CHAPTER XI
Bed Requirements in the Zone of Interior
While most changes in the hospital system, discussed in theforegoing chapter, were expected to conserve medical resources, especiallyphysicians, they obviously were not expected to reduce the total number of bedsthat would be needed. In some instances, such changes actually tended toincrease bed requirements, for policies making it impossible to place patientsof a particular type in any available vacant bed occasionally required theprovision of more beds than otherwise needed. Under current policies, forexample, vacant beds in regional hospitals could not be used for overseaspatients to reduce the number of additional beds required in general hospitals.Also, vacant beds in station hospitals could not be used for prisoner-of-warpatients requiring general-hospital-type care to avoid the establishment ofspecial prisoner-of-war general hospitals. Furthermore, the practice ofproviding different types of hospitals for different types of patientscomplicated the calculation of requirements, since beds needed for differentgroups had to be estimated separately. Another factor which increased thedifficulty of estimating bed requirements was the transition from the defensiveto the offensive phase of the war. Because of uncertainty about the tempo andscope of combat operations and about the kind of warfare to be encountered itwas always more difficult to predict numbers of combat casualties than numbersof patients resulting from the normal incidence of diseases and accidentalinjuries. Nevertheless, estimates had to be made and it was important to makethem as accurate as possible. Failure to have enough beds at any particularmoment would not only subject The Surgeon General and the Army to severecriticism but would also jeopardize the treatment of American casualties. Tohave more beds than were needed would waste personnel and might mean, in theface of the ceiling imposed upon Medical Corps officers, inadequate manning ofthe hospitals provided. The Surgeon General's Office, ASF headquarters, theGeneral Staff, and other agencies of the Government participated in determiningbed requirements, and differences of opinion that arose among them illustratedthe complexity of the process.
Despite the restrictive personnel situation in the fall of1943, The Surgeon General's Hospital Division continued to consider theproblem of meeting bed requirements primarily in terms of construction.Following the former practice of figuring bed requirements on the basis of WorldWar I experience, it estimated that the number of required station hospital bedswould decrease from about 256,000 in December 1943 to about 80,000 in December1945, but that the number of beds needed in general hospitals would increase
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from about 98,500 to over 122,000 in the same period.1To meet the anticipated need for general hospital beds, The SurgeonGeneral in September 1943 requested ASF headquarters to earmark and retain fundsthat had been appropriated but not used for the construction of approximatelyfifteen additional general hospitals. The latter refused, insisting that anyadditional general hospital beds that would be needed could be establishedwithout further construction in station hospital buildings that would becomesurplus as troops moved overseas.2
First Attempt To Base Requirements on an Estimate ofthe Patient Load
Late in 1943 the prospect of the invasion of Europe, along with limitedamounts of available personnel, and uncertainty about the patient load,necessitated a more realistic appraisal of requirements and resources than anyformerly made. The Surgeon General borrowed personnel from ASF headquarters, itwill be recalled, to establish a special group in his Office for this purpose.In the winter of 1943-44 this group, later known as the Facilities UtilizationBranch, attempted to predict the size of the patient load throughout the worldduring 1944.3 It admitted that it was "upagainst the difficulty of working with figures that had little firmness,"4and its calculations rested upon a series of estimates: the number of troops tobe engaged in combat; the rate at which troops in theaters would suffer wounds,accidental injuries, and diseases; and the proportion of patients in theatersthat would be evacuated to the United States.
Some of the estimates were basedon current World War II information while others rested primarily upon World WarI experience. Projected troop strengths for theaters were known, but theproportion of troops to be engaged in combat had to be estimated. Records wereavailable to show the rate at which disease and nonbattle injuries occurred,but information about World War II battle-injury rates was meager. To estimatethese rates the experience of the Meuse-Argonne fighting in World War I wascombined with that of the Tunisian campaign (1943), Tarawa operation (1943), andthe German campaign in Russia (1941). Information about the German campaign,incidentally, was found in a study prepared by the Office of Strategic Services.The proportion of overseas patients who would be evacuated to the United Stateswas estimated on the basis of World War I experience, "reinforced by thederived estimate of the German experience in the Russian campaign." Thisestimate-30 percent of estimated battle casualties and 3 percent of estimateddisease and nonbattle-injury cases-differed only slightly from figures forWorld War I. These estimates were used to calculate the number of patients whowould need beds in theaters of operations as well as the number who would beevacuated to the United States. To arrive at the number of patients from thezone of interior who
1(1) Memo, SG (Hosp Cons Br) for CofEngrs, 24 Aug 43, sub: Review of Est for FY 1944. SG: 632.-2. (2) Ltr, SG (Hosp Cons Br) to CofEngrs, 18 Nov 43, sub: MD Cons Reqmts for FY 1945. SG: 632.-1. (3) 1st ind, SG (Hosp Cons Br) to CofEngrs, 24 Jan 44, on Ltr, CofEngrs to SG, 18 Jan 44, sub: Engr . . . Estimates, FY 1945. SG: 632.-1.
2Ltr, SG to CG ASF, 2 Sep 43, sub: Retention of Appropriated Funds for Gen Hosp Cons, with 1st ind, Reqmts Div ASF to SG, 19 Sep 43. SG: 632.-1.
3(1) An Rpt, FY 1944, Dep Chief Hosp and Dom Oprs SGO. HD. (2) Tab A, sub: Estab of a Statistical Management Unit in the Oprs Serv, to Memo, Dir Hosp Div SGO and Dir Resources Anal Div SGO for Dir HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (3) Ltr, [Dr.] Eli Ginzberg to Col Calvin H. Goddard, 2 Jan 52. HD: 314 (Correspondence on MS)V.
4Hosp and Evac: A Re-estimate of the Pnt Load and Fac, Feb 44, Introduction, p. 1. HD: 705.-1.
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would need beds in general hospitals, recent experience in transfers fromstation hospitals (0.5 percent of the troop population) was applied to theprojected strength for 1944.
From the calculations and interpretations of this study the Surgeon General'sOffice estimated that 140,000 beds would be required during 1944 to accommodatepatients evacuated from theaters of operations and transferred from zone ofinterior hospitals. Such patients would normally have been provided for ingeneral hospitals, but on this occasion The Surgeon General did not ask for anincrease in general hospital beds to 140,000 or even to the 115,000 which,according to his previous calculations on the old percentage basis, would beneeded by the end of 1944. Instead, in view of the limited number of physiciansavailable and the fact that about 75 percent of the patients in generalhospitals were convalescent, he accepted the existing authorization of 100,000general hospital beds and proposed in February 1944 that an additional 40,000beds be provided in convalescent "facilities." Such facilities couldbe operated either as annexes of general hospitals or as separate installationsand would require lower ratios of personnel (especially physicians) to patientsthan did general hospitals.5
Suspecting that The Surgeon General's figures were too high, ASFheadquarters made a thoroughgoing study of its own. Its Planning Divisionconferred with representatives of the Surgeon General's Office, the Office ofthe Chief of Transportation, and other interested staff divisions of ASFheadquarters. It also communicated with the chief surgeons of the European andNorth African theaters. Different agencies, using battle-casualty admissionrates that varied widely, arrived nonetheless at similar estimates of thepatient load, particularly for the first ninety days of operations on theEuropean continent.6 In March 1944,therefore, ASF headquarters for the most part approved The Surgeon General'srecommendation. It authorized the conversion of vacant barracks to provide25,000 beds for convalescent patients and agreed to earmark space for 25,000more if needed.7 The Surgeon Generalthen began to establish convalescent facilities thus authorized but ASFheadquarters apparently did not seek approval of the General Staff (G-4) for theexpansion. As a result the Medical Department failed to get adequate personneland equipment for the facilities that were established until the approval of G-4was finally obtained in the fall of 1944.
Movement To Reduce the Number of Hospital Beds in the United States
During the spring and summer of 1944 other problems, such aschanges in the hospital system and the provision of medical support for theatersof operations,8 demanded more attention thanzone of
5The above two paragraphs are based on the following: (1) Hosp and Evac: A Re-estimate of the Pnt Load and Fac, Feb 44. HD: 705.-1. (2) Memo, SG for Dir Plans and Oprs ASF, 22 Feb 44, sub: Hosp and Evac. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (3) Ltr, Eli Ginzberg to Col Calvin H. Goddard, 2 Jan 52, HD: 314 (Correspondence on MS)V.
6(1) Memo, Dir Plans and Oprs ASF for Dir Planning Div ASF, 28 Feb 44, sub: Hosp and Evac. HRS: Hq ASF Gen Lutes' files, "Hosp and Evac, 1943-46." (2) Memo, Dir Planning Div ASF for Dir Plans and Oprs ASF, 1 Mar 44, sub: Hosp and Evac. HRS: Hq ASF Planning Div Program Br file, "Hosp and Evac, vol. 3." (3) Memo, Dir Planning Div ASF for Chief ZI Br Planning Div ASF, 2 Mar 44, same sub. Same file. (4) Hosp and Evac: An Anal, Mar 44. HRS: Hq ASF Planning Div Program Br file.
7Memo, CofS ASF for Dir Plans and Oprs ASF, 28 Mar 44, sub: Conf on Hosp and Evac. HRS: ASF Planning Div Program Br file, "Hosp and Evac, vol. 3."
8See above, pp. 181-99, and below, pp. 214-37.
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interior bed requirements, but gradually a tendency developed among manyagencies to question the need for all of the beds previously authorized. By thefall of 1944 this tendency developed into a general movement to reduce theirnumber.
The demand to reduce the number of beds in zone of interior hospitals aroseat first from observation of the low rate of occupancy. Statistics published bythe Surgeon General's Office showed that only about half of the beds in allhospitals in the United States were used during most of 1944.9(Chart 8.) Furthermore, optimism about an early end of the war made itseem unlikely to officers in ASF headquarters and the General Staff that theoccupancy rate would increase appreciably.10Meanwhile various expedients were being used to supply theaters with theirquotas of beds, among them the shipment of hospital units without fullcomplements of professional personnel.11 TheDeputy Chief of Staff expressed the opinion that this practice would beunnecessary if medical personnel and facilities were properly used. He thereforedirected The Inspector General in September 1944 to investigate duplication ofhospitalization in the United States.12 Bythat time ASF headquarters, the War Department Manpower Board, and divisions ofthe General Staff had already begun to make their own estimates of bedrequirements in the zone of interior.
A reduction in the authorized ratio of station hospital beds had been madeseveral days before the Deputy Chief of Staff criticized the use of medicalresources. As early as May 1944, in the course of discussions with the GeneralStaff about nurse requirements, The Surgeon General's Facilities UtilizationBranch had informally proposed a reduction from 4 to 3.6 percent of troopstrength.13 The General Staffaccepted this suggestion immediately, but it was not until 20 September 1944that a new ratio of 3.5 percent-formally proposed by The Surgeon General inAugust-was established by War Department directive.14The same directive, however, authorized for the first time a ratio forregional hospital beds: 0.5 percent of troop strength. Formerly used to estimatethe number of beds in general hospitals needed to care for zone of interiorpatients transferred from station hospitals, this figure was adopted becausesuch patients were eventually to be transferred to regional instead of generalhospitals. Since no corresponding reduction was made in the number of bedsauthorized for general hospitals it is difficult to see that the reduction inthe station hospital bed ratio meant any reduction in the total number of bedsauthorized. In any event, this action must have seemed to authorities higherthan The Surgeon General as only a step in the right direction.
The ASF Director of Plans and Operations proposed a reductionin the number
9(1) Weekly Health Rpts, vol. IV, Nos 1-39, 1944. AML. (2) ASF Monthly Progress Rpts, Sec 7, Health, Mar-Aug 44.
10(1) Remarks by Col Albert H. Schwichtenberg, MC, in Notes on Conf of AAF Comd Surgs, Off of Air Surg, 16-20 Apr 45. SG: 337. (2) Interv, MD Historian with Lt Col James T. McGibony, MC, 20 Feb 50. HD: 000.71.
11See below, pp. 218-28.
12(1) Mins, Mtg of Gen Council, 25 Sep 44. HRS: AGO Reference Collection. (2) Memo WDCSA 632 (25 Sep 44), DepCofSA for IG, 25 Sep 44, sub: Hosp Fac in ZI. HRS: WDCSA 632 (25 Sep 44), Case 28, "Hosp Fac in ZI."
13Memo SPMCH 211 Nurses, Eli Ginzberg for Maj Armour, G-3 WDGS, 25 May 44, sub: Almt of Nurses. HRS: G-3 files, 210-219 incl, "vol. II."
14(1) DF, Dep ACofS G-3 WDGS to WDMB, G-1 and G-4, 10 Jun 44, sub: Almt of Nurses. HRS: G-3 files, 210-219 incl, "vol. II." (2) Memo, SG (init E. G[inzberg]) for ACofS G-3 and G-4 WDGS thru CG ASF, 29 Aug 44. SG: 632.2. (3) Memo WDGCT 211 (26 May 44), Dep ACofS G-3 WDGS for CG ASF, 18 Sep 44, sub: Almt of Nurses. Same file. (4) AR 40-1080, C 3, 20 Sep 44.
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of beds in all hospitals on 4 September 1944. Pointing to the low occupancyrate, to the expectation that regional hospitals would relieve general hospitalsof zone of interior patients, and to the fact that battle casualties and theirevacuation from overseas had been less than estimated, he called upon TheSurgeon General to analyze the entire hospital program with a view to reducingthe number of beds in station and regional hospitals by 25 percent and ingeneral hospitals to 80,000.15 To effect thisreduction would have meant closing from twelve to twenty general hospitals-aproposal made verbally by the War Department Manpower Board during the samemonth.16
The Surgeon General agreed that too many station hospital beds had beenprovided, but he pointed out that he had already begun to reduce their number.In opposing other reductions he emphasized future possibilities. He calledattention to the tendency of sick rates and hospital occupancy to be higher inwinter than in summer, to the likelihood of heavier battle casualties, to theprolongation of the war beyond what had been expected, to the expectation thatpatients from overseas would need longer periods of hospitalization in theUnited States than anticipated, and to the prospect that more beds would beneeded in all types of zone of interior hospitals when the war in Europe endedand redeployment to the Pacific began. He also pointed out that the transfer ofpatients from Europe and North Africa had hardly begun because of the Europeantheater's opposition to evacuating patients in troop transports and NorthAfrica's lack of adequate shipping.17 The bedsurplus, in short, was only temporary and earlier estimates would prove correct.These arguments failed to change the opinion of the ASF Director of Plans andOperations, but on 25 September 1944 his proposal to require The Surgeon Generalto make the desired reductions was quashed by General Somervell, who consideredit unwise to order such cuts in the face of The Surgeon General's opposition.18
Two days before, on 23 September 1944, G-4 directed both AAFand ASF headquarters to reduce the beds in station and regional hospitals to thenumber authorized by the new ratios (3.5 and 0.5 percent of troop strengthrespectively) and to plan a further reduction of 25 percent in each-the samecut proposed earlier by ASF headquarters.19Later G-4 apparently directed ASF headquarters to plan reductions in the numberof general hospital beds also.20 The AirSurgeon and The Surgeon General readily agreed to reduce beds to currentauthorizations, but they objected to a further lowering of the bed ratio. Suchaction, they said, would allow no vacant beds for dispersion or epidemics. Itwould limit beds in station hospitals to 2.6 percent and in regional hospitalsto
15Memo SPOPP 632 (23 Aug 44), CG ASF (Dir Plans and Oprs) for SG, 4 Sep 44, sub: ZI Hosp Program. HRS: ASF Planning Div file, 700 "ZI Hosp."
16(1) Remarks by Col Schwichtenberg, MC, in Notes on Conf of AAF Comd Surgs, Off of Air Surg, 16-20 Apr 45. SG: 337. (2) Transcription of written answers by Maj Gen Norman T. Kirk, USA, Ret, to questions in Ltr of 10 Nov 50, from Editor, Hist Med Dept in World War II. HD: 314 (Correspondence on MS)I.
17Memo, SG (init E. G[inzberg]) for CG ASF, 15 Sep 44, sub: ZI Hosp Program. HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
18(1) Memo, Dir Plans and Oprs ASF for CG ASF, 23 Sep 44, sub: ZI Hosp Program, with ind. HRS: ASF Planning Div file, 700 "ZI Hosp." (2) MRS, [Gen] Somervell to [Maj Gen Wilhelm D.] Styer, 25 Sep 44, atchd to Memo just cited. Same file.
19Memo WDGDS 3221, ACofS G-4 WDGS for CGs AAF, AGF, ASF, 23 Sep 44, sub: Reduction of ZI Hosp. SG: 322 "Hosp Misc."
20S/S WDGDS 4166, ACofS G-4 WDGS to DepCofSA, 20 Oct 44, sub: ZI Hosp Reqmts. HRS:
G-4 files, "Hosp and Evac Policy."
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0.4 percent of troop strength, while beds actually occupied in stationhospitals ranged from 2.5 to 2.7 percent of troop strength.21While this argument was in progress the question of general-hospital bedrequirements was being discussed among G-4, The Surgeon General, and the WarDepartment Manpower Board.
In these discussions the Manpower Board raised two new issues: the propriety of lumping together the capacities of all types of hospitals when considering present and future needs and of counting beds in convalescent facilities as part of these resources. The Manpower Board followed both practices. It considered all beds in convalescent facilities as hospital beds and added to them the beds in station, regional, and general hospitals to arrive at a total number of beds already established. Comparing the number of patients in all hospitals with this total, the Board concluded that a surplus of 78,000 beds existed in the United States.22 The Surgeon General contended that beds in convalescent facilities should not be considered as hospital beds, since the Board had until then refused to allocate personnel for them. He insisted, moreover, that beds in hospitals of different types were not interchangeable. For example, under existing policies vacant beds in station and regional hospitals could not be used for overseas evacuees. Nor were all beds in general hospitals available for the treatment of such patients. Some were used for prisoners of war, non-Army patients, and Army patients from surrounding areas who needed only minor care and treatment, while others had to be set aside to receive evacuees in transit from ports to hospitals of definitive treatment. He argued, therefore, that the Manpower Board's conclusion about a surplus of hospital beds was invalid.23
The final decision which the General Staff made in the faceof conflicting arguments proved to be a compromise. After further study by G-4of the beds required in all types of hospitals, the Staff agreed in November1944 to authorize 40,000 convalescent beds-10,500 of them in AAF hospitals.This was substantially the number recommended by The Surgeon General and the AirSurgeon and already set up in convalescent hospitals. The Manpower Board nowreluctantly agreed to provide staffs for them. Moreover, the Staff required nocut in the existing number of beds in general hospitals or in the ratioauthorized for regional hospitals. On the other hand it directed a cut in theratio of station hospital beds, but only from 3.5 to 3 percent of troop strength instead of to the 2.6percent first suggested.24 The Air Surgeon apparently considered this
21(1) Memo, CG AAF for CofSA attn G-4, 30 Sep 44, sub: Reduction of ZI Hosp. HRS: G-4 files, "Hosp and Evac Policy." (2) Memo, CG AAF (Air Surg) for CofSA attn G-4 Div, 7 Oct 44, same sub. Same file. (3) T/S SPMC 322 Hosp, SG to Dir Plans and Oprs ASF, 30 Sep 44, same sub. HRS: Hq ASF Planning Div file, 700 "ZI Hosp." (4) Memo, SG (init E. G[inzberg]) for Dir Plans and Oprs ASF, 25 Oct 44, same sub. SG: 632.2. (5) Memo SPOPP 700, CG ASF for ACofS G-4 WDGS, 30 Oct 44, same sub. AG: 323.3 (4 Sep 44)(1).
22Memo WDSMB 323.3 (Hosp), Pres WDMB for CofSA, 16 Oct 44, sub: ZI Hosp Reqmts. HRS: G-4 files, "Hosp and Evac Policy."
23(1) Memo, Eli Ginzberg, Spec Asst, Dir Hosp Div SGO for Pres WDMB, 23 Aug 44. (2) Memo, SG for CG ASF, 15 Sep 44, sub: ZI Hosp Program. (3) Inf Memo, Dir Resources Anal Div SGO for Lt Col Huncilman (ASF), 26 Dec 44, sub: Background for Staffing Conv Hosps. All in HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
24(1) S/S WDGDS 4166, ACofS G-4 WDGS to Dep CofSA, 20 Oct 44, sub: ZI Hosp Reqmts. (2) S/S WDGDS 4956, same to same, 8 Nov 44, same sub. (3) Memo, CG AAF (Air Surg) for ACofS G-4 WDGS, 31 Oct 44, sub: AAF Conv Hosps. (4) Memo, Dep SG (init A. H. S[chwichtenberg] and E. G[inzberg]) for ACofS G-4 WDGS, 2 Nov 44, sub: Reqmts for ASF Conv Fac. (5) S/S WDSMB 323.3 (Hosp), Pres WDMB to CofSA, 13 Nov 44, sub: ZI Hosps. All in HRS: G-4 files, "Hosp and Evac Policy."
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compromise satisfactory, but The Surgeon General's representatives insisted that no reduction at all should be made.25 In announcing the Staff's decision on 17 November 1944, G-4 directed both AAF and ASF headquarters to study the hospital situation further in the light of actual experience and to submit by 15 January 1945 any recommendations which they might have on changes in requirements.26
Changes in the Manner of Reporting Beds
The movement to reduce the number of hospital beds caused achange in the method of reporting them. ASF headquarters decided that"unrefined data" on hospitalization, published by the Surgeon General'sOffice in Weekly Health Reports and in ASF Monthly Progress Reports, gaveerroneous impressions and made it difficult to arrive at sound conclusions aboutthe adequacy of hospital facilities.27 Earlier the Surgeon General'sOffice had warned that a distinction needed to be made between the total numberof beds in general hospitals and the smaller number available for "truegeneral-hospital cases." To obtain the latter figure one must subtract fromthe total the number of beds necessarily vacant because of the practice ofdistributing patients into wards according to disease, sex, and rank, as well asthose set aside for other purposes-such as the care of station-hospital-typepatients, civilians, veterans, and Navy personnel, and the debarkationprocessing of patients arriving from theaters of operations.28 This impliedthat to get a true picture of hospitalization not only the capacity of hospitalsby type but their capacity to handle particular types of patients should beknown, and that the number of beds set aside for special purposes and lostthrough dispersion should be taken into account.
The Surgeon General's regular reports began to take notice of this latterfactor in statistics for the end of September 1944. Previously he had reportedthe number of beds authorized (which was reasonably close to the number normallyavailable) and the number occupied. Now he added a figure for "effectivebeds" in general hospitals. It was obtained by subtracting an allowance fordispersion and for "debarkation beds" from the number of authorizedbeds. The following month he presented similar figures for regional and stationhospitals, and at the same time gave the percentage of effective beds occupiedin each class of hospital. This percentage, for all general hospitals, was 76.5;the percentage of authorized beds that were occupied (a figure previously givenbut now dropped) would have been 58.1. The next month, instead of reportingsimply beds occupied, The Surgeon General showed "patients remaining,"a figure which included not only the number of patients occupying beds but alsothe number temporarily absent on sick leave, on furlough, and without leave. Theratio of "patients remaining" to "effective beds" was given.In the case of general hospitals, taken collectively, this ratio amounted to
25(1) Memo, CG AAF (Air Surg) for CofSA attn G-4, 7 Oct 44, sub: Reduction of ZI Hosps. HRS: G-4 files, "Hosp and Evac Policy." (2) Diary, Plans and Policy Sec, ASF Planning Div, 31 Oct 44. HRS: Hq ASF Planning Div file, 700 "ZI Hosp." (3) Memo, Dir Hosp Div (init E. G[inzberg]) for Col [William B.] Higgins, G-4, 31 Oct 44, sub: Sta and Reg Hosp Bed Reqmts. SG: 632.2.
26Memo WDGDS 5391, ACofS G-4 WDGS for CGs AAF and ASF, 17 Nov 44, sub: ZI Hosps. SG: 322 "Hosp Misc."
27(1) Memo SPOPP 705, CG ASF for SG, 20 Nov 44, sub: Data on Status of Hosp Beds and Pers, ZI. AG: 323.3 (4 Sep 44) (1).(2) Memo, Maj Gen W. D. Styer for Gen Lutes, 9 Nov 44. HRS: Hq ASF Planning Divfile, 700 "ZI Hosp."
28Memo, Eli Ginzberg, Spec Asst, Dir Hosp Div SGO for Pres WDMB, 23 Aug 44.HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
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91.3 percent. The ratio of beds occupied to "effectivebeds" would have been 73.9 percent; of beds occupied to beds authorized,56.4 percent.29 Thus, although there was little change in actualoccupancy, the new system of reporting makes it appear that hospitals were beingmore fully utilized than formerly.
By this time (November 1944) a series of conferences on bedreporting had already started under the auspices of ASF headquarters,30and in February 1945 conclusions were reached regarding the other factorconsidered necessary to a true presentation of the hospital situation. In thatmonth the Surgeon General's Office and the ASF Planning Division agreed upon asystem of reporting beds, patients, and operating personnel in terms of types ofcare or types of beds, regardless of their location in particular types ofhospitals.31 Four months later the ASF Monthly Progress Reportcarried such information. It showed that although there were 213,373 beds ingeneral and convalescent hospitals, only 180,760 were used as general andconvalescent hospital beds.32
Meeting Increased Requirementsfor the Peak Patient Load
Meanwhile the tide had long since turned in the drive toreduce hospital bed capacity. Not long after G-4's compromise decision of 17November 1944, The Surgeon General's Resources Analysis Division made a newstudy of bed requirements that showed a need for more beds in general andconvalescent hospitals than G-4 had authorized. There were several reasons forthis study: completion by the Medical Regulating Officer of new estimates ofpatients to be evacuated from theaters during 1945, the prospect thatredeployment would interfere with the use of station hospital buildings for anypossible overflow from general hospitals, and G-4'sdirective that further recommendations about bed requirements be submitted by 15January 1945.33
In this study the Resources Analysis Division concentratedupon general and convalescent hospitals rather than upon station and regionalhospitals, for there was little possibility either that G-4 would raise thebed ratio for the last two or that the Surgeon General's Office wouldrecommend reducing it. In estimating requirements for beds in general andconvalescent hospitals, the Division calculated the numbers of beds that wouldbe needed for three groups of patients: debarkees, zone of interior and non-Armypatients, and overseas patients. The minimum number of debarkation beds needed,it was assumed, was one half the anticipated monthly evacuee load, orapproximately 17,500. Experience showed that 33,000 beds in general hospitalswere used by zone of interior and non-Army patients
29ASF Monthly Progress Rpts, Sec 7, Health, 30 Sep,31 Oct, and 30 Nov 44.
30(1) Memo SPOPP 720 (9 Nov 44), Dir Plans and Oprs ASF for CofS ASF, 30 Nov 44, sub: Status of Hosp Beds and Med Pers, ZI. AG: 323.3 (4 Sep 44)(1). (2) Diary, ASF Planning Div (Lt Col H. A. Huncilman), 28 Nov 44. HRS: Hq ASF Planning Div file, 700 "ZI Hosp." (3) Memo SPOPP 700, Dir Planning Div for Gen Wood, 26 Dec 44, sub: ZI Hosps. HRS: Hq ASF Planning Div file, "Hosp and Evac." (4) Memo, Maj W. H. Hastings (ASF) for Lt Col H. A. Huncilman, 25 Jan 45, sub: Hosp Occupancy Data for Monthly Progress Rpt. HRS: Hq ASF Planning Div file,700 "ZI Hosp."
31ASF Cir 68, 26 Feb 45.
32ASF Monthly Progress Rpt, Sec 7, Health, 30 Jun 45.
33(1) Interv, MD Historian with Col John C. Fitzpatrick, MC,formerly MRO, SGO, 18 Apr 50. HD: 000.71. (2) Memo, Eli Ginzberg for the Record, 28 Nov 44. HD: 560.-2 (Hosp Ships). (3) Memo for Record on Memo, CG ASF for SG, 13 Dec 44, sub:Gen Hosp Program, ZI. HRS: Hq ASF Planning Div file, "Hosp and Evac."Documents dealing with conflicting claims to the use of station hospitals are inHRS: G-4 file, 602.3. (4) Memo SPOPP 322, CG ASF for SG, 7 Dec 44,sub: ZI Hosps. SG: 322 "Hosp Misc."
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despite the policy of transferring complicated cases from station to regional, instead of general, hospitals. Beds for overseas evacuees receiving definitive treatment were computed on the basis of the number to be brought in each month, as forecast in the study made by the Medical Regulating Officer, and on the average length of time they were expected to stay in hospitals. From these calculations, it appeared that patients in general and convalescent hospitals would reach a peak number of 198,000 in August 1945. If 17,500 beds were set aside for debarkation processing, a total of about 215,000 beds would then be needed. Additional beds for dispersion were not included in this number because it was anticipated that the patient load would ordinarily be lower than the estimated peak and that many patients would leave beds vacant when they went on leaves and furloughs.34
This study led The Surgeon General on 8 January 1945 to ask for 70,000 additional general andconvalescent hospital beds. He proposed that 49,500 of them should be in generalhospitals and that they should be provided as follows: 10,000 by converting theconvalescent annexes of general hospitals into wards; 17,500 by using hospitalbarracks for patients instead of enlisted men of the medical detachment, forwhom other housing would be provided; 8,000 by placing ambulatory patients ofgeneral hospitals in post barracks; 9,000 by converting four station hospitalsinto temporary general hospitals; and 5,000 by using beds in staging areahospitals for debarkation purposes, thus freeing an equal number of beds ingeneral hospitals for patients needing prolonged care. The Surgeon Generalsuggested that about 20,500 additional beds in convalescent hospitals could beprovided by using vacant barracks located near by. In this connection it should be noted that he followed a policy ofexpanding existing hospitals rather than establishing new ones because smallerratios of personnel to patients were required for large than for smallinstallations and scarce specialists were used more advantageously byconcentrating rather than dispersing them.35
A combination of circumstances intervened in December 1944 and January 1945to cause the General Staff to consider favorably this request. In mid-Decemberthe Battle of the Bulge put to flight all thoughts of an early end to the war inEurope. About the same time, approval by the Joint Chiefs of Staff of the MedicalRegulating Officer's estimates of evacuees to be received during 1945 made itappear that the number of patients in zone of interior hospitals would increase.In addition, a directive from the Chief of Staff on 3 December 1944 requiringthe European theater to use transports for evacuation assured the early returnto the United States of many patients from that area.36 Of perhapsmore importance, the Secretary of War wrote to the Chief of Staff early inJanuary: "If we later prove to
34(1) Memo SPMCH 322 (Hosp-Cp Edwards)C, SG for CG ASF, 21 Nov 44, sub: Useof Cp Edwards as a Debarkation Hosp. HRS: G-4 file, 602.3. (2) Memo, Asst SGfor Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen Hosp Program, ZI with tabsand incls. HRS: Hq ASF Planning Div file, "Hosp and Evac." (3) Diary,Resources Anal Div, SGO, 19, 20, 22, and 23 Dec 44. HD: 024.7-3.
35(1) Memo, Asst SG for Act Dir Plans and Oprs ASF, 8 Jan 45, sub: Gen HospProgram, ZI, with Tabs A-J. HRS: Hq ASF Planning Div file, "Hosp and Evac."(2) Memo, SG for CG ASF, 4 Jan 45, sub: Gen and Conv Hosps. Same file. (3) Memo,SG for Col Prichard, 22 Feb 45, sub: Background Info Covering the Gen HospExpansion Program. SG: 632.
36(1) Interv, MD Historian with Lt Col J[ames] T. McGibony, MC, 20 Feb 50. HD:000.71. (2) JCS Document 1199, 16 Dec 44. SG: 560.2. (3) Rad CM-OUT-72113 (3Dec 44), CofSA to CG Hq ComZ ETO and CG UK Base Sec, 3 Dec 44. SG: 560.2.
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have erred [in forecasting requirements] I want to make sure that we haveerred on the side of too much."37 Finally, The Surgeon General'sResources Analysis Division seems to have established better relations thanformerly with the War Department Manpower Board and a new Deputy Chief of Staffof the Army, perhaps inclined to be more favorable to The Surgeon General'sposition than his predecessor, had taken office in October 1944.38 During theearly part of January 1945, Surgeon General Kirk vigorously pushed his programfor additional beds in personal conferences with the commanding general of theService Forces, members of the General Staff, the Deputy Chief of Staff, theChief of Staff, and perhaps also the Secretary of War. On 20 January 1945 it wasapproved.39
In succeeding months G-4 and The Surgeon General differed about the numberof additional beds actually required. G-4 suggested, it will be recalled, thatthe number might be reduced by placing overseas patients in vacant beds in AAFregional hospitals. The Air Forces offered beds for that purpose and emphasized,along with G-4, the desirability of using them to reduce the number ofadditional beds required in other hospitals. When The Surgeon General and ASFheadquarters argued that no emergency existed to require such use of regionalhospitals, G-4 asked ASF headquarters on 3 April 1945 for a justification ofthe number of beds authorized in January.40
Meanwhile the Surgeon General's Office had reappraised its former estimate of requirements. Beginning in December 1944 the number of evacuees arriving in the United States from all theaters increased each month until in March 1945 it surpassed by about 12,000 the monthly average on which planning at the end of December had been based.41 This trend indicated that the peak load ingeneral and convalescent hospitals would occur in June, two months earlier thanpreviously expected, and that it would be higher by 46,000 patients than the 198,000 estimated in December 1944. Accordingly, in the latter part of March1945 the Surgeon General's Office asked ASF
37Memo, SecWar for CofS, n d, included as Tab B to Memo, WDCSA 700 (13 Jan45), Asst DepCofSA for ACofS G-1, G-2, G-3, G-4, and OPD WDGS and for CGs ASF,AGF, and AAF, 13 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, "Hosp, vol. II."
38Weekly Diary, Resources Anal Div SGO, 13 Jan 45. HD: 024.7-3. Lt. Gen. Joseph T. McNarney wassucceeded by Lt. Gen. Thomas T. Handy as Deputy Chief of Staff, United States Army, in October 1944.Info supplied by OCS files.
39General Kirk had a conference with the Chief of Staff on 26 December1944, with the commanding general, ASF, on 5 and 8 January 1945, and withmembers of the General Staff and the Deputy Chief of Staff on 18 January 1945.(1) Memo WDCSA 632 (26 Dec 44), Gen George C. Marshall for Gen Thomas T. Handy,26 Dec 44. HRS: OCS 632. (2) Notes for Gen Kirk on Conf with Gen Marshall,Summary, 25 Dec 44. HD: Resources Anal Div file, "Hosp." (3) MRS SPGAA705 (4 Jan 45), MPD ASF for Dir Plans and Oprs ASF, 11 Jan 45, sub: Gen and ConvHosps. HRS: Hq ASF Planning Div files, "Hosp and Evac." (4) WeeklyDiary, Resources Anal Div, SGO, 13 Jan 45. HD: 024.7-3. (5) Memo, Lt ColHuncilman, ASF for the Record, 19 Jan 45. HRS: Hq ASF Planning Div files,"Hosp and Evac." (6) DF WDGDS 7623, SecWar (G-4) to CG ASF, 20 Jan 45,sub: Gen Hosp Program, ZI. HD: Resources Anal Div file, "Hosp."
40(1) See above, pp. 185-86. (2) DF WDGDS 11208, ACofS G-4 WDGS to CG ASF, 3 Apr 45, sub:Gen Hosp Program for ZI. HRS: Hq ASF Planning Div file, 700 "Hosp."
41The increase by month from November 1944 through March 1945 was as follows:
Year and Month | Total Patients Returned to U.S. |
November 1944 | 19,700 |
December 1944 | 32,511 |
January 1945 | 33,382 |
February 1945 | 38,251 |
March 1945 | 44,845 |
These figures are from statistics compiled by the Medical Regulating Officer on the basis of monthly reports by port surgeons and the Air Transport Division. History . . . Medical Regulating Service. . .
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TABLE 13-HOSPITALIZATION DATA AS OF 29 JUNE 1945
Type of Hospital | Number of Authorized Beds | Number of Patients | Patients Reported per 100 Beds | Percent Beds Occupied | |||
Total | Occupying Beds | Army-Absent on leave, furlough, or for other reasons | |||||
Army | Non-Army | ||||||
Generala | 152,971 | 186,916 | 118,717 | 5,811 | 62,388 | 122 | 81.4 |
Convalescent (AAF and ASF)b | 59,978 | 58,345 | 41,752 | 4 | 16,589 | 97 | 69.6 |
AAF Convalescent | 11,600 | 6,240 | 5,534 | 0 | 706 | 54 | 47.7 |
ASF Convalescent | 48,378 | 52,105 | 36,218 | 4 | 15,883 | 108 | 74.8 |
Regional (AAF and ASF) | 50,078 | 38,045 | 33,842 | 2,944 | 1,259 | 76 | 73.4 |
AAF Regional | 19,960 | 14,554 | 13,172 | 936 | 446 | 73 | 70.6 |
ASF Regional | 30,118 | 23,491 | 20,670 | 2,008 | 813 | 78 | 75.2 |
Station (AAF and ASF) | 51,561 | 34,980 | 28,305 | 6,338 | 337 | 68 | 67.1 |
AAF Station | 21,306 | 11,728 | 10,045 | 1,577 | 106 | 55 | 54.5 |
ASF Station | 30,255 | 23,252 | 18,260 | 4,761 | 231 | 77 | 76.0 |
General and Convalescent | 212,949 | 245,261 | 160,469 | 5,815 | 78,977 | 115 | 78.0 |
General, Convalescent and Regional | 263,027 | 283,306 | 194,311 | 8,759 | 80,236 | 107 | 77.2 |
All Hospitals | 314,588 | 318,286 | 222,616 | 15,097 | 80,573 | 101 | 75.5 |
aGeneral hospitals-only general hospitals proper.
bConvalescent hospitals-included both separate convalescent hospitals and those operated in connection with general hospitals.
Source: Weekly Hospitalization Report, vol. II, No. 26. AML.
headquarters for 9,000 additional debarkation beds and for25,000 additional convalescent beds.42Perhaps in recognition of theinconsistency of requesting additional beds at a time when they were arguingthat no emergency existed to require the use of vacant beds in regionalhospitals for overseas patients, representatives of the Surgeon General'sOffice and ASF headquarters agreed in conference on 5 April 1945 not to passthis request on to G-4. Instead, they would care for the higher number ofpatients in beds already authorized by placing more patients on leave andfurlough, by speeding the disposition of cases being treated, and by limitinggeneral and convalescent hospitals more strictly to overseas patients. ASFheadquarters agreed to some additional construction to increase the capacity ofexisting debarkation facilities and justified the beds authorized in January byexplaining to G-4 the upward trend in patient evacuation.43
The peak patient load in the zone of interior occurred at the endof June 1945, approximately twomonths after V-E Day.44An analysis of hospital-occupancy figuresat that time shows that all beds in general, convalescent, and regionalhospitals were needed and that even more might have been required if manypatients had not been placed on leave or furlough. For example, the patientcensus of general, convalescent, and regional hos-
42(1) Memo, SG for Dir Plansand Oprs ASF, 19 Mar 45, sub: Temp Debarkation Reqmts. SG: 632.2. (2) Memo, SG for CG ASF, 23 Mar 45, sub: Gen Hosp Program, ZI. SG: 322 "Hosp."
43(1) Memo, SG for CG ASF, 6 Apr 45, sub: Gen Hosp Program, ZI, with 1st ind. SG: 322 "Hosp." (2) 1st ind, CG ASF to ACofS G-4 WDGS, 9 Apr 45, on DF WDGDS 11208, ACofS G-4 WDGS to CG ASF, 3 Apr 45, same sub. HRS: Hq ASF Planning Div file, 700 "ZI Hosp."
44This statement is based upon figures in WeeklyHospitalization Reports that include both Army and non-Army patients as ofmidnight of Friday of each week. Statistical Review, World War II: A Summaryof ASF Activities, prepared by the Statistics Branch, Control Division, ASF,lists the average number of Army patients each month and shows the peak loadoccurring during July.
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pitals was 283,306, while the number of beds in thosehospitals was only 263,027. Of these beds, 203,070 were occupied. The rest ofthe patients-80,236-were absent from hospitals on leave or furlough. Not allhospitals were equally used, and the patient load was unevenly distributed.General hospitals were filled beyond the saturation point, normally consideredto be 80 percent of their total bed capacities, and had more than 62,000patients on leave. Regional hospitals, on the other hand, were only 73.4-percentoccupied, and had few patients on leave. This suggests either that beds in thesehospitals might have been reduced in number or that some might have been usedfor overseas patients to relieve general hospitals of part of their heavy load.In general, ASF hospitals showed higher occupancy ratios than did those of the Air Forces. This raises thequestion of whether the number of beds in the latter might have been reduced orvacant beds in them used for more non-AAF personnel. The low occupancy of bothAAF and ASF station hospital beds indicates that the Staff had been justified inreducing their ratio to 3 percent and in suggesting even further reductions.
A more even distribution of patients and a fuller utilizationof all hospitals would have been achieved, perhaps, by modifications of existinghospitalization policies but this was precluded chiefly by the separation ofzone of interior hospitals into AAF and ASF hospitals and by the struggle forpower between The Surgeon General and the Air Surgeon. (Table 13, Charts 9,10)
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