Centers
A final change in the hospital system was the establishmentof hospital centers. During 1944 convalescent hospitals were opened in severalinstances on the same posts as general hospitals. With the expansions of 1945these hospitals grew beyond all previous expectations. For example, by April1945 the Percy Jones General and Convalescent Hospitals, with their annexes, hada strength, including both patients and operating personnel, of more than16,500. This was greater than that of an infantry division. These installationsoccupied not only the Percy Jones General Hospital building, located in BattleCreek, Mich., but also almost all of Fort Custer, which was situated near by. Inmost instances such installations operated under separate commanders. Each hadits own administrative organization for activities such as receiving anddisposing of patients; feeding, clothing, and paying both patients and operatingpersonnel; and handling mail, personnel records, and legal problems. Eachexercised administrative control over its own patients, requiring the transferof records and a change of command every time a patient was transferred from oneto the other.82
Early in 1945, the chief of the Surgeon General'sOperations Service decided that combination of such installations under ahospital center commander would simplify the administration of supply andservice activities and would permit the transfer of patients between adjacentgeneral and convalescent hospitals without red tape. This had proved to be truewhen hospital centers were established overseas. Meanwhile, the Percy JonesGeneral Hospital had already begun to centralize under a single headeach activity common to both hospitals. Therefore the Operations Service sentrepresentatives to observe its organization and operations, and to discuss withits commander plans for establishing hospital centers. These representativesfound merit in such centralization, and the Surgeon General's Office decided toapply it to other installations.83
In establishing hospital centers the Medical Departmentencountered several difficulties. There was opposition in the General Staff,because G-3 feared that additional personnel would be requested to manhospital center headquarters.84 The Surgeon General's Officebelieved that the integration of activities common to both general andconvalescent hospitals under a single command would actually save personnel andtherefore agreed to a condition imposed by the General Staff in approvinghospital centers. Personnel for center headquarters would be a part of, and notan addition to, that already provided for general and convalescent hospitals.85On 11 April 1945 the War Depart-
81(1) Memo SPMGO(4)383.6, Chief Med Liaison Br SGO for Dep Chief Hosp and Dom Oprs SGO, 8 Jan 45, sub: Util of Enemy Protected Pers. HD: 319.1-2. (2) Rad, Lull (SGO) to CGs 4th, 7th, 8th, and 9th SvCs, 5 Feb 45. HD: 319.1-2. (3) An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD.
82An Rpts, 1945, Percy Jones, Wakeman, and Cps Butnerand Carson Conv Ctrs. HD.
83Interv, MD Historian with Col McGibony, MC, 20 Feb 50.HD: 000.71.
84Diary, Hosp Div SGO, 31 Mar and 2 Apr 45. HD: 024.7-3.
85(1) WD AGO Form No 026, Request and Justification forPublication, prepared by SGO, 24 Feb 45, sub: Hosp Ctr (ZI). (2) Memo SPMCH300.5 (WD Cir), SG for TAG thru CG ASF, 6 Mar 45, sub: Proposed Amendment to WD Cir 140, 1944. (3) Memo, SG forACofS G-4 WDGS, 31 Mar 45, same sub. (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.
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ment announced that nine hospital centers, each composed of ageneral and a convalescent hospital, would be established at Camp Pickett, Va.;Camp Butner, N. C.; Camp Edwards, Mass.; Camp Carson, Colo.; Camp Atterbury,Ind.; Fort Custer, Mich.; Fort Sam Houston, Tex.; Fort Lewis, Wash.; and CampForrest, Tenn.86 Local commanders then ran into problems inconsolidating and reorganizing general and convalescent hospitals into hospitalcenters. Lacking authoritative standard guides, center commanders proceededaccording to their own ideas or the demands of the local situation to set uporganizations, establish administrative procedures, and work out relationshipswith subordinate components, on the one hand, and with post headquarters, on theother.87
Despite these difficulties the establishment and operation ofhospital centers proved advantageous. The administration of supply and serviceactivities by center headquarters freed hospital commanders of administrativedetail, saved personnel, and avoided duplication of effort in those fields.Centralization also made it easy to shift personnel between hospitals as it wasneeded. Finally, the operation of a single registrar's office for both generaland convalescent hospitals made it possible to move patients from one to theother by simple inter-ward transfers, rather than by the complicated proceduresrequired when they were moved between separate installations.88
The establishment of hospital centers represented the last of a succession ofadjustments in the hospital system during the war. While most of them wereprompted primarily by the necessity of using limited resources effectively,other considerations entered in. For example regional hospitals developedpartially from attempts of the Air Forces to establish a completely separatemedical service while convalescent hospitals received an additional impetus froma belief that convalescent patients could best be restored to physical conditionfor full duty or prepared for return to civilian life in an installation with anonhospital atmosphere. Some of the changes made in the latter part of the war,such as specialization in general hospitals, had their origins earlier and weredesigned to improve the quality of hospital care. Others, such as the merger ofadjacent station and general hospitals and the establishment of hospitalcenters, were expected to improve administration. Since most of the changes werethe result of wartime demands, when peace came the need for them no longerexisted and the hospital system in the United States reverted to its prewarform.
86WD Cir 115, 11 Apr 45.
87(1) An Rpt, FY 1945, Percy Jones Hosp Ctr; and An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD. (2) Edward J. Morgan and Donald O. Wagner, The Organization of the Medical Department in the Zone of the Interior (1946), pp. 162-64. HD.
88An Rpts, 1945, Percy Jones, Wakeman, and Cps Carson and Butner Hosp Ctrs; and An Rpt, FY 1945, Hosp and Dom Oprs SGO. HD.
