CHAPTER XIV
Changes in Size and Make-Upof Staffs of Zone of nterior Hospitals
Changes in policies and procedures affecting the occupancy ofbeds resulted in part from limitations upon the amount of personnel availablefor the hospitals. One such limitation was a definite requirement that hospitalsget along on proportionately smaller staffs than accustomed to. Although theManpower Board and ASF headquarters were chiefly responsible for thisdevelopment, the Surgeon General's Office participated indirectly. Establishedin March 1943 to advise the Chief of Staff on personnel matters,1the Manpower Board analyzed the functions of hospitals in the UnitedStates, as it did those of other installations, and developed"yardsticks" by which to measure their personnel requirements.2Using these yardsticks, the Board estimated the total amount of militaryand civilian personnel which ASF installations needed, and the General Staffnormally accepted the Board's estimates in making personnel authorizations.ASF headquarters then subdivided its quota among service commands. Servicecommanders in turn authorized personnel for subordinate installations which thentook similar action.3 Under thissystem, despite its nominally advisory capacity the Manpower Board exercised arigid control over the personnel which the Service Forces received, andsubordinate commands might or might not authorize as much for hospitals as theManpower Board's yardsticks showed they needed.4To provide a guide for subordinate commands in manning hospitals, and perhaps toinfluence service commanders in making authorizations, the Surgeon General'sOffice developed manning tables for general, regional, and station hospitals ofvarious sizes and obtained sanction for them in a War Department circular issuedin the spring of 1944.5 They agreed gener-
1(1) Memo W600-27-43, 11 Mar 43, sub: WD Manpower Bd. (2) Ltr, CofSA to CG SOS, 12 Mar 43, same sub. Both in SG: 322.7-1 (Bds, etc.).
2(1) WDMB Yardstick No 7 for Measuring Pers Reqmts of Named Gen Hosps. SG: 323.7-5. (2) Rpt, SGO Bd of Offs on the Util of MC Offs, 19 Oct 43. Off file, Gen Bliss' Off SGO, "Util of MCs in ZI" (19) #1.
3(1) History of Control Division, ASF, 1942-45, pp. 31-33. HD. (2) ASF Cir 39, 11 Jun 43. (3) 1st ind, CG ASF to SG, n d, on Memo SPMDC 320.2 (2d SvC)AA, SG for CG ASF, 10 Apr 45, sub: Strength Auth, MD. HRS: ASF SPGA 320.2 "Med."
4For example, see Diary, Hosp Div SGO, 28 Sep 44 and 16 Mar 45. HD: 024.7-5.
5(1) Memo, Gilbert W. Beebe, Control Div SGO for Col Tracy S. Voorhees, Control Div SGO, 31 Oct 43. SG: 632.-2. (2) Memo SPMCH 300.5-5, SG for CofS ASF, 19 Apr 44, sub: Pers Strength Tables for Med Instls in ZI. AG: 320.3 (18 Apr 44)(1). (3) WD Cir 209, 26 May 44.
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ally with the Manpower Board's yardsticks and with recommendations made bythe Inspector General's Office. While they were not compulsory they served asguides supplied by the Medical Department for the reduction of hospital staffs.6
General Nature of Changes
The general reduction made in hospital staffs can be illustrated by changesin the ratio of employees to beds. In July 1943 the average number of employees(military and civilian) per 100 beds in general hospitals was 94. At that time58.6 percent of all beds in general hospitals were occupied. Therefore thenumber of employees per 100 occupied beds was 160. By July 1944 the averagenumber of employees per 100 beds in all general hospitals had dropped to 68.6.At that time, however, only 42 percent of the beds were occupied, and thereforethe number of employees per 100 occupied beds was 160-the same as a yearbefore. About a year later (June 1945), when 81.4 percent of all generalhospital beds were occupied and the number of patients on the rolls of generalhospitals (those absent from hospitals on leave or furlough as well as thoseoccupying beds) was 122 percent of their bed capacities, the average number ofemployees per 100 beds was 71.1, but the average per 100 occupied beds was only87. Thus, by the middle of 1945 the staffs of Army general hospitals in theUnited States had been reduced to the point where they had roughly only abouthalf as many people to care for patients as in former years.7
Another general change in hospital staffs during the latter half of the warwas the widespread substitution of civilians, Wacs, and limited servicepersonnel for the enlisted men, officers, and nurses who were taken out of zoneof interior hospitals for overseas assignments. This change resulted from a WarDepartment policy governing the use of personnel by the Service Forces,reiterated by ASF headquarters in June 1943. In general, men qualified foroverseas service were to be released as rapidly as possible from assignment toall zone of interior installations. In replacing them commanders were not toassign men to positions that could be filled by women; they were not to assignmilitary persons, male or female, to those that could be filled by civilians;and they were not to assign officers to duties that could be performed byenlisted persons or civilians.8 Compliancewith this policy had two effects upon hospital staffs. In the first place, asofficers, nurses, and men were withdrawn from hospitals for overseas service,hospital staffs were subject to a continuous personnel turnover. For example,during 1944 Birmingham General Hospital gained 53 Medical Corps officers, butlost 33; it gained 177 nurses, but lost 89; and it gained 758 enlisted men, butlost 416.9 Redeployment following V-E Day anddemobilization following V-J
6(1) Memo, SG for DepCofSA thru CG ASF, 10 May 44, sub: Pers Strength Tables. . . . (2) Memo, WDMB for ACofS G-4 WDGS, 25 Apr 44, sub: Anal of Proposed Strength Tables. . . . Both in AG: 320.2 (18 Apr 44)(1).
7(1) Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div, SGO. (2) Statistical Health Rpts. Off file, Med Statistics Div, SGO. In 1939 civilian hospitals in the United States had an average of 83 employees per 100 beds and 121 employees per 100 patients. See Warren P. Morrill, "Ratio of Personnel to Patients," Hospitals (The Journal of the American Hospital Association), XIV (1940), pp. 47-49.
8ASF Cir 39, 11 Jun 43.
9An Rpt, 1944, Birmingham Gen Hosp. See also An Rpts, 1944 and 45, Ashford, Wakeman, Baker, and Lovell Gen Hosps and Waltham, Ft Geo. G. Meade, Cps Bowie, Crowder, and Shelby Regional Hosps. HD.
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Day gave impetus to this turnover. Secondly, as hospitals replaced personsqualified for overseas service with those in other categories, their staffsgradually became heterogeneous mixtures of doctors, administrative officers,Army nurses, civilian nurses, paid nurses' aides, voluntary nurses' aides,general and limited service men, Wacs, skilled and unskilled civilians, andprisoners of war. Some of the problems involved in the reduction, turnover, andreplacement of personnel in particular categories will now be considered.
Wider Use of Administrative Officers
Medical Corps officers available for assignment to zone of interior hospitalswere limited in number. According to manning tables, the proper ratio ofphysicians to beds ranged from 2.5 per 100 in a 1,000-bed general hospital to 2per 100 in a 4,000-bed installation. During 1944 the actual average ratio forall general hospitals was approximately 2.6 per 100 beds. The next year, withthe expansion of the hospital system, that ratio dropped to about 2.3 per 100and remained there until November 1945.10Hospital commanders apparently accepted the fact that additional doctors werenot available, for they complained about shortages during this period less thanearlier. In a few instances hospital commanders and service command surgeonsreported that the quality of professional care declined. In others they calledattention to the need for more specialists, such as neuropsychiatrists,orthopedic surgeons, and neurosurgeons.11 Morefrequently, they complained about constant changes in professional staffs andabout the inferior quality of replacements received.12Despite these complaints, there seem to have been enough Medical Corpsofficers to care adequately for all patients provided they were relieved ofadministrative work and permitted to devote full time and attention toprofessional activities.13
The chief method of relieving physicians of administrative work was the moreextensive use of Medical Administrative Corps officers. It will be recalled thatsubstitution of these for Medical Corps officers in strictly administrativepositions had begun during the early war years, but had not reached widespreadproportions. In the fall of 1943 a strict limitation upon the number of Armyphysicians combined with an increasing supply of Medical Administrative Corpsofficers to suggest to both the Surgeon General's Office and the medicalofficer on The Inspector General's staff a wider use of administrativeofficers, not only in administrative work unconnected with medical practice butalso in jobs having semiprofessional aspects.14In November 1943, therefore, The Surgeon General proposed that MedicalAdministrative Corps officers be used throughout the Army in many positions
10Tables on basic data and ratios in gen hosps. Off file. Resources Anal Div SGO.
11An Rpts, 1944, 2d, 4th, 7th, and 9th SvC Surgs; An Rpts, 1945, 5th and 7th SvC Surgs; An Rpt, 1944, Ashburn Gen Hosp. HD.
12(1) An Rpts, 1944, 4th and 5th SvC Surgs; An Rpt, 1944, Ft Benning Regional Hosp; An Rpts, 1945, 1st, 4th, 5th, and 9th SvC Surgs; An Rpts, 1945, Beaumont Gen Hosp, Ft Bragg and Cp Lee Regional Hosps. HD. (2) Mins, Conf of Hosp Comdrs, 7th SvC, 22 Aug 45. HD: 337.
13(1) Memo, Act IG for CG ASF, 7 Feb and 15 Mar 45, sub: Med Pers and Hosp Fac in ZI. IG: 333.9-Med Pers (2). (2) Memo WDSIG 333.9-Hosp Fac (2), Act IG for DepCofSA, 14 May 45, sub: Rpt of Surv of ZI Hosps. SG: 333 WDCSA 632 (14 May 45). (3) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45. HD: 337.
14(1) Mins, Mtg of Bd of Offs to Study Util of MC Offs, 17 Sep 43. (2) Ltr IG 333.0-Med Pers, IG to DepCofSA, 13 Jan 44, sub: Util of Med Off Pers in ZI Instls. Both in Off file, Gen Bliss' Off SGO, "Util of MCs in ZI" (19) #1 and (20) #2.
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previously held by doctors, such as battalion surgeons' assistants in thefield and registrars in hospitals.15 TheGeneral Staff approved this proposal.16 InMay 1944 this policy was reflected in hospital manning tables prepared by theSurgeon General's Office.17
The demand for Medical Administrative Corps officers to fill positionsassigned to them under the new policy created a temporary shortage in the latterpart of 1944. Gradually, as the supply of such officers increased they took overall customary administrative positions in hospitals in the zone of interior,except those of executive officer and commanding officer, as well as newpositions established to handle such additional wartime functions as legalassistance, personal affairs, vocational counseling, and reconditioning. Inaddition, during 1944 and 1945 some hospital commanders appointed MedicalAdministrative Corps officers as assistants to doctors to relieve them of dutiesnot directly connected with the treatment of patients. In such positions,Medical Administrative Corps officers assumed responsibility for all property inhospital wards, for the cleanliness of wards, and for the discipline ofpatients; granted passes, leaves, and furloughs to patients; and in someinstances assigned and supervised the work of enlisted and civilian wardemployees. Thus, by the end of the war Medical Administrative Corps officers,whose use had been almost negligible in 1942, had become an important part ofArmy hospital staffs.18
Alleviation of the "Shortage" of Army Nurses
During 1944 and the early part of 1945 hospital commanders and servicecommand surgeons complained loudly of an "acute shortage" of Armynurses; but by the middle of 1945, they reported, the shortage had beeneliminated and there were plenty of nurses for the rest of the year.19During the first four months of 1944 (for which figures are available) theaverage number of beds per Army nurse in general hospitals ranged from 21.2 to23.8, but the average number of patients per Army nurse was between 10.1 and13.7. In June 1945, when the peak patient load was reached, the average numberof beds per nurse in general hospitals was 13.7, but the average number ofoccupied beds per nurse (11.2) remained about the same as the year before.20If one considers the general situation, and that only in terms of the ratio ofoccupied beds to nurses, there seems to have been no more reason for complaintin 1944 than later when hospitals reported that the shortage had beeneliminated. At any rate, the validity of complaints made in 1944 was openlyquestioned by the commander of the Fifth Service Command.21
15Memo SPMCT 353.-1, SG for CG ASF, 25 Nov 43, sub: Conservation of MC Offs. AG: 320.2(10-30-41)(2) T/Os.
16DF WDGCT 322 (25 Nov 43), ACofS G-3 WDGS to TAG, 1 Mar 44, sub: Conservation of MC Offs. AG: 320.3(10-30-41)(2) T/Os.
17WD Cir 209, 26 May 44.
18An Rpts, 1944, 5th and 9th SvC Surgs; An Rpts, 1944, Baker, Beaumont, Birmingham, O'Reilly, and Wakeman Gen Hosps and Cps Barkeley, Shelby and Ft McClellan Regional Hosps; An Rpt, 1945, 5th SvC Surg; An Rpts, 1945, Birmingham, Crile, and Lovell Gen Hosps. HD.
19An Rpts, 1944, 2d, 3d, 4th, 5th, and 9th SvC Surgs; An Rpts, 1945, 2d, 5th, 7th, and 9th SvC Surgs; An Rpts, 1944 and 45, Ashford, Fitzsimons, Baker, Halloran, O'Reilly, Baxter, Beaumont, Lovell, Birmingham, and Wakeman Gen Hosps and Waltham, Cps Barkeley, Crowder, and Shelby, and Ft McClellan Regional Hosps. HD.
20Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div SGO. See Charts 8, 9, and 10, and Table 13.
21Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 202-03. HD: 337.
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Hospital commanders may have been complaining about a potential rather thanan actual shortage of nurses, but whether potential or actual there were reasonsfor their belief that it was serious. In the first place, the authorized ratioof nurses to beds during 1944 was lower than that to which hospitals had beenaccustomed. Early that year the Deputy Chief of Staff of the Army ordered itreduced from one for every ten beds to one for every fifteen.22Next, the number of nurses actually assigned to hospitals during 1944 was oftenlower than the number authorized23 and therewas thus a shortage of nurses to fill authorized quotas. If hospitals had beencalled upon to operate at full capacity at that time, they might haveencountered serious difficulties. Furthermore, at the time when hospitals wererequired to adjust to lower ratios of nurses, their enlisted staffs were reducedalso and some of their trained technicians were withdrawn for overseas service.24This situation perhaps contributed to a feeling on the part of nurses themselvesthat they were shorthanded and overworked, a feeling possibly heightened by thefact that nurses had to devote attention to new activities, such as theeducational and physical reconditioning programs, that were being introducedduring 1944.25 Finally, the continuous turnover of personnelinterfered with the achievement of stable, well-organized staffs to operatehospital wards. Whatever the reason, there was a widespread belief in Armyhospitals during 1944 and the early part of 1945 that there was an "acuteshortage" of nurses; and the Medical Department, from the Surgeon General'sOffice down, tried to alleviate that condition.26
A number of measures were adopted to insure an adequate nursing service forthe Army's patients. Some, such as the elimination of inessential nursingrecords and the concentration of patients requiring continuous nursing care inas few wards as possible, were administrative.27Others, such as the employment of civilian registered nurses and senior studentnurses, were designed to supplement the professional nursing service.28By April 1945 there were in general hospitals more than 2,000 cadet nursesand more than 1,000 civilian nurses.29 Ameasure that was pro-
22(1) DF WDGAP 320.21, ACofS G-1 WDGS to CG ASF and SG, 8 Jan 44, sub: Nurse Pers Reqmts. HD: 211. (2) Memo, SG for DepCofSA thru CG ASF, 10 May 44, sub: Pers Strength Tables for Med Instls in ZI. AG: 320.2(18 Apr 44) (1). (3) WD Cir 209, 26 May 44.
23For example, see Conf, Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44. HD: 337.
24See below, pp. 253-56.
25An Rpts, 1944 and 45, Birmingham, Lovell, Wakeman, and Baker Gen Hosps. HD.
26Florence A. Blanchfield and Mary W. Standlee, Organized Nursing and the Army in Three Wars (1950) (cited hereafter as Blanchfield and Standlee, Organized Nursing) gives a full discussion of the nursing "shortage" in the winter of 1944-45. In general, the authors indicate that the Medical Department's estimate of nurse requirements was unrealistically high. In an interview on 20 November 1951 General Kirk stated that the Medical Department was "always short" of nurses until a draft was proposed in the winter of 1944-45. (HD: 314 Correspondence on MS) V. The question of whether or not there was a shortage of nurses in zone of interior hospitals was only part of a larger question of a shortage of nurses for use in theaters of operations as well as in the zone of interior. This question will be discussed more fully in John H. McMinn and Max Levin, Personnel (MS for companion vol. in Medical Dept. series), HD.
27(1) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 128. HD: 337. (2) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 191-93. Same file. (3) An Rpt, 1944, O'Reilly Gen Hosp. HD.
28An Rpts, 1944, 2d, 3d, 4th, 5th, and 9th SvC Surgs; An Rpts, 1944, Fitzsimons, Halloran, O'Reilly, Birmingham, and Baxter Gen Hosps, and Waltham, Cps Shelby and Crowder Regional Hosps. HD.
29Tables on basic data and ratios of gen hosps. Off file, Resources Anal Div SGO.
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posed, but not adopted, was a draft of nurses.30Still another measure was the increased employment of ancillary personnel torelieve nurses of nonprofessional duties in the care of patients. During 1944and 1945 hospitals hired civilian nurses' aides and ward orderlies, sought theservices of volunteer Red Cross nurses' aides, and used both enlisted men andWacs, as they were available, to assist nurses in the care of patients.31
Greater Use of Limited Service Men
Along with measures affecting the allotment of officers andnurses to hospitals, there were changes in the type of enlisted men employedduring 1944 and 1945.32 The existing policy ofreassigning general service men from zone of interior installations to overseasunits was made stricter and applied more widely during 1944 than before. InJanuary ASF headquarters began a drive to have all general service men, exceptthose who were more than thirty-five years old, those who had already servedoverseas, those who had had less than one year of Army service, and those whowere considered to be in certain "key" categories, released from itsinstallations by June; later, October.33 Thisdrive threatened to strip hospitals of even their trained technicians. In orderto prevent this, the Surgeon General's Office got the Military PersonnelDivision of ASF headquarters to consider such men as dental laboratorytechnicians, meat and dairy inspectors, pharmacists, X-ray technicians,reconditioning instructors, medical technicians, surgical technicians, andlaboratory technicians as being in "key" categories.34In July 1944 ASF headquarters announced that even "key"technicians, if physically qualified for overseas service, would be taken out ofzone of interior installations as soon as replacements were available.35Service commands interpreted these directives differently, and some pulled"key" men out of hospitals without thought of the availability ofproperly trained replacements.36 Torecover for the Medical Department some of the technicians improperlytransferred as well as those misassigned initially to the Ground Forces, theSurgeon General's Office succeeded in getting orders published during 1944 and1945 requiring their retransfer to Medical Department units and installations.These actions saved enough technicians, so the Enlisted Personnel Branch of theSurgeon General's Office reported at the end of 1944, to man all hospitalsproperly,37 but not all
30Blanchfield and Standlee, Organized Nursing, pp. 551-95.
31An Rpts, 1944 and 45, 2d, 3d, and 9th SvC Surgs; An Rpts, 1944, Deshon, Halloran, O'Reilly, Baker, Fitzsimons, Baxter, Wakeman, Birmingham, and Lovell Gen Hosps. HD.
32For example, see An Rpts, 1944 and 45, Fts Bragg and Knox, Cps Barkeley and Lee Regional Hosps, and Baxter, Beaumont, Halloran, Schick, and Wakeman Gen Hosps. HD. See also McMinn and Levin, op. cit.
33(1) ASF Cir 26, 24 Jan 44. (2) Quarterly Rpt, 3d Qtr 1944, Enl Pers Br, Mil Pers Div SGO. HD.
34(1) ASF Cir 193, 26 Jun 44. (2) WD Memo W615-44, 29 May 44, sub: Critically Needed Specialists. HD. (3) Quarterly Rpt, 3d Qtr 1944, Enl Pers Br Mil Pers Div SGO. HD. (4) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 194. HD: 337.
35ASF Cir 239, 29 Jul 44.
36(1) Ltr, Capt Luther F. Dunlop, QMC, Hosp Div SGO to HD SGO, 4 Jul 44, sub: Summary of Civ Situation in Sta and Gen Hosps during the Past Few Months. HD: 230.-1 "Civ Pers (Gen)." (2) Quarterly Rpt, 4th Qtr 1944, Enl Pers Br Mil Pers Div SGO. HD. (3) An Rpts, Ft Bragg Regional Hosp and Beaumont Gen Hosp. HD.
37Quarterly Rpt, 3d and 4th Qtr 1944 and 2d Qtr 1945, Enl Pers Br Mil Pers Div SGO, and An Rpts, 1944, Baxter and Schick Gen Hosps. HD.
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commanders were satisfied with saving technicians. Some complained loudlyabout the loss of certain clerical employees, such as those occupying theposition of sergeant major, whom they considered also as "key"persons.38
One reason that hospital commanders complained about the loss of generalservice men was that they encountered personnel-management problems in usingcivilians, Wacs, and limited service men to replace them.39As a rule, limited service men assigned to hospitals came either fromnonmedical units in the United States or from organizations overseas. Many werenot trained for work in hospitals and had to be oriented and trained on the job,even in clerical positions. Some felt that they had already contributed theirshare toward winning the war and wished to be discharged from the Army. Otherswere psychoneurotic and their job-assignments had to be made with caution. Stillothers had mental limitations which made it difficult for them to absorbjob-training. Many were physically handicapped and could not do heavy work.These restrictions on the use of limited service men complicated the problem ofstaffing hospitals.40 Furthermore, theassignment of such men to hospitals often created morale problems. Under the ASFpersonnel-control system, each hospital was authorized a specific number ofnoncommissioned officers. So long as it had that number it could make nopromotions.41 Many limited service men assignedto hospitals held noncommissioned-officer grades which they had earned innonmedical units. They were usually not qualified, either by experience or bytraining, to hold such grades in hospitals. When required to do work which theyconsidered beneath the dignity of their grades, they became resentful. Moreover,their mere presence prevented the promotion of other men who, by reason ofqualifications and jobs held, deserved to be noncommissioned officers. Lack ofopportunities for promotion lowered the morale of these men.42
Hospital commanders were powerless to correct this situation, and the SurgeonGeneral's Office tackled it. Hoping to solve the dual problem of having menwith proper job qualifications assigned as replacements and of promoting men whodeserved noncommissioned-officer grades, that Office in 1944 prepared tables oforganization for zone of interior hospitals, showing job specifications andcorresponding grades.43 These tableswere not published in 1944. In January 1945, after the problem of grades forenlisted men was made more acute by the proposal to assign WAC companies tohospitals,44 Surgeon General Kirk appealed tothe Secre-
38For example, see remarks of hospital commanders in the following: (1) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, pp. 204 and 209. HD: 337. (2) An Rpt, 1944, Ashford Gen Hosp. HD.
39In the middle of 1943 the Army abolished the term "limited service" but continued to classify men as qualified or not qualified for overseas service. Unofficially men not qualified for overseas service continued to be called limited service men.
40An Rpts, 1944, 2d, 4th, 5th, 7th, and 9th SvC Surgs; An Rpts, 1944, Halloran, Beaumont, Wakeman, Baxter, Baker, Ashford, and Birmingham Gen Hosps and Cps Barkeley, Lee, and Ft Knox Regional Hosps. HD.
41ASF Cir 39, 11 Jun 43.
42(1) An Rpt, 1943, 2d SvC Surg; and An Rpts, 1944, Wakeman and Birmingham Gen Hosps. HD. (2) Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, p. 190. HD: 337.
43An Rpt, FY 1944, Enl Pers Br Mil Pers Div SGO. HD.
44See below, pp. 256-59.
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tary of War to approve the table-of-organization method ofmanning hospitals in the zone of interior.45The Secretary approved this proposal in principle, and the Surgeon General'sOffice revised the tables it had prepared in 1944.46During the following six months, the latter attempted to have them published.For some reason, perhaps simply red tape, this was not done and the problem ofjob qualifications and grades remained unsolved in ASF hospitals.47
Replacement of Military by Civilian Employees
Although limited service men were authorized as replacementsfor men physically qualified for overseas service, chief emphasis of WarDepartment policy regarding nonprofessional personnel was on the use ofcivilians to replace military employees, whether general service men, limitedservice men, or enlisted women. Beginning in 1943 civilians were used actuallyto replace enlisted men, rather than to supplement them. Under the ASFpersonnel-control system established in June of that year, hospitals hadpersonnel ceilings which they could not exceed, and as they employed additionalcivilians they had to release proportionate numbers of enlisted men.48The War Department's goal during 1944 and 1945 was to replace militarypersonnel with civilians up to about half the total force.49This goal-one to which Surgeon General Magee had objected vigorously inthe fall of 194050-was approached, though notreached, during the later war years. In June 1944 ASF station and regionalhospitals employed 33,023 enlisted men and women, but only 19,469 civilians,exclusive of registered nurses-a ratio of approximately 17 military to 10civilian employees. During the following year civilians replaced enlistedpersons at such a rate that in June 1945 such hospitals had 17,673 enlisted menand women and 11,703 civilians-approximately 10 civilians for every 15enlisted men and women.51 General hospitals used civilian employees ingreater proportion. In March 1944 the ratio of enlisted to civilian workers inall general hospitals was about 10 to 10.5, for there were 28,060 enlisted menand women and 29,546 civilians employed in those installations. About a yearlater, when general hospitals employed 40,659 enlisted and 45,793 civilianworkers, the ratio had changed to about 10 enlisted persons to 11 civilians.52
In replacing military with civilian employees, hospitals encountereddifficulties,
45Memo SPMDA 322.05, SG for SecWar, 10 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, "Hosp, vol. II." It should be noted that this was a reversal of The Surgeon General's traditional opposition to staffing zone of interior hospitals according to tables of organization.
46(1) DF WDGAP 321 Med, ACofS G-1 WDGS for ACofS G-4 WDGS, 29 Jan 45, sub: Med Mission Reappraised. HRS: G-4 file, "Hosp, vol. II." (2) Diary, Hosp Div SGO, 31 Jan 45. HD: 024.7-3. (3) Quarterly Rpt, 1st Qtr 1945, Enl Pers Br Mil Pers Div SGO. HD. (4) Unsigned Memo for Record, 22 Feb 45. SG: 320.3 "(T/O) Jan-Mar 45."
47(1) Memo, Dir Resources Anal Div SGO for Gen Bliss, 20 Jun 45, sub: Pers Guides. HD: Resources Anal Div file, "Hosp." (2) 2d ind, Dep SG to CG ASF, 14 Jul 45, on basic not located. Same file.
48ASF Cir 39, 11 Jun 43.
49Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, pp. 197, 207, and 208; and Mins, 6th Conf of SvC Comdrs, Edgewater Park, Miss, 1-3 Feb 45, pp. 193-94. HD: 337.
50See above, pp. 31-32.
51Tables on basic data and ratios for sta, regional, POW, and conv hosps. Off file, Resources Anal Div SGO.
52Tables on basic data and ratios for gen hosps. Off file, Resources Anal Div SGO.
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as they had earlier.53 They stillhad trouble recruiting civilians in sufficient numbers, maintaining stablecivilian-personnel forces, and using women and elderly or partially disabledmen. They had to hire civilians who were not qualified for jobs they were tohold, and train them afterward. For example, hospitals in the Fourth ServiceCommand trained civilians as apprentice dietitians, dental assistants, dentalmechanics, laboratory helpers, X-ray technicians, guards, firefighters,telephone operators, steamfitters, refrigeration and air-conditioning mechanics,laundry operators, ward attendants, mess attendants, orthopedic shoe mechanics,cooks, and meatcutters. Furthermore, particularly in wards, hospital commandersconfronted the difficulty of replacing enlisted men who worked twelve hours aday with civilians who worked only eight. Hoping to solve this problem, TheSurgeon General asked for replacements on a basis of three civilians for twoenlisted men. Some service commands followed this practice, but the WarDepartment Manpower Board disapproved it and recommended allotments of civilianreplacements for enlisted men on a one-for-one basis.54 Hospitalsthen used split shifts for civilian employees and made other changes in workschedules, in order to have sufficient numbers on duty during the hours whenwork was heavy. Other difficulties for hospital commanders resulted from theirlack of control over civilians, who often failed to show up for work, refused towork on night shifts, and, because of civil service regulations, could not bemoved from one job to another to meet emergency needs. In such instances it wasnecessary to assign enlisted personnel to fill the vacancies. Finally, hospitalsbegan to employ a different type of civilian during the later war years-paidnurses' aides-who, although not numerous, often created morale problemsamong enlisted Wacs by their mere presence.55
Use of Wacs in Army Hospitals
Although the Medical Department had begun to use Wacs56in hospitals earlier, by the middle of 1943 their number was small in proportionto that of enlisted men and civilians. Apparently WAC headquarters could notsupply more, for in January
53See above, pp. 33, 135. This paragraph is based in general upon the following: An Rpts, 1944, Surgs 4th, 5th, 7th, and 9th SvCs, and 1945, 2d and 5th SvCs; and An Rpts, 1944 and 45, Brooke, Halloran, O'Reilly, Ashford, Baker, Birmingham, Wakeman, Baxter, Beaumont, Ashburn, and Battey Gen Hosps and Regional Hosps, Cps Shelby, Polk, Lee and Crowder, Scott and Keesler Flds, and Fts Bragg, Knox, and Meade, all in HD; and Ltr, Capt Luther F. Dunlop, QMC, Hosp Div SGO to HD SGO, 4 Jul 44, sub: Summary of Civ Situation in Sta and Gen Hosps during Past Few Months, in HD: 230.-1 "Civ Pers (Gen)."
54(1) Memo, WDMB for ACofS G-3 WDGS, 25 Apr 44, sub: Anal of Proposed Strength Tables for Med Instls in ZI. (2) Memo, SG for DepCofSA thru CG ASF, 3 May 44, same sub. (3) Memo WDSMB 323.3 (Hosp), WDMB for CofSA, n d, sub: WD Cir 209, 1944. (4) Memo SPMDM 300.5, SG for ACofS G-1 WDGS, 17 Feb 45, same sub. (5) Memo WDGSA 200.3 (3 Mar 45), Asst DepCofSA for ACofS G-1 WDGS, 7 Mar 45, same sub. All in AG: 320.2 (18 Apr 44)(1). (6) WD Cir 87, 19 Mar 45. (7) Mins, Conf of Post Surgs and COs of Gen Hosps, 2d SvC, 19-20 Jun 44, p. 199. HD: 337.
55ASF Cir 226, 20 Jul 44. The best discussion available of the employment of civilian nurses' aides in Army hospitals is in Blanchfield and Standlee, Organized Nursing, pp. 487-89, 492-93, 568.
56The Women's Army Corps (WAC) was authorized by Congress to supersede the WAAC on 1 July 1943. For a general discussion of the use of Wacs by the Medical Department see McMinn and Levin, op. cit., and Mattie E. Treadwell, The Women's Army Corps (Washington, 1954), Chap XIX, in UNITED STATES ARMY IN WORLD WAR II.
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1944 The Surgeon General's Hospital Administration Divisionreported that many unfilled requisitions were on hand.57As the withdrawal of general service men from zone of interior hospitals and thelack of sufficient nurses to fill authorized quotas increased the need ofhospitals for ancillary personnel, The Surgeon General approved the use of Wacsand of both voluntary and paid nurses' aides. During 1944 and 1945 specialrecruiting campaigns were conducted both by WAC headquarters for additional Wacsand by the Red Cross for civilian nurses' aides. By the spring of 1945 asurplus of Wacs had been recruited for the Medical Department.58In order to use all of them, and at the same time to offset the shorter hourswhich Wacs were by then authorized to work, The Surgeon General requested theirallotment to replace enlisted men in a ratio of three Wacs for two men. TheStaff refused this request, and some of the Wacs recruited for the MedicalDepartment had to be transferred to other assignments.59
As hospitals began to use more Wacs, a controversy developedover policies governing their employment. Basically, it sprang from the questionof whether Wacs were to be considered primarily as women or as enlistedpersonnel. The director of the Women's Army Corps placed more emphasis ontheir sex than on their enlisted status. Interested in their welfare and in thesuccess of recruiting programs, she wanted Wacs to work shorter hours than wascustomary for enlisted men assigned to ward duties, to be used only astechnicians and not as ward orderlies or kitchen workers, and to be given gradescommensurate with technical duties performed.60Aware of difficulties which hospital commanders encountered in manninginstallations in compliance with War Department policies, The Surgeon Generalwished to give them as much flexibility as possible in the employment ofmilitary personnel. Therefore, he emphasized the enlisted status of Wacs andinsisted that they should not be given preferential treatment, just because theywere women, in jobs, work-hours, or grades.61This attitude, along with the kind of jobs to which some Wacs in hospitals wereassigned, laid the Medical Department open to the accusation in the fall of 1944that it sidestepped recruiting promises.62
In the winter of 1944-45 The Surgeon General almost lost outin the controversy over policies on Wac employment. In December 1944 G-1 ruledthat Wacs should work the same hours as nurses
57(1) Tables on basic data and ratios of gen, regional, sta, and conv hosps. Off file, Resources Anal Div SGO. (2) Diary, Hosp Admin Div, 25 Jan 44. HD: 024.7-3.
58(1) Treadwell, op. cit., Ch. XIX, gives from the WAC viewpoint a full discussion of both the recruiting of Wacs for, and their use by, the Medical Department. (2) Blanchfield and Standlee, Organized Nursing, pp. 489-93, have a discussion of the nurses' aide recruiting campaign.
59(1) Ltr, SG to CG ASF attn Dir Mil Pers Div, 23 May 45, sub: Asgmt of MD Enl Pers (WAC). SG: 322.5-1(WAC) 1945. (2) Ltr, SG to CG ASF attn Dir Mil Pers Div, 23 Jun 45, sub: Tng of Enl Pers (WAC). Same file. (3) Quarterly Rpts, 2d and 3d Qtrs (1 Jun and 1 Oct) 1945, Enl Pers Br Mil Pers Div SGO. HD.
60Ltr WDWAC 720 (29 Jun 44), Dir WAC to CG ASF, 29 Jun 44, sub: WAC Duties on KP Detail and Hosp Orderly Asgmt. AG: 220.3 "WAC(29 Jun 44) (2)."
61(1) T/S, SG to ACofS G-l WDGS, 31 Oct 44, sub: WAC Pers Asgd to Hosp Duties. AG: 220.3 "WAC(29 Jun 44)(2)." (2) Memo, Dir Tng Div SGO for Chief Prof Admin Serv SGO, 22 Nov 44. HD: 353 "WAC Gen."
62(1) T/S SPGAM/322.5 WAC(6 Sep 44)-97, CG ASF to ACofS G-1 WDGS, 12 Sep 44, sub: WAC Duties on KP Detail and Hosp Orderly Asgmts. AG: 220.3 "WAC(29 Jun 44)(2)." (2) Blanchfield and Standlee, Organized Nursing, p. 494.
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(normally less than those of enlisted men employed in wards).63The following month the Chief of Staff, in approving a recruiting programfor Wacs for the Medical Department, directed that WAC table-of-organization ortable-of-distribution companies should be organized for general hospitals. Thetable of distribution that was adopted listed only technical jobs, except forcompany administrative work, and contained no grades lower than that oftechnician fifth grade (the equivalent of corporal).64If the wishes of the WAC director had been followed, all of the Wacsalready serving in hospitals under the bulk-allotment system would have beeneither assigned to these companies or transferred from hospitals. Either actionwould have deprived hospitals of the use of Wacs as ward orderlies, drivers,clerks, cooks, and bakers. The Surgeon General objected to such an arrangementand the General Staff then agreed that general hospitals might retain some Wacs,without assigning them to table-of-distribution companies, for use innontechnical jobs.65 After V-J Day WACcompanies were disbanded and the Medical Department returned to the formersystem of employing enlisted women, along with enlisted men, as part of its bulkallotment of military personnel.
As hospital commanders employed greater numbers of Wacs, some reported thatthey could be used in all departments on almost every type of job, but othersbelieved that Wacs could not replace enlisted men on a one-for-one basis in thewards and kitchens of hospitals, where the work was heavy and the hours long.66To keep enough men in such places for heavy work, the General Staffapproved The Surgeon General's proposal that the number of enlisted womenassigned to wards and diet kitchens should not exceed 40 percent of the totalenlisted staff.67
While some hospital commanders resented limitations upon their authority toselect the jobs and set the duty-hours of Wacs, the most common problem inemploying them was one of morale. Nurses rarely thought of enlisted women interms of the nursing service and objected to their assumption of manyprofessional nursing duties.68 Becauseof misleading recruiting publicity, Wacs came to expect more opportunities inthe nursing care of patients than was warranted, and many were disillusioned anddisappointed when they found their actual jobs less glamorous than had beendepicted.69 Enlisted men resented thepreferential treatment which Wacs received in the matters of rank and workingconditions. Wacs in turn resented
63 DF WDGAP 220.3 WAC, ACofS G-1 WDGS to SG thru CG ASF, 26 Dec 44, sub:WAC Pers Asgd to Hosp Duties. AG: 220.3 "WAG (29Jun)(2)."
64T/D 8-1037, WAC Hosp Co (ZI), 17 Feb 45. SG: 322.5-1 (WAC) 1945.
65(1) Mins, Mtg Held in Off of Dir WAC, 9 Mar 45. SG: 322.5-1 (WAC) 1945. (2) Memo, Act Chief Pers Serv SGO for SG, 14Mar 45, sub: WAC Recruiting Program for T/D Co at Named Gen hosps. Same file.(3) Memo, Lt Col E. R. Whitehurst for Dir Tng Div SGO, 18 Jul 45. Same file. (4)Quarterly Rpt, 1st and 2d Qtrs, 1945, Enl Pers Br Mil Pers Div SGO. HD.
66(1) An Rpts, 1944 and 45, Lovell, Wakeman, Baker, Percy Jones, Baxter, Birmingham, Beaumont, Ashford, and Crile Gen Hosps, and Waltham, Ft. Knox, and Cps Polk and Barkeley Regional Hosps; and Quarterly Rpt, 3d Qtr (2 Oct 44) 1944, Enl Pers Br Mil Pers Div SGO. HD. (2) Weekly Summary of Daily Diaries, Hosp and Dom Oprs SGO, 14 Jul 45. HD: 024.7-3.
67(1) Memo SPMCQ 300.5 (WD Cir), SG for Dir Publication Div AGO thru CG ASF and ACofS G-1 WDGS, 31 Jan 45, sub: Proposed WD Cir. . . . AG: 220.3 "WAC (29 Jun 44)(2)." (2) WD Cir 71,6 Mar 45.
68Blanchfield and Standlee, Organized Nursing, pp. 487, 594.
69Treadwell, op. cit., Ch. XIX, and Blanchfield and Standlee, Organized Nursing, p. 487.
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preferential treatment accorded civilian nurses and nurses' aides.70Despite these difficulties, Wacs became valuable and integral parts of hospitalstaffs by the end of the war.71
Use of Prisoners of War in Army Hospitals
A final category of personnel which proved advantageous in the operation ofhospitals in the United States was prisoners of war. Hospitals began to use themduring 1944 and by the end of the year some general hospitals employed as manyas two or three hundred each. They continued to be used until their repatriationin 1945. Normally, prisoners of war were not used in wards in the care ofpatients. The most common place for their employment was in kitchens and messesand on buildings and grounds. In some hospitals they served also in warehouses,motor pools, laundries, post exchanges, and orthopedic shops. Some prisoners had skilled trades and others were skilled technicians. Hospital commanders used them, when desirable, on jobs for which they had been trained. Generally, prisoners of war seem to have been an industrious, easily managed lot, who did their work efficiently and well so long as they were properly supervised.72
The record of the Medical Department's experience in manning hospitals leads to two conclusions. In the first place, during the earliest part of the war Army hospitals had larger staffs than they actually needed to maintain a satisfactory standard of care, for the Surgeon General's Office itself was agreeable to some reductions in 1944 when necessity required them. It is a moot point whether or not the reductions required by policies and practices of the War Department Manpower Boardand ASF headquarters were too great. In the second place, experience showed thathospitals could be operated with a lower ratio of doctors and able-bodiedenlisted men to total hospital staffs than had been thought possible. TheSurgeon General's Office resisted the substitution of Medical AdministrativeCorps officers for doctors in administrative positions as well as thesubstitution of civilians, limited service enlisted men, and Wacs forable-bodied enlisted men; but when necessity or directives from higher authoritycompelled these steps to be taken experience proved that they were notdisastrous.
This is not to say that the practice of reducing the staffsof hospitals and of substituting personnel of various kinds for able-bodiedenlisted men had no adverse effect upon hospital operations. On the contrary, asshown above, changes in personnel created serious problems for hospitalcommanders. Furthermore, opinion differed about the effect of those changes uponthe quality of professional care. Many hospital commanders reported that
70(1) Draft Ltr, SG to CG ASF, 23 Jul 45, sub: Discipline andMorale of ASF Trps. (2) Memo, Consultant Women's Health and Welfare Unit SGOfor Chief Pers Serv SGO, 28 Jul 45, sub: Use of WAC in Army Med Instls.Both in SG: 322.5-1 (WAC).
71(1) Rpt, Subcmtee on Employment of Mil Med Resources to the Exec Sec, Cmtee on Med and Hosp Serv of the Armed Forces, 25 May 48, p. 542. HD. (2) Memo, Dep Dir Educ and Tng Div SGO for Spec Planning Div SGO, 17 Apr 46, sub: Wacs in Postwar Mil Estab. HD: 353 "WAC Gen."
72(1) An Rpts, 1944, Percy Jones, Ashford, Baker, Letterman, andHalloran Gen Hosps, and Cp Barkeley and Ft McClellan Regional Hosps; and AnRpts, 1945, Birmingham, Lovell, Baker, Baxter, and Ashford Gen Hosps andWaltham and Cp Shelby Regional Hosps. HD. (2) Mins, 6th Conf of SvC Comdrs,Edgewater Park, Miss, 1-3 Feb 45, p. 192. HD: 337.
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they continued to maintain high standards; but some, as wellas certain service command surgeons and indeed the chief of the Surgeon General'sHospital Division, believed that medical care suffered as a result of changes inboth the quality and quantity of personnel assigned to hospital staffs.73
On the other hand, a group of nonmedical officers whoinvestigated complaints of the hospital commander at Fort Jackson (SouthCarolina) during the spring of 1944 believed that many hospital commandersbecame "panicky" when faced with changes in their staffs and that mostof their problems were capable of solution through "determined and efficient personnelmanagement."74 Certainly the problems of hospital commanders would havebeen fewer and the possibility of adverse effects upon professional care less ifchanges eventually made in hospital staffs, as well as measures to improvepersonnel management in hospitals, had been initiated early in the war by theMedical Department itself.
73(1) See above, pp. 249-59. (2) Interv, MDHistorians with Brig Gen Albert H. Schwichtenberg, 29 Apr 52. HD: 000.71.
74Proceedings, Bd of Offs Held at Ft Jackson, SC, 1-4 May 44,Pursuant to Verbal Orders CG [ASF]. HRS: SPGA/320.2 Med.
