CHAPTER XVI
Changes in the Organization and Equipment ofHospital Units Prepared for OverseasService
Since hospitals operating in overseas theaters were lesssubject to The Surgeon General's authority than those in the zone of interior,they were largely unaffected by the movement, discussed in the foregoingchapter, to standardize organization and simplify administrative procedures.Nevertheless, certain changes in their organization and equipment were madebefore they left the United States. Changes in organization were primarily oftwo types: the creation of units that would supply larger numbers of bedswithout corresponding increases in personnel and the reduction of personnelauthorized for hospitals of different types.
Trend Toward Use of Larger Units
One method of supplying greater numbers of beds to theaterswithout proportionately increasing the number of personnel was to emphasize theuse of larger hospital units.1 Tablesof organization for various sizes of station hospitals, ranging in capacity to900 beds, had been developed during the early war years; but until the middle of1944 a general hospital of only one size (l,000-bed capacity) was authorized.During the winter of 1943-44 the Technical Division of the Surgeon General'sOffice developed tables of organization, published in July 1944, for 1,500- and2,000-bed general hospitals.2 Another method ofsupplying more beds with limited amounts of personnel-the use of convalescentfacilities to receive the convalescent patients of general hospitals-wasemployed successfully in the United States and needed to be extended, in theopinion of the Surgeon General's Office, to theaters of operations. Tables oforganization for l,000-bed convalescent camps and 3,000-bed convalescent centerswere developed, but the General Staff would not include such units in the troopbasis without requests from theaters. The latter were reluctant to requisitionthem because their capacities counted against fixed-bed quotas while theirstaffs were meager as compared to those of general
1See above, pp. 218-19.
2(1) T/O&E 8-550, Gen Hosp, 3 Jul 44. (2) An Rpt, Tec Div Oprs Serv SGO, FY 1945. HD.
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hospitals with equal numbers of beds.3 Asa result, such units were not used widely, only four of each being activated intheaters and none in the United States. Instead, theaters requisitioned stationand general hospital units to meet authorized quotas of beds and establishedconvalescent facilities with personnel available from other sources.4
Cuts in Personnel of Hospital Units
As in zone of interior hospitals, reductions were made in the staffs ofnumbered hospitals. In compliance with a G-1 directive, the Surgeon General'sOffice in March 1944 reduced the ratio of nurses in station and general hospitalunits from 1 for every 9 or 10 beds to 1 for every 12. Thus the numberauthorized for a 1,000-bed general hospital was lowered from 105 to 83 and for a750-bed station hospital from 75 to 63.5 Alsoin March, in consonance with the general policy of replacing physicians withadministrative officers wherever possible, a War Department circular directedthat both the executive officers and registrars of station and general hospitalsshould be Medical Administrative Corps officers. The Surgeon General protestedthat executive officers, who served as commanding officers in the absence oftheir superiors, needed professional training in medicine, and subsequently theGeneral Staff amended the announced policy to permit Medical Corps officers tocontinue serving as executive officers of general hospitals.6Meanwhile, the Surgeon General's Office was revising the tables oforganization of both station and general hospitals, in order to reduce thenumber of Medical Corps officers and to increase the number of MedicalAdministrative Corps officers authorized for such units.7In July 1944 the number of physicians in a 1,000-bed general hospital wasreduced from 37 to 32. Three months later the number of Medical Corps officersin station hospitals was also reduced, that for a 250-bed station hospital, forexample, dropping from 13 to 10 and for a 750-bed station hospital from 23 to20. At the same time, the number of Medical Administrative Corps officersassigned to these units was increased, the number in a 1,000-bed generalhospital rising from 7 to 10 and in a 750-bed station hospital from 10 to 12.8No significant
3(1) Memo, SG for Dir Mil Pers Div ASF, 4 Aug 43, sub: Conv Cps. SG: 322.15-1. (2) T/O&E 8-595, Conv Cps (1,000-bed), 12 Jun 44. (3) T/O&E 8-591T, Conv Ctr (3,000-bed), 12 Jun 44. (4) Interv MD Historian with Col Arthur B. Welsh, 27 Dec 50. HD: 000.71. (5) Telewriter conv between Surg ETO and SG, 22 Oct 43. SG: 337.-1.
4An Rpt, MOOD SGO, FY 1945. HD.
5(1) DF WDGAP 320.21, ACofS G-1 WDGS to MPD ASF and SG, 8 Jan 44, sub: Nurse Pers Reqmts. HD: 211 (Nurse Reqmts). (2) T/O 8-550, Gen Hosp, C 3, 4 Mar 44. (3) T/O 8-560, Sta Hosp, C 3, 4 Mar 44.
6(1) WD Cirs 99, 9 Mar; 122, 28 Mar; and 152, 17 Apr 44. (2) Memo WDGCT 320.3 (11 Mar 44), ACofS G-3 WDGS for CG ASF, 25 Mar 44, sub: T/O&E 8-500 and T/O&E 8-550, with 4 inds. SG: 320.3-1.
7Ltr, SG to CG ASF, 17 Mar 44, sub: Revision of T/O&E 8-560, Sta Hosp, and Revision of T/O&E 8-550, Gen Hosp. SG: 320.3-1.
8(1) T/O 8-550, Gen Hosp, 1 Apr 42; C-2, 5 Oct 42; and T/O&E 8-550, Gen Hosp, 3 Jul 44. (2) T/O 8-560, Sta Hosp, 22 Jul 42, and T/O&E 8-560, Sta Hosp, 28 Oct 44. In 1948 the wartime chief of the Surgeon General's Mobilization and Overseas Operations Division stated that these cuts of Medical Corps officers had been too great. (Ltr, Col Arthur B. Welsh, MC, USA, 19 Apr 48, quoted in Rpt, Subcmtee on Employment of Med Resources, "Use of Med Resources," Cmtee on Med and Hosp Serv of Armed Forces, Off SecDef, 25 May 48. HD.) Several years later the number of Medical Corps officers in a 1,000-bed general hospital unit was further reduced to 28. (T/O&E 8-551, Gen Hosp, 3 Jul 50.) This final cut in physicians in general hospital units after the war represented a reduction of over 50 percent in the number of doctors authorized for a 1,000-bed general hospital in 1940.
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reductions were made in the latter half of the war in the number of Medical Corps officers or nurses authorized for evacuation hospitals.9
In the spring of 1944 the General Staff directed reductions in the number of enlisted men in hospital units, as wellas in those of units of other technical services.10 The TechnicalDivision of the Surgeon General's Office complied with this directive byreducing in the table of organization of general hospitals the number of men whoperformed housekeeping functions. It overcompensated for that reduction byproviding for the attachment to hospitals of personnel from other technicalservices.11 This meant that the number of enlisted men authorizedfor assignment to a 1,000-bed general hospital was reduced from 500 to 450, butthat additional men could be supplied by attaching teams from nonmedicalservices, such as a Signal Corps team to operate communications systems and aMilitary Police team to supply interior and exterior guards.12 Subsequently,in the fall of 1944 cuts were made also in the number of enlisted men authorizedfor station hospital units but, as in the case of general hospitals, provisionwas made for the attachment of teams of men from other technical services.13While this change did not necessarily mean that the total number of menworking in and around a hospital plant was always reduced, it actually had thateffect in many instances because some theater commanders did not approve the useof the teams authorized by the War Department and desired by theater surgeons.As a result, the change was unpopular with many Medical Department officers,especially those in theaters who wished the personnel needed to perform stationservices for hospitals to be organic elements of hospital units and not dependent upon decisions andactions of theater staff officers. In this connection, it is significant thatthe chief complaint which theater Medical Department officers made about cuts inboth enlisted and commissioned personnel in hospital units was not that theywould endanger the care of patients but that they would reduce the ability ofhospitals to expand beyond table-of-organization capacities.14
Another change designed to save personnel was made in theorganization of the hospital-center unit. This unit, intended to operate a1,000-bed convalescent camp and to perform certain administrative servicescommon to all hospitals in a center, was authorized 29 officers, 4 warrantofficers, 1 nurse, and 255 enlisted
9Compare T/O&E 8-581, Evac Hosp, Semimobile, dated 26 Jul43 with that dated 25 Mar 44, and T/O 8-580, Evac Hosp, 23 Apr 43, withT/O&E 8-580, Evac Hosp, 31 Jan 45.
10Memo, Dir Tec Div SGO for Chief Oprs Serv SGO, 17 Apr 44,sub: T/O&E 8-550, Gen Hosp. SG: 320.3-1.
11Memo, Dir Tec Div SGO for SG thru Chief Oprs Serv, 20 Apr 44, with incl. SG: 320.3-1.
12(1) T/O 8-550, Gen Hosp, C 4, 16 May 44. (2) WD Cir256, 16 Oct 43.
13Ltr, SG to CG ASF, 21 Jul 44, sub: Revision to T/O&E 8-550, Sta Hosp. SG: 320.3-1. Compare T/O&E 8-560, Sta Hosp, 28 Oct 44, with T/O 8-560, Sta Hosp, 22 Jul 42.
14(1) Memo, Off Chief Surg Hq ETO for SG, 14 Jul 44, sub: Difficulties Presently Being Encountered in the Med Serv, ETO. HD: MOOD "ETO." (2) Memo, Dep Chief Plans and Oprs SGO for Dir Tec Div SGO, 21 Sep 44, with routing slip. SG: 320.3-1. (3) Ltr AG 320.3(14 Aug 44) OP-I-WDGCT-M, TAG to COs and CGs in TofOpns, 28 Nov 44, sub: Revised T/O&E 8-560, Sta Hosp. SG: 320.3-1. (4) Memo, Plans and Oprs MTO for Maj Gen [Morrison C.] Stayer, 25 Dec 44, sub: Memo for Dir Hosp Div SGO, 31 Oct 44, with incl. SG: 320.3 "T/Os Apr-Jun45." (5) Memo, Dep Dir MOOD SGO for Insp Br SGO, 14 Aug 45, sub: Comments on Rpt by Col [Floyd L.] Wergeland and Lt Col Moorhead ref their visit to SWPA and POA. HD: MOOD "Pacific." (6) Rpt, Gen Bd USFET, "Orgn and Equip of Med Units," Study No 89. HD: 334 (ETO).
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men until the early part of 1944.15 During that year thebelief developed that no saving in personnel was gained by concentratinghospitals and then providing them with increased overhead personnel.16 Furthermore,separate tables of organization had been developed for convalescent camps andconvalescent centers. The old table of organization for hospital centers, inconsequence, was superseded in April 1944 and a hospital center headquarters,consisting of 7 officers, 1 warrant officer, 1 nurse, and 23 enlisted men, wasauthorized.17 This headquarters was not expected to operate aconvalescent camp and it was to borrow any additional personnel it needed forthe performance of its functions from general hospitals located in the center.Only two of the hospital centers activated under the old table of organizationwere sent overseas. The other eight were inactivated and their personnel used inunits of other types.18 Toward the end of the war, six hospitalcenter headquarters were activated under the new table of organization in theSouthwest Pacific and sixteen in the European theater.19
New Hospital Units
Although emphasis in the latter half of the war was less uponthe development of new hospital units than upon the use-throughimprovisation, if necessary-of Medical Department units already available, twonew hospital units were developed and a third was proposed. In response to arequest from the chief surgeon of the European theater for a hospital that wouldspecialize in the treatment of neuropsychiatric cases, the Surgeon General'sOffice developed a table of organization in the latter half of 1943 for a neuropsychiatric general hospital. It was published inOctober.20 The second hospital developed was for use in forwardareas. In the absence of small surgical hospitals that were highly mobile, theneed to treat and hold near the front lines nontransportable casualties (thosewho could not be moved immediately without danger to their lives) was metthroughout most of the war by improvisation. During 1945 the Ground Surgeon andsurgeons of some forces in combat zones proposed publication of a table oforganization for a unit to meet this need. The Surgeon General opposed thisdevelopment, believing that the reinforcement of available units-such asplatoons of field hospitals -with surgical teams met the need adequately andat the same time promoted flexibility in the use of scarce categories ofofficers. The former view finally prevailed and on 23 August 1945 a table oforganization for a 60-bed mobile army surgical hospital was published.21 Thethird hospital, proposed but not developed, was also intended for use
15T/O 8-540, Hosp Ctr, 1 Apr 42.
16Speech, Med Hosp, Evac, and Sanitation, by Maj John S.Poe, MC, SGO, 11 Feb 44. HD: 322 (Hosp).
17T/O&E 8-500, MD Serv Orgn, 23 Apr 44.
18The 12th and 15th Hospital Centers were shipped to theEuropean theater; the 9th, 10th, 11th, 16th, 17th, 18th, 19th, and 24th wereinactivated. An Rpts. HD.
19(1) Quarterly Rpts, 1945, 26th, 27th, 28th, 29th, 30th, and 31st Hosp Ctrs. HD. (2) An Rpts, 1945, 801st, 802d, 803d, 804th, 805th, 806th, 807th, 808th, 809th, 812th, 813th, 814th, 815th, 818th, 819th, and 820th Hosp Ctrs. HD.
20(1) Telewriter conv, Surg ETO and SGO, 9 Aug and 22 Oct 43. SG: 337.-1. (2) Memo, CG ASF for AG, 26 Oct 43, sub: T/O&E 8-550S, Gen Hosp (1,000-bed) NP, ComZ, with Memo for Record. AG: 320.2 (13 Jul 43)(4). (3) T/O&E 8-550S, Gen Hosp, NP, 26 Oct 43.
21(1) Memo, Lt Col C[lifton] F. Von Kann for ACofS G-4 WDGS, 11 Aug 45, sub: Conf Rpt, Proposed Mobile Army Surg Hosp, T/O&E 8-571. HRS: G-4 files, "Hosp, vol. IV." (2) T/O&E 8-571,Mobile Army Surg Hosp, 23 Aug 45. Additional documents on this subject are on file in SG: 320.3.
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in forward areas. Both in theaters of operations and in the Surgeon General's Office there was a belief that a small hospital was needed near the front lines to treat neuropsychiatric casualties who could be salvaged for further duty. A table of organization for such a unit was never published and theaters met this need by improvisation.22
Changes in Supplies and Equipment
During the latter part of the war changes occurred in both the medical andnonmedical equipment of hospitals. As a result of changes and improvements inpharmaceuticals and biologicals and of the accumulation of experience in theoperation of hospitals under various sets of conditions in different parts ofthe world, the Surgeon General's Office made three complete revisions andseveral partial revisions of Medical Department equipment lists between themiddle of 1943 and the end of 1945. Revision of these lists involved theselection of types and amounts of pharmaceuticals and biologicals, of surgicalinstruments and other operating room equipment, of X-ray and laboratoryequipment, of ward equipment, and of other Medical Department items needed byhospitals of different types for the performance of their missions. Theserevisions, made by the Surgeon General's Organization and Equipment AllowanceBranch, were based on combat experience as revealed by reports of essentialtechnical medical data (ETMD's), interviews with officers who served overseas,and inspections of theater medical services; on changes in the size andpersonnel of units; and on the advice and recommendations of the Professionaland Preventive Medicine Services of the Surgeon General's Office, the Army Medical Center, and the National Research Council. Asignificant administrative feature of these revisions was the consolidation andpublication during 1944 and 1945 of equipment lists as parts of the medicalsection of the ASF supply catalog and their distribution by the Adjutant General'sOffice. Until that time, such lists had been issued in mimeograph form by theMedical Department alone. Items added to them made available to hospitals thenewer drugs and biologicals and improved items of equipment developed during thewar.23
Changes in the nonmedical equipment of hospital units revolved around theproblem of supplying items of equipment necessary for station services, orhousekeeping functions. The chief question was whether such equipment would beincluded in tables of equipment of hospitals, and therefore suppliedautomatically, or whether it would not be included, and supplied only when andif theater commanders requested it. Types of nonmedical equipment which demandedthe attention of the Surgeon General's Office were those needed for suchstation services as laundries, electric lighting systems, and telephonecommunications systems.
Inspections of theater medical services by Surgeon General Kirk and his chiefof Professional Services in the middle of 1943 revealed what they considered tobe inadequate laundry service for hospitals in both the North African andSouthwest
22(1) Ltr, Surg Fifth Army to SG thru Surg MTOUSA, 22 Jun 45, sub: Mobile Med Hosp. SG: 320.3. (2) An Rpt, NP Consultants Div SGO, FY 1945. HD.
23(1) History of Organization and Equipment Allowance Branch [SGO], 1939-44. HD. (2) An Rpt, Sup Serv SGO, FY 1944. HD. (3) An Rpt, Orgn and Equip Allowance Br Oprs Serv SGO, FY 1944. (4) An Rpt, Tec Div Oprs Serv SGO, FY 1945. Copies of the Equip Lists are on file, HD.
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Pacific theaters. In their opinion this resulted from lack of sufficientnumbers of laundries and from the use of improper types of laundry equipment. On5 June 1943 The Surgeon General informed ASF headquarters of the improvements heconsidered necessary.24 As a result, the offices of The QuartermasterGeneral and The Surgeon General collaborated in changing washing formulae andlaundry equipment to improve the quality of service which laundries affordedhospitals.25
The provision of adequate amounts of laundry equipment and of sufficient numbers of laundry operators was more complicated. On 1 July 1943 The Quartermaster General informed ASF headquarters that there was sufficient laundry equipment in this country to meet the needs of theaters, provided the latter requested its shipment.26 Theater opinions of what constituted an adequate laundry service differed from The Surgeon General's, for theaters accepted lower standards of service than he considered desirable.27 He wished, therefore, to find some way to assure that sufficient laundry equipment and personnel would be shipped with each hospital unit. The director of the ASF Planning Division, on the other hand, felt that theater commanders, with the advice and help of their surgeons, should determine the laundry services needed and request the War Department to supply the necessary equipment and personnel.28 The ASF view prevailed and in August 1943 theater commanders were reminded of the necessity of planning in advance for the laundry service of hospitals but were informed that the War Department would not supply them with laundry equipment and personnel unless such were requested.29 During the following year, after the General Staffauthorized the attachment of technical-service teams to units of othertechnical services, revised tables of organization and equipment of hospitalunits carried a statement that Quartermaster Corps laundry teams were authorizedfor attachment to hospitals when theater commanders requested them.30Although this served as a reminder to theater staffs that they had to makespecific provisions for hospital laundry services, it left to theatersconsiderable discretion in the matter and the Surgeon General's Officecontinued its unsuccessful attempt to have laundry equipment and personnel madeintegral parts of numbered hospitals.31
24(1) Ltr, SG to CG ASF, 5 Jun 43, sub: Laundry Fac in TofOpns. SG: 486.3. (2) Memo, Col R[obert] B. Skinner for the Record, 8 Jul 43, sub: Gen [Charles C.] Hillman's Trip to SWPA. Ground Med files, Chronological file (Col Skinner). (3) Memo, SG for CG ASF, 10 Aug 43, sub: Interim Progress Rpt: Steps Taken During First Sixty Days Since Apmt as SG. SG: 024.-1.
25Ltr, SG to CG ASF, 5 Jun 43, sub: Laundry Fac in TofOpns, with 1st, 2d, and 4th inds. SG: 486.3.
26Memo SPAOG 331.5, Dir Oprs ASF for Dir Planning Div ASF, 23 Jun 43, sub: Laundries and Laundry Equip, with 1st ind. HD: Wilson files, "Day File, Jul 43."
27(1) Memo, Col Arthur B. Welsh, MC for Dep SG, 13 Aug 43, sub: Data for Gen Somervell. SG: 486.3. (2) Memo, Dep SG for CG ASF, 16 Aug 43, sub: Interim Progress Rpt. HRS: ASF Control Div, 319.1 "SGs Interim Rpt, G-56."
28(1) Memo, Col Arthur B. Welsh, MC for Dep SG, 1 Jul 43, sub: Laundry for Overseas Hosps. SG: 331.5. (2) Memo, Maj John S. Poe for Col [Howard T.] Wickert, 16 Jul 43. SG: 414.4-5. (3) Historical Record, Laundry Section, Hospital Division [SGO], 1 July 1944, p. 18. HD: 024.
29Memo SPOPP 008, CG ASF for TAG, 3 Aug 43, sub: Aux Fac for Fixed Hosps. SG: 632.-1.
30(1) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (2) T/O&E 8-550, Gen Hosp, 3 Jul 44. (3) T/O&E 8-560, Sta Hosp, 28 Oct 44. (4) T/O&E 8-580, Evac Hosp (750-bed), 31 Jan 45.
31Ltr, SG to CG ASF attn Dir Mob Div, 10 May 45, sub: Tables of Orgn and Equip. SG: 320.3. Success came after the war. For example, see T/O&E 8-566, Sta Hosp, 500-bed, ComZ, and T/O&E 8-551, Gen Hosp, 1,000-bed, ComZ. Reviewing the experiences of World War II several years after its end, the formerchief of the Surgeon General's Mobilization and Overseas Operations Divisionpointed out the failure to solve this problem. (Extract from Ltr, Col Arthur B.Welsh, MC, 19 Apr 48, quoted in "Use of Med Resources," Rpt bySubcmtee on Employment of Mil Med Resources to Hawley Bd, 25 May 48, p. 346. HD:334.)
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A similar problem arose in connection with electric lighting equipment. The Surgeon General's Office recommended that such equipment, including electric generators, should be specifically listed in tables of equipment of hospital units to insure its being provided for each.32 During 1944 and 1945 this action was taken for field and evacuation hospital units; but electric lighting equipment was not included during the war in tables of equipment for general and station hospitals, convalescent hospitals, and convalescent camps and centers. Instead, a War Department memorandum placed upon the Chief of Engineers responsibility for furnishing electric lighting equipment, including generators, to such units when they received orders to move to theaters.33
At the beginning of the war the table of basic allowances for the Medical Department authorizedtelephone and switchboard equipment for the 750-bed evacuation hospital only.During the early part of the war, the tables for general and convalescenthospitals were revised to include that equipment. Similar action was taken for station and 400-bed evacuationhospitals during the latter part of the war.34
Other significant changes in the equipment of hospital units were additionsof tool chests of various sorts. Experience showed that hospital personnel inmany instances had to perform much maintenance work and that the number of toolchests previously provided was insufficient. Consequently, in successiverevisions of tables of equipment of hospital units there were added tool chestsfor carpenters, refrigeration mechanics, electricians, plumbers, automobilemechanics, and the like.35
32An Rpt, Tec Div Oprs Serv SGO, FY 1945. HD.
33(1) T/O&E 8-510, Fld Hosp, C 3, 24 Mar 44. (2) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (3) T/O&E 8-580, Evac Hosp (750-bed), 31 Jan 45. (4) WD Memo W 100-44, 9 May 44. HD: 412.-1. (5) WD Memo 100-45, 31 Mar 45. AG: 412 (5 May 44) (1).
34(1) T/BA 8, MD, 1 Oct 41. (2) T/BA 8, MD, 15 Jul 42; C 1, 29 Aug 42.(3) T/O&E 8-560, Sta Hosp, 28 Oct 44. (4) An Rpt, Strategic and LogisticPlanning Sec MOOD SGO, 5 Jun 45 (HD), stated that switchboards andcommunications equipment had been provided for 400-bed evacuation hospitals.However, a search of the T/O&E for this hospital does not disclose suchauthorization until publication of T/O&E 8-581 on 11 January 1949.
35For example, see (1) T/E 8-560, Sta Hosp, 28 Dec 43. (2) T/O&E 8-581, Evac Hosp (400-bed), 25 Mar 44. (3) T/O&E 8-510, Fld Hosp, 31 Mar 44. (4) T/O&E 8-550, Gen Hosp, 3 Jul 44. (5) T/O&E 8-560, Sta Hosp, 28 Oct 44. (6) T/O&E 8-580, Evac Hosp (750-bed), 31 Jan 45.
